How Israel is using AI to implement proactive care

When it comes to regions around the world where health tech is in full bloom, it would be hard not to mention Israel. Today we are seeing a rise of health IT innovation and digital health companies rising from this relatively small country in the Middle East. 

That is also true when it comes to the country’s largest healthcare organization, Clalit Health Services, which is combining its swaths of patient data and artificial intelligence to move towards predictive care with actionable steps. Clalit had a leg up when it implemented this system – its integrated EMR. 

“We have had a single EMR in the community-care setting and hospital care. …[A]ll of the data is going to a central data warehouse … where it is stored and used in order to provide predictive, proactive and preventive care to our population,” Dr. Ran Balicer, chief innovation officer of Israel’s Clalit Research Institute, said during HIMSS20 Digital’s Israel’s Largest Healthcare Organization Implements Innovation at Scale

While many countries had a goal of moving toward predictive care, Israel’s healthcare structure made the switch easier. 

“We had all the ingredients to make it happen a little bit earlier and a little bit ahead of the curve as compared to … other countries, simply because that data was there,” Balicer said. “We could take and use this data, and use a predictive model in order to have a different way to provide care to our populations. The second thing is we had responsibility for a population in the larger sense and not a necessarily on a patient specific visit approach. Everyone one of our physicians knows they’re responsible. Every one of our physicians knows [their] population.” 

Keeping the end user in mind is key, he said. Success doesn’t depend solely on whether or not the tech works. 

“You have to make the right way be the easy way. You can’t make something the is over cumbersome and is a list of requests or accommodations coming from upstairs , with little heed to the daily impossible practice of GPs, and physicians and nurses in general,” Balicer said. “If you are trying to give a set of orders by email of accommodations that usually is going to fail.”

Balicer explained that clinician education is fundamental to predictive care. He gave the example of a pilot done on predicting patients with chronic kidney disease back in 2010. When a patient gets to the point of needing dialysis there is little clinicians can do to turn the condition around. If caught earlier the condition can be avoided.

The new technology could help pinpoint the time a patient was at risk for a disorder. However, just telling clinicians that a patient may or may not  develop a disorder is no use unless the prediction tool is combined with training about what to do if your patient is developing this disorder. 

The tool also has to fit into a clinician’s workflow and not take too much work. 

“I think one of the key things that made that possible was the information systems put in place made proactive care something that was feasible and intuitive. Every physician had a list of patients for proactive care and had guideline embedded in there that [say] what is done in a proactive manner.”

This predictive tool came in handy recently at the dawn of the coronavirus pandemic. The health system was able to identify its most vulnerable 200,000 patients that the virus was spreading to and tell them to stay in their homes. 

“Our doctors have personally called these hundreds and thousands of people [to say] ‘Here is my number don’t come in. The risk is too great. We will sort it out through online care, telephone or house visits,’” he said. 

Today Israel continues to have a relatively low coronavirus death count, at 281 – something that he attributes to both predictive care and the young population. 

 

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Relugolix superior to leuprolide in advanced prostate cancer

(HealthDay)—For men with advanced prostate cancer, the oral gonadotropin-releasing hormone (GnRH) antagonist relugolix maintains testosterone suppression compared with the GnRH agonist leuprolide, while enzalutamide is associated with improved survival versus placebo in nonmetastatic, castration-resistant prostate cancer, according to two studies published online May 29 in the New England Journal of Medicine to coincide with the American Society of Clinical Oncology Virtual Scientific Program.

Neal D. Shore, M.D., from the Carolina Urologic Research Center in Myrtle Beach, South Carolina, and colleagues randomly assigned patients with advanced prostate cancer to receive relugolix (orally once daily) or leuprolide (injections every three months) for 48 weeks (622 and 308 patients, respectively). The researchers found that 96.7 and 88.8 percent of men receiving relugolix or leuprolide, respectively, maintained castration (sustained testosterone suppression to castrate levels) through 48 weeks. The difference indicated noninferiority and superiority of relugolix. The superiority of relugolix over leuprolide was also demonstrated in all other key secondary end points.

