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The Patterning Table That Changed My Life – The MIT Press Reader

When my sister suffered from Rett Syndrome, an old patterning table and a dubious therapy brought my community together and offered hope.

By: Adriana Knouf

For more than two decades, Sherry Turkle has challenged our collective imagination with her insights about how technology enters our private worlds. The moving essays in the The Inner History of Devices, edited and introduced by Turkle, bring together writings about devices that come supplied with sanctioned ways of understanding them objects ranging from cell phones to prosthetic eyes, from televisions to dialysis machines. By taking time to go further, its authors reveal how what we make is woven into our ways of seeing ourselves, often finding what they did not know they were looking for.

In Adriana Knoufs essay, featured below, a medical device, in its presence and absence, allows her to dream. Faced with her sister Robins illness the gravely debilitating Rett Syndrome Knouf and her family learn of a technique that offers some hope. The family moves Robins limbs rhythmically in crawling and walking movements on a specially built patterning table. While Robin lives, Knouf is immersed in the community around the table. After Robin dies, the tables absence opens a reflective space for Knouf to consider how it shaped her life. With Robin, says Knouf, the volunteers, the discredited therapy method, and the patterning table, we had tried to awaken cognition with care, with the soft sheepskin, the men and women gathered around. But the table has stood in the way of many things, and it takes her time to find her way after Robin and the table are gone. With loss, Knouf is able to re-integrate the past.

Our basement walls were covered with charts, schedules, and sets of instructions. In the southeast corner stood the patterning table. Made when I was eight years old by a friend of the family who lived in a nearby town, the patterning table came up to my chest. Supported on its four corners by thick wooden legs attached with massive bolts, the highly varnished table was strong enough for a 50-to-80 pound person to be moved around on its flat surface. That surface was padded with Naugahyde, which in turn was covered by sheepskin that fitted snugly around the edges.

At this table, every Monday through Saturday, three people (five, if we were training new volunteers) surrounded my sister, Robin. We gently took hold of her fragile arms, legs, and head. With a regular rhythm we moved her extremities in the motions of a crawl: one, turn the head to the left, bring the left arm away from the body and next to the head, bend the left leg next to the torso, and vice versa for the right side; two, keep the head where it was, pull the right arm back next to the body, extend the left leg, and vice versa for the right side; three, repeat as one, but switching left for right; four, repeat as two, but switching left for right. One, two, three, four, the count continued over the course of five minutes, and the patterning session was done, for this hour. The ding of a kitchen timer told us it was time to move on. Next hour we repeated it, on the same table with the same sheepskin cover, with different volunteers. All day this continued, according to the schedules, instructions, and charts that my mom wrote in thick strokes on butcher paper and taped to our recently sheetrocked basement walls. Patterning was combined with breathing exercises, using a mask designed to increase the blood flow to Robins brain.

When I was in first grade Robin was diagnosed with Rett Syndrome, a rare neurological disorder that may include devastating mental and physical symptoms. It afflicts only girls, most of whom are not expected to live past their 18th birthday. The girls often make rocking motions while sitting, wringing their hands. Many are able to develop some basic level of functioning, such as simple mobility or being able to feed themselves. Robin, however, could do none of these things; she was utterly dependent on us. Even so, there were still the smiles, tears, and frowns of any young girl, and in her eyes you could see thoughts she could not speak.

There were still the smiles, tears, and frowns of any young girl, and in her eyes you could see thoughts she could not speak.

Robins disease led our family to take on a major commitment: a full-time, in-home physical therapy program. Our location, rural Iowa, meant we had to develop everything ourselves. To build the equipment, to schedule the people who came in on a regular basis, week after week, we found volunteers, some local, some from afar.

The patterning table took up a good part of our basement, but at a certain point during Robins therapy we set up another apparatus for her, a jungle-gym-like contraption made by the same volunteer who built the patterning table. The new contraption reached from the floor to our seven-foot ceiling. The height of the jungle-gym bars was adjustable. At certain times the overhead bars were low enough so that Robin could walk her hands along them. When she was stronger, the bars were raised and Robin had to grab onto freely swinging handholds of thick nylon rope that hung from the bars; she wore specially designed Velcro footies that stuck to our short-pile institutional carpeting. The resistance from the Velcro was meant to make it harder for her to lift her foot, while the swinging rope was meant to improve her sense of balance. It was hoped that this would strengthen Robins legs and upper body in preparation for walking on her own.

Our work at the patterning table was based on the Doman-Delacato method. It laid out a series of therapies designed to help brain-damaged children toward better functioning. The method is based on an evolutionary metaphor: The individual develops in their lifetime just as the human evolved over generations. That is, development begins at the fish and reptilian stage (crawling) and moves through to mammals and primates (creeping, with the stomach off the ground). Doman-Delacato reasons that if you pattern a brain-damaged child with the motions that are involved in each of these stages, you will unlock the later stages of development. So the repetitive motions on the patterning table were supposed to teach Robins muscle memory to crawl. Yet she never was able to crawl on her own: She learned only to walk a step or two, lightly aided.

The Doman-Delacato method reasons that if you pattern a brain-damaged child with the motions that are involved in each of these stages, you will unlock the later stages of development.

The Doman-Delacato method has not found empirical support, and the American Academy of Pediatrics has issued a number of warnings about the technique over the years. As a child I never questioned our program. To me, it seemed natural that if we moved Robins arms and legs in a certain manner, we eventually would train her brain to move body parts on its own. And of course my parents, like so many others, seized on the programs marketing and the bits of anecdotal evidence that suggested it worked. The Doman-Delacato method provided hope, but I think back on it now with sadness, regret, anger, and resignation.

Robin began to experience seizures when I was in fifth grade, not unusual for Rett girls who often regress from their developmental plateau. I remember the huge stuffed rabbit that lay on the table the day Robin was rushed to the hospital because of her first, unexpected seizure. The seizures made it impossible to continue with the treatments on the patterning table. Yet the patterning table remained in the basement. We removed the sheepskin, and then the Naugahyde quilting, and used the table as any other flat surface, a place to store papers, books, and mail. Gradually the schedules and charts on the butcher-block paper began to come off our walls, but the patterning table remained, a reminder of what we had done, of what we had tried to do.

Even as a young child, I read the few journal articles our family had about Rett Syndrome. They were over my head, but I persisted in my efforts to figure out what was going on with my sister. I launched into my parents popular science book on genetics. A year or two before I took any proper biology class, I was discovering genotypes, phenotypes, and karyotypes, the genetic bases of diseases such as sickle-cell anemia and Parkinsons. At the time, the Human Genome Project was in its nascent stages and the hope for miracle cures was strong. With the insufficient knowledge I had, and bolstered by the arguments in the genetics book, I believed that finding the gene or genes that caused her disease would lead immediately to gene therapy that would reverse Robins genetic malfunction. Of course you had to have a way to get the genes into the cells, so I eagerly read about techniques to force the existing chromatin to take up new genetic materialretroviruses and exotic electro gene therapy. Then came the problem of how to reverse the damage in existing cells. Neuron regrowth in the brain is meager at best; there, repairing genes would not be enough.

The Doman-Delacato method provided hope, but I think back on it now with sadness, regret, anger, and resignation.

As a middle school student growing up with my sister, I thought these problems surmountable. And I determined that all of this would be my doctoral work: I would find the gene that caused Rett Syndrome and discover the necessary therapies to cure the disease. It was merely a matter of time. The summer before high school, I enrolled in a summer program in molecular biology at the state university, a first chance to work with the tools I had read about: restriction enzymes, plasmids, and ethidium bromide stains. I was in the throes of passion: I pored over books I could not understand; I persuaded other students to work unattended in laboratories full of dangerous reagents. I was in a hurry.

But Robin died in the fall of 1993, just short of her ninth birthday. I sunk into a world of grey and black, my schoolwork the only thing that kept me going. I remember the rush to finish assignments in my high-school biology course that were late because of Robins funeral and the time I took off after her death. I remember the fleeting thought that if I could complete my work faster, I could start college early and be on my way to finding the cure for other Rett girls.

I went to Caltech as an undergraduate to study molecular biology with one sole objective in mind: to find a cure for Robins disease. In high school I had performed in a chamber music group and had notions about attending a conservatory. I devoured literature and thought about being an English major and studying philosophy. But now, stronger than all of these were my memories of Robin and the patterning table. I was driven to discover the gene for Rett syndrome. I saw it as an achievable goal.

Then, on a gray California winter day during my sophomore year, I read that a group of researchers had discovered the gene responsible for Rett Syndrome. I posted the article outside my room. I told all of my friends. I wanted to be among the people in the article. But there was more work for me: turning the genetic discovery into a treatment for Rett patients. Soon after, experience as a research assistant convinced me that I was not suited for the biology workbench. I moved toward cognitive sciences, with its higher-level descriptions of perception, action, and emotion.

The patterning table, long unused even during Robins life, was finally removed from our basement, probably passed on to another family using the Doman-Delacato method. Its absence left a space. I had passed the patterning table and its volunteers in the early morning; I had looked toward it when I came home from school; I had walked to it when it was my turn to be part of the group that moved Robins head, legs, and arms.

The table was more than a focus for our thoughts; it anchored our love for Robin and the energy we put into giving her a future.

Without the steady presence of the table, where would we turn? Where would our efforts be channeled? Without Robins influence, what would be our purpose? The table was more than a focus for our thoughts; it anchored our love for Robin and the energy we put into giving her a future. Like the tables in traditional Midwestern churches or cafes, the volunteers who assembled chatted and gossiped and spoke about their lives. It brought Robin into a community. When Robin was happy and obedient, her attendants gave her praise; when she was cranky and ornery, they understood, but lightly scolded. The patterning table made life coherent, all of a piece. With Robin, the volunteers, the discredited therapy method, and the patterning table, we had tried to awaken cognition with care, with the soft sheepskin, the men and women gathered around.

I originally wrote this in 2005, and in the interim there has been a tremendous increase in research on Rett Syndrome in light of the gene discovery. I have moved away from cognitive science and into media arts and design, yet I still draw upon the scientific, social, and emotional experiences written about here in my work. Finally, this was written from the perspective of an assigned-male-at-birth person, however I have recently come out as a transgender woman. The experiences with Robin, the volunteers, and my family have all contributed to making me the woman that I am.

Adriana Knouf is an Assistant Professor of Art + Design in the Department of Art + Design in the College of Arts, Media, and Design at Northeastern University in Boston, MA.

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The Patterning Table That Changed My Life - The MIT Press Reader

Recommendation and review posted by Bethany Smith

Utah hemp farmers find success and struggles in their first year of growing – Salt Lake Tribune

Spanish Fork Jud Harwards first hemp crop dangles from his hay barn rafters, drying as it saturates the air with an eyebrow-raising cannabis aroma.

Though he hasnt sold much of it yet, the Utah County farmer is proud of how his 10-acre experiment turned out. Paging through pre-harvest cellphone photos, he shows off his neatly lined plants, some with stalks soaring above shoulder-height and crowned with what he calls the filet mignon of hemp buds.

As part of Utahs industrial hemp vanguard, he relied mainly on his instinct to coax the temperamental crop into flourishing. Little guidance was available, and there were few examples to follow. He was never sure if he was doing it right or wrong.

Its on the fly, says Harward, whos been farming sweet corn and hay for decades. Every day was new.

This legal sea-change coincided with the rising popularity of cannabidiol, or CBD oil, a hemp extract marketed for numerous purported health benefits and beautifying properties. The craze has spawned everything from CBD deodorant to CBD hamburgers, and with estimates that the U.S. market could grow to $20 billion by 2024 some Utah entrepreneurs saw a hemp license as a golden ticket.

In a time of financial struggle for farmers, some in Utah ripped up their hay fields and tossed out their lettuce plants to replace them with the new cash crop. David Lee, Harwards partner in the hemp venture, said hes heard of people mortgaging their farms for funds to get in on the business.

But any get-rich-quick hopes rapidly faded, and Harward said some threw in the towel because of crop failure. Three hemp cultivators separately said it felt like theyd strayed into the agricultural Wild West where reliable information was hard to come by and sketchy consultants and suppliers ran rampant.

They saw an opportunity and some doe-eyed entrepreneurs here in Utah, said Tom Paskett, executive director of the Utah Cannabis Association.

Ruston Peterson has grown hydroponic lettuce out of a greenhouse in Annabella for about a decade. Without a local market for his greens, hes had to drive most of his produce to Salt Lake City for sale, a commute that became tiring.

So, earlier this year, he decided to try his hand at industrial hemp. He shut down his lettuce operation in about a week and began growing hemp starts for a larger cultivator south of him.

People assured him that the cannabis plant is a weed and would grow anywhere. Peterson, along with many others, was about to have a different experience.

There are tons of ways to lose at this game, he said. And everybody, I think, found that out this year.

Some growers, he said, just saw money in their eyes and were victims of their own zeal, determined to plant even though theyd already missed the growing window. And even for people who did everything by the book, nature took its toll, with withering heat stunting one of Lees hemp grows in southern Utah and a September frost claiming plants in fields near Harward Farms.

And then there was the states mandated pre-harvest test to make sure the hemp plants didnt contain an illicit amount of THC, the psychoactive compound in marijuana.

The states Department of Agriculture and Food ordered the destruction of 16,323 plants this year after finding theyd tested hot, or above the 0.3% limit. While that was less than 1% of the states total harvest, the department estimates, it was a setback for the farmers who lost their expensive plants.

Its absolutely doable,"Rigby said. "But is it easy? No.

The difficulty in distinguishing hemp from marijuana, which look and smell the same, also created confusion for local police and passersby at the states hemp farms.

Michelle Finch, a hemp grower for Hansen Plants in Benjamin, said she found people snooping around her greenhouse, drawn by the cannabis scent. And Harward said he had to erect signs around his hemp crop to ward off thieves, who he suspects were passing off the plant as marijuana to gullible buyers.

For the states experienced farmers, cultivating hemp wasnt like growing hay or corn or wheat or anything that they were used to. The cannabis plants were finicky.

You have to be there. You have to baby it, Peterson said.

In Harwards case, he decided to spoon feed the hemp plants fertilizer. He sprayed molasses on them to give them a kick of sugar. And he and other farmers painstakingly harvested them by hand rather than by machine. Learning the ins and outs of the crop was no simple task because, in the nascent and chaotic industry, the farmers didnt know who they could trust.

"There's a lot of crooked people," Harward said. "Rip 'em off Ralph kind of guys."

Paskett said hes also heard from a number of farmers who complained they were taken for a ride by consultants or hoodwinked by out-of-state seed banks. Its possible that some cases could lead to legal action, he said, but thats a heavy lift for farmers who are already financially underwater because they took out a loan to buy seeds.

His group is stepping in to advocate for hemp farmers in some of these situations and has done some investigating and vetting of these suppliers.

We dont want these farmers who took the leap of faith and then got hosed to wash their hands and be done with it forever, he said.

The consequences for picking the wrong business partner can be disastrous, according to farmers.

Hemp plants carry sex chromosomes, and only the female varieties are preferred because they contain cannabinoids in much higher concentrations. Farmers carefully cull through their fields to uproot the male plants so that they dont pollinate the rest of the crop lowering the CBD content in the surrounding females.

To maximize their yield, farmers often sought after feminized seeds that yield mostly female plants. But many of them feel they were sold a bill of goods.

Peterson bought a batch of seeds that was marketed to him as feminized. To his dismay, when the plants grew up, about half of them were males.

So it was three days-worth of work or more because we had to pull plants, Peterson said.

The same thing happened to Amber Berry, who tried growing hemp with her husband near Cedar City. They, too, thought they were getting good seed and ended up with a disappointing blend of male and female plants.

I think everybody jumped in thinking they were going to get rich the first year, said Berry. But theres a reason the value is there. Its not easy to grow, its not easy to do. And I think a lot of people have been let down that way.

Planting an acre of wheat costs about $400 an acre, Harward estimates. Hay is more like $600 an acre, and corn is a little more expensive at $1,200 an acre.

But the price tag for growing hemp dwarfs the others it can easily cost farmers $15,000 an acre, he said. And Harward would guess hes spent more like $20,000 an acre on his crop, if you count the cost of drying the plants and stripping the leaves and flowers off the stems to prepare for CBD extraction.

Tyson Hinkins of Black Dragon Ranch landed one of the states hemp licenses, but the front-end costs were so high that he decided against planting the crop this year.

I was scared, said the Ferron hay farmer, whod been looking to grow hemp with his father, state Sen. David Hinkins, R-Orangeville.

So, hes waited to see how the first year plays out for other Utah farmers.

Berry already anticipates she and her husband wont turn a profit this season; theyll probably try again next year, but on a smaller scale. Even for Harward and Peterson, both of whom had a successful hemp harvest, the battle isnt over. The key to recouping their costs will be careful timing and finding the right buyers, they say.

