Health inequality in England was bad. It has got worse – The Economist

The Marmot Review revisited ten years on

Feb 27th 2020

TEN YEARS ago the Marmot Review, a study commissioned by the government, asked a big, complicated question: why do some people in England live longer, healthier lives than others, and what can be done to reduce the gap? The answer it found was simple. Some people lived longer because they were better-off. To change this, it concluded, the government would have to reduce social inequality.

A new report by its author, Sir Michael Marmot of University College London, reviews the past decades changes. The numbers speak for themselves. In the three decades leading up to the first report, life expectancy at birth for men increased by a year every four years. Between 2011 and 2018 that rate slowed to a year every 15 years. For women the decline was even starker, from a year every five-and-a-half years to one every 28 years. And for the very poorest women, things have gone backwards. Life expectancy for those in the most deprived areas has declined by 0.3 years from 2010-12 to 2016-18. All women born later in the past decade are expected to have fewer healthy years than those born at the start of it.

Moreover, both men and women under the age of 50, particularly between 45 and 49, have seen mortality rates tick up (see chart). Sir Michael suggests that this could be related to suicide, alcohol use and rising drug toxicity, making it the British version of rising mortality rates among poor Americans, termed deaths of despair by Anne Case and Sir Angus Deaton, two economists who study the phenomenon.

What happened? The report stops short of putting the blame squarely on austerity, though it notes government spending has declined sharply in the past decade. One reason women may have suffered more than men is that spending cuts hit them harder. Research by the House of Commons library found that the majority of reductions have been borne by women, because the benefits they were likelier to receive saw deep cuts. Regional differences matter too. Poorer areas in the north are even more likely to have worse health than those in the south-east. I invite you to speculate that it is highly likely that some of these [cuts] will have had an adverse effect on health, says Sir Michael.

Yet the link between austerity and poor health is hard to pin down. David Sinclair of the International Longevity Centre, a think-tank, points out that several European countries underwent a period of austerity in the 2010s without drastically worsening health outcomes. And increases in life expectancy have slowed across the rich world, notes David Buck of The Kings Fund, another think-tank, though the slowdown in Britain has been sharper than most. Both Davids agree with Sir Michael that to improve public health governments must spend not just on health services but also on education, child support and community services. The health secretary, Matt Hancock, also welcomed the report. He said were committed to levelling up, and levelling up, and levelling up. He said levelling up four times I think, says Sir Michael, referring to the governments plan to boost poor parts of the country. And in case I hadnt got it: levelling up.

This article appeared in the Britain section of the print edition under the headline "Groundhog day"

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Health inequality in England was bad. It has got worse - The Economist

Movers and Shakers Week Ending 2.28.20 – milehighcre.com

Rodney Anderson

Alliant National Announces Addition of Executive Vice President and National Agency Manager

Alliant National Title Insurance Company, a unique title insurance underwriter that partners with independent agents to improve their competitive position in the marketplace, announced that Rodney Anderson has been promoted to executive vice president and national agency manager, effective immediately.

Anderson will expand his current responsibilities for developing, marketing and managing Alliant Nationals Southwest Region Agency operations to include national market expansion and oversight of the companys 32 licensed state agency operations.

Anderson will be a member of the senior executive leadership team working to aggressively expand Alliant Nationals footprint.

I am honored that our CEO and ownership group, Presidio Partners, has placed their trust in me with such a key role within Alliant National, says Anderson. Throughout my career I have worked to support the independent agent, and I look very forward to working with the agency team assembled at Alliant National to help independent agents across the country.

Anderson is a seasoned real estate and title insurance industry expert with over thirty years experience in agency operations as the current Southwest regional manager for Alliant National, former co-owner of an independent title agency, and agency operations manager for a national independent agency. In addition, Mr. Anderson served three full terms as a State Representative in the Texas Legislature.

It is not often one gets the opportunity to work side-by-side with an industry professional of Rodneys caliber, says David Sinclair, Alliant National president and CEO. His unique experience combined with his passion for independent agents makes him the perfect person to lead our agency team, particularly at this juncture of accelerated company growth.

Alliant National distinguishes itself from competitors by combining strong underwriting capability with independent agents in-depth knowledge of local markets. The result is a nationwide network with deep roots in local communities, and a wealth of expertise that is flexible, nuanced and continuously growing.

Gensler Promotes 9 in Denver

Gensler, a global architecture, design, and planning firm, announced the promotion of nine in its Denver office.

Juan Padilla

Bekah Wagoner

Austin Zike

Juan Padilla,Rebekah Wagoner,AIA, LEED-AP, and Austin Zike, NCIDQ, IIDA, RIDwere promoted to associate.Juan Padilla is an architectural designer with experience across workplace to lifestyle project types.Rebekah Wagoner is an architect with 10+ years of experience with a passion for sustainable solutions for the built environment. Austin Zike is a senior project manager with 20+ years of experience successfully delivering large, complex projects across many sectors of workplace design.

Joy Hughes

Ronnie Leone

Erin Vinezeano

Joy Hughes, AIA, Ronnie Leone, IIDA, ErinVinezeano, AIA, and Michael Yeager, AIA were promoted to senior associate. Joy Hughes has been an architect with Gensler for 20 years and is a regional leader forthecritical facilities practice area.Ronnie Leone is an interior designer with 10+ years of experience designing award-winning creative workplaces for technology and financial services firms.She is also takingon a new role as Co-Studio Director. ErinVinezeano is an architect and interior designer with 10+ years of experience in a wide range of project types, from professional services to technology workplaces, including multiple nationally publicized workspaces.Michael Yeager is anarchitect with 20+ years of experience in a range of project types, recently leading three major development projects in Denver.

Michael Yeager

Christy Headlee

Alex Garrison

Christy Headlee, IIDA, LEED AP and Alex Garrison, AIA were promoted to design director. Gensler design directorsare thought leaders and stewardsfor design excellence; they are responsible for overall design quality of their projects and advancing the Gensler design culture. Christy Headlee is an interior designer with 10+ years of experience. She leads design efforts with intention and bold creativity. She is collaborative, passionate about inspiring and empowering others and is an inclusive leader who mentors and inspires others to explore their own creativity. Alex Garrison is an architect with 10+ years of experience. He is an award-winning designer who brings a strong conceptual approach to every design opportunity. A firm believer in always being curious, he leads project teams in the tireless pursuit of innovative design solutions.

Dunton Commercial Announces Two New Hires

Brett Welker

Caleb Krumsieg

Dunton Commercial, a Denver-based commercial property management and investment company has hired Brett Welker as the new director of property management and Caleb Krumsieg as the new director of Leasing.

Welker brings tremendous experience and leadership to our property management team, as well as asset management, acquisitions analysis and due diligence to our investment side of the business. He has achieved the designations of RPA (Real Property Administrator, BOMA) and CPM (Certified Property Manager, IREM).Prior to Dunton, Welker spent 21 years with Lowe, a commercial real estate investment company, most recently as vice president.

Krumsiegs focus at Dunton is to maintain high occupancy levels within the portfolio by leveraging Duntons technology and implementing a highly pro-active leasing strategy. He brings significant office and retail leasing experience to Dunton, most recently as a broker with Waveland Property Group in Wheaton, IL. Krumsieg has a B.A. in Business and Economics from Wheaton College.

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Movers and Shakers Week Ending 2.28.20 - milehighcre.com

Brain Amyloid Deposition and Intracranial Atherosclerotic Disease in Adults – Neurology Advisor

There is no evidence for an association between cerebral -amyloid deposition, a marker of Alzheimer disease, and intracranial atherosclerotic plaque or stenosis, according to study results published in JAMA Neurology.

Although previous studies have shown that intracranial atherosclerotic disease (ICAD) is a significant risk factor for stroke and may increase the risk for all-cause dementia, limited data are available on the association between ICAD in adults without dementia and cerebral -amyloid deposition.

The cross-sectional study included data on dementia-free adults aged 70-90 years from the Atherosclerosis Risk in Communities-Positron Emission Tomography (ARIC-PET) study that completed florbetapir PET scans and magnetic resonance imaging high-resolution vessel wall imaging. The main outcome was the global cortical standardized uptake value ratio (SUVR), as a scan was considered positive for -amyloid if the global cortical SUVR was >1.2 on florbetapir PET.

The study cohort included 300 patients (mean age 76 years, 56% women) with available imaging data, of whom 105 participants (35%) had evidence for ICAD of any vessel. Mean SUVR was higher in participants with intracranial plaques compared with participants without plaques (1.340.29 vs 1.270.23, respectively; P =.03). In adjusted models, there was no statistically significant association between the presence of any plaque (adjusted odds ratio [OR] 1.20, 95% CI, 0.69-2.07), number of plaques (adjusted OR 1.10, 95% CI, 0.96-1.26), or plaque location (anterior circulation, adjusted OR 1.15, 95% CI, 0.61-2.16; posterior circulation, adjusted OR 1.27, 95% CI, 0.69-2.36) with elevated SUVR.