Cora N. Sternberg, M.D., from Weill Cornell Medicine in New York City, and colleagues conducted a double-blind study in which men with nonmetastatic, castration-resistant prostate cancer and a rapidly rising prostate-specific antigen level who were receiving androgen-deprivation therapy were randomly assigned to receive enzalutamide or placebo (933 and 468 patients, respectively). The researchers found that median overall survival was 67 and 56.3 months in the enzalutamide and placebo groups, respectively (hazard ratio for death, 0.73).

“These results add to the growing body of evidence that androgen-receptor inhibitors not only delay the time to metastasis but also improve overall survival among men with nonmetastatic, castration-resistant prostate cancer,” the authors write.

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Vitamin D overdose: Do you have a metallic taste in your mouth?

Vitamin D supports immune function, the hardening, growth and remodelling of bones, and the absorption of magnesium. But an overdose can lead to an adverse reaction.

Stepping outside of your home can result in vitamin D formulating in your body.

Direct contact sunlight enables the skin to create this much needed vitamin.

It’s also available in the foods you eat, such as salmon, red meat and egg yolks.

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And then there’s vitamin D supplements that are readily available to buy.

So how do you know if you’re suffering from a vitamin D overdose?

The NHS confirmed that from late March to September, “most people should be able to get all the vitamin D they need from sunlight on their skin”.

But, in combination with diet and supplements, certain symptoms of an overdose can appear.

The toxicity threshold is thought to be 200ng/mL and above, and hypercalcemia may result.

Hypercalcemia is an excess of calcium in the bloodstream, which can lead to complications.

One such complication is leaving a metallic taste in the mouth.

Another is an irregular heartbeat, as well as continuous headaches and loss of appetite.

Moreover, some people may experience muscle weakness, unexplained exhaustion, irritability and anxiety.

The NHS stated: “High calcium levels can lead to rapid kidney failure, loss of consciousness, coma, or serious life-threatening heart rhythm abnormalities.”

Long-term or excessive consumption of vitamin D supplements or foods can lead to toxicity.

Even when you stop popping vitamin D pills, it may take months for the effects of toxicity to fully wear off.

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Also, vitamin D supplements aren’t suitable for everybody – even during the winter months.

This is because the supplement can interact with certain types of medication.

For instance, people on cholestyramine – to treat high cholesterol – should be wary of vitamin D supplements.

Another example is people taking phenobarbital or phenytoin to treat epilepsy.

This is why it’s important to speak with your doctor before taking vitamin D supplements.

Some medical conditions can increase a person’s sensitivity to vitamin D.

These include cancer, Williams syndrome, sarcoidosis and primary hyperthyroidism.

Do note that vitamin D toxicity can cause a wide range of symptoms that will be unique to each individual.

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Women Less Likely to Be Prescribed Statins: What They Can Do to Protect Their Heart Health

  • Researchers say women are less likely to be prescribed heart medications such as statins.
  • Experts say this makes it even more important for women to understand cardiovascular health risks and symptoms.
  • They urge women to be better personal advocates and to adjust their lifestyle to improve their heart health.
  • They also say women should be aware of mental health issues and how they can affect cardiovascular health.

The shift away from seeing heart disease as a “man’s disease” is the focus of many programs, including the American Heart Association’s Go Red for Women.

However, according to a recently published systematic review of how women are treated for cardiovascular issues, there’s still a long way to go toward heart health equity.

The study, published in the Journal of the American Heart Association (JAHA), took a deep dive into 43 international studies with data on primary care prescriptions among more than 2 million patients who were at risk for heart attack.

Almost 30 percent of those study participants were women with an average age between 51 and 76.

Researchers say the systematic review found that women are prescribed classic treatments for heart disease significantly less often than men.

Statins were prescribed 10 percent less, ACE inhibitors 15 percent less, and aspirin 19 percent less.

“The historical suggestion was long that cardiovascular disease is considered to be a man’s disease,” said Sanne Peters, PhD, a study lead author and a research fellow in epidemiology at The George Institute for Global Health in the United Kingdom, as well as an associate professor at the University Medical Center in the Netherlands.

“We can see from this that this is still a message we see sometimes,” she said.

Peters told Healthline that particularly with older physicians, there can still be a tendency to overlook some preventive steps for women and cardiovascular disease.

Women and heart disease

For at least one cardiologist, the strength of this study comes from the wide breadth of data it drew from.