Since the passage of the 2018 farm bill late last year, the total licensed acreage for hemp cultivation has shot up by more than 455% nationwide, according to Forbes. And the ballooning hemp supply has pushed down prices, especially now that the harvest is coming in.

The price of the oil is rock-bottom, said J.R. Carter, who co-owns Rooster Valley Botanicals in Salina, a company that extracts CBD from hemp. Its the lowest its been all year.

CBD oil that was selling for about $4,500 a liter last year is going for about $800 per liter now, he said. Carters strategy is to hold onto the majority of his oil until the glut subsides and the prices rebound.

That is, if he can discover a doorway into the market, something he and many Utah hemp growers are struggling to do.

I got flower at my house, but I havent had anybody buy it, Peterson said.

Until he does sell it, he wont know if his hemp experiment was worthwhile. Harward is in the same situation, searching for hemp buyers and still wondering if his first-year venture will pan out.

Our long-range goal, he said, is to get through today.

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Utah hemp farmers find success and struggles in their first year of growing - Salt Lake Tribune

Recommendation and review posted by Bethany Smith

Briefly Noted Book Reviews – The New Yorker

Artificial Intelligence, by Melanie Mitchell (Farrar, Straus & Giroux). Without shying away from technical details, this survey provides an accessible course in neural networks, computer vision, and natural-language processing, and asks whether the quest to produce an abstracted, general intelligence is worrisome. Although recent advances are staggering, Mitchell emphasizes the limitations of even advanced machines. A program called AlphaGo has bested one of the worlds best Go players, but its intelligence is nontransferable: it cannot think about anything except Go, let alone steal someones job. Mitchells view is a reassuring one: We humans tend to overestimate AI advances and underestimate the complexity of our own intelligence.

The Accusation, by Edward Berenson (Norton). In 1928, after a young girl went missing in the town of Massena, New York, the towns Jews were accused of killing her, a theory that became the focus of the police investigation. This was the first and only time that the so-called blood libel, which flourished in medieval Europe, gained traction in the United States. Berenson, a historian whose great-grandparents were among the first Jews to live in Massena, explores the origins of the blood libel and traces its circuitous route to upstate New York. He shows how the particular contours of racism at the time allowed this long-buried idea to surface, and describes the ensuing debate among American Jews over the challenge of claiming a place in their new home.

Frankissstein, by Jeanette Winterson (Grove). This novelistic homage to Frankenstein weaves together the life of its author, Mary Shelley, and a merrily slapstick plot set in the present. While Mary, on the shores of Lake Geneva, in 1816, imagines a man whose desire to seize the divine power of creation unleashes a monster, a transgender doctor named Ry (formerly Mary) falls under the spell of a Gospel Channel scientist with a secret laboratory, where they are joined by a sex-toy entrepreneur, an evangelical Christian, and a scoop-hungry journalist. Refracting the past through the present, Winterson links automation, A.I., cryonics, and sexbots to the human yearning to transcend the aging, mortal bodies that we are born into.

Red at the Bone, by Jacqueline Woodson (Riverhead). Anatomizing the consequences of an accidental pregnancy, this multivocal novel uses the sweet-sixteen celebration of the resulting child, Melody, as its centerpiece. Gradually, Melodys perspective, and those of her parents and grandparents, map the pressures surrounding her birthher fathers upbringing as the child of a single mother and the class tensions the pregnancy unleashes in her mothers family, members of the black lite. Melodys mother leaves her behind to attend Oberlin and conceals her motherhood from her new friends, straining the parental relationship. The novel subtly explores the ways in which desire can reconfigure our best-laid plans, and its expansive outlook suggests how easily, in African-American life, hard-won privileges can be dissolved.

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Briefly Noted Book Reviews - The New Yorker

Recommendation and review posted by Bethany Smith

Texas Gov. Announces Investigation Into Custody Battle Over Boys Gender Transition – National Review

Texas governor Greg Abbott(Brendan McDermid/Reuters)

Texas Governor Greg Abbott announced Wednesday night that the Texas Attorney Generals Office and the Texas Department of Family and Protective Services are looking into a case involving a custody battle over a seven-year-old boy who is said to be transgender by his mother.

On Tuesday, a Texas jury denied Jamess father, Jeff Youngers, request for sole conservatorship, ruling that he must continue parenting with Jamess mom, who has been encouraging Jamess social transition against his fathers wishes.

Jamess mother, Dr. Anne Georgulas, who is a pediatrician, separated from Younger several years ago after James and his brother were born, and was given exclusive rights and duties, while Youngers custody rights were limited.

Georgulas has said that seven-year-old James began to show signs of identifying as a girl when he asked for a girls toy from McDonalds, began imitating the female characters from Disneys Frozen, and started asking to wear dresses.

After being referred to a LGBT family therapist, Georgulas was advised to begin affirming James by calling him Luna, as well as socially transitioning him at school. Medical records presented by the boys pediatrician list James as Luna Younger, female, and included a recommendation to visit GENecis clinic at Childrens Hospital Center, which offers hormone therapy and puberty suppression.

Georgulas legal team has brought several therapists and counselors as witnesses, all of whom testified that James told them that he was a girl and wanted to be called Luna.

Younger has contended in court that James is happy to present as a boy when they are together, referring to himself as James and wearing male clothing.

He has also argued that the situation violates one of the two requirements for gender dysphoria in the DSM-V, the current manual used by the American Psychiatric Association. In addition to displaying characteristics related to gender expression, such as clothes, pronouns, etc., the patient must display distress. Witnesses who testified in the case including those who diagnosed James with gender dysphoria said that he has not displayed any such distress, according to the Texan.

Conservatives, including Texas Senator Ted Cruz, voiced their concerns about the case on Twitter ahead of Abbotts announcement.

Georgulas legal representation told the Daily Caller in a statement Wednesday that a completely distorted and untrue version of events in this case has been circling the media . . . The pleadings in this case are available online, including, but not limited to, the Courts prior annulment proceedings and the numerous findings of fraud that the Court made in this case against Mr. Younger.

The lawyers said that Georgulas case is being viciously attacked and threatened by complete strangers based on false and untrue statements.

The judge presiding over the case is expected to read the final ruling and order on Thursday, which may force Younger to call his son Luna, and attend classes on transgenderism. He could also be barred from taking his son outside the home dressed as a boy.

On Thursday, Judge Kim Cooks ruled that Jeff Younger is entitled to a say in his sons gender-transition process.

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Texas Gov. Announces Investigation Into Custody Battle Over Boys Gender Transition - National Review

Recommendation and review posted by Bethany Smith

Oz & Roizen: The respiratory effects of vaping – Online Athens

I was a cigarette smoker for 30 years until my doctor told me that I needed to quit immediately. So I started vaping. It sure made it easy to walk away from tobacco. But can I use nicotine vapes safely? Jordan B., Milwaukee

The reason it was easy to go from cigarette to vape is because you were substituting one nicotine source for another. And that's no way to reduce your health risks.

Nicotine is an addictive drug that is associated with increased risk of cardiovascular, respiratory and gastrointestinal disorders, decreased immune response, harm to reproductive health and DNA mutation that leads to cancer. Plus, the American Heart Association says that vapers who think vaping nicotine can help them stop using cigarettes are likely to continue smoking cigarettes while they vape that's called "dual use."

Vaping anything has never been safe. The only studies that say there's no harm associated with e-cigarettes are those funded by the vaping (tobacco) industry. The Altria Group (formerly Philip Morris of Marlboro and Virginia Slims fame) recently acquired a 35% stake in Juul. It's an old, familiar bag of tricks. Remember the '50s ad slogan that said, "More doctors smoke Camels than any other cigarette"?

The Centers for Disease Control and Prevention has reported that as of this writing more than 1,080 people have developed lung illnesses and at least 19 people have died from vaping. Those numbers could be just the tip of the iceberg. Lung damage from vaping isn't associated only with THC; nicotine also has been a cause. According to Mayo Clinic doctors, vaping-induced lung injury "looks like a toxic chemical exposure, a toxic chemical fume exposure or a chemical burn injury." That's because vaping is a delivery system for flavorings, ultrafine particles, heavy metals and volatile organic compounds.

So go to http://www.heart.org and type in "5 Steps to Quit" (it includes vaping). For more comprehensive program, talk to your doctor.

I've been waking up grumpy lately, and I don't know why. I'm usually fine by midday. What can I do when I wake up to set myself up for a good mood in the morning? Chondra B., Chicago

Lots of people wake up feeling grumpy at least a couple of days a week. In fact, one shower company in Great Britain did a survey and found that six out of 10 Brits wake up in a bad mood. The shower company's solution? Take a shower!

Well, we agree, but to maintain that good mood throughout the morning and the day that follows you need to provide your body with the nutrition it needs to smoothly regulate your hormones, gut function and brain power. That means eating a nutritious breakfast. Your best bet is to put together a protein- and fiber-filled first meal of the day.

A great choice is oatmeal, muesli or granola (100% whole grains) with nonfat yogurt and lots of strawberries, blueberries and/or raspberries. Whole grains digest slowly and steadily raise levels of your feel-good hormone serotonin. They also help to keep your blood sugar stable, which improves mood.

Fresh berries deliver polyphenols, which can help you moderate your stress response and improve heart health. For variety, you can try grapefruit, oranges and melons (honeydew and cantaloupe).

Low-fat yogurt can deliver about a third of your daily requirement for calcium, which is good for your blood pressure and (along with magnesium) can have an anti-anxiety effect.

To mix up your morning menu, you might also try these foods that deliver mood-enhancing benefits: whole-wheat avocado toast; an egg-white omelet with vegetables; a green smoothie; or almond oatmeal. All those recipes and more are available at sharecare.com or doctoroz.com.

Other mood enhancers: Go to bed an hour earlier and get up an hour earlier. Get plenty of physical activity (sex counts); that'll stimulate the release of oxytocin, which increases your happiness. All these choices may help you see a turnaround in your morning mood.

Mehmet Oz, M.D. is host of "The Dr. Oz Show," and Mike Roizen, M.D. is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. Email your health and wellness questions to Dr. Oz and Dr. Roizen at youdocsdaily@sharecare.com.

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Oz & Roizen: The respiratory effects of vaping - Online Athens

Recommendation and review posted by Bethany Smith

Miscarriage Signs, Causes & Treatment: What to Expect – Glamour

An incomplete miscarriage is when a person experiences bleeding and severe cramping and may pass some pregnancy tissue at home. When an ultrasound is done, the gestational sac may not be visible, but there may remain pregnancy tissue. In that case, treatment options to remove the remaining tissue will be discussed. A complete miscarriage means all of the tissue has been passed and an ultrasound reveals no tissue remains in the uterus. This scenario would not require additional medical treatment because the uterus has fully released all pregnancy tissue.

After 20 weeks, pregnancy loss is no longer officially considered a miscarriage. But White believes that stillbirth, ectopic pregnancies, and molar pregnancies belong in the discussion.

Stillbirth is the birth of an infant who has died in the womb after surviving at least 20 to 28 weeks. Ectopic pregnancy is when an egg implants outside the uterus, usually in the fallopian tube. Molar pregnancy is when the fetus never grows and theres hypergrowth of the placenta. In all of these cases, the pregnancy ends before term, often risking the mothers health.

The first signs of miscarriage are spotting and cramps. Anytime you experience spotting, especially if youre spotting before your first ob-gyn appointment, its important to call your doctor. I would never tell a patient bleeding or spotting in pregnancy is normal. Its not uncommon, but its not normal, says McConnell. You may notice that any symptoms you might have had with pregnancylike exhaustion, tender breasts, and nauseadisappear.

If your pregnancy hasnt been confirmed by an ultrasound, a doctor will take one to ensure the bleeding doesnt indicate an ectopic pregnancy. If you dont yet have an ob-gyn or your doctors office is closed, go to the emergency room to have an ultrasound done. Its possible that at some point you will miscarry on your own [before an appointment], says White. Thats the hard thing. Sometimes youll be in a position to know its happening, and other times it starts on its own and you end up passing tissue before you can even get in to see your doctor.

Miscarriages dont always happen on their ownmost of the time they require medical treatment. Depending on timing, necessity, and cost, youll have one of three treatment options: expected management, medication, or a surgical procedure.

Opting for expected management is essentially letting nature run its course, giving your body the space to expel the fetal tissue on its own. This can take weeks80% of people will pass the pregnancy tissue within eight weeks of the cervix's being open, according to White.

With this method you will most likely experience heavy bleeding and severe cramping; your doctor may recommend ibuprofen or acetaminophen to mitigate the pain. (In pregnancy, acetaminophen is typically the only medication approved, but if youre miscarrying, its safe to take other pain-relieving medications.) Expected management means you can miscarry at home, which may make it more comfortable.

If you decide to have your miscarriage at home but dont want the limbo of waiting for your body to miscarry naturally, your doctor may prescribe you a medication called misoprostol, one of the medications commonly referred to as the abortion pill. You will still experience bleeding and cramping, but the miscarriage would take place within one to two weeks.

The third option is the quickest: a dilation and curettage procedure, also called a D&C. In this procedure the doctor will dilate the cervix to manually remove the tissue from the uterus. General or local anesthesia is given for the procedure, and spotting and light cramping may persist for a few days after.

The physical side of recovery can take up to three weeks. After a treatment its common to bleed for two to three weeks and experience cramping over the first 48 hours, with it calming down in the following days. Your doctor may say the pregnancy is over, but when youre still managing symptoms for two to three weeks, it may not feel like it, White says. I tell people if you push it too hard [with work or exercise], you may increase your bleeding. Its okay, but it might make you uncomfortable and want to slow it down. See how your body reacts and then slowly ramp it up.

In general, your menstrual cycle should return within six weeks, and hormonal changes, like pregnancy acne, should balance out within three months. If you experience ongoing heavy bleeding or severe cramping, you should contact your doctor immediately.

As far as trying to conceive again, White recommends waiting two weeks, to be on the conservative side. You dont always feel like having sex, but at the same time having sex can also be really life-affirming, she says.

The aftermath of miscarriage, like grief itself, is different for everyone. Some people are ready to try again soon after, and others, like me, bury their grief for months. The absolute last thing a person experiencing miscarriage needs is someone telling them how to feel. Theres no right or wrong way to move forward.

Rachel Wells is a writer based in Nashville, covering the intersection of reproductive rights, mental health, and sexual violence. Follow her on Twitter @rachelwells and on Instagram @rachelwells1.

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Don’t believe what you read about transition regret – Metro.co.uk

We have to be able to have more nuanced and frank discussions about health care for transgender people (Picture: Ella Byworth for Metro.co.uk)

I was 18 years old when I first came out as transgender.

Id been harbouring it for as long as I can remember, but wasnt properly able to articulate it until then. I simply didnt know that it was a thing, or that there were other people like me.

Even when I did tell everyone and started living as myself, there was still a lot of shame, secrecy and fear about being transgender. One of the biggest fears surrounding it was the possibility of regret, or regretting undergoing hormone therapy and genital surgery.

Some people thought that I was simply a gay man who was a bit confused, and that Id end up regretting this all later on if I went through with it. I knew I wasnt a gay man, and I was fortunate enough to be raised in an environment where I could have easily come out as one. That just wasnt me. For me (and for transgender people in general) it was never about who I was attracted to, or my sexual orientation.

It was about who I was and who I knew myself to be. Being able to medically transition was life-saving for me.

The discussion around regretting transitioning has been rearing its head recently. Various stories about individual cases have been used as an example, casting doubt on healthcare for transgender people.

A recent story hit the headlines where a person claimed there are hundreds of people wanting to detransition but there are no numbers that indicate this.

The use of increase in referrals to medical transitioning is often used with statistics that sound quite high, but they are never put into context of the general population.Even with increased numbers of referrals, the number of trans people are still just around one percent of the population in the UK. More referrals simply means there are more people seeking this type of health care. It doesnt mean that everyone who is referred undergoes a medical transition.

Getting access to these types of services is actually really difficult, and people have to wait several years for a single appointment at a gender identity clinic. So claims that someone can just enter a clinic and get hormones and surgery quite easily simply arent true.

I would never diminish or question someones experience who says they regretted their medical transition. There are those who do, and they deserve to be believed. But their stories and experiences should never be used to advocate against health care that has benefitted the lives of thousands of people across the UK and beyond. It should never be used as a reason not to allow people to transition.

One of the comparisons I have to this is when women who have regretted having an abortion are used to advocate against them. Its an illogical argument, as the benefits of safe abortions outweigh the possibility of regret, much like with transgender health care.

Medically transitioning is life-saving for some transgender people. The number of people who experience regret with transgender related surgery is actually really low according to recent research in the Netherlands (between 0.3 and 0.6 percent) and much lower than regret rates for various surgeries such as knee arthroplasty or cosmetic procedures.

When it comes to any surgery, there is always the risk of regret and there will always be people who regret surgeries for a multitude of reasons.

A large portion of people who experience regret about medically transitioning do so because of the social rejection they face when they come out as transgender.