Similarly, there was no significant association between any measurable stenosis (adjusted OR 1.27, 95% CI, 0.71-2.27), a stenosis of >50% (adjusted OR 2.33, 95% CI, 0.82-6.60), or a stenosis of >70% (adjusted OR 2.35, 95% CI, 0.19-29.48) with elevated brain -amyloid.

The study had several limitations, according to the researchers, including the cross-sectional nature, single measurement of -amyloid deposition, exclusion of patients with dementia, and inability to fully adjust for potential confounders.

We found no evidence of an association between plaque presence and global cerebral -amyloid in individuals without dementia broadly, concluded the researchers.

Reference

Gottesman RF, Mosley TH, Knopman DS, et al. Association of intracranial atherosclerotic disease with brain -amyloid deposition: secondary analysis of the ARIC study [published online ahead of print, 2019 Dec 20]. JAMA Neurol. doi: 10.1001/jamaneurol.2019.4339

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Brain Amyloid Deposition and Intracranial Atherosclerotic Disease in Adults - Neurology Advisor

New study uncovers the neurology behind how kind and generous you are – Ladders

Virtually every society rests its principles on the basic constructs of good and evil. The tendency presumes that one denotes the absence of the other when the reality actually exists in a clinical gray area.

As concluded by a pioneering new paper published in the February edition ofNature Neuroscience, human ecology is informed by physiological signatures. When the amygdala and the medial prefrontal cortex fail to communicate in sync, instances of anti-social behavior increases.

Social behaviors recruit multiple cognitive operations that require interactions between cortical and subcortical brain regions. Interareal synchrony may facilitate such interactions between cortical and subcortical neural populations, the authors write. These findings suggest that specialized coordination in the medial prefrontalamygdala network underlies social-decision preferences.

The new study was co-authored byOlga Dal Monte,Cheng C. J. Chu,Nicholas A. FaganandSteve W. C. Chang ofYale Universitys department of psychology.

This neurological correlation observed by Dal Monte and her team not only determined the presence of prosocial and antisocial traits, but it also allowed the experts to gauge the extent to which they were present.

The first leg of the research employed non-human primate models. Monkeys were encouraged to choose between sharing fruit juice with another monkey and keeping the sample for themselves over the course of multiple trials. During each scenario, the psychologists would monitor neural activity.

In every trial, a monkeys decision to act benevolently was preluded by the basolateral amygdala and the rostral anterior cingulate gyrus region of their medial prefrontal cortex expressing high synchronization. The exact inverse was evident when the subjects decided to act selfishly.

By merely analyzing the degree of neural suppression andsynchronicitythe authors were able to reliably predict which outcome each primate was about to realize.

We found aunique signature of neural synchrony that reflects whether a prosocial or an antisocial decision was made, senior authorChang, who is an assistant professor of psychology and neuroscience at Yale, said in anews release. We all know there are individual differences in levels ofgenerosity. Maybe Scrooge did not havehigh levels of synchronyafter all.

While lesser primates may not evidence as many genetic similarities to us as the great apes, the researchers suspect their finds to be translatable to human subjects saying nothing of the previously published literature bridging the gap between aggression and neurological deficiencies.

Not unlike the thesis recently motioned by the journal Scientific Reportsback in January the core elements of empathetic behaviors are authored by biological predispositions as opposed to someconditioned moral avatar.

Synchronization between the two nodes was enhanced for a positive other-regarding preference but suppressed for a negative ORP, the authors write. These interactions occurred in beta and gamma frequency bands depending on the area contributing the spikes, exhibited a specific directionality of information flow associated with a positive ORP and could be used to decode social decisions.

The new study, published on February 24th, 2020, is titled Specialized Medial PrefrontalAmygdala Coordination in Other-Regarding Decision Preference.

The report can be read in full in the Journal of Nature Neuroscience.

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New study uncovers the neurology behind how kind and generous you are - Ladders

CBD consumption to rise across the treatment of neurological conditions – Health Europa

With an exponential rise in the availability of CBD products and public opinion towards it becoming more positive over the past decade, the consumption of the ingredient has exploded. Global Market Insights, Inc., forecasts that global cannabidiol market size will be worth more than $89bn by 2026.

However, the industry will need to overcome the complex regulatory landscape as well as quality and supply challenges in the near future.

Over the past few years, cannabidiol, or CBD, has caught the publics imagination as an ingredient presenting a range of health benefits when infused in various consumables. More and more individuals worldwide are now vouching for its effectiveness in terms of alleviating certain chronic illnesses and treating several health conditions.

CBD has conquered industry after industry, from pharmaceuticals to personal care and cosmetics, food and beverages, and nutraceuticals.

Cannabidiol is the legal and non-psychoactive counterpart of tetrahydro cannabidiol (THC), the chemical compound responsible for cannabiss psychological effects. CBD is the second most-commonly used active ingredients of cannabis. The cannabinoid is derived directly from the hemp plant, a cousin of the cannabis plant, and forms an essential component of medical cannabis.

Factors such as population growth, nationalised healthcare, GDP, and cultural historic use of CBD in many European countries make the continent an attractive market for global producers of both medical and retail cannabis-based products. Hemp cultivation in the region has witnessed a massive upsurge in recent years; the European Union (EU) constitutes more than 25% of the global hemp production.

In July last year Epidiolex CBD oil received a positive recommendation for marketing approval from the European Medicines Agency (EMA) for the treatment of seizures. EMAs Human Medicines Committee (CHMP) approved the oral solution for use with clobazam for the treatment of seizures associated with Dravet syndrome or Lennox-Gastaut syndrome in patients aged two or more.

The European Commission granted marketing approval to Epidyolex, the trade name for Epidiolex in Europe, in September 2019. Epidiolex is the only federally-approved CBD product in the U.S.

Additionally, the use of CBD in cosmetics is harmonised within the European Cosmetic Regulation 1223/2009. The regulation prohibits the use of cannabis and its derivatives in cosmetic products. Essentially, EU prohibits the use of CBD derived naturally from cannabis plants. However, the use of hemp-derived or synthetically-produced cannabidiol is approved.

Europe CBD market is poised to witness monumental growth in the forthcoming years on account of surging consumer demand for safe-strength CBD products that are easily available in their normal retail environments and cultivated, extracted, processed and labelled as per the European standards.

Europe has witnessed a growing occurrence of various neurological conditions in recent years. These include epilepsy, migraine, stress, anxiety, and numerous sleeping disorders. An expanding geriatric population base indicates rising incidences of these conditions. Citing data from the European Brain Council, more than 220 million people in Europe suffer from at least one neurological condition, which is more than the populations of France, Germany, and the Great Britain combined.

Described below are some of the most prevalent neurological conditions in Europe and the effectiveness of CBD in their treatment.

Surging popularity of cannabidiol among boomers along with ongoing research and development into its potential health benefits will augment CBD market forecast. More and more boomers are adding CBD to their health regimes to help reduce stress and anxiety, get better sleep, and alleviate chronic pain. Increasing awareness towards the safety and efficacy of cannabidiol products will drive future CBD industry trends.

Hrishikesh KadamGuest ContributionGlobal Market Insightswww.gminsights.com

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CBD consumption to rise across the treatment of neurological conditions - Health Europa

Global Minimally Invasive Neurology Device Market Demand Analysis, Development Factors, Overview with Manufacturers And Forecast 2026 – News Times

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Global Minimally Invasive Neurology Device Market Demand Analysis, Development Factors, Overview with Manufacturers And Forecast 2026 - News Times

Neurology Software Market Perceive Robust Expansion by: Epic, Bizmatics, Athenahealth, healthfusion, Allscripts – New Day Live

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Advanced Neurology EMR SoftwareOther

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Neurology Software Market Perceive Robust Expansion by: Epic, Bizmatics, Athenahealth, healthfusion, Allscripts - New Day Live

How Family in the Room Affects Patient Care – Medscape

Until recently, seriously ill people were often treated at home, surrounded by friends and family. As scientific advances have shifted medical care to the hospital, patients now rely on family visits for emotional support, and also for assisting with practical matters: helping with basic care, accessing old medical records, keeping track of medications. In my role as neurohospitalist at a county hospital, I have noticed another vital function of hospital visitors that is perhaps underappreciated: improving patient care.

I make daily hospital rounds with a neurology resident and occasionally medical students. Rounds are always hurried; we must examine every patient, review neuroimaging and laboratory results, discuss cases with consultants, and document everything in the cumbersome electronic medical record. We explain as much as we can to patients and their families.

