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The First Phone Network Exclusively for Kids Aims to Curb Screen Time Addiction – Yahoo Lifestyle

Posted: September 20, 2019 at 11:47 am

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In todays world, owning a smartphone is not so much a rite of passage as it is a standard for kids. A recent Pew Research Center survey found that 95% of teens have a smartphone or can readily access one, making them one of the most tech-savvy and well-connected generations. But such easy access to the internet and social media comes with its own host of issues, including an increased risk of online bullying, mental and emotional health problems, and an unhealthy attachment to screens all of which Gabb Wireless, the first company to provide phones and a network exclusively designed for kids, aims to combat.

Gabb, which announced its nationwide rollout for its phones and network this week, claims to be the premier safe network for young kids and teens. Gabbs phones stick to the basics, offering call and text options with a limited number of pre-installed apps, including a camera, a calculator, a calendar, and FM radio. And while neither of Gabbs phones or usage plans offers an internet browser or an app store, its products resemble popular smartphones on the market.

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I wanted [the phones] to look and feel just like a smartphone because I dont know if you remember what its like to be 12, or 13, or 14, or 15, but these kids are mortified when their parents give them flip phones, Gabb founder and CEO Stephen Dalby told SheKnows.

Gabb currently offers two phone models: Gabb Z1, manufactured by ZTE; and Gabb S1, manufactured by Samsung and available on October 15. At $99, the Gabb Z1 is the more basic model, featuring a five-inch screen, a five-megapixel back camera, a two-megapixel front camera, and 32GB of expandable memory. Gabb S1 is a bit more sophisticated, with a nearly six-inch screen, an eight-megapixel front camera, a five-megapixel back camera, Bluetooth capabilities, and 512GB of expandable memory; it retails for $199.99. Both phones run on a leading 4G LTE provider.

The company also offers two usage plans, Gabb Basic and Gabb Plus. The Basic option, which is available now, comes with unlimited calls and text and costs $19.99 per month. As with the S1, the Plus plan offers a bit more, with unlimited calls and text, picture messaging, and group text capabilities; it costs $22.99 per month and will be available soon. Neither plan requires a contract.

It was critical to Dalby that both the phones and the plans were simple. As a parent of teens, Dalby said hed exhausted 30-40 hours of research looking for age-appropriate options that were safe as well as reasonably priced. Ultimately, none of the options on the market seemed worth it; even with parental controls, every phone allowed far too much access to the internet and social media apps. To top it all off, the phones and plans were exorbitantly priced. It was just a really painful experience, he said.

Keeping kids safe online is a growing concern for many parents, and rightly so. A recent study published in JAMA Psychiatry found that teens who spend more than three hours a day on social media were at a higher risk of mental and emotional health issues. These findings were consistent with a 2018 study published in Preventative Medicine Reports which found that kids ages 2-17 who spent more than an hour a day using screens had lower psychological well-being than those who didnt. The same study found that teens who had seven or more hours of screen time were twice as likely to have depression and anxiety. These findings are concerning, especially since 71% of teens reported that they use one or more social media platforms regularly, according to the Pew Research Center.

Additionally, the World Health Organization recommends reduced screen time including time spent on mobile devices, in front of gaming systems, and watching TV for kids of all ages, as it could cause developmental delays.

The evidence is clear, children who are consistently exposed to screens and excessive social media are suffering, Collin Kartchner, national social media activist and founder of Save the Kids, said in a Gabb Wireless press release. Whether its FOMO, anxiety, or exposure to predators, we owe it to our children to create safe ways for them to adopt mobile technology and content in ways that are better suited to their age and maturity levels.

Dalby says one of his objectives with Gabb is to teach kids about responsible technology use and to hold them accountable for the ways they interact via text messaging. He says parents can do this by first introducing kids to the Gabb Basic plan. Once kids have proven theyre more mature, Dalby suggests graduating to the Gabb Plus plan, where kids can enjoy group messaging and send photos. Ultimately, Dalby says he hopes that Gabb phones will prepare kids for their inevitable online usage.

So far, Dalby says both kids and parents have embraced Gabb phones.

The feedback were getting is really positive, he said. Its really positive from the kids because theyre excited to get the phone. Its really positive from the parents because they just dont need to worry about [kids accessing harmful apps or websites].

Gabbs goals are ambitious, and its mission to reduce the number of hours kids spend online will be hard-fought. But its a challenge Dalby and his team are happy to take on, starting in their own homes.

The same phones that were selling at Gabb Wireless are the same phones that my children are using, Dalby said. Theres never going to be a phone on this network thats not safe for kids.

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Oak Knoll to Host ACL Prevention and Recovery Panel – Patch.com

Posted: September 20, 2019 at 11:47 am

Oak Knoll School of the Holy Child will host "ACL: The Physical and Mental Prevention and Recovery," a panel discussion, on Monday, September 23, 2019, from 6:30-8 p.m. on the school's 11-acre campus in Summit, New Jersey.

The event is free and open to the public. Pre-registration suggested.

