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Global Kinetics Corp Secures First US Patent For Its Digital Health System – Markets Insider

Posted: August 15, 2017 at 1:40 pm

Melbourne, Australia and Minneapolis, Minn., Aug. 14, 2017 /PRNewswire/ — Global Kinetics Corporation (GKC), a digital health company revolutionizing the management of Parkinson’s disease, announced today it has recently received Notice of Allowance for U.S. patent application 12/997540, protecting the company’s lead product, the Personal KinetiGraph (PKG) (Parkinson’s Kinetigraph outside of the U.S.) system, which the company is marketing in the U.S. The patent application pertains to the objective measurement of bradykinesia. Bradykinesia, or slowness of movement, is one of the most common symptoms, and a defining feature, of Parkinson’s disease. The capacity to continuously measure this movement symptom underpins the PKG system.

“The allowance of this application supports GKC’s continued progress in the commercialization of our novel, U.S. FDA-cleared PKG system, which is being used to support the management of Parkinson’s disease in over 215 clinics in 16 countries around the world,” said GKC’s global head of business development and legal affairs, Michelle Goldsmith. “We are aggressively pursuing clinical and commercial milestones that will ultimately enable us to make measurable change in the lives of people with Parkinson’s.”

The PKG system, developed by Professor Malcolm Horne and Dr. Rob Griffiths following many years of research at Melbourne’s Howard Florey Institute and Monash University, incorporates a patient-friendly wrist-worn device to record body movements over several days as people go about their daily lives. The PKG system is the only commercially available mobile health technology which provides clinically meaningful measurement of the key symptoms of Parkinson’s using cloud-based proprietary algorithms that measure bradykinesia, dyskinesia, tremor, and the relationships of these to medication timing, sleep and exercise.

Inaccurate assessment of Parkinson’s symptoms may result in patients experiencing uncontrolled symptoms, reducing their quality of life and increasing healthcare costs. By adding the PKG system into a patient’s routine care, treating clinicians now have an effective tool that assists them to augment their clinical assessment with GKC’s proprietary objective data, captured by the PKG watch over seven days.

“GKC has long held the view that measurement is key to optimal management in Parkinson’s. Our algorithms underpin GKC’s ability to provide clinically meaningful and actionable information about Parkinson’s symptoms to clinicians,” explained Professor Horne, GKC’s co-founder and chief scientific officer.

The results of a recent study show the PKG system detected 85% of Parkinson’s patients previously considered “controlled” by their treating physician were, in fact, uncontrolled and experiencing treatable symptoms. The study also showed that without the PKG, one third of the patients that the PKG system detected as having treatable symptoms would have been missed by expert movement disorder specialists (MDS).1 When patients, who were classified as uncontrolled, were treated per their physicians’ recommendations, their outcomes improved, including the subgroup where only the PKG, not the MDS, detected the need for treatment changes.1

GKC is currently conducting studies to establish the value of the PKG system in improving the entire advanced therapy pathway from more efficient referrals to better optimization on therapy. Early evidence suggests the PKG may enhance the DBS pathway, this research is ongoing.2

About Global Kinetics Corporation (GKC) and the Parkinson’s KinetiGraphTM System (PKGTM)

GKC, recognized as a Top 10 Most Innovative Health Company by the Fast Company Awards 2017, is a commercial-stage digital health company revolutionizing the management of Parkinson’s.

The company’s PKG System is a patient-friendly, algorithm-based system that records body movements and other symptoms over the course of many days and creates data-driven reports that empower more personalized treatment and management decisionswith the goal of leading to a higher quality of life for patients.

The PKG System continues to be accepted as a first line clinical system and is the only FDA-cleared and clinically validated digital health technology that can provide continuous and objective measurement of patients’ symptoms in everyday environments. This includes the continuous and objective measure of bradykinesia (or slowness of movement), the most clinically important symptom of Parkinson’s disease.

In addition to increased use in routine clinical care for Parkinson’s disease, Global Kinetics continues to pursue partnerships with major pharmaceutical and medical technology to help measure the efficacy of new and advanced therapies, as well as use in clinical trials, telehealth, remote monitoring and other augmented platform opportunities.

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Man with spinal cord injury throws first pitch at Brewers game –

Posted: August 14, 2017 at 3:50 am

by Gabrielle Mays, FOX 11 News

Lucas Lindner near the dugout at Sunday, Aug. 13 Brewers game. (Photo courtesy Scott Paulus with Milwaukee Brewers Baseball Club)

MILWAUKEE (WLUK) — Sunday marked another milestone for a Fox Valley man as he threw the first pitch at Sunday’s Brewers game.

With a baseball in Lucas Lindner’s right hand, he moved his arm back and threw the ball right into the catcher’s mitt with ease.

The crowd cheered and Lindner couldn’t help but smile.

He suffered from a severe spinal cord injury after he crashed his truck last year. The crash left him paralyzed from the chest down.

Thanks to an experimental stem cell treatment called AST-OPC1, Lindner gained mobility in his arms, hands and fingers.