However, many patients are alone with minimal, if any, ability to communicate. Often, neurology patients are encephalopathic or comatose, limiting our interaction. Some are homeless or have poorly controlled mental illness. The patient may be a "John Doe" whose true name is unknown. No visitors will arrive until administrators identify the patient. Demented elderly patients, many of whom have lost a lifelong partner, may also endure hospitalizations alone. In all these situations, without family to communicate with, my time in the room may be brief. Sometimes patients remain alone and incommunicado for days.

A concerned family also holds me to account.

The persistent absence of visitors seems to convey a silent message: "In the outside world, no one cares about me." Although visitors may not be in attendance for many reasonswork obligations, distance, lack of knowledge of the hospitalization, or even an independent patient's wishesan empty room advocates poorly for the patient.

Face-to-face time with each patient varies depending upon many factors, especially the complexity of the case and the clarity of the diagnosis. When family members are present, I take additional time to explain the diagnosis, prognosis, and therapeutic plan.

Sometimes that extra time improves the patient's care. It provides space for a more thorough exploration of the case and for consideration of fresh diagnostic and therapeutic options. Extra minutes may solidify a nascent therapeutic alliance. A concerned family also holds me to account, elevating the patient's importance in my mind.

Of course, longer patient visits aren't necessarily better visits. Families can be distracting when their needs and behavior pull focus from the patient.

But I often thank visitors for their presence and assistance. Many must sacrifice much needed income by taking leave from work, cope with unexpected travel expenses, or otherwise place their lives on hold. I have walked in those shoes and it is not easy.

Lately, after examining a patient alone in his or her room, I pause for a few seconds. I methodically wash my hands and thoroughly dry them with a paper towel. I scan the monitors. I watch the patient breathe. I let my thoughts settle.

Then I mentally explain the case to a nonexistent family member. Although patients cannot participate, they bear witness to these silent conversations. It's my hope that this additional attention improves their care. Maybe someday one of my patients will tell me.

Andrew Wilner is a professor of neurology at the University of Tennessee Health Science Center in Memphis, a health journalist, and an avid SCUBA diver. His latest book is The Locum Life: A Physician's Guide to Locum Tenens.

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How Family in the Room Affects Patient Care - Medscape

Focus on Diversity Boosts Number of Women Speakers at ISC – TCTMD

LOS ANGELES, CAA concerted effort by the American Heart Association/American Stroke Association (AHA/ASA) and the program planning committee of the International Stroke Conference (ISC) successfully increased the number of women who were invited as speakers at the 2019 meeting, a new study shows.

Between 2014 and 2018, only 28% of invited speakers at the annual stroke meeting were women, but that number jumped to 47% in 2019, Anjail Sharrief, MD (McGovern Medical School at UTHealth, Houston, TX), reported at the ISC here last week.

A particularly large gain in the proportion of women was seen among physician speakersincreasing from 17.7% in 2014-2018 to 37.9% in 2019.

Its important for . . . the [meeting] committees to acknowledge the disparities and enhance focus on diversity among speakers, and this influences change, Sharrief, director of stroke prevention for the UTHealth Institute of Stroke and Cerebrovascular Disease, said during her presentation. Increased opportunities to speak at major scientific conferences for women may help to address factors that contribute to gender differences in academic advancement and promotion.

She noted, however, that more work must be done to increase speaker diversity by race and country, and across different presentation categories.

Women Underrepresented in Multiple Areas

Its known that at the faculty level in neurology, men exceed women in terms of academic positions, rank, and number of publications. The proportion of women is highest among assistant professors (47%), falling to 38% among associate professors and 21% among full professors, according to Sharrief.

Speaker lineups at meetings are also male-dominated, she pointed out. As reported at ISC 2019 by Sharriefs colleague Lauren Fournier, MD (McGovern Medical School at UTHealth), women made up only about one-quarter of invited speakers in the prior 5 years of the meeting despite representing 37.7% of all attendees, with no changes over that span. Representation was particularly problematic when it came to physician speakers and women from racial/ethnic minority groups.

Its important to have different perspectives and different lenses through which we look. Anjail Sharrief

The ISC program planning committee encouraged Sharriefs team to look into the issue, and between 2018 and 2019, put a focus on increasing diversity among speakers and recruiting more qualified women to present. At the 2019 meeting, ISC included a mentoring lunch for women and a special event around womens issues in stroke, and at this years meeting, there were even more programming activities around womens issues, Sharrief said.

To find out if those efforts had an impact, Sharrief and her colleagues obtained data from the American Heart Association/American Stroke Association on invited speakers who presented at the 2019 meeting.

The gains in the proportion of women speakers from 2014-2018 to 2019 seemed to be evident across various academic-degree categories, although numbers were small for certain categories.

Women were more likely to be invited for debate in 2019 than in the prior 5 years (37.5% vs 13.1%) and to be invited to speak in the acute, in-hospital care category (39.8% vs 19.0%). Of the speakers who presented more than once in 2019, 46% were women, an improvement over the 21.3% rate seen in prior years.

Increases in the proportion of women were also seen across racial/ethnic categories, with substantial jumps among whites (32.7% to 48.2%) and Asians (20.0% to 41.2%). There were apparent improvements among Hispanic and African-American women as well, although overall numbers of speakers from these groups remained small.

Geographically, female representation was improved among speakers from North America and Europe, but speakers from other parts of the world remained less common. There were no female speakers from Africa.

I think theres still work to do in terms of further diversity, Sharrief told TCTMD.

Importance of More-Diverse Speakers

Sharrief said that having a more diverse lineup of speakers at major medical meetings is important for a number of reasons. For one, it makes for better science, because there are issues in stroke that differentially affect women and people from racial/ethnic minority groups. Its important to have different perspectives and different lenses through which we look, Sharrief said. So by having a diversity of speakers presenting you really are looking things from different perspectives.

Then, on a professional level, data presented by Sharriefs colleague, Pamela Zelnick, MD (McGovern Medical School at UTHealth), showed that even women account for half of medical students, they remain less likely than men to go into neurology or vascular neurology. If we want to continue to attract the brightest and the best students and residents, then we have to show that there are opportunities for them in leadership, and having opportunities to speak at conferences gives people opportunities for leadership within the organization but also for academic advancement, Sharrief said.

To that last point, she noted that contributions to science and recognitions of achievement are important when it comes to being promoted. Being invited to conferences [is something] that you can list there as being evidence of peer esteem, evidence that you have had an impact on a national/international level, Sharrief said.

Thus, its important to continue to track diversity among speakers and report the findings, and ensure that the leaders of the AHA/ASA and ISC maintain their focus on the issue every year so the gains are not lost, Sharrief said, adding that it seems they are committed to doing so.

Bruce Ovbiagele, MD (University of California, San Francisco), a co-author on Sharriefs study and ISC program committee chair in 2017 and 2018, told TCTMD that its gratifying to see that in such a short period of time things seem to have improvedmaybe because were highlighting it morebut it would be nice to have a systematic way of making sure that is always the case and a way of obviously measuring later on to see if the effect is actually sustained.

The key to ensuring a lasting effect is the attention factor, he said, noting that Louise McCullough, MD, PhD (McGovern Medical School at UTHealth), who was vice chair of ISC 2019 and 2020 and will be chair of the meeting for the next 2 years, has a number of strategies she wants to incorporate. One, for example, is making sure each invited speaker panel has at least one woman. He noted that inviting more women is one thing, but ensuring that the speakers who actually attend the meeting are more diverse is another. McCullough, he said, has promised to intensify efforts to replace women who decline invitations with other women whenever possible.

The ASA is definitely doing a lot to make sure that there are more womanels and not manels, Ovbiagele said.

What Sharrief takes away from this look into representation of women at the ISC is that change can happen if we think to look and see where the differences are. Diversity is important for many reasons.

See the article here:
Focus on Diversity Boosts Number of Women Speakers at ISC - TCTMD

CAR T Cells to Go? Outpatient Therapy Can Be Safe – Medscape

ORLANDO, Florida Chimeric antigen receptor (CAR) T-cell therapy can be safely delivered in the outpatient setting, which could make the life-extending treatment available to patients who don't have access to a major teaching hospital or treatment center, contend investigators who analyzed data from three clinical trials.

Looking at outcomes for patients with large B-cell lymphomas (LBCL) who were treated with the CAR T-cell construct lisocabtagene maraleucel (liso-cel) in the outpatient setting at both university-based and nonacademic medical centers in three clinical trials, Carlos Bachier, MD, from the Sarah Cannon Blood Cancer Network in Nashville, Tennessee, and colleagues found that the incidences of severe adverse events were relatively low and manageable.