The school's panel of doctors will discuss both prevention and recovery of the ACL injury. Physical and mental aspects will be discussed and how proper training is vital to both the prevention and recovery of such a prevalence injury. The conversation will focus on preventative techniques and then transition into what happens after injury. We will then focus the conversation on both the physical and mental aspects of rehabilitation and coming back from what once was thought to be a career ending injury.

Our Panel:

Andrew A. Willis, M.D.: A sports medicine surgeon specializing in athletic injuries and disorders of the shoulder, knee, elbow, wrist, and hand at the Sports Medicine Center and the Hand & Upper Extremity Center at Tri-County Orthopedics.

Lonnie Sarnell, Psy.D.: A a licensed psychologist who provides clinical and sport psychology services for children, adolescents and adults, at her private practice in Millburn, NJ.

Brianne O'Connor, PT, DPT: Graduated with honors from Columbia University with a Doctorate in Physical Therapy.

Jeff Boucher: Owner of Parisi Speed School in Morristown

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Research suggests how environmental toxin produced by algae may lead to ALS – Penn State News

Posted: September 20, 2019 at 11:47 am

HERSHEY, Pa. Can a computer be used to explain why an environmental toxin might lead to neurodegenerative disease? According to Penn State College of Medicine researchers, a computer generated-simulation allowed them to see how a toxin produced by algal blooms in saltwater might cause Amyotrophic Lateral Sclerosis (ALS).

The researchers investigated an environmental toxin called -Methylamino-L-alanine (BMAA) that has been linked to significantly increased occurrence of sporadic ALS in populations with frequent dietary consumption of food sources containing high levels of BMAA including the Chamorro population of Guam where ALS incidence is approximately 100 times greater than other populations.

The toxin is produced by cyanobacteria, a blue-green algae, and can occur in marine ecosystems. According to the researchers, BMAA accumulates in sharks, shellfish and bottom feeders so populations relying mainly on these food sources may be at risk.

Elizabeth Proctor, assistant professor of neurosurgery, and Nikolay Dokholyan, professor of pharmacology, used a computer to investigate why exposure to the toxin may lead to the development of diseases like ALS.

According to the researchers, if BMAA becomes part of a protein called copper-zinc superoxide dismutase (SOD1), the protein may adopt a form that is toxic to neurons.

Proctor, who holds a doctorate in bioinformatics and computational biology, said the study may be a model for investigating non-genetic cases of ALS, which account for 90% of all diagnoses.

Our results suggest a need for further investigation of SOD1 modification patterns in ALS patients, Proctor said. If we can determine the molecular patterns of disease onset and progression, it may aid in the development of lifestyle and preventative interventions for sporadic ALS.

What eluded researchers was an explanation for why BMAA led to the development of ALS and other neurodegenerative diseases.

In their study, published in PLOS Computational Biology, Proctor and Dokholyan proposed that BMAA causes the protein SOD1 to fold into a form that is toxic to neurons.

Proteins are built using 20 amino acids according to specific recipes coded in DNA. Slight changes to the ingredients can result in proteins that arent able to function the way they are supposed to. Proctor said if enough BMAA is present in a motor neuron that is building SOD1, it may be mistaken for the amino acid L-serine, which has similar properties.

According to the researchers, who used computer modeling to see what the protein would look like with BMAA instead of serine, this substitution critically alters the structure and stability of the protein.

More than 150 mutations of SOD1 have been associated with ALS, but the structural changes from those mutations arent enough to affect the stability of the protein according to Nikolay Dokholyan, professor of pharmacology and co-author of the study.

SOD1 has a higher level of stability compared to most normal proteins, said Dokholyan, who has a doctorate in physics. Although many mutations in this protein are associated with ALS, the resulting changes to its structure are not strong enough to cause significant destabilization.

Serine, the amino acid that BMAA competes with, occurs ten times in the recipe for SOD1. The researchers tested their theory by substituting BMAA for serine in each of those ten occurrences using a computer program developed by Dokholyan. They observed that BMAA incorporation had detrimental effects to the structure and stability of the protein and caused it to fold, or adopt its shape, incorrectly.

According to the researchers, studying patterns of SOD1 modifications in patients may be useful in developing potential interventions for sporadic ALS. One example of a possible intervention is L-serine supplementation for people exposed to a high amount of BMAA.

Although the study suggestions a connection between two pieces of ALS evidence, Dokholyan says many molecular factors contribute to the presentation of symptoms that doctors see.

A variety of gene mutations and external factors, like BMAA exposure, are associated with ALS, Dokholyan said. If we can figure out one pattern out, it may give clues for how to unlock others.

David Mowrey, of the University of North Carolina at Chapel Hill also contributed to this study.

This work was supported by the National Institutes of Health Grants R01GM080742 and R01GM114015.

The authors declare no conflict of interest.

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Have DNA? These Yale geneticists want it – Yale Daily News

Posted: September 20, 2019 at 11:47 am

Yale professor Michael Murray and a team of scientists want to collect over 100,000 samples of DNA in the coming years.

They want yours, too.

Since its recent launch in September, a new DNA sequencing project called Generations has been collecting blood samples from willing patients across the Yale New Haven Health System. Researchers plan on sequencing the protein-making parts of the genetic material in the blood to better understand, prevent and treat diseases and cancers.