The procedure took place at the Medical College of Wisconsin.

FOX 11 did a story on Lindner last year.

“Throwing out the first pitch at a Major League game is not something I could have imagined a year ago. I want to show everyone that there is hope that spinal cord injury patients can regain function. I am looking forward to going back to school, pursuing my dream of working in the IT field and living independently someday,” Lindner said to Asterias Biotherapeutics.

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Walker helps Brewers knock off Reds 7-4 – La Crosse Tribune

Posted: at 3:50 am

MILWAUKEE (AP) When Milwaukee manager Craig Counsell found out the Brewers had traded for Neil Walker, he immediately wanted to know if he could get the veteran infielder into the lineup for Sundays game against Cincinnati.

After collecting just 3 hours of sleep, Walker arrived in plenty of time to collect a pair of hits in his Milwaukee debut, helping the Brewers to a 7-4 victory over the Reds.

It is easier, in my opinion, to get thrown in the fire and see how it goes, Walker said. I was happy to not be out of the lineup for two straight days.

Domingo Santana hit a three-run homer for Milwaukee, and Ryan Braun had two hits and drove in a run. The Brewers took the last two games of the weekend series after dropping six in a row.

Walker came over in a trade with the New York Mets on Saturday. He started at third base in place of the banged-up Travis Shaw and went 2-for-4 with a run scored.

He played a position that he hasnt played a ton this year and made some very nice plays, Counsell said. He handled it very professionally like hes been over there. He had quality at-bats. It was a good spot today. We needed him with Travis being out.

Brewers starter Matt Garza (6-6) allowed four runs, three earned, and five hits in 5 innings. He struck out two and walked five.

Jeremy Jeffress got two outs, Jacob Barnes tossed two scoreless innings and All-Star Corey Knebel worked the ninth for his 22nd save. Jesse Winker singled with two out, but Joey Votto flied out to left to end the game.

The Brewers jumped on Sal Romano for three runs in the first inning. Jonathan Villar drew a leadoff walk and scored on Brauns double. Walker followed with a single to right field that Winker misplayed, allowing Braun to score.

Manny Pina made it 3-0 by dropping a ball just fair down the right-field line for a ground-rule double that scored Walker.

Adam Duvalls two-run homer got Cincinnati within one in the fourth, but Eric Sogard tripled and scored on Hernan Perezs squeeze bunt in the bottom half of the inning. Santana then provided the big blow in the fifth, driving a 1-0 fastball from Romano (2-5) over the wall in right-center for a 7-2 lead.

That three-run homer to Santana really cost us, Romano said. Ive just got to be able to get that guy out in that situation.

STREAK SNAPPED: Votto went 0-for-3, ending his career-best 17-game hitting streak. He did draw a pair of walks to extend his run of reaching base at least twice to 18 games, the longest streak since Barry Bonds reached multiple times in 20 consecutive games in 2004.

SPECIAL GUEST: Lucas Lindner, an Eden, Wis., resident who regained the use of his hands and arms following a severe spinal cord injury suffered in a car accident, threw out an honorary first pitch. Lindner received treatment in a clinical trial at Froedtert Hospital in Milwaukee to the injured area of his spinal cord following the May 2016 accident.

TRAINERS ROOM: Shaw was out of the lineup after fouling a pair of pitches off his right leg Saturday. With an off day Monday, Counsell expects Shaw to be able to play Tuesday against Pittsburgh. … LHP Brent Suter was placed on the 10-day disabled list with a left rotator cuff strain. … RHP Chase Anderson (strained left oblique) allowed four runs over 4 innings in a rehab start for Triple-A Colorado Springs. … C Stephen Vogt (left knee sprain) went 1-for-4 in his third rehab game with Class A Wisconsin … RHP Anthony Swarzak was unavailable Sunday due to a stiff neck.

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Veteran Goode back for Packers long snapper competition with rookie Hart –

Posted: at 3:50 am

GREEN BAY, Wis. Brett Goode had quite an eventful week.

Returning to the Green Bay Packers was only part of it.

Last Monday morning, the veteran long snapper an unsigned free agent despite spending the past nine seasons with the Packers was still unemployed when his wife, Monica, went into labor with the couples second child.

Shortly after daughter Blakely arrived, Goode was on a plane from his home in Arkansas for a tryout with the New York Jets, one of a number of NFL teams that had called expressing interest in him.

Like, the baby was born and I left, Goode said Sunday, following his first practice with the Packers. My wife is a good wife.

Goode said he had been monitoring the Packers special teams issues kicker Mason Crosby had missed six of 11 field-goal attempts during the teams annual Family Night practice on Aug. 5 and was still hoping for a call from his old team, as hed received at the end of training camp last year.

Sure enough, the phone rang late in the week and by Saturday, Goode was on his way back to Green Bay, having signed to compete with rookie Derek Hart for his old job.

For now, Goode and Hart will compete for the job. During the Packers closed practice Sunday that was devoted to preparations for the teams Sept. 10 regular-season opener against Seattle, the long snappers both worked with holder Justin Vogel, a rookie punter, and Crosby, who has worked with Goode for virtually his entire NFL career.