"Outpatient administration of liso-cel and subsequent monitoring were successfully implemented in multiple clinical trials at both university and nonuniversity sites," he said here at the Transplantation and Cellular Therapy annual meeting.

Dr Carlos Bachier

The need to monitor and treat serious side effects from CAR T therapy, such as the cytokine release syndrome (CRS) and neurologic toxicities, has previously limited the therapy to major treatment centers with extensive resources. Yet most patients in the US with relapsed or refractory large B-cell non-Hodgkin lymphoma are treated at nonacademic centers where cancer therapies are typically delivered in outpatient infusion centers, Bachier said.

"Infusion and monitoring of patients receiving CAR T-cell therapy in the outpatient setting can lead to wider utilization and improved access," he said.

To get a better idea of the safety and efficacy of CAR T-cell therapy in the outpatient setting, Bachier and colleagues examined outcomes from the phase 1 TRANSCEND NHL 001 trial of liso-cel in one or two doses for a variety of aggressive lymphoma histologies, conducted in both university-based and nonuniversity centers; the phase 2 TRANSCEND-OUTREACH trial of outpatient liso-cel therapy after two or more prior lines of therapy against various lymphomas and lymphoproliferative disorders, conducted in nonuniversity centers; and the phase 2 TRANSCEND-PILOT-017006, testing liso-cel in patients with LBCL relapsed or refractory after a single line of immunochemotherapy who were ineligible for either high-dose chemotherapy or stem cell transplant. This trial was conducted in both university and nonuniversity settings.

In OUTREACH and PILOT, liso-cel was administered at a dose of 100 x 106 CAR-positive T cells; in TRANSCEND, it was given at doses of 50, 100, or150 x 106.

To qualify for outpatient administration and monitoring, both university centers and nonuniversity specialty oncology centers had to have at least hematopoietic stem cell therapy (HSCT) or phase 1 trial capability, an outpatient infusion center or inpatient infusion unit with same-day discharge; an affiliated aphereseis center; and a multidisciplinary medical team that can coordinate care between inpatient and outpatient settings, have standard operating procedures for outpatient monitoring and admissions when necessary, and an oncologist on call at all times.

In addition, each center had to have one designated hospital for care of CAR T-cell recipients with staff trained to manage typical CAR T-cell toxicities and a ready supply of tocilizumab (Actemra, Genentech) for treating CRS.

For their part, patients needed to have caregiver support and stay within 1 hour travel of the treatment center for the first 30 days after infusions, had to commit to returning to the site for immediate medical evaluation as necessary, and had to be educated about the early signs and symptoms of CRS and neurologic toxicities.

The analysis included data on 44 patients with a median age of 62 years (range 24 to 82), including 25 enrolled in TRANSCEND, 13 in OUTREACH, and 6 in PILOT. Eighteen patients were age 65 or older, 12 had high tumor burden, and 6 had lactate dehydrogenase (LDH) levels of 500 U/L or higher.

Treatment-related adverse events (TEAEs) occurring in at least 25% of outpatients were similar to those among all patients in TRANSCEND, with the most frequent grade 3 or 4 events being neutropenia, anemia, and thrombocytopenia. There were no treatment-related deaths among those monitored as outpatients.

CRS of any grade occurred in 12 of 25 outpatients (48%) in TRANSCEND, in 5 of 13 (38%) in OUTREACH, and in none of the 6 outpatients in PILOT. Grade 3 or 4 CRS was seen in 1 outpatient in TRANSCEND, but in none of the other patients in the other two trials.

Grade 3 or 4 neurologic events occurred in two outpatients in TRANSCEND, but were not seen in any outpatients in OUTREACH or PILOT.

Three patients in TRANSCEND and two in OUTREACH received either tocilizumab or corticosteroids for CRS, and five patients in TRANSCEND received corticosteroids for neurologic adverse events. Prolonged grade 3 or greater cytopenias were seen in three patients in TRANSCEND, five in OUTREACH, and one in PILOT.

The median onset of CRS was 5 days, and the median onset of neurologic toxicities was 8 days among all outpatients, and was similar to combined inpatient and outpatient population in TRANSCEND. The median duration of the events 6 days for CRS, 16 days for neurologic events was also similar to that seen in TRANSCEND.

Of the 44 patients from all three trials, 24 (55%) were hospitalized after liso-cel administration, for a median of 6.5 days (range 2-23). The median time to hospitalization was 5 days. One third of the hospitalizations were for either CRS or neurologic events. There were 2 cases of ICU admissions after liso-cel administration, for a median ICU stay of 4 days.

In all, 45% of outpatients did not require hospitalization, and there was no increase in ICU admissions compared with inpatients, Bachier pointed out.

The overall response rate was 80%, with a complete response rate of 55%, similar to that seen in TRANSCEND, he said.

In an interview with Medscape Medical News seeking objective commentary on the findings, Yago Nieto, MD, from the University of Texas MD Anderson Cancer Center in Houston, said that he would be comfortable with CAR T-cell therapy in the outpatient setting, provided that several key components of care are in place.

"It requires an organized effort to be able to see those patients in an outpatient clinic weekdays and weekends, having every contingency discussed beforehand, including for ICU team members to admit patients into the ICU if necessary which is unusual, particularly with liso-cel but it has to be all worked out in advance in a multidisciplinary effort," he said.

Nieto comoderated the session where the data were presented, but was not involved in the study.

Comoderator Mazyar Shadman, MD, MPH, from the Fred Hutchinson Cancer Research Center in Seattle, Washington, who was not involved in the study, told Medscape that his center treats patients with CAR T therapy in the outpatient setting.

"But it's important to know that when you talk about outpatient care, it's not your outpatient clinic where you see patients once a week," he said. "These are intensive outpatient centers. We have a team that's just outpatient, but we see these patients on a daily basis, we have dedicated nurses and practitioners, and we have labs and immunotherapy services for getting results quickly."

"I feel comfortable giving CAR T therapy to a patient in this setting," he added, "but not to a patient being treated in the middle of nowhere."

The study was funded by Juno Therapeutics, a Bristol-Myers Squibb company. Bachier disclosed advisory board activities for various companies, not including Juno or BMS. Nieto disclosed research funding and consultancy for various companies not including the sponsors of this study. Shadman disclosed research funding, honoraria, and consultancy with various companies not including Juno or BMS.

Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR 2020: Abstract29. Presented February 19, 2020.

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Study Shows Hyperbaric Oxygen Therapy (HBOT) Protocols Can Improve Cognitive Function in Stroke Patients – BioSpace

TEL AVIV, Israel, Feb. 27, 2020 /PRNewswire/ -- The Sagol Center for Hyperbaric Medicine and Researchat Shamir Medical Center, one of the largest hyperbaric medicine centers in the world, announced study results indicating its hyperbaric oxygen therapy (HBOT) protocols induce significant improvement in most cognitive domains of patients who suffered stroke even months to years after the event.

The retrospective analysis study, published in Restorative Neurology and Neuroscience, demonstrated that through elevating oxygen concentration in the blood and injured brain tissue, the Sagol Center's HBOT protocols supply the energy needed for brain tissue recovery regardless of the stroke location or cause.

"Despite nearly half of stroke survivors suffering from differing degrees of cognitive dysfunction, most rehabilitative efforts focus on restoring motor functions," said Shai Efrati, MD, Director of the Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, and study co-author. "Our study shows that stroke-related cognitive deficits can be treated as brain wounds, regardless of the stroke's location or origin ischemic or hemorrhagic. The rehabilitation potential lies in the metabolic characteristics of the chronic damage, or brain wound. By utilizing our HBOT protocols, the injured but viable brain tissue can be recovered even years after the acute insult."

Stroke is the second highest cause of mortality and the third leading cause of disability worldwide. When stroke occurs, whether ischemic or hemorrhagic, dysfunction typically presents in the affected brain region and impacts more than one cognitive domain such as memory or attention. Cognitive recovery after stroke mainly transpires within the first 30 days, with some patients gaining additional mild improvement up to 90 days after.

The study evaluated the sustained impact of Sagol's HBOT protocols on all aspects of cognitive function including memory, executive function, visuospatial skills, verbal function, attention, information processing and motor skills. Results demonstrated clinically significant improvement in cognitive function in most evaluated cognitive domains after HBOT.

The study found the following:

Of the 351 patients assessed for eligibility, a total of 162 patients met the inclusion criteria for the final analysis. Criteria comprised the receipt of treatment after more than three months post-injury, the completion of the Sagol Center HBOT protocols and at least two cognitive evaluations, conducted using a fully computerized cognitive testing battery (NeuroTrax test battery). Patients were treated in a multi-place hyperbaric chamber at the Sagol Center.