The project may sound like 23andMe, the for-profit DNA testing company that is famous for predicting ones ancestral makeup. But Murray, a professor of genetics at the School of Medicine, said Generations is much more complex.

What theyre doing is not to be dismissed, but it only covers a small amount of risk, he said. Well be looking at more genes and more conditions, and well be looking at them in a more detailed way.

The process is free and fairly simple. Once a patient reads and signs a consent form, they can do a blood test. A few weeks later, he said, if the samples test positive for a gene variant that could lead to certain diseases, the patient is notified.

In the best case, you could do it all in a half hour, he said.

Murrays team collects the DNA from blood tests instead of cheek swabs because it is more reliable. And unlike blood donations, which can turn potential donors away for their medicine use or sexual orientation, Generations wants as many samples as possible, with the goal of collecting over 100,000 individuals DNA.

All one needs is a medical record number, he said, and that can be generated on the spot for Yale students.

Theres no age or health status inclusions or exclusions. Anybody thats interested can sign up, he added.

The DNA sequences will then be stored in a biobank, or a data repository, for researchers to access and analyze in conjunction with patients medical records. With such a large amount of data, Chair of the Department of Laboratory Medicine Brian Smith said that Generations can look for trends that would not be as apparent in smaller study groups.

And because the New Haven area mimics locally what the entire United States looks like in terms of ethnic origin, Smith said the data will be especially helpful in making connections between diseases and genes.

The fact that there are so many people from a wide spectrum of genetic backgrounds, combined with the information from the electronic medical record, really gives us the ability to understand that a gene is clearly associated with a medical problem, he said.

Privacy is a big concern for the project. Since Murray and his team are working within the health system, which legally requires strict confidentiality measures for patient data, the genetic data they collect will be kept safe, Murray said.

But he is well-prepared for the task. In fact, that is what Yale hired him to do.

The researcher came from Geisinger Health in Pennsylvania last year, where he helped to create a biobank with over 50,000 patients genetic data.

Now at Yale, Murray plans on replicating that project, but at roughly twice the size. However, much of the testing his team will do will happen later on, as they work out any kinks in the system, he added.

For example, once it becomes available, Generations will also use samples to predict patients responses to certain medicines. Armed with such information, Murray said, doctors could know if a patient may need more or less of a medication to reach the desired outcome, compared to the average person.

You dont start everything at once, he said. Every sample they receive will be tested in the future once more features roll out.

To chair of the genetics department Antonio Giraldez, who participated in Generations himself, the project is also a way to prevent costly diseases that can pop up later in life. If a babys genetic data reveals that they have a high chance of developing cancer, he said, preventative measures could be taken to make sure cancer does not arise saving thousands of dollars.

I hope that many people in greater Connecticut [participate], he said.

Partial genome sequencing costs hundreds of dollars, according to Smith.

Matt Kristoffersen | matt.kristoffersen@yale.edu

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4 Steps Healthcare Organizations Need to Take to Automate Their Data – – HIT Consultant

Posted: September 20, 2019 at 11:47 am

Alex Gorelik, CTO & Founder of Waterline Data

According to IDC, all the data thats being created and captured in healthcare is projected to grow by 36 percent (CAGR)more than any other industry.

While managing growing volumes of data is a common challenge for many organizations across all sectors, healthcare is uniquely set apart by the sheer number of new data sources thats being made availablewith new sources being added all the time. This is driven in large part by advancements in telemedicine, personalized or precision medicine, as well as IoT-based medical and personal health devices. While this flood of real-time data and analytics adds to the opportunities for all kinds of data-driven benefits like more advanced and customized care as well as faster drug development, it also means healthcare organizations will have to manage increasingly large and varied data assets. This is creating some big challenges that these organizations will need to resolve, including how to ingest and organize the information, ensure it complies with HIPAA and other regulations, and make it valuable for all stakeholders.

The problem is compounded as healthcare focuses on population health management and becomes more preventative rather than merely reactive. This, of course, requires capturing and analyzing even more data that can be used to detect early indications of health risks. Meanwhile, there has been a shift toward more remote health monitoring and response. You may go to Kaiser and think your medical professionals are all on site, but its becoming more common for hospitals to tap the expertise of specialists who could live elsewhere on the globe. They connect via teleconference systems and trade data from different systems located in different countries, all with different regulatory requirements. Using data-driven collaboration to provide the best possible care for individuals or enable the most comprehensive research for global responses to disease outbreaks while meeting various compliance needs is no easy task.

To support these needs, IDC for its part recommends big investments in health IT, blockchain and analytics tools along with effective strategies for digital transformation. A big enabling part of this transformation requires using AI and machine learning technology thats taught to recognize patterns in unstructured data and automatically converting it into structured data that can be retrieved and analyzed. This is how you automate many of the time-, cost- and resource-intensive manual processes that often sink an organizations big data ambitions. These steps include:

1. System and Silo Consolidation:

The healthcare industry is constantly consolidating. This creates a challenge in integrating all the disparate systems and data silos that need to come together to provide a big data ecosystem that can draw from all the incoming streams of data and various data sources. This means everything from hospital monitoring machines to personal IoT-enabled medical devices. Together, they can paint a holistic picture of a patients health and medical needs, accelerate pharmaceutical drug development and so much more. Using AI and machine learning-driven technology to automate data classification and consolidation across systems, departments and organizations around the world in this way can dramatically cut the time, cost and required expertise of migrating disparate data into centralized data lakes.