Research done at the gender clinic in the Netherlands showed that between 1972-2015, a total of 14 people experienced regret. Half of them said it was because of social rejection or the fact they identify as non-binary and not as a trans woman or a trans man.

Trans people face stigma and discrimination in their day to day lives and are often rejected from their families, lose their jobs or experience bullying and violence for simply being trans. For some this is simply too much, and they feel they have no choice but to retreat and conform to societys expectations of them.

Another reason people might regret genital surgery is because they simply arent satisfied with the results. Like with any surgery, there are things that can go wrong. Genital surgery is far from perfect, especially surgery for transgender men and trans masculine people.

For some it was a journey they had to take that ultimately wasnt the right one for them. People can only make choices based on the knowledge they have at any given time, so of course there will be people who had to go on a journey to discover who they are. It doesnt always necessarily mean they arent trans or that the journey they went on was wrong, but something they felt they needed to do.

Such binary terms as in, blanket regret versus no regret, do the whole topic a disservice, ignoring the nuances of our gendered experience.

By allocating more resources into transgender health care, whether that be with increasing the quality of psychological care and hormone treatments or making advancements in genital surgery, regret rates will inevitably decrease. By fighting against stigma and prejudice that keeps trans people from living their lives in peace as who they know themselves to be, regret rates will also decrease.

The vast majority of people reap the rewards of medically transitioning. I went from being seen as a depressed, shy and reserved teenager to being an active, social and outgoing person. I started participating in life with enthusiasm, I started to tend to my hobbies, I did better at school. I became someone who was finally excited for life.

The change was so apparent to those around me. My family were finally able to get to know me properly, and even family members that had been quite prejudiced towards transgender people had a real change of heart. They saw that I was finally happy, so how could that be a bad thing?

I now have a partner whom I love very much, we live in a nice little house together, and we talk about having kids and getting a cat or another dog. We have hopes, fears, and aspirations about the future but the difference is that now I dont have to worry about not being myself.

So lets not forget the bigger picture here, and the thousands of people that benefit from being able to medically transition and undergoing genital surgery. This doesnt mean were not going to talk about those that experience regret.

We have to be able to have more nuanced and frank discussions about health care for transgender people, without regret being used to jeopardise the well-being of people who need transgender related health care.

Only that way can we truly create well-rounded solutions and health care that minimises the chance of regret, and allows everyone the opportunity to live their lives to the fullest.

As themselves.

MORE: Sades son praises her support as he completes transition from woman to man in emotional message

MORE: Cancel culture can be toxic in the trans community

MORE: The shaming of trans people and those who love us is deadly

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What is menopause and perimenopause? – Sydney Morning Herald

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You have to surrender to it, British comedian Dawn French proclaimed last year of menopause. "I promise that, afterwards, theres life."

Disturbed sleep. Thinning hair. Anxiety. Mood swings. Memory loss. Weight gain. Or, for some women, nothing much at all.

Despite being a fundamental biological transition affecting half the world's population, the symptoms of menopause have been deemed, traditionally, "secret" women's business. Now it's starting to become more a part of the conversation.

In Britain, women are gathering at pop-up "menopause cafes" to swap notes on their experiences. Workplace policies to cater for menopausal employees are up for discussion too: Britain's Labour Party wants to mandate them for large organisations, and a major media company introduced one in October.

What is menopause and what is it with a "peri" in front? What happens to women experiencing it? What happens afterwards? And is there a male equivalent?

On average, a woman in Australia will have 400 to 500 periods in her lifetime. Menopause is when the periods stop. The word itself stems from the Greek pausis ("pause") and men ("month"), meaning the "end of monthly cycles".

Women are on a path to menopause from birth. A baby girl has more than a million eggs in her ovaries. Steadily, as she ages, they deplete. By the time puberty hits, only about 300,000 remain, and so it goes, through her adult life.

[Menopause] represents the end of a womans reproductive life, says Martha Hickey, professor of obstetrics and gynaecology at the University of Melbourne. Specifically, menopause is the final menstrual period a woman experiences it is a one-off event. All women will go through menopause. It is inevitable."

(In a reproductive life spanning decades, the average Australian woman will have two or fewer babies.)

Menopause is considered a normal part of ageing when it happens after the age of 40. But some women can go through menopause early, either as a result of surgery such as hysterectomy, or damage to the ovaries such as from chemotherapy. When menopause happens before 40, regardless of the cause, it is called premature menopause.

The average age of menopause is about 51 but it can happen sooner, with most women experiencing symptoms in the lead-up which brings us to perimenopause.

Comparing notes on perimenopause: there's a lot to talk about. Credit:Illustration: Dionne Gain

Technically speaking, the symptoms women experience in the lead-up to menopause are actually perimenopausal. Peri, a Greek word for "around" or "near" menopause refers to this transitional state.

Perimenopause is when a woman's ovaries begin to make less oestrogen and the body responds. It's a phase that lasts until menopause and, on average, begins when a woman is 47, although it can last from a year to a decade.

As the body makes less oestrogen, the pituitary gland produces higher levels of signalling hormones follicle-stimulating and luteinising hormones in an effort to keep the ovaries producing eggs and to make oestrogen and progesterone levels "normal".

This can lead to ovulation occurring twice in a cycle, the second time during a period, which can lead to high hormone levels. In other cycles, ovulation might not occur at all.

Some women describe perimenopause as a time of hormonal chaos akin to a second-wave puberty. Symptoms also include hot flushes, changes in libido, mood swings, memory problems, vaginal dryness and a higher risk of osteoporosis. Periods can be less regular, lighter or heavier, last longer or be briefer.Womens' experiences vary greatly some barely register anything.

"It's what's called the menopause transition when those symptoms start," Professor Hickey says. "That can go on for a number of years and the end of that transitional period is a year after the final menstrual period."

Genetic factors play some role in timing. If your mother and other close female relatives had an early or late perimenopause, it's likely you will too. But various studies also point to lifestyle factors, such as smoking, being linked to early onset while other studies have pointed to alcohol consumption delaying perimenopause.

Credit:IStock

After a woman has had 12 consecutive months of amenorrhea (lack of menstruation) she is said to be postmenopausal.

Perimenopausal symptoms ease but health risks related to the loss of oestrogen rise. This includes a decrease in bone density, which can lead to osteoporosis, where bones become thin and fragile. It also includes weight gain, which can increase the risk of obesity, diabetes and cardiovascular disease. Women are advised to keep active, which also releases endorphins that improve mood, and to do strength training to increase blood flow and strengthen the heart.

Hormone replacement therapy (HRT), or menopausal hormone therapy (MHT) as it's now known, is currently the most effective type of treatment available for perimenopause symptoms; more than 300,000 Australian women and about 12 million women in Western countries are using it. But it has been linked with breast and ovarian cancers.

"All medications carry risk and benefits," Professor Hickey says. "A benefit of HRT is that it's really good for symptoms. A risk is that it does increase the risk of cancer. I don't think we should beat around the bush about that. But it varies by the type of hormone therapy you take and it might vary depending on how long you take it for."

The risks are greater, for example, for users of oestrogen-progestagen hormone therapy than for oestrogen-only therapy. A large study by the Institute of Cancer Research in London found that women who took hormone therapy for five years were 2.7 times more likely to develop breast cancer than those who did not. Recent research also suggests that, in some cases, the danger can persist for more than a decade after treatment stops.

Another study found that women using hormone therapy for between one and four years have a 60 per cent higher chance of developing breast cancer compared with those who have never used it.

The report's authors, who examined 58 studies across the world, found that of 108,647 women who developed breast cancer at an average age of 65, almost half had used hormone therapy.

When asked if women should avoid hormone therapy due to the increased risk of cancer, Professor Kelly-Anne Phillips, the founder of the Peter MacCallum Breast and Ovarian Cancer Risk Management Clinic, has said the decision should be made on a case-by-case basis.

"Some women will find, short-term, it can help relieve their symptoms," she saidearlier this year.

Professor Phillips warned, however, that women who had been on hormone therapy for a year should have their treatment reviewed, adding there were alternatives for treating symptoms including weight loss, moisturisers for vaginal dryness and avoiding caffeine or alcohol.

The 'grandmother theory" is one explanation for menopause in humans.

Apart from humans, most mammals stay fertile until the ends of their lives. There are a few exceptions: killer whales, short-finned pilot whales, belugas and narwhals can live for decades beyond their reproductive years. Guppies also appear to go through a fish version of menopause.

But long postmenopausal lifespans are an aspect of biology that appears to be at odds with natural selection. Why do women suddenly stop having periods when they still have at least a third of their lives to live, during which they could be producing offspring?

Some experts, including Professor Hickey, believe high death rates of mothers during childbirth throughout history emphasised the importance of grandmothers in rearing future generations, unhindered by more children of their own. This is known as the grandmother theory.

Not really but andropause can affect men older than 40. Andropause is the gradual reduction of the male sex hormone (testosterone) with increasing age. Its symptoms include sexual dysfunction, weakness, fatigue, insomnia, loss of motivation, mood disorders and reduction of bone density. Though the symptoms aren't as severe as those of menopause, they can last for as long as 15 to 20 years.

An egg surrounded by sperm.Credit:Alamy

Although eggs succumb to menopause, pregnancy is still possible using a donor egg. During perimenopause, ovulation can occur, meaning a woman can conceive naturally, even if she is using hormone therapy.

When UK based former magazine editor Lynnette Peck and her friend Paula Fry first began to experience symptoms of perimenopause they found they had no safe space to share their feelings on the matter. In a bid to open up dialogue, they started a secret Facebook page in 2017.

Word got around quickly. Soon they had more than 700 members and then Feeling Flush was born; a public online community for women across the world to connect.

"We wanted women, including ourselves, to have places to share information and educate each other and have a moan," Ms Peck says.

"Women mostly ask us about hormone replacement therapy and the pros and cons. We are not medical experts so we point them to people who are. There is now a conversation. It was hidden before. Here in the UK, even political parties and huge brands are getting involved."

Professor Hickey notes that women make up almost half of the workforce in Australia and two-thirds of the voluntary sector. They continue to look after children across generations and are often the primary carer for parents.

Our society has a big a focus on youth and the preservation of youth and menopause is a maker of age in women and ageing in women is not a topic we still have very much discussion about," Professor Hickey says.

"It's quite likely that women who experience menopause may not have been informed fully about what to expect. It's quite possible a lot of men don't know very much about menopause at all."

Last week, British free-to-air television Channel 4 launched a menopause policy to support women experiencing perimenopausal symptoms such as hot flushes, anxiety and fatigue by giving them access to flexible working arrangements and paid leave if they feel unwell.

It's a shift Professor Hickey wants in Australia. She would like to see menopause treated as a "diversity issue" with workplaces actively supporting women experiencing it.

"Pregnancy would be a similar example: only women get pregnant, and we've learnt to adapt, and I think we need to take a similar perspective to menopause."

Melissa Cunningham is The Age's health reporter.

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5 times when you should skip your workout and take a rest day – NBC News

Exercise is an important aspect of maintaining a healthy, functional body, but there is also a time and place for letting ourselves rest.

I'm a personal trainer and many people are shocked to find out that I dont exercise every single day. Ive found that my workouts are much more enjoyable and effective when I can look forward to a relaxing day off. It can help boost your mental morale, kind of like what a Friday does at work. Its also important physically: Allowing your body time to rest is a necessary part of an effective training routine. These days give you time to heal from the stress youve placed on your joints and muscles, prevent fatigue and burnout, and can even help you break through the difficult plateaus you may be facing.

Just how many rest days we need each week is not a one-size-fits-all model. One study found that it took 72 hours of rest or 3 days between strength training sessions for full muscle recovery, while research from the ACE Scientific Advisory Panel says that a recovery period could be anywhere from two days up to a week depending on the type of exercise. This number will vary based on certain factors like your fitness level, age and type of exercise and intensity of your workouts. So knowing your own body and its limits is essential to determining the amount of work and rest days you need each week.

In addition to scheduled rest days, there are other times when it may be best to sit it out. Here are some scenarios when you should consider hanging up your sneakers and giving your body a little R & R.

When your workload feels like its never ending and your schedule is overloaded with juggling work and family commitments, the stress starts to take a toll mentally and physically. While exercise can be a stress-reliever it isnt always. This is an important time to really listen to your body. When you exercise, youre working hard to raise your heart rate. This puts added stress on the body and leads to your overall stress-load increasing. For some people, this can actually exacerbate symptoms. Especially if making it to the gym is another thing youre trying to squeeze into an already jam-packed day.

On the other hand, exercise is one of the most common recommendations for stress reduction, as it stimulates the production of endorphins which make you feel good after a workout. And, it does work for many people. So if you do find that exercising works for you as a stress release and you feel better afterwards, then go for it. On particularly stressful days, you may want to consider swapping intense workouts for those that help your body wind down and relax like yoga or walking or jogging outside.

Its common knowledge that sleep is essential, but yet, many people still don't prioritize it. If you arent getting enough sleep, hitting the hay (instead of hitting the gym) may be the best way to prioritize your health. Look at it this way: If youre sleep deprived your body isnt performing as highly as it could be. Exercising when you're running on empty also increases your risk of injury. So if youre exhausted, the best thing you can do for your body is to get a good night of rest and get back in the gym the next day.

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Insufficient sleep is associated with decreased insulin sensitivity, reduced levels of a hormone associated with appetite suppression (leptin) and increased levels of a hormone associated with hunger (ghrelin)," says Lisa Cottrell, a licensed psychologist board certified in behavioral sleep medicine at Aurora Health Care. "Insufficient sleep and chronic sleep deprivation can increase activation of the sympathetic nervous system (activating the 'fight or flight' response) and affect cardiovascular systems, inflammation, immune responses and metabolism.

In this way, getting to bed an hour or two earlier can be just as beneficial (if not more so) for not only your overall health, but your waistline, as hitting the gym. If youre exhausted and burnt out, take it as a sign that your body needs some TLC and let yourself rest.

If you arent feeling your best, the gym might not be the best place for you. But how sick is too sick to workout? One general rule I always share with my private clients is that if the pain is coming from above the neck, its okay to workout. If the pain is below the neck, skipping the gym is a good idea. The exception to this rule is if youre running a fever. If you have a fever, exercise should be off the table. The work youll be putting in wont be as beneficial because of the increased dehydration youll be facing.

Dr. Gustavo Ferrer, MD, founder of the Cleveland Clinic Florida Cough Clinic, advises that if you have a runny nose, nasal congestion, and/or a sore throat, exercising is OK. You may consider reducing the intensity of the exercise. If you exercise for one hour, cut to 1/2 hour during those days, he says. He does recommend avoiding the gym and exercise for the first few days of a viral infection like the flu and the common cold not only for your own health, but also because this is the period when you are contagious to others. Also avoid the gym if you have shortness of breath, severe cough, fever or wheezing, says Dr. Ferrer.

You may need to take some time off after a really intense workout, especially if you wake up the next day feeling extreme soreness or muscle fatigue.

Gregory Marcolin, PT, director of Physical Therapy at OceanView Rehabilitation, explains that the dull ache, soreness, and/or sickly sensation that you feel in your muscles following the performance of a new or restart of an exercise routine (specifically strength training) is referred to as Delay Onset Muscle Soreness or DOMS. This is typically experienced within the first or second day following the workout session, he says. Although the exact cause for this sensation at a physiologic level is not fully understood, it is believed that a type of strengthening for the musculature known as eccentric or lengthening of a muscle while under stress may cause micro-trauma to the muscle fibers. The soreness that is experienced is the body repairing the muscular fibers in order for growth to occur for the future. Rest is needed in order for the body to repair the damage (however small) that has occurred.

Pushing through soreness and exercising, instead of giving your body adequate rest, can be detrimental in a few ways. First, your body may take longer rest periods in order to heal, says Marcolin. There may be an inhibition of essential nature hormone production that is required to heal and improve muscular strength/function such as Human Growth Hormone (HGH), he explains. You also may increase your risk of injury: Musculature is simply soft tissue that has the ability to perform amazing things throughout the body. However, with continued breakdown of these fibers due to excessive and prolonged DOMS, further injury such as tearing can occur, Marcolin explains.

If youve just completed a race or another strenuous athletic feat youve been training for, its time to take some time off and celebrate. Its always a great idea to factor in how much youve pushed your body when youre calculating your recovery time. You can think of it as: The more stress youve put on your body during the workout, the longer you should give yourself to recover.

But just how much time should you give yourself? Marcolin says that theres not a clear-cut period of rest thats recommended, and that a recovery period varies from person to person. However, following long periods of extensive exercise, the body's metabolic system may be stressed to its limit, therefore it is advised for anywhere from a minimum of 3-7 days of complete rest, hydration and sleep. Active recovery is also recommended as it helps increase blood circulation needed for recovery." Walking, swimming, and light jogging are all activities that will get your blood pumping and help your muscles heal, without putting additional stress on the body.