It can go one of two ways. Either you bow down, or you stand up and improve and bring the best out of yourself and keep going, said Hart, whose snaps were solid during Thursday nights preseason opener. Crosby made a 39-yard field goal and three extra points in the Packers 24-9 win over Philadelphia.

Competition brings the best out of people, I think. (Goode) did it here for nine, 10 years, so I think any little thing I can pick up from him will be good, too, along the way. Were just going to keep truckin and see what happens.

Goode took over as the Packers long snapper in 2008 after veteran Rob Davis retired after 11 years on the job. Goode handled every special teams snap until suffering a season-ending knee injury in December 2015 in a game at Oakland. He then returned to the team just before last years regular-season opener and was the snapper all season. Crosby made 26 of 30 regular-season field goals and sent the Packers to the NFC championship game with a 51-yard game-winning field goal against Dallas, the longest walk-off field goal in NFL postseason history.

The Packers decided to go younger with Hart, but Goode said the Packers had indicated that they might call at the end of camp as they had last year. When Hart struggled and other teams in the league expressed an interest in Goode, the timeline changed.

I knew I was going to get a call at some point. I didnt know from whom, Goode said. Because of Mason being here and all the other guys that Ive been here with forever and obviously the coaches the way everythings run, you know how training camps run, you know the city its like home.

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5 All-Natural Remedies To Treat Eczema Without The Doctor – The Alternative Daily (blog)

Posted: at 3:48 am

Eczema is a skin condition where a section of the dermis become irritated, inflamed, itchy, flaky and occasionally blistered. It is surprisingly common in infants and children, but it is a problem that afflicts many teenagers and adults too.

There is no sure-fire cure, and eczema sometimes goes away on its own, but there are natural treatment options that can help reduce flare-ups. Here are some important things you need to know about eczema and treating it naturally.

The term basically refers to a variety of rash-like skin conditions. The symptoms of eczema include red, blotchy skin that is inflamed, irritated and itchy. Frequently, a person with the condition will scratch their skin incessantly, which can exacerbate pus-filled sores, flaking and scaly patches.

Scientists believe a number of different factors can cause or contribute to the condition. For example, heredity, allergens, autoimmune disorders, environmental irritants, hormones, stress and temperature can all play a role in precipitating eczema.

A susceptibility to eczema seems to run in families. However, sensitivity to detergents and common allergens can also induce symptoms. Likewise, hormonal changes linked to pregnancy, menstrual cycles and menopause have all been associated with eczema outbreaks too. Here is a list of common culprits:

Eczema is classified In many ways depending on the cause, the location on the body and the specific symptoms. For example, here are some common types of the condition:

Needless to say, the types of eczema can vary widely in terms of etiology and prognosis. However, promoting healthy skin is one of the safest and most effective ways alleviating eczema and restoring your skin to its optimal state. With that in mind, here are five all-natural remedies that will help you cope with the underlying factors that contribute to eczema.

Hempseed oil is a fixture in many body care products including shampoos, body lotions and moisturizers. Thats because the hemp plant is especially rich in omega-3 and omega-6 fatty acids, which are renowned for promoting healthy hair and skin growth.

In particular, omega-3 and omega-6 oils are natural moisturizers that prevent dryness while promoting lipid and collagen growth, which help rejuvenate your damaged dermal layers. In addition, omega-3 and omega-6 act as a natural sunscreen, which helps block harmful UV rays that can damage skin at the cellular level.

Hemp is a close cousin of the marijuana plant. So, its not surprising that Cannabis sativa would contain compounds that are extremely beneficial for the skin too. As it happens, THC and CBD have anti-inflammatory, antioxidant and antimicrobial properties, which promote healthy skin. However, smoking marijuana is not a good way of getting these compounds. Put simply, inhaling any plant-based smoke means breathing in hydrocarbons, which are not conducive to your skins health.

However, cannabis-based topicals such as lotions, creams, tinctures and oil are a terrific way of delivering the benefits of cannabinoids to your skin. Thats because endocannabinoid receptors are dispersed throughout the epidermis. Therefore, when you apply cannabis-based topicals you are delivering natural cannabinoids most notably THC and CBD directly to the endocannabinoid receptors in the skin.

To begin with, THC and CBD are natural anti-inflammatory agents. Therefore, they quickly act to reduce swelling and pus at the cellular level. Second, cannabinoids are potent antimicrobials. Consequently, they naturally combat bacteria, fungi and other microorganisms that can cause skin infections. Finally, THC and CBD are powerful antioxidants. Indeed, cannabinoids contain higher levels of free radical scavengers than vitamins A, C and E. As a result, cannabis-based topicals help counteract genetic damage at the cellular level that diminishes skin health.

In a landmark study on cannabis and skin care, a team of scientists led by Dr. Gerald Weissmann found that cannabis-based topicals promote healthy lipid production, which is critical for regulation of dry skin and counteracting many epidermal disorders.