Furthermore, to avoid complicating effortsits complex enough alreadydont try to build Rome in one day. Start with a few critical projects that require certain data that can be processed in order to form your projects bloodstream. Focus on a few key systems and get them cleaned up. Dont try to boil the ocean all at once. Settle on a few essential use cases to launch with. Apply your automation, curation, assessment of data quality, etc., and then use it in your AI and ML initiatives. Once youre able to demonstrate success, steadily build on those successes.

2. Data Lake Management:

After suffering some setbacks due to improper management, data lakes are regaining the luster they first captured in 2010 when organizations began using them to cost-effectively store their raw data. The problem? The data lake is great for storing data, but not so great when it comes to generating value. Organizations would often dump their data there with no proper management, leaving the data to rot ungoverned and unused. But the emergence of the cloud has combined with the development of new AI-driven cataloging techniques that help automate and simplify many management functions that keep data lakes healthy. Organizations can now use them to combine data from different systems in one place where the stored data can be rendered governable, searchable and accessible.

3. Packaging Data:

Storing all your data in one data lake doesnt automatically make it usable. All that data is still streaming in from all kinds of different sources, including medical records, patient surveys, cancer or cardiac registries, claims records, and so on. You need to be able to recognize and find data regardless of its source and then format and provision it for use according to what the use case requires. This is what will enable the self-service retrieval and analytics that todays medical practitioners want in order to provide better care. Sure, theyre more data-savvy now than ever, but you still need to package data in a way that makes sense to them.

4. Governance:

Healthcare generates oceans upon oceans of data, and all of it needs to be governed. This is an area that requires absolute automation to ensure every bit of data adheres to the rules governing that particular bit of data. All have to be maintained. Some data can be seen but not copied. Some data can be shared by one party with another party but only if anonymized. There are a lot of regulations and restrictions. Only granular governance will ensure youre deriving the most value from both restricted and unrestricted data without breaking any industry or governmental rulesor disobeying the patients stated data privacy and security preferences. For governance to work, you need to make sure all your data is properly identified so that the automated enforcement rules theyre bound by can be applied.

As advancements continue to be made in AI and machine learning to further enable data automation, the healthcare industry is poised for a dramatic transformation that will greatly improve the quality of care for humankind. But data automation cant be applied in one fell swoop. It requires deliberate implementation across many iterative stages. Making those modest moves to automate now will get you on track towards the giant leaps that data will undoubtedly make in the quality and effectiveness of healthcare.

About Alex Gorelik

Alex Gorelik, the author of the newly published book, The Enterprise Data Lake (published by OReilly Media), is CTO and founder of Waterline Data as well as three startups. He also served as GM of Informaticas Data Quality Business Unit. In addition, Alex was an IBM Distinguished Engineer and co-founder, CTO at Exeros and Acta Technology.

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New documentary claims eating meat could kill you – Yahoo News Australia

Posted: September 20, 2019 at 11:47 am

A documentary featuring world class athletes speaking about the pros of a plant-based diet claims eating meat could kill you.

The Game Changers focuses on the truth in nutrition and features the likes of Arnold Schwarzenneger talking about the benefits of veganism in sports training.

It also aims to debunk the theory that people need to consume meat to build muscle and claims eating meat can cause cancer and cardiovascular disease.

On the documentarys website, it claims, citing a Harvard study, avoiding animal products can reduce the risk for coronary heart disease by 55 per cent.

Arnold Schwarzenneger is one of many former and current athletes interviewed in The Game Changers. Source: The Game Changers

Dr Dean Ornish, founder of the Preventative Medicine Research Institute, is also cited in the trailer stating eating plants can reverse diabetes and heart disease.

The doco also features interviews with Formula 1 driver Lewis Hamilton, Australian Olympic sprinter Morgan Mitchell, and former NFL players Griff Whalen and Derrick Morgan.

While the documentary calls on a number of scientific studies, its been criticised by some experts.

Brian St Pierre, Director of Performance Nutrition at Precision Nutrition, told Mens Health while getting people to eat plants isnt bad the documentary shouldnt be telling people meat will kill them.

Some have criticised the documentary for claiming eating meat could kill people and cause many health problems. Source: Getty Images (file pic)

That is a false dichotomy, Mr St Pierre said.

Instead, teach them the benefits of adding more wholesome plant foods to their meat intake and then teach them to eat higher-quality meat options.

He added another alternative could be telling people to swap some meat for plant-based protein and find a happy middle ground.

UK mens news site Joe.co.uk also criticised the documentary with health writer Alex Roberts writing its a huge generalisation to claim all meat has the same risk.

High levels of saturated fat are linked to conditions such as atherosclerosis, true, Roberts wrote.

But a very lean cut of turkey is not as harmful as a fatty, rib eye steak, for instance.