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Obesity Rates May Be Increasing but so Is the Ability to Fight It, Says Dr. Feiz and Associates – PR Web

Is it the food that makes people fat or the hormonal drives that make food nearly impossible to resist.

LOS ANGELES (PRWEB) October 26, 2019

An October 13 article on Yahoo News reports on the increasingly alarming rate of obesity in the United States. According to the article, while no U.S. state had an obesity rate above 15 percent in 1985, all 50 states now have a population that is over 20 percent obese. The article cites quite a few reasons for this rise, including eating out more often (restaurant food tends to be significantly higher in calories), poor diets lacking in nutritious foods, and a lack of exercise caused by lifestyles that have become increasingly sedentary. Los Angeles-based weight loss center Dr. Feiz and Associates says that, while obese individuals should naturally be making a concerted effort to eat better and exercise, failing to lose enough weight to defeat obesity is not a sign of poor willpower and its definitely not a character flaw. Instead, the clinic holds the bodys own mechanisms as a primary offender in preventing people from achieving sustained weight loss. So far, the clinic notes, certain weight loss procedures have proven to be highly effective in circumventing hormonal efforts to keep obese people forever obese.

The primary chemical enemy of dieters, the medical group explains, is a hormone known as ghrelin that is believed to be responsible for creating sensations of hunger in the body. When an individual loses a large amount of weight, particularly if this loss occurs at a rapid pace, the body sends false alarms that the individual is not receiving enough calories and enters into a survival mode of sorts trying to induce us to eat more calories as if a famine was coming soon. The clinic notes that these hormonally induced feelings feel essentially the same as real hunger and, over time, typically wear down even the most disciplined and strong-willed individuals. Dr. Feiz and Associates notes that there is no countervailing biological process in place that tries to reduce our food consumption when we are too heavy.

Dr. Feiz and Associates says bariatric surgery offers a significant boost in the fight against obesity. The clinic cites sleeve gastrectomy, which removes roughly 75%-85% of the stomach, as a prime example of weight loss surgery that can help patients lose and maintain their weight without being as radically invasive as older procedures. This surgery is particularly effective in that it removes an area in the stomach that appears to be responsible for ghrelin production alongside making overeating physically uncomfortable. The clinic says that by dramatically reducing hormonal hunger, patients are finally able to sustain their weight loss once they are no longer plagued by incessant hunger pangs. Dr. Feiz and Associates note that patients who come out of the sleeve gastrectomy typically lose significant amounts of weight and even more important are able to stave off the return of obesity over the long term.

Readers can learn more about weight loss surgery by visiting Dr. Feiz and Associates at https://www.drfeiz.com/ or by calling 310-855-8058.

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Beating the winter blues – Weyburn Review

As autumn transforms into winter, the number of available hours of daylight slowly dwindles. Some areas of Alaska and Canada see only about three or four hours of daylight per day in the winter months. Conversely, those who live in Key West, Florida, the southernmost point of the contiguous United States, may enjoy around 10 hours of daylight.Fewer daylight hours can adversely affect mood and productivity. Seasonal affective disorder, often referred to as SAD or the winter blues, has been recognized and included in the Diagnostic and Statistical Manual for Mental Disorders. Clinicians say that, as days become short and dark, a predictable set of symptoms of SAD may emerge. Individuals with SAD may experience a host of symptoms, including difficulty waking in the morning; diminished energy levels; a tendency to eat more; an inability to concentrate; and depression.The Cleveland Clinic advises that approximately half a million people in the United States suffer from winter SAD, while 10 to 20 percent may suffer from more mild forms of winter blues. The Canadian Mental Health Association states that between 2 and 3 percent of Canadians will experience SAD in their lifetime. Another 15 percent will experience a mild form of SAD that leaves them only slightly depressed. Similar symptoms can occur for those people who live in cloudy regions or high latitudes.Evidence strongly suggests SAD is linked to sunlight. This lack of sunlight may trigger production of melatonin in some individuals. Melatonin is a hormone made in the pineal gland that regulates sleep onset and sleeping patterns.

A combination of self-care strategies as well as professional medical treatment may help those with winter blues or more severe SAD. The U.S. Department of Health and Human Services says that these strategies can help people coping with SAD. Get out of the house into sunlight or brightly lit spaces early in the day when the sun is out. Increase time spent outdoors. Take a break midday and enjoy lunch outside or take a walk, even if its chilly. Try to spend time with other people and chat with friends and relatives. Avoid overloading on carbohydrates like cookies and candies. Talk to a doctor about using light therapy, which is the first line of SAD treatment, according to the University of Maryland School of Medicine. Consider cognitive behavioral therapy or talk therapy with a licensed mental health provider. He or she also can make recommendations about the use of medication to alleviate symptoms if other treatments do not provide results.There are many ways to mitigate the symptoms of winter blues.

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INTERVIEW (Part I): Former Transgender Walt Heyer Talks About His Detransition, The Dangers Of ‘Affirmation,’ And Childhood Sexual Trauma – The Daily…

As the transgender movement continues to develop, the cultural sentiment has moved rapidly toward acceptance and affirmation. While some believe the affirmation campaign is a step in the right direction, others are concerned that a rush to champion hormones and gender reassignment surgery while ignoring other potential drivers of gender dysphoria could ultimately do more harm than good.

The affirmation of gender dysphoria has even gained steam among the youth population. According to a study published in 2017 from The Williams Institute, an estimated 0.7 percent of youth ages 13 to 17 identify as transgender in the United States. This is approximately 150,000 young people.

Despite the increasing social acceptance of transgenderism by Hollywood and the mainstream press, there is a segment of the trans population that is feeling regret, and seeking to detransition.

Walter Heyer, a former male-to-female transgender individual, runs a website called Sexchangeregret.com. The website serves as a contact point for Heyer to help those who are seeking to detransition.

On Wednesday, I had the opportunity to speak with Heyer about his life and his work. In part one of this two-part interview, Heyer speaks about the circumstances that led to his own gender dysphoria, his transition to female-identifying, the childhood trauma and comorbid disorders uncovered in the transgender population with whom he interacts, and more.

DW: Could you walk me through your early story about how you developed your dysphoria?

HEYER: Yeah. At four years old, my grandma was a seamstress and was making dresses. Thats where she made her money. Its 1944, and so Im the kid thats being babysat by grandma, and I was curious about what she was doing, and just kind of watched her as the women came in and out of the house. That curiosity got her to make me a purple chiffon dress. And then she put it on me, and that was my little dress as a four-year-old. She thought I looked very cute, and today we would probably call it affirming. That curiosity and what occurred later, this affirmation process, led me to become confused about whether I should have been a girl or a boy. In 1944, we didnt have any names for it, and I was just struggling with who I was. It took a long time for me to go to sleep at night. I struggled for a long time.

My dad and mom found out about it because it was a secret for two and a half years. I was at grandmas, and then when my dads teenage brother found out, who was adopted, he thought I was good game to be sexually molested because I was wearing this purple dress at grandmas. When I told my parents I was being sexually molested, they said that couldnt be true because Fred said he didnt do it.

So, you start off life before youre nine years old with some of these confusing events, and Christine Jorgensen came along in the 1950s, and when I saw that news story, I thought, Well, that must be me. That must be what I am. The association without having any other knowledge and information, I assumed that that was me.

I continued to cross dress and think that I was born in the wrong body throughout my life. Never really stopped as a teenager. I took on a secret name, Crystal West, and didnt tell anybody about it. As time went on, I continued to cross dress all the way through high school and early college. Still confused, still struggling. Then I got married in my early twenties because, like so many people who identify as transgender, Im not homosexual. The ones that I work with, probably over 90% of them are not homosexual; theyre just people confused about their gender identity, but their sexual identity is still heterosexual. So, I married, had kids, worked on the Apollo space mission, and at American Honda Motor Company.

I went to a gender therapist in San Francisco at the age of 40 to 41, and he diagnosed me with gender dysphoria, gender identity disorder and he was the author of the original standards of care that are in place today. His name is Paul Walker. He was kind of the number one guy in the country on diagnosing and treating these disorders. So, I thought that was pretty radical and talked to my wife about it, and over the next couple of years I started on hormones. In April of 1983, I underwent gender reassignment surgery while I was an executive with American Honda Motor Company. They terminated me when I notified them of my new identity, and I became homeless not long after that. I was divorced and broke and struggling with alcoholism and drug addiction, then began to crawl my way back.

I lived for about eight years as Laura Jensen, female, in the San Francisco area. I studied psychology at UC Santa Cruz as a way to try to get myself back. Id been living with a family in Pleasanton, California, because I had no real source of income for a long time.

When I saw and studied psychology at UC Santa Cruz, I realized that people who identified as transgender were also suffering from many disorders that no one ever talked about things like separation anxiety and body dysmorphia and schizophrenia, bipolar disorder, depression, anxiety, social adjustment disorders. Just a pretty big laundry list of things that people who identified as transgender carried with them that were typically not addressed during the pre-surgical evaluation.

I then started going for therapy and realized that no one could actually land on anything specific. One therapist said that I had dissociative disorder; the other one said I didnt. No one could come to a solid agreement. They just felt that the sexual molestation that occurred when I was young, the cross-dressing, all precipitated into me having difficulty identifying with who I was, electing to identify with my transgender identity. I eventually through therapy and actually going to church in Foster City, California kind of walked my way out of that, and detransitioned in 1990, and have been restored back to my sanity since 1990. Now, Ive been married for 22 years to a real woman, and Ive been clean and sober for 33 and a half years.

DW: So those two things the chiffon dress and the sexual abuse you believe were the primary contributors to your developing gender dysphoria?

HEYER: Yeah, and the people that Ive known for a long time and work with even today, find thats what it is. The people that I work with today, 45% to 50% of them were sexually abused as children, and they ended up identifying as a transgender later on. These are the ones that are also detransitioning.

DW: Can you explain the idea of comorbidities and past trauma as it relates to transgenderism?

HEYER: Yeah. Well, comorbidity is just a fancy word for additional disorders. These are things like schizophrenia, which some studies say that theres a certain portion of people who identify as transgender have schizophrenia or bipolar disorder. These disorders typically werent there prior to identifying as transgender, but often times these disorders develop as a result of identifying, cross-dressing. A portion of them are disorders like autogynephilia and transvestic fetish disorder. Autogynephilia and transvestic fetishism are two pretty major factors that people dont talk much about, and thats men who cross dress and look at the mirror, and what they see in the mirror becomes the object of their own sexual affection, that becomes their sexual arousal. And so theyre typically not homosexual, they dont need a partner, its just looking at themselves, they become complete sexually.

The person with transvestic fetish usually attaches himself sexually to one particular type of clothing, whether its shoes or whatever, and they become sexually aroused by those garments or female clothing. So, these are typically not transgenders; theyre actually people with other disorders, but they identify as transgender.

You also have people who are just cross-dressers, and transvestites. Then you have the drag queens, many of whom dont have bottom surgery. They just are flamboyant, over-the-top homosexuals who identify as drag queens. But most of those groups, actually, are not transgender; they just identify as transgender when they have these other issues that we call comorbidities.

DW: Why do you believe people identify as transgender when what theyre experiencing is rather just a set of comorbidities?

HEYER: I dont think it plays well when somebody sees you cross-dressing, and you tell them, I have autogynephilia because I get sexually aroused by looking in a mirror. Its just a lot more socially palatable to tell people, Im transgender, without going into the details of what that means.

And people who have dissociative disorders, your bipolar disorder, or whatever you just throw all of these things into a basket, toss a blanket over it, and call it transgenderism, when, if you take the blanket off and begin to look deep into these things, you can see what the underlying comorbidities are but we typically dont do much of that. I do it all the time, 100% of the time, with the people who contact me after theyve had a failed transition, and want to de-transition and we dig into, Well, lets find out why you transitioned. 100% of the time, the people that Ive worked with over the last ten years can come up with a situation, an event, that caused them to transition, whether its from female-to-male or male-to-female. So, they can identify it usually after the fact when the transition failed, which usually occurs between five and 15 years.

DW: Has there ever been someone you helped who didnt either have a comorbidity or a past trauma?

HEYER: No.

DW: Back to your story, you transitioned when you were about 42, right?

HEYER: Yeah, thats right.

DW: What were the years like while you were transgender?

HEYER: Well, I worked for FDIC and banking; I worked for the postal service. I was also at the same time studying psychology at UC Santa Cruz. Thats when I started looking into the books and finding comorbidities. So my life was fairly reasonable. I had a decent job. When I wanted to work, I could work, and I lived in San Francisco part of the time, I lived in L.A. part of the time, and in Pleasanton, California, part of the time. I was clean and sober. So I would call it unremarkable, except that I was really learning a lot about what they were doing in terms of identifying people who are transgender actually having other issues. So I was kind of beginning to crack into that in the late 1980s.

DW: Can you tell me about your detransition experience? What first ignited it, and then the process of going through that detransition?

HEYER: Well, a series of things happened and it took probably a year and a half maybe to come all the way back. I think once I had begun to look into this idea of comorbidities, and begun to explore that I was working actually in a psych hospital in L.A. on the unit as part of my schoolwork. I was called a chemical dependency technician in a lockdown psych unit. There was a psychiatric doctor there and hes the one who began to talk to me about the comorbidities and other issues. I told him where I was trying to go with this, and he recommended I go see a therapist that he knew. I went and saw that therapist, and several other ones. It took me a lot of convincing through psychotherapy from many different people that it would be safe for me to detransition, and that I wouldnt have this gnawing feeling that Id made a mistake and needed to come back.

So, once I had resolved all those early childhood issues and could rectify what had happened, then it was relatively easy for me to realize that not only am I one of the ones that had gone through this unnecessarily, but that there were probably others and thats when I built the website sexchangeregret.com. The first year, we had 700 people come to the website. In 2015, we had 356,000 people come to the website. Today, we get 25,000 or 30,000 people a month. So many people are struggling. Somebody in the U.K. wrote an article recently they are detransitioning and said theyve found hundreds of people, and thats the same thing I reported. I myself have worked with hundreds of people who are detransitioning, but its kind of a taboo subject. Nobody wants to hear about it; nobody wants to believe it. But this thing runs its course between five and 15 years.

Strangely enough, theres a Dr. Charles Ihlenfeld who worked at the Harry Benjamin Gender Clinic in New York in 1979 as an endocrinologist, had administered hormone therapy to 500 people who had transitioned over a six year period, and he said in New York in 1979 that he was leaving the practice of administering hormones to these individuals, and going to become a psychiatric doctor so that he could actually help them because he said, and I quote, Giving them hormones and changing their genders, it is causing too much unhappiness and too many of them ended in suicide.

In part two of this interview, which you can read here, Heyer discusses the shockingly high suicide rate among the post-op transgender population, the dangerous consequences of youth transitions, the future of the trans movement, his relationship with his ex-wife and kids, and more.

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INTERVIEW (Part I): Former Transgender Walt Heyer Talks About His Detransition, The Dangers Of 'Affirmation,' And Childhood Sexual Trauma - The Daily...

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Fertility specialist Ellen Drew talks about her career, starring in new show Making Babies and her own struggles with conceiving – The Sunday Post

She is the mother of thousands of children across Scotland, but Ellen Drew knows having a baby is never easy.

The lead embryologist at Dundees Ninewells Hospital has experienced first-hand the heartbreak of spending years trying to start a family only to discover you cant conceive. It is a dilemma that faces one in seven couples struggling to fall pregnant.

This week marks National Fertility Awareness Week when BBC Scotland will air Making Babies, a documentary about the ups and downs of IVF.

The programme follows three couples on their exciting yet agonising journeys through fertility treatment, from the stress of daily hormone injections to countless scans, not to mention the anticipation and tears that come along the way.

IVF isnt always successful, as Ellen can attest to. She said: IVF doesnt work more often than it does. Its an intense process and there are no guarantees it will be successful. Even if patients have a top grade embryo, its still quite likely not to work.

Putting that across to people is one of the hardest parts of the job.

With over 30 years experience in the industry, Ellen has helped make thousands of babies and turned countless couples dreams of having a child into reality.

When we manage to make a baby, its just incredible, she said. Even in all these years, I dont think Ive ever taken a new baby in my arms and not shed a tear or two. You see the heartbreak and pain these people go through trying to have a baby and how much they want it and its such a privilege to be able to help them when we can.

In an ironic twist, Ellen herself is one of those people. The mum of four endured secondary fertility problems after having her first child.

And becoming a patient in her own ward was an eye-opening experience.

My husband and I wanted a baby for quite a while, but struggled to conceive, the 53-year-old explained. I didnt ovulate very well and realised very early on that we would likely have problems conceiving.

By the time we got married, I hadnt used contraception for a year.

The natural conception and arrival of Sam (now 22) was a welcome relief.

But when Ellen and Rob tried for a sibling, life had other plans.

The second baby really wasnt coming, then we discovered I wasnt ovulating, she said. I was prescribed HCG medication, but that didnt work. Then hormone injections, which werent successful either. Eventually I had to move onto IUI treatment, basically having Robs sperm inserted into my womb to increase the chances of conception. To be honest, I thought it would never work. Every month, I would have two weeks of hope I might be pregnant, and then my period would arrive.