According to Dr. Weissman, the latest research shows that we may have something in common with the marijuana plant. Just as THC is believed to protect the marijuana plants from pathogens, our own cannabinoids may be necessary for us to maintain healthy skin and to protect us from pathogens.

This view is echoed by Phytecs, a consortium of scientists investigating how foods and other natural substances support endocannabinoid health. Summing up their research they wrote, Endocannabinoids regulate skin inflammation, oil production and even play a role in unwanted hair growth. Skin care products that target the endocannabinoid system are likely to be a fundamental element of next-generation cosmetic treatments.

Aloe vera gel has been used as a skin care remedy for centuries. It has most often been used to treat sunburn and psoriasis, but there is a lot of anecdotal evidence that it can help treat eczema too.

In particular, when applied topically to the skin, aloe vera gel helps deliver a cooling and soothing sensation, which can reduce the urge to itch. In addition, compounds in aloe vera gel have both hydrating and anti-inflammatory properties. The former creates a humectant effect, which may counteract the dryness and flakiness of the outermost epidermal barrier that is often associated with eczema.

The scientific evidence that aloe vera can treat eczema still remains scant, but it has been used safely for centuries as a topical remedy to relieve symptoms associated with dry, broken or irritated skin.

Coconut oil is rich in lipids. Therefore, it helps fill in intercellular space in your skin, which can lead to moisture loss. Coconut oil is especially well-suited to treating eczema for several other reasons too. To begin with, it has immuno-modulating properties. Therefore, it can detoxify histamines, which contributes to skin inflammation, but without any of the negative side-effects associated with cortisone creams or ointments.

In addition, coconut oil is rich in fatty acids that strengthen the connective tissue in your skin. Finally, coconut oil is rich in lauric acid, which helps the skin resist bacteria, fungi and other microorganisms.

Chamomile tea is known to relax the mind, but what about your skin? In fact, chamomile contains traces of a natural alcohol known as bisabolol which has antimicrobial anti-inflammatory properties.

To soothe your skin, try taking a chamomile tea bath. Youll need four chamomile tea bags (or four teaspoons of dried chamomile tied inside a cheesecloth bag). Run warm water from your bathtub faucet for ten to fifteen minutes over chamomile tea. Next, steep yourself in this calming brew. The natural compounds in chamomile should reduce itchiness, fight germs and lessen inflammation too.

Theres no cure-all for eczema that works for everybody all the time. Thats because eczema is a complex condition with many contributing factors. However, there are a number of all-natural remedies that can help you alleviate eczema symptoms while promoting healthier skin. Hopefully, by understanding how these natural compounds work you can discover the ones that work best for you.

Scott OReilly

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Expanded concussion program protects more NJ student athletes – Press of Atlantic City

Posted: at 3:48 am

Our knowledge about the dangers of sports-related concussions has come a long way in the past decade.

There was a time when the NFL celebrated the biggest hits in popular weekly videos and many held the misguided belief that athletes, from pros to pee-wees, should be expected to play hurt and just shake it off when they had their bell rung.

That thinking has not been eliminated, but the scientific evidence about how serious, even deadly, brain injuries can be has raised awareness about the risks involved with athletic competition. The federal Centers for Disease Control and Prevention estimates there are about 300,000 sports-related brain concussions in the United States each year.

New Jersey was among the first group of states to address the issue at the scholastic level, when legislators passed an interscholastic athletics program in 2010 that required special head-injury and concussion diagnosis and treatment training for high school physicians, coaches and trainers. The law outlined protocols for when a student suffered a serious head injury.

Shortly after that, the law was expanded to include cheerleaders.

Last month, New Jersey legislators wisely expanded the program beyond athletes competing against other schools to include students participating in recreational and intramural sports.

The step makes it less likely that student head injuries will go unnoticed or untreated.

Part of what we have learned about concussions is that most instances do not involve loss of consciousness. New Jerseys parent/guardian acknowledgement form for sports participation points out that people can sustain a concussion even if they dont hit their head that a blow elsewhere can transmit an impulsive force to the brain.

These facts show how important it is to have those who coach and supervise students involved in athletics at any level to be trained in recognizing the symptoms of a serious head injury and the steps that need to be taken immediately and in the long run.

We have learned the importance of immediately removing victims from play and not participating in further sports activity until they are evaluated by a proper health care professional and given written clearance to return.

There is a significant danger, even more so with younger people, of reinjuring a brain still symptomatic from a previous concussion. That can result in Second Impact Syndrome, which can involve brain swelling, increased pressure inside the cranium, coma and even death.

The information is frightening. So are stories about young athletes whose lives are ruined after playing through multiple concussions. And so are the latest stories about 96 percent of deceased NFL players whose autopsied brains showed evidence of Chronic Traumatic Encephalopathy, the degenerative brain disease associated with concussions.

The many benefits to students of sports and recreation activities should not be forgotten. But expanding New Jerseys scholastic concussion protections is a step that demonstrates the states dedication to making sure those benefits come with as few risks as possible.