Vegan mixed martial arts fighter James Wilks who was heavily involved in the documentary rebukes the criticism, saying the documentary never makes the claim that all meat carries the same risk.

Writing to Yahoo News Australia after publication he said the above criticism suggests that dietary fat is the only issue ... It's far more complicated than that, with meat containing other inflammatory mediators, concentrated pesticides, toxic heavy metals etc.

He also pointed to the raft of experts featured in the film, and claimed the documentary had been accredited by the American College of Lifestyle Medicine as well as the US Defense Health Agency.

The Game Changers premieres in Australian cinemas on Wednesday.

Do you have a story tip? Email: newsroomau@yahoonews.com.

You can also follow us on Facebook and Twitter, download the Yahoo News app from the App Storeor Google Play and stay up to date with the latest news with Yahoos daily newsletter. Sign up here.

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Racial Disparities in Survival Outcomes Shown in Pediatric Hodgkin Lymphoma Patients – Newswise

Posted: September 20, 2019 at 11:47 am

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Newswise New Brunswick, N.J., September 17, 2019 In what is believed to be the largest dataset study to date examining the role of race on survival outcome for pediatric patients with Hodgkin lymphoma, investigators at Rutgers Cancer Institute of New Jersey have found that black patients have significantly worse overall survival at five years than white patients when accounting for all available clinical variables. The work is being presented as part of a mini oral presentation at the Annual Meeting of the American Society for Radiation Oncology (ASTRO) in Chicago this week.

The National Cancer Database, which captures oncology data from more than 1,500 facilities accredited by the Commission on Cancer, was utilized in the study. Identified and evaluated was a final sample of 9,285 eligible patients aged 21 and younger with a diagnosis of stage 1 to stage 4 Hodgkin lymphoma from 2004 to 2015.

Eighty-three percent of patients were white, 12 percent black and five percent other. Black patients were found to be younger (under age 15), at a lower stage of disease when diagnosed, less likely to have a sub-type of disease known as nodular-sclerosis, and more commonly to exhibit what are known as B symptoms (fever with no infection, night sweats, unexplained weight loss). This population also was found to be of lower income and lower education status, and more likely to be under/uninsured. Similar among the races were treatment interventions, including use of chemotherapy, radiation therapy, or combined modality therapy (chemotherapy followed by radiation). Clinical features and survival outcomes were evaluated using various statistical tests and models.

Black patients experienced a five-year overall survival of 91.5 percent compared to 95.9 percent experienced by their white counterparts. This difference was seen across all stages of disease. There were also differences in stratification of risk factors by race. Specifically, under age 15, stage 4 disease, presence of B symptoms, treatment with radiation, and income were prognostic factors for overall survival in white patients but not for black patients. Among the age groups 15 and younger, 16 to 18 years, and older than 18, poorer overall survival was associated for black patients compared to whites (95.4 percent versus 97.7 percent, 87.1 percent versus 96.1 percent, and 91.6 percent versus 94.6 percent respectively).

The race-based disparity demonstrated through this work transcends that of differences in socioeconomic status, notes the works senior investigator, Rutgers Cancer Institute radiation oncologist Rahul Parikh, MD, who is the director of the Laurie Proton Therapy Center at Robert Wood Johnson University Hospital, an RWJBarnabas Health facility. Future research should focus on understanding the biological causes of this disparity and identifying ways to alleviate it, adds Dr. Parikh, who is also an associate professor of radiation oncology at Rutgers Robert Wood Johnson Medical School.

Along with Parikh, other investigators on the work are Karishma Khullar, MD, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School; Zorimar Rivera-Nunez, PhD, Rutgers Cancer Institute and Rutgers School of Public Health; Sachin R. Jhawar, MD, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School; Richard Drachtman, MD and Peter D. Cole, MD, both Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School; and Bradford S. Hoppe, MD, MPH, University of Florida, Gainesville.

Related work published earlier this year by Parikh and colleagues believed to be the largest study to date involving this same population showed improved overall survival in those who received combined modality treatment versus chemotherapy alone in early stage patients (JAMA Oncology, doi: 10.1001/jamaoncol.2018.5911).

Other data set exploration by Rutgers Cancer Institute investigators includes that of radiation oncologist Nisha Ohri, MD and colleagues. She is the senior author on work presented during a poster presentation this past Sunday at ASTRO that evaluated the change in volume of a lumpectomy cavity during hypofractionated breast radiation therapy and assessed the benefits of adaptive planning for lumpectomy boost delivery.

A retrospective review of Rutgers Cancer Institute data identified 37 eligible patients who were treated with hypofractionated radiation therapy followed by a lumpectomy boost from October 2017 to December 2018. Two separate CT scans were obtained. The first was utilized to plan whole breast irradiation and the second to plan the lumpectomy cavity boost. Patient and tumor variables were examined for correlation with change in lumpectomy cavity volume between CT scans.