"This is the largest cohort of stroke patients who have undergone strict cognitive, imaging and neurological assessments to evaluate the rehabilitation potential of HBOT treatment," said Amir Hadanny, MD, Chief Medical Research Officer at the Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, and lead author of the study."To identify the true cognitive and clinical impact of our protocols, all patients were evaluated with two validated alternate forms of the cognitive test battery prior to and post-HBOT. Significant improvements were demonstrated in all cognitive domains including memory, information processing speed, attention and executive functions. We are thrilled to bring a new hope to stroke patients worldwide."

About the Sagol Center for Hyperbaric Medicine and Research at Shamir Medical Center

The Sagol Center for Hyperbaric Medicine and Research at Shamir Medical Center (formerly Assaf Harofeh Medical Center), is a leader in advancing our understanding of the impact of hyperbaric medicine on cognitive and physical function. Serving as one of the largest Hyperbaric centers worldwide, the Sagol Center offers highly advanced large multi-place chambers, treating more than 200 patients daily. Research conducted at the Center has proven that brain rejuvenation is possible across a wide range of neurological pathologies and illnesses.

Media Contact:Nicole GrubnerFinn Partners for The Sagol Center for Hyperbaric Medicine and Research+1-929-222-8011nicole.grubner@finnpartners.com

View original content:http://www.prnewswire.com/news-releases/study-shows-hyperbaric-oxygen-therapy-hbot-protocols-can-improve-cognitive-function-in-stroke-patients-301012441.html

SOURCE The Sagol Center for Hyperbaric Medicine and Research

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Global Artificial Intelligence in Medical Imaging Market Trends 2020 by Applications: Neurology, Cardiovascular, Breast & Lung, Other – Nyse…

Acquire Market has introduced a new market research study, titled Artificial Intelligence in Medical Imaging MarketReport which provides detailed coverage of the specialty Artificial Intelligence in Medical Imaging product industry and main market trends. The Artificial Intelligence in Medical Imaging research report studies the market size, Artificial Intelligence in Medical Imaging industry share, key drivers for growth, major segments, and CAGR. The leading players are competing on the basis of product differentiation, states a new research report by Acquire Market Research [AMR]. The market segmentation has been done on the basis of consensus made, product type, key industrial players, competitive landscapes, applications, end-user, topological players, and more.

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Epilepsy is one of the commonest conditions affecting the brain – Gulf News

Dr Sulaiman Al Habib Hospital Image Credit: Supplied Highlight

Dr Mohamed Osman Eltahir Babiker, Consultant Paediatric Neurology, Dr Sulaiman Al Habib Hospital, talks about how properly diagnosing epilepsy in children is the most important step towards treatment

What are the types of patients you see as a paediatric neurologist?

Paediatric neurology is a sub-specialty branch in paediatrics and child health that essentially covers medical conditions that affect the brain, spine, nerves and muscles of children from the first day of life up to the age of 16. Common conditions that a paediatric neurologist sees, diagnoses and treats include epilepsy, headaches, cerebral palsy, developmental delay, disorders of movement, muscle weakness and nerve problems to name a few.

What is epilepsy and what are epileptic seizures?

Epilepsy is derived from a Greek word that literally means a state of being overcome, seized or attacked. Interestingly, the Arabic word al saraa is translated in English as to be knocked down, which reflects the ancient name the falling sickness, so called because the patient suddenly falls to the ground during a fit. Epilepsy is one of the commonest conditions affecting the brain.

- Dr Mohamed Osman Eltahir Babiker, Consultant Paediatric Neurology, Dr Sulaiman Al Habib Hospital

There are billions of cells on the brains surface and these cells communicate with each other by sending tiny electrical currents at very calculated levels to execute the different body functions such as raising an arm, talking and walking. An epileptic seizure occurs when a localised area in the brain or the brain in its entirety is dominated by an out-of-control burst of this electrical activity.

There are different types of seizures depending on where in the brain this aberrant electrical activity is coming from. Epilepsy is the individuals tendency to have recurrent epileptic seizures.

How do you diagnose epilepsy in children?

Properly diagnosing epilepsy in children is perhaps the most important first step towards the best possible treatment outcomes. Many conditions in children may present in a manner similar to epileptic seizures. Hence, it is paramount that we take adequate history that describes the episodes in question in as much detail. Nowadays, almost everyone has a mobile phone with a camera. Taking videos of the episodes as they happen can prove very helpful when they are reviewed by the neurologists. The next step is to perform a test called electroencephalogram (EEG for short), which involves application of wires over the head to record the patterns of the brains electrical waves and circuits.

The EEG can be run for about an hour or so but sometimes we may need to extend the recording for 24 hours or even longer to gain more information. The EEG usually serves to give supporting evidence before we can confidently diagnose epilepsy but it can also give valuable information about the type of epilepsy the child has.

Epilepsy can result from a wide range of causes and that is why other tests might be needed to understand why the child has developed epilepsy. These may include brain imaging via magnetic resonance imaging, or MRI. Nowadays we are relying on genetic testing more and more. It is worth pointing that it is not always feasible to find a direct cause for the childs epilepsy despite our best efforts.

What are the treatment options for patients with epilepsy?

There are three main levels of treatment. These are medications, brain surgery and the ketogenic diet. Often, we start with an anti-epileptic medication that has been appropriately chosen based on the childs characteristics and the type of epilepsy he or she has. A balance has to be struck between the effectiveness of the medicine and its side effects. In children, we tend to start with smaller doses then build them up slowly over time to ensure safety and tolerability.

Up to 70 per cent of patients respond well to one or two medications and we will be able to successfully withdraw the medicine within a couple of years. In cases whereby medications do not work satisfactorily or when there is a diseased part of the brain, the surgical option is then considered. There are different surgical options and these are chosen after careful consideration and planning on a case-by-case basis.

Does a ketogenic diet help in epilepsy?

The role of the ketogenic diet in epilepsy treatment has been recognised for nearly a century now. Essentially, it is a strict type of diet that consists of low-carbohydrate, high-fat and calculated protein content. In the face of low carbohydrate and sugar intake, the body is forced into producing chemicals known as ketones that the brain uses as its main source of energy. This is thought to be the mechanism through which the ketogenic diet works although this does not seem to be the whole story thus far.

In cases where medication or brain surgery do not seem to fully control the epileptic seizures, the ketogenic diet may be a reasonable option. We know from research that the chance of response can be as high as one in three. It must be remembered that the selection for and administration of the ketogenic diet should be under strict medical supervision. This is because this type of diet can potentially cause problems such as low blood sugar levels, tummy upset, kidney stones, poor body growth and so forth.

What is the hardest part of being a paediatric neurologist and what are the challenges of looking after children with neurological problems?

Paediatric neurology is such an intellectually stimulating branch of medicine. Many of the conditions we deal with are rare and, needless to say, serious. Most share similar symptoms and some require time, patience and sometimes a lot of detective work before they are diagnosed. Given that several neurological problems may last for a long time, paediatric neurologists are privileged to have the opportunity of establishing long-term trusting relationships with the children and their families. Transparent, honest and responsive communication with the families all the way through is the foundation of these relationships. Although many of the conditions we see and manage have no cure because of their very nature, the satisfaction for us comes from the mere fact that we can always care!

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Epilepsy is one of the commonest conditions affecting the brain - Gulf News

Global Neurology Software Market Drivers, Key Players, Regions, Application and Forecast to 2020-2025 – News Times

This study has articulated the Global Neurology Software Market with a detailed view of the Global Neurology Software industry including Global production sales, Global revenue, and CAGR. The report delivers core insights regarding the Neurology Software Market report with an in-depth study of market size, country-level market size, region, segmentation market growth, market share, sales analysis, value chain optimization, market players, the competitive landscape, recent developments, product launches, strategic market growth analysis, trade regulations, opportunities analysis, technological innovations, and area marketplace expanding. Moreover, it critically focuses on the application by analyzing the growth rate and consumption of every individual application.

Key vendor/manufacturers in the market:

The major players covered in Neurology Software are: Epic, Brainlab, healthfusion, Athenahealth, Practice Fusion, Nextgen, Bizmatics, Greenway Health, Allscripts, Kareo, Advanced Data Systems, NueMD, etc.

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By Type, Neurology Software market has been segmented into Advanced Neurology EMR Software, Other, etc.

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By Application, Neurology Software has been segmented into Hospitals, College & Research Institutes, Other, etc.

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Major Table of Contents

1 Neurology Software Market Overview2 Company Profiles3 Market Competition, by Players4 Market Size by Regions5 North America Neurology Software Revenue by CountriesContinued

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Scientists Connect Brain Cells to Machines Over the… – Labiotech.eu

An international group of researchers has set up a brain-machine interface between cultured nerve cells and electronic chips linked over the internet, which could lead to the development of AI implants for treating neurological disorders.