“Numerous studies have suggested that both women and men are not getting [preventive heart medications they may need], but women to more of a degree,” Dr. Elizabeth Jackson, MPH, FACC, FAHA, a professor in the Division of Cardiovascular Disease at the University of Alabama at Birmingham, told Healthline.

“The strength of this finding is it allows us to look at a huge number of patients and draw from that. That’s the strength of a systematic review,” she said.

Jackson noted that medical professionals “should not be automatically treating women the same as men,” but she also points out “there is an overlap.”

She said basic preventive health steps such as taking aspirin, for example, “should not have a noticeable difference in usage between men and women.”

“Heart disease has long been thought of as a man’s disease,” said Dr. Ileana Piña, MPH, FAHA, a professor of medicine at Wayne State University in Michigan, a clinical professor of medicine at Central Michigan University, and a lead national volunteer for the American Heart Association.

“The reality is cardiovascular disease is the number one killer of women annually. It claims more women’s lives than all forms of cancer combined,” she said.

Heart disease and stroke can affect any woman at any age.

In fact, recent research shows there’s an increase in heart disease in women under age 55.

Experts say gender disparities in research, as well as misconceptions and a lack of understanding of symptoms and risk factors, have caused women to be overlooked when it comes to understanding how cardiovascular disease may impact them differently.

Taking action

Experts say women can use this research to take action by learning, asking, and doing.

“The best thing a woman can do is know her risk factors,” said Jackson. “There’s a lot of information out there.”

Jackson points to the American College of Cardiology’s “Cardio Smart” program as well as the Heart Association’s Go Red for Women program.

“Know your blood pressure, cholesterol, fasting glucose or A1c, and know what it means,” Jackson said. “Know that smoking causes heart attacks a decade sooner.”

Piña told Healthline that women should also pay attention to symptoms.

“As women, we may often deprioritize our own health and focus on the health of our children, partners, parents, or loved ones. Women need to continue to put their heart and brain health first,” Piña said.

She said this is where a program such as Go Red for Women is valuable.

“While there are many similarities in the symptoms of heart disease and stroke in men and women, there are even more differences,” Piña said. “Pain in the jaw, nausea, and shortness of breath are heart attack symptoms that somewhat appear more often in women. While most people do not immediately associate these symptoms with a heart attack, it’s important to remember that they could be the initial signs of a major cardiovascular event.”

Experts say there are steps women can take to be proactive about heart health beyond education.

Jackson suggests women reframe how they think about heart health and risk, and how they communicate it with their primary care doctors.

“Learn about it, talk about it, ask about it, and take action about it, not just as a 10-year risk but as a lifetime risk,” she said.

Jackson also suggests some “prescriptions” women can write for themselves right away.

“Eating healthy and exercising really are some of the best ‘medications’ one can use,” said Jackson. “Ample data shows the benefits of these lifestyle adjustments. They don’t replace statins when they are needed, but they are a nice addition that benefits all.”

Piña said the AHA and Go Red for Women are working hard at helping women do all those things and more.

Currently, they’re working on amping up the data and understanding from all heart research with “Research Goes Red.”

This program’s goal is to build the world’s largest longitudinal women’s health study and research marketplace to further shine a light on women’s heart health by closing gender disparity gaps in research and clinical trials.

The mental health angle

The organization is also currently looking into the ties between women’s heart health and mental health.

In particular, they’re examining how the COVID-19 pandemic is impacting women’s mental health in their Women and Worry study, which was launched earlier this month.

Because another “prescription” women can write themselves, Piña said, is a reduction in daily stress.

“Women lead busy, often stressful lives, taking care of their families, working, and remaining connected to their friends and social activities.” Piña said.

“Inadequate sleeping patterns and stress also increase a woman’s risk for heart disease and stroke,” she added. “Too much stress can encourage behaviors that increase your risk, such as eating a poor diet, physical inactivity, and excessive smoking or drinking alcohol. Socioeconomic status may also increase stress and affect access to basic living necessities, medication, doctors, and the ability to adopt healthy lifestyle changes.”

Experts agree that less stress, better diet, more movement, and a basic education about the risks of heart disease over a lifetime may help bridge the male-to-female cardiovascular treatment gap.

“The ‘men’s disease’ view has improved over time,” Jackson said, “but this shows us we can do more.”