I found the whole experience pretty brutal and not being able to talk about it was hard. I would have patients going through treatment, crying and telling me going through fertility treatment was so hard and I couldnt understand what it was like and I would just have to swallow and say, No, I cant imagine. I didnt want anyone at work to know, it was all a big secret.

I would bring the sperm sample into work and prep it, then a colleague and I would sneak off and she would insert it into my womb.

However, when she did fall pregnant, it didnt go quite as planned.

Ellen said: When I found out I was pregnant, I was ecstatic. When we discovered it was twins, I was shocked. The morning sickness, especially with twins, was horrendous but I would have put up with anything for another child, and it wasnt half as bad as the treatment, or the waiting to get pregnant.

Ellen, who lives in Dundee, had just returned to work after maternity leave with twins Josh and Jake (now 17) when she got the bombshell news that she was pregnant again with fourth child, Johanna.

I still wasnt using contraception, she said. To be honest, I hadnt used any for so long that the thought never crossed my mind. One day I arrived at work and realised I couldnt remember when I had last had a period. I did a pregnancy test and it was positive.

A scan showed I was about nine weeks. It was crazy. Id gone from spending my whole life trying to get pregnant and being prepared to be a parent to it happening naturally when I least expected it. We werent even trying. My husband saw me upset one night and asked what was wrong.

He joked: Dont tell me youre pregnant with twins again? I said Its not twins. To my surprise he was delighted. He told me not to worry, it would all be okay and it was a blessing.

And it was. After Johanna (now 15) was born, Ellen went back to work and Rob gave up his IT job to become a stay-at-home dad.

Im really good at planning and organising, and Rob is great at doing. Its the perfect marriage, she said. A few years ago, the couple decided to add to the chaos by becoming foster parents. They now foster three children.

We moved into this big house and decided we would let some of it out to students, but I didnt like the idea of people we didnt know living with the kids. So we came up with a plan. We are pretty good parents so why not extend that to more children?

Now were a big family, and were a great team. I always wanted a noisy house with lots of children and thats exactly what Ive got. And I am surrounded by babies at work. I honestly have no idea how many babies I have helped to make but its certainly into the thousands.

I do miss that side of the job. Now I manage, guide and direct, and try to develop the service. And, while it has improved tenfold, theres still so much I want to do. I vowed to leave the service after 40 years, so that leaves a decade to get through my list.

As for childrenI think seven is enough so no more for me. But I eagerly await the grandchildren.

Amy Wanless, from Edinburgh, did a week of work experience at Ninewells in Dundee when she was 22, while preparing to study for a Masters in clinical embryology at Leeds University.

She told Ellen that finding out as a teenager she was an IVF baby herself had led to her career choice, and she wanted to work at Ninewells as that was where her parents had their fertility treatment.

Ellen checked the records, and came back to tell Amy she had made her.

Amy, now 27, said: It was a really lovely surprise as not many people get the chance to meet the person who made them, if its not their parents.

If you think about it, Ellen is the very first person who will ever have seen me, and that blew my mind. I asked, Should I start calling you Mum?, and we both laughed.

I know the chances of something like this happening are so slim, and I feel really lucky to have met Ellen.

Shes been a complete inspiration.

Amy is seeking a career in fertility medicine. After graduating, she worked for a spell as an IVF technician at a Glasgow clinic.

Shes hoping to complete the specialist training required to become a clinical embryologist.

She added: I feel very proud to be an IVF baby and Id love to be able to help other couples have children, in the same way that Ellen helped my parents.

Its a very special thing to be able to give someone the gift of a family.

It was her own experience of infertility that led BBC producer Laura-Jane McRae to work on the Making Babies documentary.

Last year, she posted a heart-wrenching video of herself talking about IVF on BBC social media page The Social.

And it prompted such a reaction that she decided to open up on the subject by filming couples going through the process.

Once my husband Findlay and I had been trying to conceive for about 18 months, we were referred to the Assisted Conception Service, said Laura-Jane.

We have what is called unexplained infertility, which means the doctors cant find a clear reason why its not working.

After lots of tests, the doctor said, You have a healthy womb, you have great sperm. You should be making babies, but we dont know why youre not.

It can be incredibly frustrating and we have tried everything, but when you cant find the problem, its hard to find a solution.

Laura-Jane, 35, from Glasgow, and Findlay have gone through two rounds of fresh cycle IVF and two rounds of frozen IVF. Sadly, none of the attempts have been successful.

In the early days, trying to have a baby was all-consuming. There were babies everywhere I looked.

Meeting so many people who have gone through IVF, I realised were not alone and its more normal than not normal. Im now grateful for what I have an amazing husband and a fantastic life. Having a baby would be a bonus, but were so lucky already.

IVF is largely a taboo subject. Few people understand how hard a process it is and what is involved.

I thought we would ace IVF, but then came to the realisation there is potential failure at every point.

So hopefully this documentary can open the largely taboo subject up and help people understand a bit more.

Were taught from an early age how to prevent unwanted pregnancy, but were never taught how difficult it can be for some couples to get pregnant.

Its not easy for everyone, but at least in Scotland we have the gold-star package of three rounds of IVF.

Not everyone is that lucky.

Were taking a break for now, but will definitely use our last round.

We dont know if it will be third time lucky, but well certainly give it a try.

Making Babies, BBC Scotland, 10pm, Tuesday

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Fertility specialist Ellen Drew talks about her career, starring in new show Making Babies and her own struggles with conceiving - The Sunday Post

Recommendation and review posted by Bethany Smith

Charley Webb reveals she’s storing her baby son Ace’s stem cells in emotional post – Heart

28 October 2019, 12:40 | Updated: 28 October 2019, 16:46

The Emmerdale actress welcomed baby Ace into the world in July of this year

Charley Webb has revealed that she's storing her baby son Ace's stem cells in an emotional Instagram post.

Read more: Strictly judge Craig Revel-Horwood blames viewers for shock Catherine exit after fierce backlash

Sharing an adorable photo of the tot, who she shares with her husband Matthew Wolfenden, she wrote: "We decided to store Aces stem cells. As parents every single one of us wants to do whats best for our children. When I was pregnant, I heard about the possibility of collecting and storing my baby's umbilical cord stem cells, which could then be used in the future should they be needed for treatment (I hope with every part of me we never need it).

"After researching, we learned that the baby's umbilical cord is a valuable source of stem cells, and these cells can be collected at birth and stored.

Read more: Coronation Streets Sally Dynevor couldn't watch Sinead's devastating death after her own cancer battle

"These could then be used as a crucial part of treating or curing an illness. Currently, there are over 80 diseases cord blood stem cells can treat. I decided to use Smart Cells to store the stem cells: the process was easy (genuinely) and they organised everything.

"Like I said, we hope we never need to use them, but it's comforting to know that we have them stored if we ever do. This is a once in a lifetime opportunity, and Im so grateful we were able to do this. Xx".

Many parents rushed to voice their approval, with one commenting: "Amazing! Such an important thing and I think every parent should consider doing this as it may save a life so respect for you. And Ace is so cute."

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Charley Webb reveals she's storing her baby son Ace's stem cells in emotional post - Heart

Recommendation and review posted by Bethany Smith

A winding romp through advances in cell biology pushes readers to ponder the boundaries of life – Science Magazine

Philip BallUniversity of Chicago Press2019384 pp.Purchase this item now

A small bundle of human nerve cells are being cultured in a petri dish. The cells divide. They differentiate into cell types found in the brain. The cell network grows dense and develops brain-like structureslayers and folds. The cells begin to signal. The brain cell cluster has been derived from skin cells harvested from science writer Philip Balls shoulder.

The scientists who created Balls skin-turned-brain organoid study brain development and want to understand the basis of neurodegeneration. But what exactly goes on inside these cell aggregates, and could we reach a point at which they are more brain than brain-like?

Biologists can also build embryo-like structures (embryoids) from human stem cells, which can be used to study early prenatal development. However, synthetic embryos can develop certain featuressuch as the primitive streak, a structure that establishes bilateral symmetry in an organismthat mark, for some, the transition from embryo to individual human being.

Balls experience grappling with how to think about these living structures, as documented in his new book, How to Grow a Human, is part of a larger question with which humanity has wrestled for centuries: What is life, and how might our understanding of it change with our ever-increasing capability to manipulate it?

The book offers a provocative, meandering take on the progression of groundbreaking biotechnological capabilities. For example, in chapter 3, Ball explores the dawn of tissue culture at the turn of the 20th century and the motivations of the scientists who conducted the research. Ross Harrison sought to settle a debate between Camillo Golgi and Santiago Ramny Cajal over the makeup of nervous systems; the former argued that nervous systems were one uninterrupted structure, whereas the latter believed there to be distinct nerve cells. Along the way to showing that nerve fibers lengthen through nerve cell proliferation, confirming Ramny Cajals hypothesis, Harrison was the first to develop a technique to keep tissues alive with active cell growth in vitro, sustaining amphibian embryonic tissue in jars.

Alexis Carrel, on the other hand, was a white supremacist striving to preserve a superior stock of humankind. Carrel and his team iterated on and applied Harrisons method to many different tissues, including those of birds, embryonic chickens, and, of course, humans. Here, Ball also works in how science fiction writing was influenced by early advances in cell biology, describing Julian Huxleys The Tissue-Culture King, which centers on a biologist who redesigns members of a remote tribe and builds living objects of worship from the flesh of the tribes king. Although interesting, asides such as this disrupt the narratives continuity.

Balls writing is most absorbing when he reflects on boundary-pushing research, such as advances toward converting human skin cells to eggs or sperm or the promise of approaches for fabricating human organs to help people who need transplants. In chapter 5, for example, he describes experiments in which rat cells formed pancreases in mice, and others in which human cells survived in pig and cattle embryos, and then considers how governments and the public might approach the prospect of harvesting human organs grown in other animals.

Discussing how and where we have drawn ethical and legal lines for procedures such as in vitro fertilization and preimplantation genetic diagnosis (PGD) of embryos, Ball contemplates what historical precedent may mean for the governance of emerging biotechnological capabilities. Unlike in the United Kingdom, where PGD is permitted only to avoid implanting an embryo with a serious heritable disease, the United States does not regulate PGD-enabled embryo selection at the federal level, meaning PGD can be used to select for offspring of a particular gender or to rule out embryos that have an elevated risk of intellectual disability. (As Ball points out, it may be possible to adapt this testing to screen for embryos that are predicted to have exceptional cognitive ability.)

At the center of an adjacent debate are germline genome-editing technologies. As exemplified by the so-called CRISPR-baby controversy and expounded upon by Ball, access to, and affordability of, new biotechnologies may serve some segments of society while underserving others. Ball appeals to the democratic process to determine the balance between personal liberty and state-dictated equity, acknowledging that everyone has a stake in and therefore the right to be heard on this important issue.

Because of the immense power of emerging biotechnologies, those of us who are intimately involved with these advances must make a concerted effort to equip both policy-makers and the public with the knowledge and tools needed to navigate this evolving landscape. Ambitious and expansive, How to Grow a Human could be one piece of this effortBalls look at the state of human-facing cutting-edge bioscience is a thought-provoking read

The reviewer co-leads the Congressional Science Policy Initiative at the Federation of American Scientists, Washington, DC 20036, USA

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A winding romp through advances in cell biology pushes readers to ponder the boundaries of life - Science Magazine

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Bloomberg Philanthropies, Johns Hopkins University School of Medicine, and The New York Stem Cell Foundation Research Institute Announce an…

NEW YORK, Oct. 22, 2019 /PRNewswire/ -- Bloomberg Philanthropies, Johns Hopkins University School of Medicine (JHUSOM), and The New York Stem Cell Foundation (NYSCF) Research Institute today announced an initiative to fundamentally advance and expand the science of precision medicine, in which diagnostic disease markers are defined with pinpoint accuracy to help researchers understand disease pathways and customize therapeutic approaches. The collaboration will combine the renowned clinical and medical expertise of Johns Hopkins with the unique stem cell technologies and research capabilities of the NYSCF Research Institute to accelerate Hopkins' pioneering Precision Medicine Initiatives.

"Johns Hopkins is working intensively to realize the great promise of precision medicine for all those in our care, locally and globally," said Johns Hopkins President Ronald J. Daniels. "This significant new collaboration with Bloomberg Philanthropies and NYSCF moves us ever closer to that aim as we join together our far-reaching research capacities to advance knowledge and deliver better health outcomes for populations and people around the world."

This collaboration will also establish an unprecedented cache of human disease models available to researchers worldwide thus promoting the real world application of precision medicine and driving a new paradigm for understanding and improving the approach to human disease.

"Bloomberg Philanthropies' mission is to ensure better, longer lives for the greatest number of people," said Michael R. Bloomberg, founder of Bloomberg LP and Bloomberg Philanthropies. "For years, Johns Hopkins University and the New York Stem Cell Foundation have shared that mission and we're honored to deepen our partnerships with them as they explore new, innovative ways to save lives through the application of precision medicine."

Diseases manifest themselves differently in different patients. To understand the basis of these differences and to tailor treatments for specific patients, researchers need more accurate biological tools. Stem cell models provide a "biological avatar" of the patient from which they were created, allowing scientists and clinicians to better understand, define, and account for differences in individual patients and groups of patients.

The new initiative will use induced pluripotent stem cells to study disease characteristics in subgroups of patients, identifying markers that lead to varying disease manifestations. For example, by examining stem cells from seemingly similar patients with different forms of multiple sclerosis, we may be able to better understand the full range of disease mechanisms and pathways.

The Johns Hopkins Precision Medicine Initiative already includes 16 Precision Medicine Centers of Excellence (PMCOE), each focusing on a specific disease, and is now working to develop 50 Precision Medicine Centers in the next five years. Johns Hopkins believes that this advancement in the study and application of precision medicine has the potential to transform the diagnosis and management of many diseases.Often, what is now categorized as a single disease is actually made up ofmultiple diseases that display similar symptoms, but require quite different therapies. Using a wide range of data sources, precision medicine seeks to better elucidate these differences, so that doctors can treat patients with precisely targeted therapies. At Johns Hopkins, dozens of researchers are bringing this idea to reality across a spectrum of debilitating and life-altering diseases.

In this collaboration, the process will begin with the full consent of patients in JHUSOM PMCOEs who wish to participate. Biological samples from the JHUSOM PMCOEs will be collected by the NYSCF Research Institute where scientists will create stem cell models of disease using the NYSCF Global Stem Cell Array, the world's first end-to-end automated system for generating human stem cells in a parallel, highly controlled process.Integrating robotics and machine learning, NYSCF's technology reprograms skin or blood cells into stem cells, differentiates them into disease-relevant cell types, and performs genome editing to unravel the genetic basis of disease.

"The NYSCF Research Institute has invented and scaled the most advanced methods of human cell manipulation, which is critical for studying disease at the level of the individual patient," explained NYSCF CEO Susan L. Solomon. "By combining our capabilities with Johns Hopkins' extensive clinical data and expertise, we will be able to develop effective, personalized therapies for patients suffering from diseases with a high unmet need."

The stem cells generated by NYSCF will be used to research and drive effective therapeutic and diagnostic development in a wide range of diseases that include, but are not limited to, Multiple Sclerosis, Alzheimer's, chronic renal failure, and cancers of the lung, breast, prostate, pancreas, and bladder. These stem cell lines will reside in the NYSCF Repository and serve as an extraordinary resource in perpetuity for the disease research community. This vast collection will allow scientists unprecedented insights into the biochemical and genetic mechanisms underlying different diseases and subtypes thereof, thereby illuminating avenues for effective, tailored interventions.

"Stem cell science holds enormous potential for the treatment of a wide range of diseases," said Paul B. Rothman, dean of the School of Medicine and CEO of Johns Hopkins Medicine. "By combining this approach with Johns Hopkins' groundbreaking work on precision medicine, we are creating a scientific powerhouse that will help us advance medicine and science at an even faster pace. I am excited to see the discoveries and innovations that will be produced by this collaboration."

About Bloomberg PhilanthropiesBloomberg Philanthropies invests in 510 cities and 129 countries around the world to ensure better, longer lives for the greatest number of people. The organization focuses on five key areas for creating lasting change: Arts, Education, Environment, Government Innovation, and Public Health. Bloomberg Philanthropies encompasses all of Michael R. Bloomberg's giving, including his foundation and personal philanthropy as well as Bloomberg Associates, a pro bono consultancy that works in cities around the world. In 2018, Bloomberg Philanthropies distributed $767 million. For more information, please visitbloomberg.orgor follow us on Facebook, Instagram, YouTube, and Twitter.