As described in a study published in Nature Scientific Reports, the team set up a system where cultured rat nerve cells in Italy could send real-time electrical signals to artificial neurons circuits that behave like nerve cells in Switzerland. The online signals were passed via electronic synapses or memristors in the UK. The signals could also go the other way, sending communications from the artificial nerve cells to the biological nerve cells.

Technology linking the nervous system with machines, called neural interfacing, is an established field, including technology such as cochlear implants treating hearing loss. In the last few decades, however, scientists have made technological advances that let machines use artificial neural networks and integrate better with real brains. This could lead to implantable AI computing chips that treat complex neurological problems like Parkinsons disease.

One key challenge to developing brain-machine interfaces is that lots of time, effort and money are needed to get experts and specialist equipment in one place to link up. This is what the researchers, based in the UK, Italy, Germany, and Switzerland, wanted to combat by connecting nerve cells with machines via the internet.

The virtual lab connecting Southampton, UK; Zurich, Switzerland; and Padova, Italy.

To achieve the same outcome, scientists would have to be co-located, spending significant time in a place and resources for physically linking the capabilities, said Themis Prodromakis, Professor of Nanotechnology at the University of Southampton, and lead author of the study.

There are several academic groups and companies also developing brain-machine interfaces, such as the US firm Blackrock Microsystems and the Dublin-based Medtronic. However, Prodromakis told me that this is the first time anyone has combined biological nerve cells, artificial nerve cells, and memristors into one system across the internet.

It sets the basis for a novel scenario that was never encountered during natural evolution, where biological and artificial neurons are linked together and communicate across global networks; laying the foundations for the internet of neuro-electronics, Prodromakis stated.

This study could pave the way for advances in neurological treatments. For example, it could lead to implanted AI chips that can help patients to control blood pressure, or prevent bladder problems caused by neurological conditions.

In another potential application, AI implants could treat the symptoms of Parkinsons disease patients. Unlike deep brain stimulation a neurostimulation technique currently used for some patients with Parkinsons disease this tech could learn and replace the function of damaged brain tissue.

Image from Shutterstock and the University of Southampton

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VA-sponsored study says research on long-term dangers of antimalarials is inconclusive – WUSA9.com

WASHINGTON Veterans hoping a new report from the National Academies of Sciences, Engineering and Medicine would vindicate their claims of serious long-term side effects caused by antimalarial drugs were disappointed Tuesday when it failed to draw any concrete links instead only finding that further research was warranted.

The report was the result of a more than year-long process undertaken by the National Academies of Sciences, Engineering and Medicine (NASEM) and sponsored by the Department of Veterans Affairs. The goal was to look into possible long-term neurological and psychiatric effects of antimalarial drugs particularly of mefloquine (brand name Lariam), which has been linked to insomnia, depression, anxiety, severe nightmares and suicidal and homicidal ideation.

FULL REPORT | Assessment of Long-Term Health Effects of Antimalarial Drugs When Used for Prophylaxis

WUSA9 has reported for years on the stories of U.S. servicemen and women, and members of the Peace Corps, who were prescribed mefloquine while deployed in Iraq and Afghanistan and subsequently reported long-term, sometimes permanent, neurological and psychological damage as a result.

RELATED: Army SSGT who pleaded guilty to murdering 16 in Afghanistan wants new civilian trial, says 'mefloquine psychosis' was ignored

RELATED: Navy SEAL sues Roche, claims anti-malaria drug caused permanent paranoia, nightmares

RELATED: After the Peace Corps: a volunteer's harrowing story after using an anti-malaria drug

The FDA ordered mefloquine labeled with a black box warning in 2013, noting that neurological side effects can occur at any time during use, and can last for months to years after the drug is stopped. The military reclassified mefloquine as a drug-of-last-resort following the FDAs black box decision, and its former U.S. manufacturer, Roche, no longer produces it in the United States.

Veterans and advocacy organizations have pushed for the Department of Veterans Affairs to recognize the service-related disabilities they say antimalarials like mefloquine have caused.

But the committee, which was made up of professionals from the fields of epidemiology, psychiatry, neuroscience and other health disciplines, did not come to that conclusion instead finding that the 21 existing studies looking at long-term adverse effects of antimalarial drugs were, taken together, inconclusive.

The committee recognized that adverse events while taking some antimalarial drugs are quite common, but the pressing, well-justified question of whether health problems continue after use has simply not generated the rigorous research needed to answer it, said committee chair Dr. David Savitz, professor of epidemiology at the Brown University School of Public Health in a statement Tuesday. The absence of evidence on long-term health effects of these drugs does not mean the link doesnt exist, only that there is a critical need for well-designed studies to answer important safety questions.

The committee did find there was empirical basis for additional research into possible long-term adverse events caused by four common antimalarials:

The only case where the committee felt there was sufficient evidence to come to a positive conclusion was the link between tafenoquine and vortex keratopathy a harmless condition involving microscopic sediment buildup in the cornea.

Dr. Remington Nevin, a former Army epidemiologist and physician who testified before the committee last January, said the report appeared to have been hamstrung by the Department of Veterans Affairs decision to restrict the committee from conducting its own review of veterans medical records.

"Veterans disabled by the militarys reckless misuse of mefloquine should be deeply disappointed that the VA tied the hands of committee members by preventing them from reviewing their medical records, Nevin said. Expert drug regulators in the U.S., Canada, and the European Union have already concluded on the basis of a careful review of such records that mefloquine does cause permanent neuropsychiatric disability. The committee's rushed and error-filled report represents a tragic missed opportunity to begin to recognize the human suffering caused by this drug. Veterans deserve better.

A spokeswoman for the National Academies said reviewing individual cases was beyond the statement of task the VA set for the committee. She also noted that the committee didn't dispute the body of evidence regarding side effects while actively taking antimalarials:

"There is robust evidence about concurrentside effects of mefloquine. However, not enough studies were designed to specifically determine whether the drugs cause long-termside effects that occur while the drug was in use and persist after cessation; or occur months or years after the drug was stopped. Veterans certainly deserve answers, and even though conducting high-quality research to answer this question is challenging, that should not prevent it from being done."

Committee Chair Dr. David Savitz also released an expanded statement to WUSA9:

Although several other individuals and research groups have reviewed subsets of the literature on mefloquine and its association with adverse health outcomes, they used different frameworks, inclusion criteria, or methods to judge association or causality, and therefore their conclusions may differ from those of this committee. This committee was charged with examining persistent or latent adverse events specifically, not adverse events that occur during use of a drug or immediately after its use has ended. The published literature is very limited in both the number and the quality of studies that examined adverse events 28 days or longer after the use of an antimalarial drug (e.g., mefloquine) ended. Studying the persistent or latent effects of exposures is challenging and there is not one definitive study that can be done to put the issue to rest. But it is possible to design and conduct studies that would contribute to the evidence base on whether there are persistent or latent health outcomes associated with use of an antimalarial drug. Such studies should include explicit documentation of the antimalarial dosage used; timing of both antimalarial drug use and symptom or event occurrence; sufficient sample sizes; extended follow-up of users that includes assessments at multiple time points; and validated documentation of potential confounders and health outcomes, including a careful collection of neurologic and psychiatric outcomes using validated instruments.

RELATED: How a drug prescribed by the Peace Corps shattered a family

RELATED: The Peace Corps and anti-malaria drugs: What you need to know

RELATED: Retired Army General calls on VA leaders to take responsibility for anti-malaria drug side effects

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Jordan Fischer is an investigative reporter with WUSA9. Follow him on Twitter at @JordanOnRecord.

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VA-sponsored study says research on long-term dangers of antimalarials is inconclusive - WUSA9.com

Appalachian Unsolved: The trucker who liked redheads – WBIR.com

In life, Jerry Leon Johns liked to boast that he'd never hurt a woman and no one could ever prove otherwise.

In death, his crimes may finally be catching up with him.

The Tennessee Bureau of Investigation announced in December that a grand jury had determined the Rockford, Ill., man likely killed a woman found strangled and bound Jan. 1, 1985, along Interstate 75 in Campbell County.

Nevermind that Johns died in 2015.

Investigators have always wondered about the independent trucker, who was convicted in 1987 of attacking a woman he met at a Knox County adult club. Even 35 years ago, there was speculation he might be the man behind what came to be known in the South as the "Redheaded Murders."

But he never was charged with murder. There never was enough evidence.

RELATED: Records offer chilling details about Knox victim's encounter with possible 'Redhead' killer

RELATED: TBI names suspected killer in 1985 'Redhead Murder' case

RELATED: TBI names suspected killer in 1985 'Redhead Murder' case

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RELATED: Woman found dead 33 years ago finally identifed

Today, the TBI is working to see if it can link Johns to other killings of women, who typically had reddish hair, found dumped near highways and roadways in states like Tennessee and Kentucky.