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Biz Buzz: Health and wellness medical spa opens in Short Pump –

Posted: at 3:47 am

Erasing facial wrinkles and lines with Botox and plumping up lips and cheeks with products such as Juvederm and Radiesse is big business.

Spending on facial injectables topped more than $2 billion in the U.S. in 2015, according to one report.

Betting on that trend, Dominion Womens Health & Wellness Med Spa moved into larger quarters in June.

Formerly located in a 500-square-foot space in Mechanicsville, the medical spa moved to a 2,600-square-foot space at 11739 W. Broad St. in The Shoppes at Westgate in Short Pump. The space was previously occupied by Jingles Bridal Salon, which closed in 2015 when the owner retired.

The medical spa is a division of Dominion Womens Health Inc., an obstetrics and womens health practice with medical offices in Chesterfield, Hanover and Henrico counties and Tappahannock.

We offer a pretty progressive menu of treatments, said Badeha Hamze, spa director and a master esthetician. We do all sorts of facials and waxing like a normal spa would.

In addition, spa staff procedures include facial chemical peels, microdermabrasion, dermaplaning, microneedling, permanent hair reduction, laser resurfacing for scars, and laser liposis body contouring.

Our vision has always been the integration of beauty and medicine, and now with our expanded location in Short Pump, we can offer a more complete array of services, including bio-identical (hormone replacement therapy), in a convenient location, said Dr. Danny Shaban, founder of Dominion Womens Health and medical director at DWH Health & Wellness Med Spa.

The interior design for the new space was done by Gaylin Vandenbroucke. Henrico County-based Freeman Morgan Architects did the architecture work, and MGT Construction was contractor for the renovations, which cost an estimated $425,000.

Need some junk lugged away?

Businessman Andy Taylor has opened a local franchise of The Junkluggers moving company, which bills itself as an eco-friendly junk hauling service.

Our mission is to give these items that are no longer wanted or needed a second use or second home, Taylor said.

Whatever we cant donate, we recycle through about a dozen different partners in the area we work with. Our whole guise is not to put things in the landfill, he said.

The Junkluggers of Central Virginia at 12104 Washington Highway, Unit 7, in Ashland opened in July. Taylor, who said he has two employees, opened the franchise after taking a buyout from his previous employer, a media solutions company that was a division of Texas-based Harland Clarke.

We spent about four months looking for opportunities, said Taylor, referring to himself and his wife, Melody Taylor.

The cost to have The Junkluggers haul away depends on how much room items take up in The Junkluggers truck. Taylor said there is a minimum $60 fee for a job, and estimates are available at no charge.

In cases where the collected items are donated to charities, customers receive a tax-deductible receipt for the item, Taylor said.

The Junkluggers company started in 2004 and is based in Stamford, Conn. The company started offering franchises in 2013. According to the company website, the franchise fee is $35,000.

2nd Beef Jerky Outlet opens in Hanover

Craving some chewy, spicy slivers of dried meat?

A second Beef Jerky Outlet has opened in Hanover County.

Jeff and Debbie Gelzinis and son Nick are owners of the franchise at 6493 Mechanicsville Turnpike, Unit B, near the intersection of Jackson Arch Drive.

Jerky is a high-protein, easy-to-carry-around snack popular among people on the go, such as hunters and other outdoorsy types. Beef, turkey, bacon, kangaroo, alligator, venison, elk and salmon are some of the types of jerky available.

The Beef Jerky Outlet in Mechanicsville is the chains second area location.

A Beef Jerky Outlet that opened in 2012 at 11670 Lakeridge Parkway, next to Bass Pro Shops, in Hanover County is operated by husband-and-wife team Allen and Kelly Musick.

Tennessee-based Beef Jerky Outlet was founded in 2010. The company operates six founder-owned stores and has more than 100 franchise locations.

Tidewater Physical Therapy firm acquired

Maryland-based Pivot Physical Therapy acquired Tidewater Physical Therapy, which operated locations in Hampton Roads and Richmond.

The acquisition was completed last year but only recently announced by the company.

Prior to the purchase, Newport News-based Tidewater Physical Therapy had more than 360 employees at 34 clinics and three performance centers from Virginia Beach to Richmond.

With the acquisition, Pivot Physical Therapy has more than 50 locations in Virginia and nearly 250 locations along the East Coast. There are 15 locations in the Richmond region, including former ProCare physical therapy practices that were part of another Pivot acquisition.

Of the companys 2,400 employees, 384 are in Virginia, including 120 in the Richmond area.

The Restroom Kit earns $10,000 prize

Former Richmond-area resident Bill Massey took home the $10,000 top prize on reality TV show Steve Harveys Funderdome on Aug. 6.

The show features entrepreneurs and their new products competing for investment money.

Masseys product, The Restroom Kit, contains a toilet seat cover, toilet paper and sanitary wipes everything you need when using a public restroom.

Massey and his wife, Sonia, were on the show. He said they may use the prize money for marketing, office space and paying off business debt.

Since were a product development company, the money could be used for new product design, Massey said. We could definitely use the funds for more inventory, and moving the business from our home into a office space/warehouse would be great.