The mean reduction in lumpectomy cavity volume with adaptive boost planning was 18.8 percent. Adaptive planning allowed for significant reductions in mean heart and lung doses. In comparing the 18 patients (47.4 percent) who had a significant reduction in lumpectomy cavity volume (defined as 20 percent or greater) to those who did not, no significant differences were found in age, body mass index, breast volume, tumor size, history of re-excision, or presence of an implantable marker. Length of time from surgery to initial CT scan was significantly associated with a reduction in lumpectomy cavity volume, and patients who had a large initial lumpectomy cavity volume often demonstrated significant volume reduction with adaptive boost planning. With these findings, investigators note that adaptive lumpectomy cavity boost planning can be considered for select patients to reduce normal tissue exposure, although longer follow-up is needed to assess the clinical benefits.

Along with Dr. Ohri, other investigators on the work include Mutlay Sayan, MD; Zeinab Abou Yehia, MD; Irina Vergalasova, PhD; Marc Reviello, CMD; Shicha Kumar, MD, and Bruce Haffty, MD, all Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School.

Rutgers Cancer Institute faculty members are also collaborators on a number of other on-site presentations and abstracts/posters published in conjunction with the ASTRO annual meeting that are not listed here.

About Rutgers Cancer Institute of New Jersey

As New Jerseys only National Cancer Institute-designated Comprehensive Cancer Center, Rutgers Cancer Institute, along with its partner RWJBarnabas Health, offers the most advanced cancer treatment options including bone marrow transplantation, proton therapy, CAR T-cell therapy and complex robotic surgery. Along with clinical trials and novel therapeutics such as precision medicine and immunotherapy many of which are not widely available patients have access to these cutting-edge therapies at Rutgers Cancer Institute of New Jersey in New Brunswick, Rutgers Cancer Institute of New Jersey at University Hospital in Newark, as well as through RWJBarnabas Health facilities.

Along with world-class treatment, which is often fueled by on-site research conducted in Rutgers Cancer Institute laboratories, patients and their families also can seek cancer preventative services and education resources throughout the Rutgers Cancer Institute and RWJBarnabas Health footprint statewide. To make a tax-deductible gift to support the Cancer Institute of New Jersey, call 848-932-8013 or visit http://www.cinj.org/giving.

###

For journalists contact:

Michele Fisher, Public Relations Manager

732-235-9872

michele.fisher@rutgers.edu

For patient appointments/inquiries contact:

844-CANCER-NJ (844-226-2376)

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Revealed: the UAE’s best and worst gov’t centres – ArabianBusiness.com

Posted: September 20, 2019 at 11:47 am

Management at the worst performing government centres in the UAE were immediately replaced while bosses at the best performing have been rewarded with bonuses as the country seeks to improve services for its residents.

Sheikh Mohammed bin Rashid Al Maktoum, Vice President, Prime Minister and Ruler of Dubai, on Saturday revealed the UAE's top five and bottom government centres following a comprehensive evaluation.

In a tweet, he said: "Today I reviewed the comprehensive evaluation report of services in 600 government centres. We had promised to announce the five best and worst centres."

Taking the best centre position was Fujairah's Federal Authority for Identity and Citizenship while Sharjah's Emirates Post received the worst centre ranking.

The Ministry of Education's Ajman Centre, Ajman Traffic and Licensing Centre, Wasit Police Station in Sharjah and Sheikh Zayed Housing Programme's Ras Al Khaimah Centre were also named among the best performers.

Muhaisnah Preventative Medicine Centre in Dubai, General Pension and Social Security Authority's Sharjah Centre, Bani Yas Social Affairs Centre in Abu Dhabi and Tawteen Centre in Fujairah were identified among the worst.

Sheikh Mohammed said in comments published by state news agency WAM: "We directed immediate management replacement in the worst centres with highly capable leaders. We ordered director-generals to closely monitor their entities and improve centres' performance in a month and I will visit."

"Teams of the best centres will receive a two-month salary reward," he added.

Service centres, ministries and entities, along with ministers, managers and services provided will undergo an annual evaluation, with transparent reporting of results, Sheikh Mohammed said.

"We have the courage to evaluate ourselves and our teams because the cost of hiding mistakes is much higher," he noted.

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Incidence of Type 2 Diabetes Up in Younger People and Risks Greater – Medscape

Posted: September 19, 2019 at 9:52 am

BARCELONA - The proportion of younger adults (18-40 years) diagnosed with type 2 diabetes has risen from 9.5% to 12.5% since the year 2000, with younger diabetics having higher cardiovascular (CV) risk factors compared with older people with the disease, finds a study of UK primary care data.

Type 2 diabetes incidence in people aged 41-50 years also increased from 14% to 17.5% over the 17 years of the study that began in 2000. CV morbidity and all cause mortality rates remained stable in younger age groups after 2005, even while mortality rates declined substantially among patients aged over 60.

Effectively, in the UK today, around 1 in 8 new cases of type 2 diabetes is in someone aged 18-40 years, compared with 1 in 10 in the year 2000.

The findings add to a growing body of evidence of an increased incidence of type 2 diabetes including worrying complications in younger people. Earlier this year, Medscape Medical News reported how young people diagnosed with type 2 diabetes in their early teens had an "alarming" high rate of diabetes-associated complications by the time they were in their mid-20s. Another study reported results showing that early treatment in teens with prediabetes or recent-onset type 2 diabetes failed to prevent deterioration in beta-cell function.