"Could he be involved in other cases?" TBI Special Agent Brandon Elkins said. "I think it's possible. Are we going to get there? I don't know, but we're not going to stop trying to connect anything we can connect."

Significant advancements in forensic science make it easier to prove -- and disprove -- any involvement Johns may have had with past redhead cases. That's assuming evidence from those old crimes can still be found.

Tina Marie Farmer, whose remains were found Jan. 1, 1985, near Jellico. She finally was identified in about 2018.

TBI

It was years after the Campbell County killing that authorities were able to show DNA found on the victim's shirt and the blanket she was wrapped in came from Johns. Back in the 80s, the testing tools available were more limited and primitive.

So, who knows what else police and the TBI may learn about Jerry Johns and a handful of unsolved killings of female victims.

Dave Davenport, a former TBI agent and sheriff of Jefferson County, was part of a task force that met several times in the 1980s so law enforcement departments could share information and brainstorm leads about the women.

He doesn't know if the TBI will be able to tie Johns to any unsolved killings. Johns certainly had the personality of someone who thought he could get away with murder, he said.

It's also possible police caught Johns before he could kill anymore, Davenport said.

Johns was arrogant and condescending with the cops. He acted like he was smarter than everyone else, and boasted about his knowledge of serial killers, Davenport said.

"You never know what evil lurks in people," he said.

Dave Davenport, retired TBI agent.

WBIR

Bodies off the interstate

Local interest grew intense in the 1980s as women's bodies started turning up -- in the South and elsewhere. Often they were found along highways like Interstate 81, Interstate 75 and Interstate 40.

Often the women had been bound and strangled. Often they had red hair, which led to the "Redheaded" nickname.

Davenport recalls that local law enforcement became aware there might be a trend after the discovery of the woman's body beyond a guardrail off I-75 on Jan. 1, 1985, near Jellico.

They couldn't identify her, and wouldn't be able to for decades. She'd been dead a few days, an autopsy determined, and she was pregnant.

"We started going to places all over Kentucky, trying to identify her and putting up posters," he said. "Then we started hearing from Kentucky state police who said, Yeah, we have one (a female homicide victim) on the interstate."

Authorities in Arkansas, Mississippi and Ohio started comparing notes about their cases.

Brandon Elkins sought re-testing of key evidence found in the homicide of Tina Farmer.

WBIR

Looking back, Davenport and Elkins say it's clear the crimes weren't all related. It's logical, however, that some shared key links.

Nudged in part by heavy media play, Davenport said, area law agencies met several times as a "task force" to talk about the killings. According to Davenport, the gatherings actually produced little progress in terms of solving major crimes.

In March 1985, attention began to focus on Johns after he was arrested driving the car of a dancer he'd picked up that night at a notorious "adult" club called the Katch One north of I-40 near Lovell Road.

The woman told police Johns had tried to strangle her and left her for dead in a culvert off I-40.

An interesting detail, according to Elkins: She had reddish hair.

'Strangled to unconsciousness'

The woman known as "Tasha" danced nude at the Katch. It was a lucrative profession, sometimes bringing her a thousand dollars a week.

Evidence presented at Johns' trial in Knox County included the gun he pulled on her and her clothing.

WBIR

Johns, then age 36, ran his own small trucking operation, called Rebel Trucking Company out of Cleveland, Tenn.

He and his brother Wayne Johns went to the Katch the night of March 5, 1985. Johns had his own Katch membership card.

The dancer agreed to go with him to a Knoxville motel after work for sex for $200. Johns tore two $100 bills in half and gave her two halves, according to records. She would get the other two halves later at the motel, he said.

She helped arrange the services of another woman to have sex with Wayne Johns, court records state.

Everyone drove their own cars to the Holiday Inn on Dale Avenue, a business that's now gone.Tasha hid the two halves of her $100 bills in her Datsun 280Z.

Johns got adjoining rooms for him and his brother, according to records. He had a gun, and told the dancer he was an undercover Texas Ranger, which was a lie. He drove a pickup with Texas plates.

After they had sex, she took a bath and prepared to leave. Johns had other ideas. When they walked to her Datsun, he forced her to move over so that he could drive. He'd never given her the other halves to the $100 bills.

Johns drove back to the Katch.

While parked in the club's parking lot, Johns ripped Tasha's T-shirt into strips, which he used to tie her hands and feet, records state.

He put a gag around her mouth and threatened to kill her if she tried to leave or screamed," an appellate opinion states. He headed west on I-40, finding some woods where he pulled the sports car over.

He forced her to go with him into the trees. She asked him if he was going to kill her, and he said yes, Elkins said.

The Katch One, where dancer Tasha worked and met Jerry Johns.

WBIR

"She said why, and he said, You've become a nuisance," the agent said.

He also was angry, she told authorities, because he'd discovered she wasn't a real redhead. She colored her hair, Elkins said.

Johns taunted her with his pistol. But rather than shoot Tasha, he wrapped a strip of her shirt tightly around her neck and strangled her until she lost consciousness.

Survival, a chase and a capture

She survived, however.

She would later tell authorities she came to in a culvert, crawled out of it and made it to the interstate where she flagged down a trucker.

"She told him and others who stopped to help that someone had tried to kill her," court records state. "She was fearful of her benefactors and begged them not to kill her."

Tasha told troopers who responded to the scene what had happened. She said Johns had driven off in her Datsun, and she gave the room numbers at the Holiday Inn on Dale Avenue.

The victim was treated at Parkwest Hospital off Cedar Bluff Road.

Knox County authorities headed for the Holiday Inn.

A trooper spotted Johns' pickup in the parking lot. A deputy joined him. The men saw the Datsun approach the lot but then suddenly speed off.

A chase ensued on nearby I-40.

After getting off at the business loop exit, the 280Z crossed the median and slid across another exit lane before coming to a rest. Inside the sports car, police found Johns' loaded gun.

Jerry Johns shown while serving as a Tennessee inmate

TDOC

During questioning, authorities found that Johns had a Holiday Inn motel room key, $752 in cash and the Katch One membership card. They saw him wad up and throw away several $100 bill halves.

The jury found the evidence was enough to convict Johns of the crimes. He received a long sentence behind Tennessee bars.

Friends and family members tried to convince the Knox County judge to show mercy. They insisted Johns was a good man who looked after his family.

They wrote that he and his wife had gone through hard times, losing a young son to a disease.

Few mentioned that he had a felony criminal record out of Mississippi.

The long-sought break

Johns never would leave prison after his 1987 trial in Knox County Criminal Court. He tried.

Jerry Johns, shown while a Tennessee inmate.

TDOC

He hand-wrote numerous petitions insisting he should be released because authorities had the wrong man.

In February 1986, the woman known as Tasha sued Johns in Knox County Circuit Court for suffering, physical and emotional, that he'd caused her that night in March 1985.

Johns then turned around and sued her in July 1986 in the same court.

"It is the contention of plaintiff, Jerry L. Johns, that defendants...and (her lawyer) conspired to perpetrate a fraud upon the plaintiff..." his handwritten complaint states.

WBIR sought to speak with the victim for this story. The TBI contacted her, and she said she wasn't ready to talk publicly, according to the TBI.

Johns sometimes talked with the media after his arrest, complaining about how the police were portraying him. He'd never done anything, he insisted.

Working against investigators at the time was a relative lack of physical evidence.

Jerry Johns filed numerous appeals while held in Tennessee.

WBIR

Or so they thought. Because as the 80s passed into the 90s and then into the 2000s, forensic science got better. Analysts became able to identify suspects through their DNA, and they built up a national database of that information that could be used by agencies across the country.

The Campbell County case had particular meaning for Elkins. Before he went to the TBI, he worked for the Campbell County Sheriff's Office, and the homicide victim was one of his cases.

He never forgot about the bound woman in the blanket. He kept on working it when he moved to the TBI.

In 2016, he resubmitted the blanket and shirt to the TBI crime lab for fresh testing. Elkins got the break he'd been seeking.

Testing showed Johns' genetic profile, which by now was part of the national database, was found on both items.

Now the agent knew: Johns indeed had killed the redheaded woman found dumped over that guardrail near Jellico.

Unfortunately for investigators, Johns was gone, having died in prison in 2015 at age 67.

"It was a surreal moment to discover after all those years that we had identified who this killer was, but it was deflating to know he had died just shortly before the discovery of this DNA," Elkins recalled.

Said Davenport, one of the original TBI investigators: "I'd like to have seen him alive and been there when they said, Jerry, we have your DNA on the blanket you wrapped (the victim) with. Your butt is going to jail, or the electric chair.