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Osteoporosis Care for RA Patients Found Suboptimal, Declining – MedPage Today

Posted: at 3:47 am

Action Points

Fewer than half of rheumatoid arthritis (RA) patients at a risk of fracture sufficient to warrant guideline-recommended osteoporosis treatment received appropriate care, according to a large study of U.S. osteoarthritis (OA) and RA patients.

The study, published online in Arthritis Care & Research, found that despite a higher risk of osteoporosis and fracture, RA patients were no more likely than OA patients to be treated or screened for osteoporosis according to the management recommendations of the American College of Rheumatology (ACR) 2010 guidelines on the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) or the broader guidelines of the National Osteoporosis Foundation (NOF), which target all risk groups regardless of steroid use.

“Besides this suboptimal osteoporosis care, we also showed that the relative risk of undergoing osteoporosis treatment or [bone mineral density] screening has been decreasing since 2008 in RA and OA patients,” wrote Kaleb Michaud, PhD, of the University of Nebraska Medical Center in Omaha, and colleagues. They noted that RA is associated with double the risk of osteoporosis, even at younger ages, thanks to accelerated aging, hormonal changes, physical disability, and inflammation-associated osteoclast activation.

Michaud has previously reported on this continuing treatment gap despite frequent recommendations over the past two decades that rheumatologists assess bone mineral density in at-risk patients. “With reduction in steroid use, we hope to see a reduction in fracture and osteoporosis risk, but there is still an inherent increase in risk that comes from having RA,” he told MedPage Today. “As in many other conditions, screening can create uncertainty about who is responsible for ensuring this screening is done — i.e., the rheumatologist, primary care physician, or other specialist. We hope the study’s findings will help in the ongoing conversation about these roles for best clinical care of patients with RA.”

The observational study followed osteoporosis care in 11,669 RA and 2,829 OA patients registered in the Wichita-based National Data Bank (NDB) of Rheumatic Diseases longitudinal study during 2003-2014. The mean age and gender composition in the RA group were 59.3 years and 80.4%, respectively, and in the OA group, 65.8 years and 82.6%. In the RA group, 66.3% of the patients had used glucocorticosteroids, versus 25.7% in the OA group.

With care defined as drug therapy (excluding calcium/vitamin D) or screening (OPTS, osteoporosis treatment or screening); treatment was assessed at enrollment and every six months and included bisphosphonates, raloxifene, teriparatide, and hormone-replacement therapy. The 10-year major fracture probability was assessed by FRAX, an approach based on demographic and clinical risk factors but without reference to bone mineral density.

During a median 5.5 years of follow-up, OPTS was reported in 67.4% of RA and 64.6% of OA patients overall. But of those requiring treatment according to the ACR 2010 GIOP guidelines, only about 55% overall reported osteoporosis medication use 48.4% of RA patients and 17.6% of OA patients.

And although at greater risk, RA patients were no more likely to undergo OPTS than OA patients were: hazard ratio of 1.04 (95% CI 0.94-1.15). Adjusted models showed a significant downward trend for OPTS after 2008 in both groups of patients. Factors associated with receiving osteoporosis care in RA patients included older age, postmenopausal status, previous fragility fracture or diagnosis of osteoporosis, any duration of glucocorticoid treatment, and biologic use.

“Despite the importance of implementing GIOP guideline recommendations, our findings suggest that focusing only on glucocorticoid-receiving RA patients would overlook nearly 1 of every 5 patients not treated with glucocorticoids but also deemed to be high-risk and for whom osteoporosis treatment would be indicated based on the 2014 NOF guideline,” Michaud and colleagues wrote.

Interestingly, RA patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs) were more likely to be tested for bone mineral density but not more likely to be treated for osteoporosis: “These patients might have higher disease activities and more glucocorticoid-exposure prior to bDMARDs, which may explain the better screening,” the investigators wrote.

They pointed to the need to clarify patient- and provider-related factors driving suboptimal management and develop effective interventions and reduce the burden of osteoporotic fractures. “Considering the increased osteoporosis and fracture risk in RA patients regardless of glucocorticoid use, development of an RA-specific osteoporosis prevention and management guideline might be helpful in covering all high-risk groups, optimizing the care and decreasing the health impact of osteoporosis complications in RA.”

Regarding study limitations, the authors cited the voluntary recruitment of patients and physicians to the NDB, and hence the potential for reduced generalizability to all RA patients owing to participation bias created by a better-educated and disease-conscious sample. Another limitation was the self-reporting of fractures and trauma, opening the door to misclassification errors. Michaud et al also cautioned that the ACR’s 2010 GIOP guidelines did not cover certain glucocorticoid-using risk and age groups, and even the expanded 2017 guidelines are not as extensive as their NOF counterparts, which are applicable to all fracture risk groups beyond users of glucocorticoids.

Funding for the study was partly provided by a Rheumatology Research Foundation Investigator Award to Michaud. One of the co-authors reported receiving support from a VA Merit Award and the National Institutes of Health. No conflicts of interest were reported.