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Restoring nerve-muscle communication in ALS

Patients with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, lose muscle control as nerve cells or neurons in the brain and spinal cord degenerate and can no longer send signals to muscles. Previous studies have identified that problems at the synapse, the point where signals jump from one neuron to another neuron or to a muscle, could contribute to that disconnect. But it’s unclear what causes these problems. New research from the Jefferson Weinberg ALS Center has identified a new mechanism by which the buildup of toxic proteins—a common hallmark of ALS—disrupts neuronal transmission. The findings provide a groundwork for understanding how to maintain the nerve-muscle connection in ALS, and could lead the search for new therapies. The study was published in EMBO Molecular Medicine on April 29th, 2020.

The culprit behind inherited cases of ALS is frequently an error in the C9orf72 gene, which incorrectly instructs the cell to over-produce a repetitive sequence of proteins, called dipeptide repeats (DPRs). One of the most abundant of these DPRs is the GA protein, which forms aggregates and gradually causes toxicity that can kill the neuron.

“Our collaborators in Germany had found in a previous mouse model where GA is over-produced that there are deficits in motor function,” explains Davide Trotti, Ph.D., professor of neuroscience, Research Director of the Weinberg ALS Center and co-senior author of the study. “But we did not know what GA was doing in the neuron itself.”

The researchers cultured motor neurons, the neurons that connect to muscle, from rats to take a closer look at the GA aggregates. They found that the GA aggregates are in fact mobile, traveling within the neuron and accumulating along dendrites and axons, where synapses are found. The researchers also found that the presence of GA aggregates led to an influx of calcium ions, disrupting the electrical balance of the neuron. This imbalance can impair the neuron’s ability to detect and send signals.

Indeed, when the researchers examined the synaptic machinery responsible for sending signals from the neuron to muscle, they found a reduction in a key protein called synaptic vesicle-associated protein 2 (SV2) in motor neurons grown or cultured in a petri dish. SV2 regulates the release of neurotransmitters, which are the signaling molecules that neurons use to communicate with each other and muscles.

This decrease in SV2 results in diminished release of neurotransmitters, preventing the neuron from properly communicating with the muscle. Importantly, this reduction in SV2 was also found in vivo at the neuron-muscle connections in a mouse model of GA aggregation, as well as in motor neurons derived from induced pluripotent stem cells (iPSCs) of patients with the C9orf72 form of ALS.

“The results suggest that these impairments in neuronal transmission also occur in patients’ cells,” says Piera Pasinelli, Ph.D., professor of neuroscience, Director of the Weinberg ALS Center and co-senior author of the study.

“This helps us to understand the basis for symptoms ultimately observed in patients. Importantly, it helps identify targets and mechanisms in disease-relevant systems where GA is not artificially made or over-expressed.”

Using genetic tools, the researchers then replenished the SV2 protein in the cultured motor neurons with GA aggregates, and found that synaptic function was restored to normal levels. Restoring SV2 also reduced toxicity normally caused by the GA aggregates, and even prevented cells from dying and prolonged their survival. Notably, the deficits in SV2 and synaptic transmission occur before toxicity and cell death, so intervening in that time window could be significantly beneficial in slowing disease progression.

“We’ve shown that even though the GA aggregates are still present, replenishing the SV2 protein can combat the most detrimental effects of this protein buildup,” says Brigid Jensen, Ph.D., a postdoctoral fellow at the Weinberg Center and first author of the study. “This points to SV2 as a promising therapeutic target for this genetic form of ALS.”

“We now have a better understanding of what contributes to the degradation of the nerve-muscle connectivity in this devastating disease” says Dr. Pasinelli.

Source: Read Full Article

Coronavirus symptoms: The four main risk factors linked to severe COVID-19 symptoms

Coronavirus cases have reached 5,824,697 worldwide and the total number of deaths has risen to 358,185. These figures are shocking by any standard but it is important to recognise the variations in the data. What the recorded number of cases in particular fails to reflect is the vast differences between mild and more severe cases of COVID-19.

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Why some people may simply develop a new, continuous cough and others are virtually wiped out has been the abiding focus of research.

It is also instrumental to policy direction because once the underlying risk factors can be established, efforts can be implemented to protect those most at risk.

The speed at which the scientific community has come up with answers to this question has been astounding, bypassing the usual channels to get information into the public domain.