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Appalachian Unsolved: The trucker who liked redheads - WBIR.com

11 Celebrities You Didn’t Know Were Redheads & 9 Who Actually Aren’t – OK!

Do blondes have more fun? Not judging by these redhead celebs! Some of Hollywoods biggest names from Emma Stone to Jessica Chastain are known for their scarlet locks. Want a reality check? One of those two is a natural blonde!

MORE: Sharon Osbourne reveals white hair after 18 years of dying it red!

Whos a naturally born redhead, and who turns to dye to make them ravenous in red? Discover the answers here!

MORE: Everything you need to know about celebrity beauty and hair!

OK! shows 11 celebrities you didnt know were real redheads and 9 redhead celebs who are just dyed. Who will land in which column? Were looking at you, Nicole Kidman?

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The Oscar winner has been blonde, brunette and has even sported black hair, but Nicole is a natural redhead. Check out the movie Dead Calm for a look at her real locks. Nicole has been blonde for so long that its hard to think of her as a redhead.

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Alyson Hannigan dyed her hair red for a role that many know her for no, not the American Pie movies. It was for Buffy the Vampire Slayer. She is naturally a brunette, but for the sake of her art, she had no issues being radiant in red for the Sarah Michelle Gellar-starring smash hit. In fact, she has mostly kept her hair that color ever since.

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11 Celebrities You Didn't Know Were Redheads & 9 Who Actually Aren't - OK!

Pigeons with ‘Make America Great Again’ hats glued to their heads released in Las Vegas – NBC News

LAS VEGAS Pigeons with tiny Make American Great Again hats glued to their heads were released in downtown Las Vegas this week in what appears to be a sarcastic statement of loyalty to President Donald Trump and a mock protest of Nevada's coming Democratic presidential caucuses.

A group calling itself P.U.T.I.N., Pigeons United To Interfere Now, claimed responsibility for the stunt. The pigeons were set loose Tuesday, according to the group.

NBC affiliate KSNV spotted at least one of the pigeons still in a hat on a downtown street Wednesday afternoon.

"P.U.T.I.N. have used their pigeons to launch a one of a kind aerial protest piece in response to the arrival of the 2020 Democratic Presidential hopefuls," according to a group statement. "The release date was also coordinated to serve as a gesture of support and loyalty to President Trump."

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Twenty-five pigeons were released, 24 of them wearing hats and one donning a Trump-style wig, the group said Thursday in an email to NBC News.

"Most have returned. We expect to see the rest tonight or tomorrow," the group said.

While the stunt has drawn some laughs, Mariah Hillman, who runs Lofty Hopes, a Las Vegas pigeon rescue organization, called the MAGA stunt "animal cruelty."

In December, videos of three pigeons wearing miniature red cowboy hats went viral after they were seen on Las Vegas streets.

"It started here with the press making fun of it, the police didn't do anything about it, and now it's grown into this, so when is it going to stop, and who's going to do something about it?" Hillman said Thursday.

Hillman and her volunteers are setting traps in hope of removing the pigeons' hats before rehabilitating and releasing the birds.

The pigeons are wearing the hats with the help of eyelash glue.

"It doesn't matter what kind of glue it is. It is still, in fact, cruelty, because you are impairing their vision," Hillman said, adding that her organization rescues many birds, such as wedding-release pigeons and racing pigeons, that are trained to return to their flocks.

"There's not always a guarantee that they'll return, because they can get injured or killed before that happens."

Anita Hassan reported from Las Vegas and David K. Li from New York.

Anita Hassan is a national investigativereporter for NBC News, based in Las Vegas.

David K. Li is a breaking news reporter for NBC News.

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Pigeons with 'Make America Great Again' hats glued to their heads released in Las Vegas - NBC News

Girls are reaching new heights in basketball, but huge pay gaps await them as professionals – Yahoo Sports

Women have made great strides in the world of sports over the past 50 years.

Especially in some individual sports, female champion athletes today earn far more money and command a much bigger audience than their predecessors thanks to breakthroughs by tennis champions like Billie Jean King and Venus and Serena Williams and top golfers such as Kathy Whitworth, Nancy Lopez and Michele Wie.

We are fans of womens basketball and scholars who study the role that gender plays in sports and the changing status of female athletes. Despite massive changes in attitudes toward women who excel at sports overall, with few exceptions weve observed that the disparity between what adolescent boys and girls can aspire to accomplish in professional basketball today remains enormous.

This gap has become more visible due to the deaths of retired basketball legend Kobe Bryant, his daughter Gianna and two of the other girls on the basketball team he coached in January.

Known as Gigi, the 13-year-old by all accounts inherited not only her former NBA player fathers love of the game, but silky smooth moves as well. She aspired to attend the University of Connecticut where she would play on its highly ranked womens basketball team. Mourners spoke reverently about Gigis intentions to play professionally and carry on her fathers legacy during a star-studded memorial service for both of them held on Feb. 24.

Women began playing basketball in 1892, one year after the sports emergence.

Womens basketball started as a passing game with its own peculiar rules. The court was divided into three sections and each team fielded nine players, versus the five who play on the court today. Players could not move out of their assigned area, were restricted to three dribbles, and could only hold the ball for three seconds. Players were also generally advised against engaging in strenuous activity as the medical experts at the time were convinced that overexertion would damage womens fertility.

In 1896 teams from Stanford and the University of California, Berkeley competed in the first womens intercollegiate basketball game. Women kept playing basketball despite the perceived health risks.

One of the most famous womens amateur basketball teams of the 1930s was the Golden Cyclones of the Employers Casualty Company of Dallas, which was led by track and field Olympic gold medalist and champion golfer Mildred Babe Didrikson Zaharias. The first professional womens basketball team was created in 1936. The All-American Red Heads barnstormed the country for more than 50 years.

Although the players were required to wear makeup and either dye their hair red or wear red wigs, the team played by mens basketball rules against mens teams. Despite the popularity of individual teams like the All-American Red Heads, womens professional basketball struggled to gain a firm footing for decades.

Likewise, basketball did not become an Olympic sport for women until the 1976 Montreal Summer Olympic Games, four decades after mens basketball made its debut at the 1936 Berlin Summer Olympic Games.

By that time, rules for women had become about the same as for men.

The advent of a new federal civil rights policy enacted in 1972 changed the world of womens sports. What became known as Title IX was originally intended to provide equal opportunities and access for women in fields such as science, medicine and law.

Story continues

In practice, Title IX forced high schools and colleges to open up more opportunities for female athletes and to spend more money and attention on girls and womens sports teams.

But it would take more than 20 years for the emergence of a womens professional basketball league.

Sports fans dubbed the 1996 Summer Olympic Games the Summer of the Women because U.S. womens teams won gold medals in softball, soccer, basketball and gymnastics.

The womens Olympic basketball teams success powered by star players Sheryl Swoopes, Rebecca Lobo and Lisa Leslie led to the creation of two womens professional leagues.

The American Basketball League proved short-lived, ceasing operations in 1998 after only three years. The Womens National Basketball Association, known as the WNBA, is entering its 23rd season this summer.

Despite the WNBAs staying power, its players until now have only earned an average salary of US$71,000, little more than 1% of the $6.4 million their typical male counterparts on NBA teams take home.

Average pay for WNBA players, however, will soon nearly double to about $130,000 a year, and some of the leagues star players will be making $500,000, following a collective bargaining agreement. Players will now be eligible for maternity leave at their full salary, and can become unrestricted free agents after five full seasons.

Attendance at WNBA games now averages about 7,000 per game, compared to 18,000 at NBA games. The disparity in terms of the sports finances through TV deals and licensing agreements is much larger than that. The womens league generates about $60 million in revenue, just a tiny fraction of 1% of the NBAs $7.4 billion revenue.

What will it take to bridge the huge gender gap in professional basketballs popularity and pay?

We think that it could take a player like dunking sensation Stanford freshman Fran Belibi who has captured significant media attention. Sabrina Ionescu, senior point guard for the Oregon Ducks, is another potential gamechanger.

Ionescu was named national player of the year in 2019 as a junior. She has broken the National Collegiate Athletic Associations triple-double record for college women and men. Ionescu had trained with her close friend and mentor, Kobe Bryant. And Golden State Warriors star player Stephen Curry has brought his daughters along to watch her play.

Or maybe it will take parents like Kobe Bryant and Curry, born after Title IX changed so much about athletics, to instill in their daughters an understanding that a sports career is not only feasible for women, but within reach.

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This article is republished from The Conversation, a nonprofit news site dedicated to sharing ideas from academic experts.

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The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

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Girls are reaching new heights in basketball, but huge pay gaps await them as professionals - Yahoo Sports