About The New York Stem Cell Foundation Research Institute The New York Stem Cell Foundation (NYSCF) Research Institute is an independent non-profit organization accelerating cures and better treatments for patients through stem cell research. The NYSCF global community includes over 180 researchers at leading institutions worldwide, including the NYSCF Druckenmiller Fellows, the NYSCF Robertson Investigators, the NYSCF Robertson Stem Cell Prize Recipients, and NYSCF Research Institute scientists and engineers. The NYSCF Research Institute is an acknowledged world leader in stem cell research and in developing pioneering stem cell technologies, including the NYSCF Global Stem Cell Array and in manufacturing stem cells for scientists around the globe. NYSCF focuses on translational research in an accelerator model designed to overcome barriers that slow discovery and replace silos with collaboration. For more information, visit http://www.nyscf.org or follow us on Twitter, Facebook, and Instagram.

Press Contacts:

The New York Stem Cell Foundation Research Institute David McKeon dmckeon@nyscf.org 212-365-7440

Johns Hopkins University School of Medicine Vanessa Wasta wasta@jhmi.edu

SOURCE The New York Stem Cell Foundation

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Worlds first cell atlas of developing liver created by Cambridge scientists – Cambridge Independent

The worlds first cell atlas of the human developmental liver has been created, giving fresh insight into how the blood and immune systems develop in the foetus.

A high-resolution resource, it will aid our understanding of normal development and efforts to tackle diseases that can form during development, such as leukaemia and immune disorders.

The cell atlas maps how the cellular landscape within the developing liver changes between the first and second trimesters of pregnancy, including how stem cell from the liver seed other tissues, supporting the high demand for oxygen required for growth.

Researchers from the Wellcome Sanger Institute in Hinxton, the Wellcome MRC Cambridge Stem Cell Institute, University of Cambridge, Newcastle University and their collaborators created the atlas by using single cell technology to analyse 140,000 liver cells and 74,000 skin, kidney and yolk sac cells.

In adults, it is bone marrow that is primarily responsible for the creation of blood and immune cells in a process called haematopoiesis.

In early embryonic life, the yolk sac and liver play a key role in creating these cells, which then seed peripheral tissues such as skin, kidney and ultimately bone marrow.

But until now, the precise process of how blood and immune systems develop in humans has been unknown.

Isolating cells from the developing liver, the researchers were able to identify them by what genes they were expressing and discover what the cells looked like.

They tagged haematopoietic cells in sections of developmental liver using heavy metal markers in order to map them to their location.

Prof Muzlifah Haniffa, a senior author of the study from Newcastle University and senior clinical fellow at the Wellcome Sanger Institute, said: Until now research in this area has been a little bit like blindfolded people studying an elephant, with each describing just a small part of it.

This is the first time that anyone has described the whole picture, how the blood and immune systems develop in such detail. Its been an extraordinary, multidisciplinary effort that is now available as a tool for the whole scientific community.

The scientists learned that during foetal development, mother haematopoietic stem cells stay in the liver. But the liver alone cannot supply enough red blood cells, so the next generation daughter cells called progenitor cells travel to other tissues, maturing in places such as the skin. Thee, they develop into red blood cells to help meet the high demand for oxygen in the developing foetus.

Dr Elisa Laurenti, a senior author from the Wellcome MRC Cambridge Stem Cell Institute and the Department of Haematology at the University of Cambridge, said: We knew that as adults age our immune system changes. This study shows how the livers ability to make blood and immune cells changes in a very short space of time, even between seven and 17 weeks post-conception.

If we can understand what makes the stem cells in the liver so good at making red blood cells, it will have important implications for regenerative medicine.

The study, published in Nature, also involved the mapping of genes involved in immune deficiencies to reveal which cells were expressing them.

It is known that gene mutations can lead to immune disorders such as leukaemia.

A better understanding of the development of healthy liver functions could aid our understanding of how to treat such conditions.

The work is part of the ambitious effort to create the first complete Human Cell Atlas.

Dr Katrina Gold, genetics and molecular sciences portfolio manager at Wellcome, said: Our immune system is vital in helping to protect us from disease, yet we know very little about how immune cells develop and behave in the early embryo. This study is hugely important, laying a critical foundation for future research that could help improve our understanding of disorders linked to the early immune system, such as childhood leukaemias.

The Human Cell Atlas has the potential to transform our understanding of health and disease and were excited to see these first discoveries from our Wellcome-funded multidisciplinary team of scientists.

Dr Sarah Teichmann, a senior author from the Wellcome Sanger Institute, University of Cambridge and co-chair of the Human Cell Atlas organising committee, said: The first comprehensive cellular map of the developmental liver is another milestone for the Human

Cell Atlas initiative.

The data is now freely available for anyone to use and will be a great resource to better understand healthy cellular development and disease-causing genetic mutations.

Read more

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Worlds first cell atlas of developing liver created by Cambridge scientists - Cambridge Independent

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Hormones Control your Health, Mood and Behavior A balanced hormone means happier, healthier life and success in career and relationship. – Magazine of…

Non-surgical regenerative cell-based treatment uses the bodys natural healing ability to repair damaged bones, muscles, cartilage, tendons and ligaments.Knee injuries are painful and often patients are unable to walk. Our treatment protocol always uses products following FDA guidelines.Injections done with ultrasound guided needle recognition capability to ensure safety as well target the area needing treatment. Plasma; Alpha-2-Macroglobulim (A2M) is the new biologic treatment for your arthritic knee (osteoarthritis)When your hips hurt, or your knee is stiff, or your back is throbbing, that means your joint is bone on bone and there is no lubrication to ease movement.Regenerative medicine giving new hope to patients suffering from painful joint injuries such as knee, shoulder and hip with a chance to live a pain free life.Regenerative cell-based ultrasound guided injection now available to treat pain associated with joint injury. There are indications that it reduces the pain and swelling of the joints and helps lubricating and improve movements.Commonly Treated Conditions: Osteoarthritis of the Hips, Knee, and Shoulders Rotator Cuff tears of the Shoulder Meniscus, ACL and PCL tears of the kneeOur stem cell treatment using your own stem cells and with using imaging guidance ensures precise injection of stem cell, it is a highly-specialized practice.Besides treating above injuries we have advance stem cell micro-needling treatment for the following: Cell-based PRP Hair Restoration combining micro-needling with growth factors and hair follicles voluma vitamins plus BLotinyl T1, Biotin, Anti-aging and Kopexil. Non-toxin facial renewal Anti-Aging APGF Advanced Peptide Micro-needling PRP, Dual Anti-Aging Ampoules for deep hydration, more collagen to reduce wrinkles and firm skin.Dr. Ibrahim is the staff physician at Valencia Medical Center specializing in regenerative medicine, pain management, and rejuvenation. Call for a consultation at 661-222-9117.

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Hormones Control your Health, Mood and Behavior A balanced hormone means happier, healthier life and success in career and relationship. - Magazine of...

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The extracellular matrix, and how it keeps you in tip top shape – ZME Science

Would you live in a city without streets? Or in a flat with no walls? Probably not and the cells in our bodies expect the same level of comfort. Today, were taking a look at the tissues that create and maintain an ideal working environment for our tissues: the extracellular matrix.

Weve had a look at the differences between animal and plant cells before (heres a refresher). One of the key differences between them is that plants reinforce their cells with thick, sturdy walls. These walls are why plant tissues such as wood can get so resilient. However, the reverse of the coin is that it also limits plant cells somewhat: a muscle made out of wood wouldnt be very effective.

Animals need cells that can perform a wide variety of activities, but these cells also need biological and mechanical support to perform their tasks. Thats where the extracellular matrix, or ECM, comes in.

The ECM is a complex mix of proteins and carbohydrates that fills the spaces between cells; it is comprised of the basement membrane and interstitial matrix. Going forward, Ill use the term ECM quite loosely to mean both the extracellular matrix and the interstitial matrix. If I dont mention the basement membrane specifically, Im probably talking about the interstitial matrix (as its the more dynamic and frankly more interesting half of the topic).

Think of the basement membrane as a sheet of plastic wrap the body stretches over every individual tissue or organ to keep everything tidy and in place. This membrane is made up of two layers of cells and its quite fibrous and hard to rip.

The interstitial matrix is, for lack of a better term, the goo that our cells live in. Most of the time, it looks and feels a bit like a clear gel. Its produced by the cells themselves, which secrete and release certain compounds around them.

The simplest definition of the extracellular matrix is that it represents the sum of non-cellular components present within all tissues and organs. As we go forward, keep in mind that the ECM isnt the same everywhere.

Although, fundamentally, the ECM is composed of water, proteins, and polysaccharides, each tissue has an ECM with a unique composition and topology that is generated during tissue development, Christian Frantz, Kathleen M. Stewart, Valerie M. Weaver, 2010.

Collagen, the most abundant protein in mammals, is the main component of the ECM. Outside the cell, collagen binds with carbohydrate molecules and assembles into long molecules called collagen fibrils. These fibrils extend through the ECM and lend flexibility and strength to the material, acting similarly to the role of rebar in reinforcing concrete (which is tough but inflexible). Collagen fibrils are flexible and tough to break, so theyre used to bind together the rest of the ECM. In humans, genetic disorders that affect collagen (such as Ehlers-Danlos syndrome) cause tissues to become fragile and tear easily.

While the ECM contains a wide range of proteins and carbohydrates, another important set of compounds alongside collagen are proteoglycans (groups of proteins tied to simple sugars). Proteoglycans come with many shapes and functions, depending on which proteins and sugars theyre made of, and perform a wide range of tasks in the ECM. They can also bind to each other, to collagen (forming cartilage), or to hyaluronic acid, making them even more versatile. As a rule of thumb, proteoglycans act as fillers and regulate the movement of molecules through the ECM among other functions.

Their overall structure looks like a tree: the sugar part of the polyglycans are twigs set on a branch (the protein), which ties to a trunk made out of polysaccharide (many-sugar) molecules. A class of proteins in the membranes of cells, called integrins, serve as connection ports between the membrane and material in the ECM (such as collagen fibers and proteoglycan-polysaccharide bundles). Beneath the membrane, integrins tie into the cells support girders (the cytoskeleton).

The type of ECM Ive described so far is your run of the mill variety that youll find in skin, around muscle fibers, in adipose tissue (fat), and so on. But each tissue has an ECM that fully supports its function blood plasma is the interstitial matrix of blood. Unlike the ECM of muscles, for example, which is meant to reduce friction and wear in the tissue, blood plasma primarily works as a medium to carry blood cells around. Blood vessels are coated with a basement membrane, and together, they form the ECM of blood. Each type of animal connective tissue has its own type of ECM, even bone.

Seeing as there are many types of ECM out there, it stands to reason that there are many functions they perform. However, by and large, there are a few functions that all ECMs fulfill.

The first and perhaps most important function is that they provide support to tissues, segregate (separate) them, and that they mediate intercellular communication. The ECM is also what regulates a cells dynamic behavior i.e. whether a cell moves around, and how. The ECM keeps cells in place so we dont simply unravel. The connections formed between the ECM and integrins on a cells membrane also function as signaling pathways.

It is also essential for the good functioning of tissues at large. The ECM creates and maintains the proper environmental conditions for cells to develop, multiply, and form functioning tissues. While the exact details are still unknown, the ECM has been found to cause tissue regrowth and healing after injury. In human fetuses, for example, the extracellular matrix works with stem cells to grow and regrow all parts of the human body. Fetuses can regrow anything that gets damaged in the womb, but since babies cant, we suspect that the matrix loses this function after full development. Researchers are looking into applying it for tissue regeneration in adults.

The ECM can also act as a storage space for various compounds. In joints, it contains more hyaluronic acid which in turn absorbs water and acts as a mechanical cushion. ECMs can also store a wide range of cellular growth factors and release them as needed. This allows our bodies to activate cell growth on a dime when needed without having to produce and ship these factors to a certain area.

It also seems to impact cell differentiation and gene expression. Cells can switch genes on or off depending on the elasticity of the ECM around them. Cells also seem to want to migrate towards stiffer areas of the ECM generally (durotaxis) from less-firm ones.

The ECM isnt very well known today, and it definitely goes unsung. But no matter how you cut it, it is a key part of biology as we know it today. Without it, both animals and plants would be formless, messy blobs quite literally. And I dont know about you but I love it when my tissues stay where theyre supposed to, the way theyre supposed to.

Continued here:
The extracellular matrix, and how it keeps you in tip top shape - ZME Science

Recommendation and review posted by Bethany Smith

Regenerative Medicine Market 2019 | Remarkable Growth Factors with Industry Size & Share, New Innovations of Leading Players & Forecast till…

New report on Regenerative Medicine Market 2019 focuses on the growth opportunities, which will help the Regenerative Medicine market to expand operations in the existing markets. Regenerative Medicine market research study is significant for manufacturers in the Regenerative Medicine market, including industry stakeholders, distributors, suppliers, and investors, and it can also help them understand applicable strategies to grow in the Regenerative Medicine market.

In Regenerative Medicine Market Report, Following Companies Are Covered:

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Market Overview:

Scope of the Report:

Regenerative Medicine Market Report Provides Comprehensive Analysis of:

For More Information or Query or Customization Before Buying, Visit at https://www.industryresearch.co/enquiry/pre-order-enquiry/14244620

Key Market Trends:

Dermatology is the Segment by Application that is Expected to be the Largest During the Forecast Period

Dermatology is estimated to have the largest share in revenue generation, and this high contribution is attributive to the presence of easy grafting techniques for dermatological wounds and diseases. Skin, being an organ with great cell replication characteristics, provides various types of stem cells from its different layers. Therefore, there are a broad range of products present, from patches to cure small injuries to matrix and grafts for chronic wounds and burns. Thus, the segment is expected to continue to dominate the market through to the forecast period.

The increasing number of accidents and bone defects is also expected to drive the regenerative medicine market. There are also several research studies that are being conducted on tissue engineering for the development of bone graft substitutes, with the help of regenerative medicine. So, with the new advances in bone graft, the market is expected to grow over the forecast period.

North America Holds the Largest Share and is Expected to Follow the Same Trend Over the Forecast Period

North America is estimated to have the largest share, in terms of revenue, owing to the presence of major players and rapid advances in technology, along with high investments in stem cell and oncology research. There is also an increasing prevalence of diseases, such as cancer and diabetes, which can now be cured by various stem cell therapies. Additionally, the awareness regarding the available stem cell procedures and therapies among people is rising, which in turn, is increasing the demand for the overall market.

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Detailed TOC of Regenerative Medicine Market Report 2019-2024:

1 INTRODUCTION1.1 Study Deliverables1.2 Study Assumptions1.3 Scope of the Study

2 RESEARCH METHODOLOGY

3 EXECUTIVE SUMMARY

4 MARKET DYNAMICS4.1 Market Overview4.2 Market Drivers4.2.1 Increasing Adoption of Stem Cell Technology4.2.2 Technological Advancements in Regenerative Medicine4.3 Market Restraints4.3.1 Regulatory and Ethical Issues4.3.2 High Cost of Treatments4.4 Porters Five Forces Analysis4.4.1 Threat of New Entrants4.4.2 Bargaining Power of Buyers/Consumers4.4.3 Bargaining Power of Suppliers4.4.4 Threat of Substitute Products4.4.5 Intensity of Competitive Rivalry

5 MARKET SEGMENTATION5.1 By Type of Technology5.1.1 Stem Cell Therapy5.1.2 Biomaterial5.1.3 Tissue Engineering5.1.4 Other Types of Technologies5.2 By Application5.2.1 Bone Graft Substitutes5.2.2 Osteoarticular Diseases5.2.3 Dermatology5.2.4 Cardiovascular5.2.5 Central Nervous System5.2.6 Other Applications5.3 Geography5.3.1 North America5.3.1.1 United States5.3.1.2 Canada5.3.1.3 Mexico5.3.2 Europe5.3.2.1 Germany5.3.2.2 United Kingdom5.3.2.3 France5.3.2.4 Italy5.3.2.5 Spain5.3.2.6 Rest of Europe5.3.3 Asia-Pacific5.3.3.1 China5.3.3.2 Japan5.3.3.3 India5.3.3.4 Australia5.3.3.5 South Korea5.3.3.6 Rest of Asia-Pacific5.3.4 Middle East & Africa5.3.4.1 GCC5.3.4.2 South Africa5.3.4.3 Rest of Middle East & Africa5.3.5 South America5.3.5.1 Brazil5.3.5.2 Argentina5.3.5.3 Rest of South America

6 COMPETITIVE LANDSCAPE6.1 Company Profiles6.1.1 Allergan6.1.2 Osiris Therapeutics6.1.3 Integra Lifesciences6.1.4 Cook Biotech Incorporated6.1.5 Organogenesis Inc.6.1.6 Baxter6.1.7 Medtronic6.1.8 Thermo Fisher Scientific6.1.9 Sigma-Aldrich Co.6.1.10 Becton Dickinson and Company

7 MARKET OPPORTUNITIES AND FUTURE TRENDS

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The global Prenatal and Newborn Genetic Testing Market is expected to reach US$ 11,204.74 Mn in 2027 from US$ 4,034.37 in 2018 – Yahoo Finance

The market is estimated to grow with a CAGR of 12. 2% from 2019-2027. The key factors that are driving the growth of the significant increase in the prevalence of genetic diseases among infants, supportive government for promoting the use of prenatal and newborn testing and increasing birth rate are boosting the market over the years.