Now a study published in the BMJ has advanced the effort once more, fleshing out the four main risk factors that may predict a person’s likelihood of developing severe COVID-19 symptoms.

According to the study, the four factors that put coronavirus victims at a greater risk of experiencing severe symptoms include age, sex, weight, and any underlying illness.

The study involved more than 20,000 patients in the UK across 208 hospitals, making it one of the largest study samples thus far.

Over the course of two and a half months, the study found that the median age of patients admitted to the hospital with coronavirus symptoms was 73.

Furthermore, the study found that 60 percent of coronavirus patients were men.

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The study revealed that chronic underlying conditions – the most common being heart disease – was linked to the vast majority of severe cases.

Other underlying health issues cited included diabetes and chronic kidney disease.

The study also noted that obesity was associated with a higher risk of dying from COVID-19-related complications.

This is consistent with research carried out by the NHS last month.

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According to a major study of data collected from NHS hospitals, obesity raises the risk of dying from coronavirus by nearly 40 percent.

The research, based on 17,000 COVID-19 admissions, revealed that overall a third of Britons hospitalised with the life-threatening virus die.

Death rates were 37 percent higher among obese patients, second only to dementia (39 percent) but more than heart disease (31 percent).

What are the main symptoms of coronavirus?

According to the NHS, the main symptoms of coronavirus are:

  • High temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
  • New, continuous cough – this means coughing a lot for more than an hour, or three or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
  • Loss or change to your sense of smell or taste – this means you’ve noticed you cannot smell or taste anything, or things smell or taste different to normal

Most people with coronavirus have at least one of these symptoms, notes the health site.

What should I do if I spot these symptoms?

UK health advice says to self-isolate if you have any symptoms of coronavirus for seven days.

If you live with someone who has symptoms, you’ll usually need to self-isolate for 14 days.

UK health guidelines state you are now eligible for a coronavirus test if you have symptoms.

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Immune system key to understanding cancer evolution

A collection of papers published in Nature journals have transformed our understanding of how lung cancer evolves over time, in particular how the surrounding environment and immune system drives changes.

The collective findings from the pioneering TRACERx study have already changed the way researchers and clinicians view lung cancer, leading to new clinical trials and research projects aimed at tackling these hard-to-treat tumours.

The process of cancer evolution closely mirrors the way that species evolve through natural selection. As lung cancer cells multiply, mutations take place in their DNA which can help, harm, or have no effect. A helpful mutation may make the cell resistant to certain treatments or able to more quickly digest the nutrients it needs to divide.

But observing the product of this evolution only provides part of the picture. For example, in order to understand the variety of different finches on the Galapagos Islands, Charles Darwin needed to consider the different environments in which each of the finches lived.

The same is true for studying cancer evolution. You need to understand the surrounding environment, that is the body, to understand why and how a tumour is going to evolve.

This complex challenge is being tackled by the TRACERx consortium, led by researchers at the Crick and UCL and, funded by Cancer Research UK.

Findings from the first 100 patients studied have now been brought together in this special Nature collection. This set of papers has found one key to understanding tumour evolution: the immune system.

“It is only by investigating the complex ecosystem within and around a tumour, as the cancer develops, that we can see not just the evolutionary changes themselves but what’s driving them,” says Charles Swanton, lead researcher for the TRACERx project.

Amongst the most significant findings from the study so far are:

  • that unstable chromosomes are the driving force behind genetic diversity within tumours;
  • the ability to detect whether a patient’s cancer will come back up to year before it becomes visible on a scan;
  • the discovery of different mechanisms by which tumours can evolve to evade the immune system;
  • why some cancer cells exhibit an unusual phenomenon called whole genome doubling, where every chromosome is duplicated;
  • how to accurately identify high-risk tumours after surgery;
  • how to track the spread of disease in the blood with minimally invasive approaches using circulating tumour DNA;
  • the immune cell responses key to developing future personalised immunotherapies against truncal mutations present in every tumour cell.

Two new papers are also being published as the collection launches. The first led by researchers at the Institute of Cancer Research, London, used AI to analyse the patterns and prevalence of immune cells within different areas of lung tumours. They found that patients with more ‘immune cold’ regions within their tumour were more likely to relapse. This work could help doctors predict how well a patient will respond to certain treatments, and even help personalise care.