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Family hopes to crowd-fund medical trial of cerebral palsy therapy with Kokoda Track mission – ABC Online

Posted: at 3:46 am

Updated August 14, 2017 17:31:02

How far could you carry a six-year-old?

To the park? To the shops? What about along the entire Kokoda Track?

Michael Shearman is going to do just that. His son Max weighs 27 kilograms. The Kokoda Track stretches 96 exhausting kilometres.

So why would Michael carry Max that far?

Max was diagnosed with cerebral palsy when he was an infant.

It’s a brain disorder that affects about 34,000 Australians. Symptoms range from physical weakness in one limb through to an almost complete lack of voluntary movement.

The diagnosis was devastating for Max’s parents, Michael and Claire.

“I remember just that breathlessness of going, ‘What does this mean?’ first,” Claire tells 7.30.

“They were talking wheelchairs. They didn’t know if he’d be able to talk, how his brain was going to be functioning and what the outcomes were going to be.”

The Shearmans explored therapies and treatments to try to improve Max’s mobility and muscle development, ranging from botox and bobath therapy to physiotherapy and yoga.

They say there were breakthroughs from time to time, but nothing seemed to provide a lasting improvement.

Then they came across the TheraSuit.

“There was a program on one of the TV shows that we watched,” Michael says. “And it showed TheraSuit and what TheraSuit is.

“We asked a few therapists about TheraSuit and they said, ‘Oh no, we haven’t got that in Australia, no therapists are trained in that in Australia’.”

But the Shearmans kept looking, and when a therapist they knew decided to train in TheraSuit therapy and offered to take Max on as a patient, they jumped at the opportunity.

“There are a lot of conflicting opinions,” Claire says. “A lot of people who didn’t know much about it said: ‘Look, it’s just another gimmick, it is a waste of time, it’s a waste of money’.

“We had tried so many different things it was just again a bit of trial and error and going, ‘OK, well we’ll give it a go and see. Everything is worth a try’.”

The TheraSuit has its origins in a space suit created for the Russian cosmonaut program. It functions by constricting muscles and applying pressure to the body to build up muscle strength.

It’s used as a cerebral palsy treatment in dozens of countries around the world, but isn’t widely used in Australia and doesn’t attract government funding subsidies.

Several studies of the TheraSuit overseas returned underwhelming findings.

A 2011 study concluded: “Children wearing the TheraSuit during an intensive therapy program did not demonstrate improved motor function compared with those wearing a control suit during the same program.”

A study published in July 2017 noted: “Enthusiasm with new therapeutic approaches needs to be guided by scientific evaluation. The low quality of evidence suggests caution in recommending the use of these therapeutic suits. New studies could change the findings of this review.”

Despite the findings of these studies, the Shearmans are adamant the TheraSuit has opened up a new world of mobility for Max.

“I was really sceptical at the start, as with all sorts of therapies that I have been sceptical of, because I have never seen any easy fix,” Michael says.

“When they put the suit on they can activate certain muscles just by tightening bungees and tightening elastic cords on the suit that holds it together. They go through a whole exercise program with those muscles activated.

“It helps retrain the brain as well as the muscles, you know, to reignite pathways within your brain.

“Max is a completely different boy to how he was since he has done the TheraSuit.

“He is riding a bike. He’s walking. And he surfs now. I can push him on the waves and he can trim himself along and paddle in.”

“All over, there are lots of functional things that he has gained,” Claire says. “But it’s really the strength. He’s so muscly now, whereas he used to be such a little whippet.”

Max’s TheraSuit therapist, Zoe Planck, says he has made significant advances.

“The whole point of intensive therapy is to see accelerated functional outcomes in comparison to traditional therapy methods,” Ms Planck said.

“So for Max, a huge goal for him was to strengthen his body enough that he could stand independently. But now he is strong enough that he is taking independent steps.

“And then not only that, he has got so much more strength in his body that the left arm that is affected [by cerebral palsy] is now so much more functional in daily life, using it to help him dress, to eat, to play.”

But the TheraSuit doesn’t come cheaply. The Shearmans say they spent $30,000 last year on the therapy.

They managed to afford it, but know many families simply can’t.

“I wanted to start campaigning to help other kids get access to this therapy,” Michael says. “So I thought, ‘We need to fund a trial’.

“I have got to raise $450,000, I have got to put 15 kids through this intensive program in 2018 and I am going to have it reviewed properly.”

The Shearmans have joined forces with researchers at Monash University’s Hudson Institute of Medical Research to start designing a trial to run next year.

“Just because it works in Max, doesn’t mean it’s going to work in every kid with cerebral palsy,” associate professor Tim Moss from the Hudson Institute tells 7.30.

“We need to start off with a well-defined group of children whose cerebral palsy we can quantify and measure before and after the treatment.

“If we know it works in that sort of context then we’d be justified going further and trialling it in kids with perhaps more-severe or less-severe cerebral palsy.

“This is one therapy that hasn’t been properly studied.

“There’s no adverse effects of the therapy, but there has not been an ability yet to show benefit from those treatments. But of course lack of evidence is not equal to evidence of a lack of effect.”