New York, Oct. 28, 2019 (GLOBE NEWSWIRE) -- Reportlinker.com announces the release of the report "Prenatal and Newborn Genetic Testing Market to 2027 - Global Analysis and Forecasts By Product, Disease, End User and Geography" - https://www.reportlinker.com/p05806350/?utm_source=GNW In addition, the growth opportunities in emerging markets in developing countries are likely to have a positive impact on the growth of the market in the coming years.Several types of genetic diseases affect the fetuses in the womb.The way in which these genetic diseases are inherited helps to determine the risk that they pose on pregnancy as well as the risk of its recurrence.

The risk of having genetic diseases in babies is high in cases where the parents have another child with a genetic disease, family history of a genetic disorder, or if either of a parent has a chromosomal abnormality.There is a significant prevalence of genetic diseases among infants.

Moreover, these diseases are also responsible for infant mortality across the globe. For instance, according to the World Health Organization 2016, an estimated 7.9 million infants across the world are born with genetic defects. Moreover, according to the Centers for Disease Control and Prevention (CDC), birth defects affects every 1 in 33 babies born in the US. On the other hand, chromosomal abnormalities such as Down syndrome affects 1 in 691 babies born in the US, as per the CDCs data in 2017. Thus, the high prevalence of genetic diseases among infants account for the increasing demands for prenatal and newborn genetic tests, thereby contributing to the growth of the market.Global Prenatal and Newborn Genetic Testing Market was segmented by product, disease indication, and end user.The product segment was further divided as diagnostic and screening.

On the basis of disease indication, the market is segmented into the cystic fibrosis, sickle cell anemia, Down syndrome, phenylketonuria, and other diseases.Based on the end user, the prenatal and newborn genetic testing market is segmented into hospitals and clinics, diagnostic centers, other end users.

The hospitals and clinics held a major market share among the end user segment as they are the primary healthcare centres for all patients.Some of the major primary and secondary sources included in the report for the Prenatal and Newborn Genetic Testing Market are World Health Organization, UAE Genetic Diseases Association, Centre for Arab Genomic Studies, National Health Service (NHS), Centers for Disease Control and Prevention, National Human Genome Research Institute (US), Florida Department of Health and others.Read the full report: https://www.reportlinker.com/p05806350/?utm_source=GNW

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The global Prenatal and Newborn Genetic Testing Market is expected to reach US$ 11,204.74 Mn in 2027 from US$ 4,034.37 in 2018 - Yahoo Finance

Recommendation and review posted by Bethany Smith

Genetic testing could keep you healthy. But what about personal info? – Deseret News

LEHI If given a chance, who wouldnt want to spend a few bucks to find out if theyre at heightened risk for one day having to confront some life-changing or life-ending medical malady?

Thats the concept fueling an explosion in direct-to-consumer genetic testing and one thats also elevating ethical debates about how this most personal of information should be interpreted and protected.

Utah-born Ancestry.com is the latest entry into a growing list of companies offering health-focused genetic testing an industry expected to grow to $20 billion annually in the next few years.

While best known and an industry leader for its expertise in providing answers to the Where am I from? question, Ancestry will now expand its genetic testing resources to help people anticipate future health issues and help address, Whats going to make me sick?

Last week, the company that launched more than 30 years ago as a family history search service, later adding DNA testing to help customers identify their geographic ancestral roots, announced its new, health-focused genetic testing service.

AncestryHealth will offer two levels of genetic testing that the company said will deliver actionable insights that can empower people to take proactive steps in collaboration with their health care provider to address potential health risks identified in their genes and family health history.

Ancestry CEO Margo Georgiadis said the new genetic tests will help clients proactively manage their health care needs, armed with new insight on what conditions they may be predisposed for, based on genetic evidence.

Your genes dont need to be your destiny, Georgiadis said in a statement. Understanding your familial and inherited health risks can help you take action with your doctor to improve your chances of better health outcomes.

For more than three decades, Ancestry has empowered journeys of personal discovery to enrich lives. In the same way that knowledge of your family and ethnicity helps you understand your past to inspire your future, knowledge of your genetic health profile and any associated risks can help you be proactive in managing the future for you and your family.

The two testing products, according to the company, include AncestryHealth Core, which uses the companys current genotype genetic assessment technique to detect genetic differences and deliver personalized reports related to health conditions such as heart disease, hereditary cancers, blood-related disorders, and risks for carrier status of health conditions, such as Tay-Sachs disease. The one-time test costs $149 and also includes the companys family history report. Those who have already submitted a biologic sample to the company can get the new genetic report for $49.

While likely not available until sometime in 2020, the AncestryHealth Plus will use more current, genetic sequencing technology that will provide greater coverage of DNA differences for each condition and more risk categories such as those related to potentially developing heart disease, cancers, and disorders related to blood, the nervous system and connective tissues. The sequencing test will require a $199 activation fee, which the company said includes the first six months of membership and an additional $49 membership fee every six months. Existing Ancestry customers will be able to upgrade to AncestryHealth Plus for an initial payment of $49.

Ancestrys testing regimen will assess genetic samples and indicate predispositions for high cholesterol and cardiomyopathy, which can lead to heart disease; hereditary indicators for breast, ovarian, colon and uterine cancers; and blood disorders including abnormal clotting and iron overload. The testing can also determine if the sample donor is a gene carrier for cystic fibrosis, sickle-cell anemia or Tay-Sachs disease, a fatal nervous system disorder that most commonly occurs in children.

Unlike its competitor, 23andMe, which has earned U.S. Food and Drug Administration approval for providing genetic test results directly to customers without a physicians participation, Ancestrys genetic testing service requires a physicians order to conduct the tests and the company says it has contracted with a private network of independent physicians and genetic counselors who participate in the process. Ancestrys health testing service also connects customers to educational information, including access to genetic counseling resources and provides printable and consumer and physician-ready reports that provide guidance for next steps an individual and their health care provider can take together.

Lynn Jorde, chairman of the University of Utahs Department of Human Genetics and executive director of the Utah Genome Project, said while labs are now capable of sequencing the entirety of the human genome some 3 billion genetic basis pairs the microarray technique currently used by Ancestry evaluates a small window of genes that, if a variation is found, have a viable medical response.

What theyre looking at is specific changes in the DNA that we know about in specific instances ... and are often called actionable genes, Jorde explained. If you have a disease causing variant here, there is actually something we can do about it.

Jorde said while some genetic markers, like those for cystic fibrosis, indicate a high probability that you have or will develop that condition, many more are merely suggestive.

The predictive power of genetic testing is getting better and better, but it will never be perfect, Jorde said. For many of these conditions, there are nongenetic components that impact risk.

Jorde said things like environment, diet and exercise/activity level can play a significant role in an individuals risk of developing an illness or disease.

Teneille Brown is a professor at the University of Utahs S.J. Quinney College of Law and an expert in health law and medical ethics. In an interview, she noted direct-to-consumer genetic testing services, now being offered by dozens of companies according to the National Institute of Health, are occupying a space thats in between current regulatory boundaries aimed at protecting individuals privacy rights.

In the research realm, any federally funded projects are subject to stringent privacy rules, Brown said. That is also the case for health care institutions that handle genetic material, under (Health Insurance Portability and Accountability Act) rules.

But the big databases being built by testing companies are outside of the federal funding process and are not health care providers, so the HIPAA rules dont apply, Brown said.

Ancestry appears to underscore this by noting, in its user agreement, that it is not a covered entity under HIPAA rules.

Brown noted that in addition to unanswered questions about privacy protections, genetic test results can lead to deep emotional impacts for tested individuals, either through the discovery of gene markers that are suggestive of some future medical challenge or, less obviously, when a clean test is returned, which may provide an inaccurate suggestion that theres nothing to worry about.

Theres a huge problem when it comes to understanding what these risk scores mean, Brown said. The predictive values of these results is widely variable, including what is, or is not, implied by failure to find a specific marker.

Brown said genetic testing companies have wide-ranging policies regarding sharing an individuals genetic test results or stored biologic samples with third-party researchers. Ancestry, for example, says it will only share your information if youve given them specific permission to do so, through its informed consent agreement.

While the regulatory world is lagging behind the fast-moving development of genetic testing technology, Brown said she believes the bigger companies, including Ancestry, are working to create appropriate protections for their customers. And, she added, the growing body of knowledge being accumulated by this work could lead to groundbreaking advancements in treatments for serious diseases.

These companies might play a role in developing amazing drugs and therapies, Brown said. Collectively, they are adding all of this amazing content, providing pedigrees and information and incredibly powerful databases ... and a lot of good can come of it.

Its not at all sinister, but we need consumers to know what theyre submitting and being diligent about potential secondary uses of that data. More robust consent requirements for users and strict limitations for secondary uses are certainly in order.

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Genetic testing could keep you healthy. But what about personal info? - Deseret News

Recommendation and review posted by Bethany Smith

Healthy Headlines: Breast cancer genetic testing: What you need to know to make an informed decision – User-generated content

St. Elizabeth Healthcare

At St. Elizabeth Healthcare, we know that a breast cancer diagnosis can be shocking and overwhelming. We offer comprehensive care from the moment of your breast cancer diagnosis through your surgery, treatments, recovery and beyond.

Our breast cancer care protocol has recently expanded to include meeting with a genetic counselor shortly after your diagnosis.

New guidelines recommend multi-gene panel genetic testing be offered to all newly diagnosed breast cancer patients, regardless of age or family history.

Genetic information can be very impactful, says Justine Snyder, Licensed Genetic Counselor in the Hereditary Cancer Program at St. Elizabeth Healthcare. Our goal is to help keep patients and their family members healthy by making proactive decisions.

These proactive decisions could include earlier screening mammograms for family members if specific breast-cancer genes like BRCA1 and BRCA2 are identified, as they can increase the risk of ovarian or breast cancer. Genetic testing gives our patients and their families the information they need to properly and proactively manage their health moving forward.

At St. Elizabeth Healthcare, newly diagnosed breast cancer patients will meet with a genetic counselor during their initial breast surgeon appointment.

During your meeting with our genetic counselor, you will:

Once this information is reviewed and you decide to move forward with the genetic testing, a saliva sample will be collected. Our genetic counselors will also discuss the results timeline with you, which is typically two to four weeks, as well as how the results will be communicated to you. Additionally, GINA law (Genetic Information Nondiscrimination Act) and any insurance questions will be covered during this appointment.

Patients occasionally opt out of genetic testing after meeting with St. Elizabeth counselors and thats ok.

Genetic testing is a personal decision, says Justine. Patients are given the option to proceed with testing. If they decline to test, we provide our contact information and a brochure in case they decide to proceed at a later date.

Reasons for opting out include feeling too overwhelmed at the time, concern about out-of-pocket costs and family members not wanting to know the results of the testing.

No matter what your decision, our expert team of genetic counselors are here anytime to answer any questions or concerns you may have. Please call (859) 301-GENE (4363) to speak with a genetic counselor or to learn more about the Hereditary Cancer Program.

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Healthy Headlines: Breast cancer genetic testing: What you need to know to make an informed decision - User-generated content

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Coffee therapy for rare genetic disease related to violent and involuntary muscle movements – BusinessLine

The morning Cuppa Coffee, with its caffeine is proving to be a simple therapy in the taming of a rare, involuntary movement disorder, that had defied treatment.

A 33-year-old patient from Bengaluru in October and an 11-year-old child from Paris in June, benefited from this fluke or chance treatment, according to scientists.

The efficacy of caffeine as a treatment of dyskinesia,caused by a mutation in the ADCY5 gene is causing waves in medical circles.

Dyskinesia refers to a family of disorders characterised by violent and involuntary muscle movements.

Caffeine is known to be against adenosine. Thus it prevents formation of excess cyclic AMP, which is responsible for the involuntary movements, by inhibiting its synthesis through blocking of adenosine receptors in the brain.

Scientists at the Centre for DNA Fingerprinting (CDFD), Hyderabad presented the case of 33-year-old Ramesh (name changed) who complained of involuntary movements of the limbs and face since the age of five.

This would occur 10 to 15 times per day and last for a few minutes. They were also affecting his daily routine. Such features are termed as 'paroxysmal dyskinesia'. Alterations in more than 12 genes are known to result in this phenotype.

Since many genes needed to be tested, an advance genetic testing method, called exome sequencing analysis was done by a team led by Aswin Dalal, Head, Diagnostics Division CDFD to identify genetic basis in this patient. The sequencing revealed a mosiaic mutation in ADCYS (adenylate cyclise) gene.

Ramesh had consulted neurologist Kuldeep Shetty and medical geneticist, SJ Patil at the Mazumdar Shaw Medical Centre, Narayana Hrudayalaya Hospitals, Bengaluru.

His condition is not very responsive to the currently available medication (like benzodiazepines, betablockers, tetrabenazine, anticholinergics etc).

The CDFD scientists, inspired by the case study in France decided to try out the coffee regimen. They found to their surprise a 90 per cent reduction in his involuntary movements within few days.

Although novel therapies are being developed for some genetic diseases, they are very expensive and and are not accessible to the public. "An accurate diagnosis of genetic disease is very important for proper management and prognosis," they said.

In June 2019, a group of scientists from France reported an unusual case. They found that in a family, the father and daughter were affected with a rare, involuntary movements. They were also having a mutation in the ADCYS gene. However, the consumption of coffee lead to a dramatic reduction of unwanted movements.

To cross check the results, they repeated the therapy on an 11-year-old boy with the similar symptoms. The boy was given three doses per day of coffee (in the form of espresso coffee).

To their utter surprise, they found that his had symptoms dropped from 30 bouts per day to one or two brief movements within few days of coffee treatment. Interestingly, the movements re-surfaced when the patient was given decaf coffee and disappeared again when caffeine containing coffee was given.

ADCY5-related dyskinesia is a roughly one-in-a-million disease, and there is no known cure. The gene in its normal state provides instructions for making an enzyme that helps to regulate muscle contraction. The mutation disrupts that process, and caffeine helps to restore.

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Coffee therapy for rare genetic disease related to violent and involuntary muscle movements - BusinessLine

Recommendation and review posted by Bethany Smith

Invitae Needs To Validate How It Really Intends To Make Money – Seeking Alpha

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As a professional in the genomics community, I have been following Invitae (NYSE:NVTA) with great interest. However, I cannot understand why investors are so bullish on its long-term prospects when it continues to see such large losses. There are lots of ideas on how Invitae could become incredibly profitable in the future, but none of these seem validated for their particular circumstances. I wanted to write this article to question the mechanics of how Invitae will become profitable.

Invitae is democratizing germline genetic testing by making it affordable. With its low prices and execution at scale, it has grown revenues quickly. But it still keeps reporting more losses each year.

Source: Invitae 10-K data

This isn't unique to Invitae. Many of their competitors also make increasing losses, such as Fulgent Genetics and several private companies (private data). The exception is Myriad Genetics, which has diversified from the hereditary cancer testing market.

Myriad Genetics aside, Invitae's scale of revenues/losses are greater than many of its peers, as is its valuation. Investors consider its current losses as inevitable as Invitae invests extensively to maintain its growth trajectory. This is much like many other "tech" stocks; Invitae seems highly valued because fast growth in a nascent market might translate into market dominance, profitability and/or a high-valued acquisition. This figure shows how new tech markets develop over time with a winner-takes-all outcome, while the market becomes more highly valued. In the genomics industry, many of us suspect this could happen too for germline testing.

Source: PlayBigger

In addition, tech stocks often command higher multiples because their fixed costs are low, there is long-term value in the data that is being collected, and the marginal cost of adding new customers is low. Tech companies are given flexibility by their investors to sacrifice profitability at each transaction to prioritize growth as they plan to use the collected data as a revenue-generating asset.

There are reasons to be optimistic that this could happen for Invitae too. The germline testing market is indeed growing fast as reimbursements increase and expand, there is increasing awareness of genetic testing in the broader medical community, and Invitae has built a good brand and service globally.

However, as investors you may want to consider these risks.

Tech companies form monopolies because of some type of moat.

Companies like Genomic Health and Myriad Genetics also sell genomics tests, however their emphasis is on products that give them a competitive edge with discernible scientific differences. This could be through lab-developed-tests based on processes from discovery through to validation and reimbursement, and then applying a "blockbuster" financial model.

Invitae in comparison competes in the germline testing market, where there is limited differentiation between tests, creating a commodity market. These labs set up tests by assembling a pipeline using established methods that are shared across the community, free or otherwise. For example, these include mostly the same sequencing technology (Illumina), a bioinformatics pipeline often using similar tools (e.g., GATK), variant curation that uses publicly available databases to filter out irrelevant variants and identify suspect ones (e.g., ExAC, OMIM), and a scoring system for pathogenicity that is widely accepted (ACMG guidelines). The closest thing to a competitive advantage in this space is Myriad Genetics' database of BRCA variants, a large number of which are not shared publicly.