The second, led by researchers at UCL, found that if a type of immune cell, T cells, are exposed to a tumour for prolonged periods they can stop working effectively. This is important as T cells are on the front-line of the body’s defences, destroying cancerous cells and signalling to other immune cells to active them to the threat.

“Thanks to the tremendous scientists at the Francis Crick Institute, UCL and Manchester Cancer Research UK Lung Cancer Centre and the Institute of Cancer Research involved in TRACERx in the UK, this first set of papers has unlocked a great deal of knowledge regarding the relationship between non-small cell lung cancer and the immune system, showing how much we can learn from tracking cancer’s evolutionary trajectory, from diagnosis through to relapse,” adds Charlie.

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Cheers! I’m going through Corona to be an alcoholic?

This article first appeared on brigitte.de.

I’m sitting with a friend in the Park, between us 1,5 meters distance and two Beers. I meet my parents in the garden again, there are sparkling in the sun. My colleague in the video call told by the home office with twins, it indicates telling on your wine glass. “Yes, an exceptional situation”, “Feels like vacation”, “I’ve earned it after the effort”, are the phrases that I hear to these situations, and many other constantly – and even say. The Coronavirus has not imposed a veil of downtime, but also a slight chill of the alcohol on us poured.

Tired and slightly to the side of the track we are anyway, with all the sensations and messages that we work with have to. There’s a little Rammdösigkeit by a glass or two of wine makes no difference, except that we fall asleep is supposedly better.

Photographer Lois Hechenblaikner

This book shows us that Ischgl has always been the limbo – also in front of Corona

The Corona-Schwipps

The corona-crisis changes people. Studies to find out what we already know: That some people use alcohol as a means of stress reduction. And the Gfk Consumer research confirms that sales of alcohol has increased in the last few months. This information is hardly surprising, is it?

Now we have but beginning to be a Problem. Because, while we joked a few weeks ago is still grim, to be alcoholics, developed the corona of the crisis of the exception – for the duration of the condition. And so our self-imposed vacation lasted in the home office, suddenly, weeks instead of days, soon to be months rather than weeks – and probably even a whole year. Meanwhile, the habituation effect has crept not only in terms of living with the pandemic, but also with the glass of alcohol. Not true? Well, think about it, on how many days you the last two weeks have been drinking. Caught in the act.

“This is what I call super, if noticed at all,” says Dr. Peter Strate to calm down. He is the head doctor at the Asklepios clinic for dependence diseases in Hamburg-Ochsenzoll and know why people, including him and me – like to drink alcohol:

If you have Stress at work or with the kids, then alcohol is great for a subjective feeling of relaxation. You no longer to brood on it, to worry.

Also as said sleep medication the glass would help wonderfully – de facto, the night will quality of sleep but disturbed. And we Wake up whacked. Here Dr. Strate know a better Trick that could be a simple little distraction.

Distraction instead of alcohol

“When the usual compensatory mechanisms, such as Sport, come too short, the consumption of alcohol. If I have but enough of a distraction, then I can sleep well at night,” advises the doctor. So instead of the beer after a run around the Block. Noted.

In the morning at 7

Woman drinking beer at the wheel – while in the back of the school bus and the 32 children’s seats

But what if you give in to the alcohol? How can I protect in Corona times in front of a dependency?, I want to know from Dr. Strate. He told me his personal strategy: “I’ve learned from my work is that I have no Routine in the consumption of alcohol. The art is not to reward yourself with alcohol”. The food tasting him, even without the obligatory wine, beer is for relaxing anyway counterproductive – he would rather treat themselves to a Gin and Tonic. And then, also like to two.

How often is too often?

The crowd was by the way a second factor to the topic of addiction risk, as I have from Dr. Strate learn. Although the RKI should comply with the limit of daily maximum of 10-12 grams of alcohol per woman hardly, if more than a glass of drinking would. The crux of the targeted Intoxicate: “the Binge, however, is-Drinking should not take place more often than once a month”.

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How does it look with the drink without the noise? I’m asking Dr. Strate to the 5-2 scheme that I’ve heard: five days a week to stay sober, the two of you could drink alcohol. He laughs. Actually, the recommendation around was even different: a Minimum of two days a week, you should drink anything. One way or the other: Also this should prevent above all routines. Instead, Dr. Strate gives me a different mnemonic in the Hand. A warning to Corona times and in everyday life – was, “if you think first thing in the morning to the glass of beer or wine in the evening”. Phew, that was lucky. I only have to think of coffee another site, but at least taken care of.