Michael Shearman is confident the trial he is trying to fund will show great results.

“Once we can prove that this intensive therapy does work, if we can put that to the Government, maybe other kids can grab hold of this therapy.”

With a huge fundraising task ahead of him, Michael decided to do something outrageous.

He hatched a plan to carry Max along Papua New Guinea’s notorious Kokoda Track on an eight-day mission to raise awareness and as much money as he could to fund the trial.

The past few months have been a whirlwind of fundraising, travel planning, immunisations and discussions with Max’s doctors and a lot of practice walks.

As a serving police officer Michael is pretty fit. But even he’s a little intimidated by the prospect of carrying Max for days along the Kokoda track.

“He’s just under 27 kilos now. The little bugger has put on a little bit more weight since I decided to go, four kilos I think he has put on,” Mick laughs.

Michael and Max fly out for Papua New Guinea this week, with a support team of friends and family alongside them.

Max says he can’t wait to go swimming in rivers and visit village schools in Papua New Guinea.

“We obviously went through all the checks with the paediatrician and got all the health checks,” Claire says.

“There is a paramedic going on the trip, which is very nice for me.

“I don’t doubt Michael for a second. He has got the strength and fitness and the mental strength to do it. But having Max on his back is something else. I’ll be really happy when they get back.”

Michael says the Kokoda trip will be a powerful bonding experience for him and Max.

“As father and son we’ll be rock solid after this, without a doubt.

“Max is told every day he can be anything, he can do absolutely anything you want. And I want him to know that.

“I hope, and obviously I dream, about Max being able to be fully independent.

“To drive a car, have a job, raise a family of his own, help other people that are similar to him and proving that cerebral palsy isn’t a life sentence.

“Yes you’ve got it for life, but it is not a sentence.”


First posted August 14, 2017 14:07:24

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Family hopes to crowd-fund medical trial of cerebral palsy therapy with Kokoda Track mission – ABC Online

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Md. Medicaid should cover trans-specific care – Baltimore Sun

Posted: August 12, 2017 at 10:45 pm

The 45th presidents recent tweets banning transgender people from serving in the military because of their potential medical costs underscores the difficulties the transgender community faces in accessing quality health care. They often face stigma and discrimination by health professionals, and even if they have insurance, they may not have coverage for gender affirming procedures like hormone replacement therapy (HRT) or sex affirming surgery (SAS).

On some insurance plans, including Maryland Medicaid, prior authorization is required for someone who is transgender to receive HRT or SAS. Prior authorization is typically used to confirm that extraordinary requests are medically necessary, like transplants or cosmetic surgery. The transgender community shouldnt have to ask permission and submit claims before receiving life-affirming care.

According to the World Professional Association for Transgender Health, the standards of care for the transgender community include psychotherapy, HRT, changes in gender expression and SAS. Individuals may choose to use all, some or none of these in their health management of gender expression. These are particular therapeutic needs for this population. Although there may be some overlap with cisgender people (those whose personal gender identity corresponds with their birth sex) like psychotherapy, prostate exams and mammograms it is unethical to require preauthorization for other care that is specific to a community because it is different from the majority.

Currently the Affordable Care Act does not exclude the transgender population from some medically necessary care based on gender identity. This means a man can get insurance coverage for a pap smear, but not HRT. The language in the act is ciscentric, and wasnt specific enough to make insurance companies provide coverage for HRT and SAS. Even the quality metrics Maryland uses for its insurance plans do not include sexual orientation and gender identity information. So people in the community who are shopping for private insurance have no way of knowing if their care is covered in benefit plans. Transgender people have not been given a seat at the table in health care decision-making.

Fortunately, as a state, we can shift insurance coverage to include transgender specific care starting with Medicaid. Coverage under Medicaid would give the most vulnerable population access to quality care: 26 percent of the transgender population lives under the federal poverty line ($12,060 for individuals per year). Poverty in this community leaves people susceptible to violence, drug abuse and depression. Providing this population with access to life affirming care through Medicaid would set an example for private insurance plans to start allowing trans-specific health coverage.

This small step toward transgender insurance parity under Medicaid offers huge opportunities for the community in the health care field and beyond. There would be more understanding of hormone therapy and its side effects, long-term effects and dosing. Visibility in the health care arena can transition bias and discrimination among providers to compassion and understanding. Shifts in provider perception will result in the quality care needed to address the mental illnesses, housing instability and drug abuse that runs in the community. The increased demand to address those needs could transform into a specialized field of transgender health. The possibilities are endless.

California already mandates insurance coverage for life-affirming care in the transgender community. No significant changes were made to their budget for the accommodation, and insurance surcharges on private insurances were actually dropped because there was no significant cost for adding trans-specific care to their benefits.

Every year the transgender community becomes more and more visible; we are doing them a great disservice by ignoring their needs for health care specific to their community. We can take these steps of social progress and apply it on a national level and provide access to quality health care to all Americans.

Chigo Oguh ([email protected]) is a graduate student at the University of Maryland, Baltimore.

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