There is limited lasting advantage to be gained by Invitae in performing more testing than their competitors. Comparisons with Amazon's one-stop-shop model isn't appropriate. Amazon is a channel. Genetics is a small part of most physicians' day, so it is not likely to become a channel in the same way. If anything, the one-stop-shop needs to be a big pathology company (e.g., LabCorp or Quest), a channel that has integrated the genetic testing capabilities of Invitae.

Besides, in germline testing, loyalty is often attached to low prices. This has been shown by how easily Myriad Genetics' market has eroded once their customers were offered cheaper options.

Some labs may fine-tweak this better than others to improve efficiency. However, this does not manifest as a competitive advantage. Customers rarely do "bake-offs" to see which lab performs better for a range of difficult cases. Turnaround times are usually 2-6 weeks, with only limited demand to make this even quicker. At best, one could argue that it cuts down on costs and therefore prices, which has become Invitae's key differentiation.

Invitae's success is based on taking an established market and growing with it. Because of the lack of differentiation in this market since AMP vs. Myriad, market-leading low prices have helped grow Invitae's contracts with insurers and institutions. This is reflected in how Myriad Genetics' cancer revenues started to decrease after Invitae and others emerged with lower prices.

Source: Myriad Genetics 10-K data

An average COGS of $252/per sample compared with ASPs of $440 is too simplistic a calculation because some of their tests have multiple prices, and with the introduction of NIPT and whole exome sequencing, the cost basis for some for their tests varies. Some of their prices have been broken out in a previous Seeking Alpha article, which demonstrate how Invitae is selling below their cost for some of their tests and rely heavily on Medicare (and investors for that matter) to subsidize their price sensitive customers.

The most obvious example of selling below cost is their private-pay NIPT solution that is outsourced to Illumina at a cheaper price than what Illumina charges. I'm aware the typical prices for NIPT are higher, and Invitae also implied this in their earnings call explaining that their average COGS (currently $252) had actually increased in part due to NIPT.

Through my experience working for instrument vendors and also the labs, through several off-the-record conversations with many of their competitors globally, the gossip is that Invitae is boldly selling below cost when it needs to. I've heard that one of their competitors have considered making an official complaint about this in the country they operate in. And when I asked one of Invitae's sales reps about this strategy at a conference, she smiled nervously and crossed her fingers.

You may also want to consider this: Invitae currently makes >93% of their revenue from US markets, which for now is great for them because outside of the US they tend to sell their tests at $250. However, about half of the global market for genetic testing is outside of the US (depending on the report you read), so if they need to continue expanding, their ASPs could drop further.

At the same time, how much R&D and sales & marketing costs can they strip away? Because of its valuation Invitae also needs to maintain its growth trajectory, cutting down on these areas creates risks to their long term growth. Contracts will give them some immunity to competition, but for how long if other competitors start to provide even lower prices?

Invitae has done an admirable job to grow as they have over the last few years. But how much more funds do they need to raise to keep this up? At what rate must they continue growing at to maintain your optimism, and for how much longer, before they demonstrate how they can convert their market dominance into sustainable profits?

I don't know the answer to that. But in echoing a recent tongue-in-cheek article from The New York Times, I do know that there has never been a better time for a patient without insurance coverage to get a genetic test.

The genomics market has grown at phenomenal rates regardless of which marker you want to use. 30% per year could be inferred from Illumina's data, which is much higher than pathology in general, which for example is in the single digits for Quest and LabCorp.

There is no doubt that some areas of testing will grow fast. But only a handful of Invitae's tests have actually progressed through to routine use. A market for a pathology test is created by meeting milestones, more or less in this order: analytical validity, clinical validity, clinical utility, professional guidelines, and finally reimbursement. In different geographic regions, different germline tests have been taken through this journey. As controversial as Myriad Genetics have been, we can thank them for helping to developing the acceptance of testing for hereditary breast and ovarian cancer.

Although Invitae is trying to help generate evidence to influence professional guidelines, it is not feasible to try moving the market towards reimbursement and regular usage for all their tests. Therefore their growth challenges aren't competition with other labs, but are (a) tests that aren't reimbursed and/or (b) physicians not ordering the test when they should.

To understand (a), we can use Myriad Genetics as a comparison. Myriad Genetics identifies clinical areas of interest and develops a specific test following the process described above, validating it extensively. This will help provide evidence to influence professional guidelines and eventually get some reimbursement approvals for their unique test. This model has its own risks - it relies on trials and is very slow - but to some extent, these market factors remain within their control.

On the other hand, "by leaning on well-scrubbed, publicly available data from studies of gene variants and rare disorders, Invitae doesn't need to run lots of expensive clinical trials on its own." This suggests Invitae relies on the various markets to mature on their own, without having to contribute extensively. Whether a test for say, dilated cardiomyopathy, is considered essential and not just investigational to justify reimbursement, is not in Invitae's area of influence.

To understand (b), one the biggest problem we have in germline diagnostics is tests not being ordered when they should be. Outside of the well-known areas like cancer, when a physician comes across appropriate patients they might not remember, or even want to use the test.

Invitae themselves are aware of this risk, stating that "clinicians in other areas of medicine may not adopt genetic testing for hereditary disease as readily as it has been adopted in hereditary cancer."

Not using a genetic test may not be detrimental for patients. Often, a genetic test is seen as supplementary to the diagnosis. A patient with dilated cardiomyopathy for example, can be diagnosed and managed without germline testing. Yes, a test would help, especially to identify which of their family members are at risk. But quite often, a cardiologist can make the diagnosis without genetics. It is not essential in most cases that they see. This isn't to say that cardiologists aren't ordering these tests, but it may take a while before the majority of cardiologists start to do the same. Genetic testing instead will be taken up where it dictates treatment such as for hereditary breast and ovarian cancer. But unfortunately, many germline tests are not paired to treatment outcomes.

There's a lot more cancer testing to be done, but Invitae's growth can't just be through cancer. Quoting Invitae again: "A lack of or delay in clinical acceptance of broad-based panels such as our tests would negatively impact sales and market acceptance of our tests and limit our revenue growth and potential profitability." For that to happen for other diseases, the rate of reimbursement and broad changes in physician practice may be the limiting step.

There are other ways to grow Invitae's markets, and the direct-to-consumer (DTC) market is being considered. However, expectations need to be managed. The DTC market has grown, but most of it is for ancestry uses. Color Genetics started out focusing on reaching women and offering BRCA testing at low prices, but has had to expand its markets from the DTC market to other ones, suggesting limits to their initial market. Sema4 have articulated their difficulties in this market too. Invitae may be able to learn from these companies and get a better shot, but it won't be without increasing competition from ancestry companies themselves expanding into healthcare services.

Tech companies have relatively low fixed costs. Frankly, they don't have to sequence each user's DNA and there is supplier competition.

I don't mean to state the obvious, but unlike traditional tech companies, Invitae and others in this industry have high costs to collect, sequence, and analyze each new "user." Health datasets are arguably more valuable than social media ones, but it costs a lot more.

Sequencing costs aren't coming down as quickly as it did previously. Over 2007-2015, the cost of sequencing plummeted, but this has since tailed off.

Source: National Human Genome Research Institute

Illumina in recent years does not feel the same competitive heat they did a decade ago. Although they still have competitors in their research markets, none are close to breaking in on their grip on the clinical market. This has been demonstrated many times but most recently with Qiagen ending their own sequencer's developments and instead partnering with Illumina. As a monopoly, Illumina gets to choose when to develop lower-cost sequencing, and have previously shared that they first need to investigate the elasticity of the clinical market. In the meantime, they can continue to be the arms suppliers for all parties in this price war.

There are other costs that can't be whittled away much further, such as library prep, collection costs, and staff time. As a result, there is a floor that probably isn't too far away.

If data is expensive to generate, what is this data that Invitae is getting?

It is not yet clear how much of the data Invitae has can be reused. Patients can opt out of having their data re-used, and in Europe patients have to opt in.

Consent for further use of data is taken more seriously in the medical community than in the DTC market. Physicians I've met don't sign their patients up for data exchanges, they simply want a test that is performed for the one question they are trying to answer at that point in time. This is important to understand. Even in a values-outcome healthcare system that we are moving into, pathology is still a question-then-answer model between a physician and the lab, not this multi-use and multi-direction relationship between several physicians, the lab, and their patients. This may limit the allowance provided to Invitae to re-use the data, even when de-identified.

Invitae uses a large sequencing panel to generate data for the patient being tested. This may have changed recently with more and more labs running all tests on whole exomes so that the data is uniform, but reading between the lines into Invitae's marketing materials and their COGS suggest that this isn't routine yet. This means that the data they are collecting is both lacking (by sequencing panels only and not the whole exome or more) and likely inconsistent, reducing the power of the dataset they are amassing. Genomics England in comparison sequences the entire genome for all their patients.

In addition, it is not clear how much clinical data Invitae is getting with each sample, which is crucial to bring meaning to the genomic data. Although physicians are encouraged to provide as much information as possible when a test is requested, my experience is that most of the time you just get a few relevant snippets of information. It would be specific to the clinical indication relevant to the test ordered, not across a whole range of medical information. For example, a patient may get tested for the breast cancer genes, so Invitae may collect information on their breast cancer diagnosis, personal, and family history. But would they get information on other medical conditions deemed irrelevant at the time? Would they get updated information after the test is performed and there is no more interaction with the lab? I doubt it, because Invitae's customers are in the business of diagnostics, not research.

The research arena is designed to generate genomic data paired with a rich treasure trove of clinical data that is also longitudinal. This is what "population genomics" is about, and the high water mark is the UK biobank where an extensive number of participants are documented extensively. Illumina is tracking about 50 other programs and many of these are undertaken by healthcare systems themselves because of the extent of data required and the research context.

Invitae and other labs are also getting into this business to support these projects. These include Color Genomics and Helix - both of whom had to expand upon their earlier business models to both grow revenue and collect more data. But I haven't seen evidence to suggest that Invitae has taken any sustainable leads here.

Finally, if data is their play, I cannot fathom why they got into the NIPT market given the genomic and clinical data they would get from each patient will be limited.

If Invitae sells lower-than-cost tests even when they operate on their scale, and without a moat they cannot just flip on a switch and raise their prices once they take a monopoly, they have to use this data for some future revenue stream. What are their options?

Sales of datasets to pharma:

Pharma companies benefit from these datasets to help them identify potential drug targets (e.g., what variants are correlated with a symptom that could be targeted) or to identify patients (e.g., which diagnosed patients with a relevant mutation they could trial a new drug on). One early example of this first model is Amgen purchasing deCode back in 2012 for its database, although I have been told that this has not led to much return on investment.

Invitae's datasets may not be fully consented for their research use, and may have patchy genomic and clinical information. 23andMe in comparison has built a product for this business model, collecting extensive non-genomic information from their patients. Although their genomic dataset is sparser, it is generally consistent.

From an R&D perspective, if pharma had to choose which was more important, they may prefer better clinical information linked to sparse genomic information over deep genomic information linked to sparse clinical information. This is because the clinical information helps them identify disease/symptoms/patients, while 23andMe's genomic information might provide sufficient "tags" that they can drill down on later. The genomic dataset from 23andme, although sparse, has the advantage of being genome-wide and the tool they use is designed for this purpose. I am not sure whether 23andme generates useful clinical information - I imagine it is hard through a DTC setting - but perhaps it is more harmonized between samples because they are in direct contact with their customers. Overall, this tells me that while Invitae could try selling to pharma companies, it remains to be seen what advantage they have and whether pharma will continue making these investments.

The alternative for pharma is to generate this data themselves, as Regeneron are doing.

Sales to pharma to help them generate data:

If pharma decides to generate their own dataset, they might outsource the collection, data generation and data analysis. This is what several of Invitae's competitors do too, including Fulgent Genetics (NASDAQ:FLGT) and Centogene (OTC:CNTG).

I've noticed in comments across SeekingAlpha articles that these two services to pharma are often confused. This second example has little to do with Invitae's dataset, but more to do with treating pharma as an institutional customer and providing "sequencing-as-a-service." This is a hotly contested market as non-clinical labs also compete in this space - these are the labs that hold the vast majority of Illumina's sequencers. If you thought germline testing was a race to the bottom, this market is probably already at the bottom and will bring down a lab's ASPs even further. This is not the market you growth investors are looking for.

Selling re-usable pathology tests to doctors:

I said that pathology is a transaction business model at present, rather than this multi-sided, multi-use model. The truth though, is that many doctors would love to see this new precision medicine future where pathology does not follow a use-and-dispose model.

This fits with Invitae's "Genome management" future, where the data is potentially re-usable but Invitae has not described in much detail how this will all work. This future will no doubt come in some shape or form, but the size of this change is monumental.

Source: Invitae Q2 2019 slides

It is beyond the scope of this article to describe on how a healthcare system might go through such a large, large, change. It requires changes in the way reimbursement works, the way EHRs work, and the way physicians are trained. It will likely need large numbers of trials and other data to validate this new approach, and cross-functional cooperation and funding on an enormous scale. There are studies being completed but who can say how long this future will take to be prepared? While this is the dream for medicine and a key reason I work in genomics, the system is not in place yet and there are no consensus road maps on how we reach this "genome management" future.

This is similar to the ideal future of all of us using fully driver-less cars one day. The technology for cars seems to be getting there, but this is not the only critical development required. There are factors like infrastructure, incentives, habits, etc, that also need change but aren't easy to. Illumina recognizes this too, and this may have played a factor as to why it hasn't prioritized dropping their prices.

By being the central testing lab for a range of genomic tests, Invitae will no doubt be a valuable company when this future arrives. But they need to be careful to avoid being a "Moses company." Moses featured in the Bible's Old Testament with a vision to bring his people to a new Promised Land. Although the vision was accomplished, he died before it came to pass, and instead his successor was the person who brought the people over. Invitae's vision is inspirational, but will they bring us to this Promised Land, or will they instead be laying the groundwork for other labs to do so?

I think that while monetizing data might be a useful trick to keep up its sleeve, without a validated monetization model that will work for their particular set of opportunities and challenges, Invitae might need a more mainstream business model to reach profitability to fall back upon.

Could it continue to grow as a pathology company? Invitae doesn't seem to want to compare itself to the Quests and LabCorps of the pathology industry. But if it wants to reach even more patients, what is the path forward - especially with its financial situation?

It may need to consider selling itself to one of these big pathology organizations. Genomics is an isolated pathology discipline and won't become mainstream until it is integrated with other pathology activities. For example, many pathology tests are ordered in groups by physicians and there is convenience of using the same vendor. These can be linked together so that physicians can "reflex" from one result to the next appropriate test to order. Genetic testing must be included in this pattern in order for it to become mainstream.

For this value to be realized, Invitae could be valuable to a large pathology company, because physicians are more likely to want the "Amazon of pathology," not the "Amazon of genetics." LabCorp and Quest Diagnostics (NYSE:DGX) have already purchased other germline testing labs for this purpose. It is not clear whether this has led to any synergies yet.

Invitae continues to grow its testing volumes quickly, and as a result so has its valuation. But at some point it needs to deliver profitability, either to make money off each transaction, and/or find a new business model. Invitae has grown fast primarily because of its low prices and ability to execute testing at scale. It needs to maintain its low prices because it is otherwise difficult to create a differentiator in this market.

If Invitae waits for reagent costs to go down, it has limited bargaining power, and the floor is near. If Invitae cuts into its fixed costs it runs the risk of slowing down its growth, which is risky given how it is valued. Invitae also needs the market to continue growing, much of which is not under its control.

If Invitae wants to find a new business model to capitalize on its stockpile of data, it needs to articulate this vision more specifically and validate it with the wider healthcare community. If Invitae wants to partner with a large pathology organization, it may need to validate how genetics is integrated with other areas of healthcare.

As we have found with WeWork and other recent news stories, we need to be careful not to value non-tech companies as tech companies. Even though Invitae will benefit from tech - such as its culture and ability to raise funds, it is still hampered by restrictions found in a traditional and slow moving pathology industry, regardless of whether genomics is a little quicker.

Invitae needs to validate how it really intends to make money. I write this humbly acknowledging that I am not in a position to take these questions to Invitae's senior management themselves. And I don't take pleasure in knocking Invitae. I work in their industry, have gained from their contribution, and am excited by their growth and success. However, if you are an investor who believes that Invitae's valuation will continue to rise because it is dominating a fast-growing market and collecting interesting data, make sure you ask hard questions about how this can be materialized into profits.

Disclosure: I/we have no positions in any stocks mentioned, and no plans to initiate any positions within the next 72 hours. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article.

Read the original here:
Invitae Needs To Validate How It Really Intends To Make Money - Seeking Alpha

Recommendation and review posted by Bethany Smith


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