Sanjoy Ketan Paul, PhD, chair in clinical epidemiology, biostatistics & health services research, and Digsu Koye, PhD, clinical epidemiologist, both from the University of Melbourne, Australia, presented the results at this years Annual Meeting of the European Association for the Study of Diabetes (EASD).

"The very high HbA1c of 8.6% in the youngest group, with 71% obese, and around 72% with high LDL [low-density lipoprotein] levels, suggests we need to review our whole approach to screening in the UK and the wider world," said Paul.

"Type 2 diabetes doesnt happen overnight but develops over time with high risk exposure leading to the development of the disease at young age," he added. "We need to be more proactive in the holistic management of cardiovascular and cardiometabolic risk factors such as blood pressure, lipids and so on, in addition to lifestyle management and use intensive therapeutic interventions to manage these risk factors in this age group."

The study looked at the incidence of type 2 diabetes in the UK population over time, in particular at young onset type 2 diabetes compared with later onset; trends over time in the incidence of atherosclerotic CV disease (ASCVD) by age group; as well as the risk of ASCVD and all-cause mortality by risk status at time of diabetes diagnosis in each age group.

"We dont really know what is happening to the incidence of type 2 diabetes over time in younger compared with older people, and what the risk factors are at time of diagnosis. Also, do those diagnosed early on have a higher risk of developing CVD, different to the risk in older people?" Paul said. This study addressed these outstanding research issues.

Data were analysed on 343,714 people. Five age groups were evaluated: 18-40, 41-50, 51-60, 61-70 and 71-80 years. Patients did not have ASCVD at diagnosis.

The youngest group (18-39 years) had significantly higher body mass index (BMI) compared with older age groups, with a mean of35 kg/m2, and 71% were obese. Their mean HbA1c was 8.6% with 58% having levels 7.5%,and 71% had LDL levels 100 mg/dL.

In comparison, among those in the 41-50 year age group, 70% were obese, with a mean BMI of 34 kg/m2 and 55% had HbA1c of 7.5%

Data on anthropometric, clinical and laboratory measures, as well as comorbidities atdiagnosis of type 2 diabetes, microvascular disease and all-cause mortality were measured over a median follow-up of 7 years.

Trends over time in the proportion of people with a type 2 diabetes diagnosis in all the age groups were evaluated from 2000 to 2017, as well as the temporal trend for ASCVD and all-cause mortality.

"The temporal patterns show that the incidence of type 2 diabetes has been consistent over the past 5 to 7 years, with a marginal increase in the young onset people, at around 6% in 2006/7 and 8% at the end of the follow-up period," said Paul.

Women showed a striking trend over time. "In the youngest age group (18-40 years), females have a higher incidence of type 2 diabetes diagnosis, compared with a consistently reduced incidence in females in the 40-50 and 50-60 years age groups," he highlighted.

After diagnosis, the rate of development of ASCVD remained similar post-2007, following a decline since the year 2000, across all age groups.

The rate of all-cause mortality remained unchanged among those under-60 but declined in the 60+ age group, decreasing by around 20% in the 60-70 years group and 30% in 70-80 years group.

In the youngest group, the time to a first ASCVD event was the same irrespective of risk level at diagnosis. However, in older people (40 years +) there was a clear difference of around 2 years in development of ASCVD between high-risk and non-high-risk patients. "Similarly, in terms of time to death [all-cause mortality], in the youngest age group, the time to all-cause mortality is similar, but in the older groups there was a difference again."

Commenting from the audience, Dr Roy Taylor, professor of medicine and metabolism, University ofNewcastle, said: "These are interesting data. The decreased incidence in the oldest age group is of interest but surely this is an effect of earlier diagnosis of type 2 diabetes with increasing adiposity in the population over recent decades."

Dr Naveed Sattar, from the University of Glasgow, who was moderating the session pointed out that, "It was likely that we are screening less and we are missing a lot of people at younger age. Because of the level of acquisition we are probably not capturing everyone in the community."

EASD 2019 Annual Meeting. Presented September 18, 2019. Abstract #82

COI: Dr Paul reported no relevant disclosures.

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Incidence of Type 2 Diabetes Up in Younger People and Risks Greater - Medscape

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CGM, Not Insulin Pump, ‘Is What Makes Difference’ in Type 1 Diabetes – Medscape

Posted: September 19, 2019 at 9:52 am

BARCELONA Use of real-time continuous glucose monitoring (rtCGM) can help improve blood glucose control in people with type 1 diabetes whether they use an insulin pump or multiple daily injections (MDI) of insulin, new research suggests.

Three-year data from the Comparison of Different Treatment Modalities for Type 1 Diabetes Including Sensor-Augmented Insulin Regimens(COMISAIR) study were presented here at the European Association for the Study of Diabetes (EASD) 2019 Annual Meeting by Jan oupal, MD, PhD, Charles University, Prague, Czech Republic.

The results were simultaneously published in Diabetes Care.

At 3 years the longest duration of any CGM trial real-time (not flash) CGM was superior to self-monitored blood glucose (SMBG), or fingerstick, testing at least four times daily in reducing HbA1c in patients using both pumps and MDI, with little difference between the two insulin delivery modalities.

Only the rtCGM group had improvements in time-in-range and reduced time below range. Fewer patients using rtCGM experienced severe hypoglycemic episodes.

"It is not so important how insulin is delivered, but more important is how patients with type 1 diabetes monitor their glucose," oupal said during his presentation.

oupal also said that "CGM and multiple daily injections [of insulin] can be a suitable alternative to treatment with pumps and CGM for some patients," such as those who have achieved good control using that regimen, those who are only willing to accept one device on their bodies, or for reasons of accessibility/affordability.

Patients likely to do better with pump plus CGM regimens include those with the dawn phenomenon (a rise in blood glucose in the early morning) and those who are physically active and can benefit from temporarily lowered basal infusion rates. Patients with hypoglycemic unawareness may be ideal candidates for sensor-augmented pump therapy, he added.

"Individualization of treatment is important. However, according to the results of our trial, in the vast majority of cases, CGM is what makes the difference," oupal said.

Asked to comment, Julia Mader, MD, Medical University of Graz, Austria, agreed. "The majority of patients profit from rtCGM whereas the insulin delivery mode is really not that important and should be at the patients' preference. They are equal."

Many of the oIder studies that showed improved glycemic control with insulin pumps were conducted during the time prior to use of insulin analogs, she noted, so that the comparator of twice-daily injections of NPH and Regular insulin versus Regular in the pump is not an accurate reflection of today's modalities. Today, she said, "Multiple daily injection [of insulin] is much better than before."

Mader also noted that the "real-time" aspect of CGM is important.

Participants in the current study used either the Dexcom G4 or Medtronic Enlite sensors, not the Abbott Libre (ie, "flash" glucose monitoring or FGM).

In her practice in Austria, where many patients use FGM, many don't achieve HbA1c targets with either pump or injection therapy, she noted. That's probably due in part to the alarm feature of rtCGM but not flash monitoring and that flash monitoring is less accurate in the lower ranges of blood glucose levels.

"Real-time alarms are better than just having the data...I think that's why patients are more cautious," she said.

Mader also cautioned that in some cases the introduction of CGM or flash glucose monitoring might actually lead to an increase in HbA1c if the main initial effect is reducing hypoglycemic events, which should be explained to patients, she advised.

The real-world, nonrandomized study compared changes in HbA1c among 94 patients using one of four treatment regimens: insulin pumps with or without rtCGM (15 and 20 patients, respectively) and MDI with or without rtCGM (12 and 18 patients), and all participants also used SMBG.

All patients were adults with type 1 diabetes of at least 2 years' duration and baseline HbA1c 7.0%-10.0% (53-86 mmol/mol). A total of 88 participants completed all 15 study visits at 3-month intervals over 3 years.

At 3 years, the rtCGM + MDI and rtCGM + insulin pump groups had significantly lower HbA1c levels compared with the MDI and pump groups using SMBG, at HbA1c 7.0% (53 mmol/mol), P = .0002, and 6.9% (52 mmol/mol), P < .0001, versus 8.0% (61 mmol/mol), P = .3574, and 7.7% (61 mmol/mol), P = 1.00. There were no significant differences between the two CGM groups or the two fingerstick groups.

The proportions of patients who achieved HbA1c < 7% at 3 years were 48% with rtCGM + MDI and 43% with rtCGM + pump, compared to just 9% with SMBG + pump and 16% with SMBG + injections.

Improvements in time-in-range (70-180 mg/dL, 3.9-10.0 mmol/L) were 14.2% with rtCGM + MDI versus SMBG + MDI (P = .0007), 11.1% with CGM + injections versus SMBG + pump (P = .0016), 17.6% with rtCGM + pump versus SMBG + pump (P < .0001), and 14.5% with rtCGM + pump versus SMBG + pump (P < .0001).

Significant reductions in percentage of time below 70 mg/dL (3.9 mmol/L) were seen in both CGM groups but not the SMBG groups (P = .4847 and P = 1.000), respectively.

A total of seven severe hypoglycemic episodes occurred during the study, of which two were in the SMBG + pump group, three in the SMBG + injections group, and one in the rtCGM + pump group (but the patient was not wearing the CGM at the time). There were three episodes of diabetic ketoacidosis: one in the SMBG + pump group, one in the SMBG + MDI group, and one in the CGM + pump group. All were adjudicated.

COMISAIR was supported by grants from the Agency for Healthcare Research and the Ministry of Health of the Czech Republic. Soupal has reported serving as an advisory board member, consultant, and/or speaker for Novo Nordisk, Eli Lilly, Sanofi, Boehringer-Ingelheim, AstraZeneca, Medtronic, Roche, and Dexcom. Mader has reported being an advisory board member and/or speaker for Becton Dickinson, Boehringer Ingelheim, Eli Lilly, Medtronic, Sanofi, Abbott Diabetes Care, AstraZeneca, Nintamed, Novo Nordisk, Roche Diabetes Care, Sanofi, Servier, and Takeda.

EASD 2019 Annual Meeting. Presented September 19, 2019. Abstract 40.

Diabetes Care. Published online September 17, 2019. Abstract

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