Regularity, and amount of the two risk factors that remain to me in the head. Still, I’m relaxed from the phone call. “We can’t always practice, only resignation,” says Dr. Strate, in our conversation, mild. After all, life is to Enjoy there. Even at grandma’s 90. to drink times one over the thirst is normal – but would not be celebrated daily.

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How to stay safe in restaurants and cafes

Now we have fewer cases of COVID-19, and restrictions are lifting, many of us are thinking of rejuvenating our social lives by heading to our local cafe or favourite restaurant.

What can we do to reduce the risk of infection? And what should managers be doing to keep us safe?

COVID-19 is an infectious disease spread directly from person to person, carried in droplets from an infected person’s breath, cough or sneeze. If the droplets come into contact with another person’s eyes or are breathed in, that person may develop the disease.

Those droplets can also fall onto surfaces, where the virus can survive for up to 72 hours. If someone touches these surfaces, then touches their face, they can also become infected.

Eating out has led to several clusters

We know people around the world have become infected while eating out.

Back in late January and early February, three clusters of COVID-19 cases in China were connected to dining in a single restaurant. A total of 10 people became ill over the next three weeks.

The air-conditioning had apparently carried contaminated droplets from an infectious diner to nearby tables. This prompted the researchers to recommend restaurants increase their ventilation and sit customers at tables further apart.

In Queensland, more than 20 people connected with a private birthday party at a Sunshine Coast restaurant contracted the virus. Four were staff, the rest guests. We don’t know the source of infection.

Other outbreaks have been linked with restaurants in Hawaii, Los Angeles and a fast food restaurant in Melbourne.

The path to infection

Let’s consider the risk of infection from the moment you arrive at a restaurant or cafe.

When you open the door, you may have to put your hand on a door handle. If that handle has been touched by a person while infectious, they may leave behind thousands of individual virus particles. If you then touch your face, you run the risk of the virus entering your body and establishing an infection.

If you avoid the doorknob trap, you may pick up the virus when you take your seat at the table, by touching the chair or the tabletop. Again, if you touch your face, you are risking infection. Similarly, you risk exposure by touching the menu or the cutlery.

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When the waiter comes to take your order, they will likely enter your breathing space. This is usually considered to be a circular zone of about 1.5 metres around your body.

If the waiter is infected but not yet showing symptoms, you may be exposed to droplets containing the virus on their breath or the breath may contaminate the tableware in front of you.

Now, your food is delivered and there’s good news. The virus is not transmitted through food.

But wait. The air-conditioning can help the virus travel through the air from the infected person at the next table who has just choked on a crumb and is coughing uncontrollably.

Later, on a quick trip to the bathroom, you again open yourself to the risk of infection by touching the door and other surfaces. However, this trip allows you to take one very important step to prevent infection. You wash your hands with soap, taking care to hum Happy Birthday twice as you scrub and rinse.

Unfortunately, you fail to dry your hands thoroughly. Wet hands are much more likely to pick up microbes, so you may recontaminate your hands as you open the door and go back to your table.

When you go to pay your bill, you may be worried that cash may be a source of infection. While there were concerns about this initially, there is no evidence to date of any cases linked to handling money. Just in case, you use your credit card, but inadvertently transfer the virus to your finger as you type in your PIN.

On your way out the door, you not only pick up more virus from the doorknob, but transfer some of the ones on your hand in return, ready for the next unwary diner.

How can I protect myself?

There are some simple (and familiar) things you can do to protect yourself as venues reopen.

Keep washing and drying your hands, thoroughly and regularly. If you don’t have access to soap and water, use alcohol-based hand sanitiser. Wash or sanitise after handling money, touching surfaces, before eating and after visiting the bathroom. Avoid touching your face, including wiping your eyes or licking juice off your fingers. If you must touch your face, use hand sanitiser first.

Maintain a distance of at least 1.5 metres from other people, unless they are people you share close contact with.

Sit outside if you can. Direct transmission is much more likely indoors.

Finally, think about using a credit or debit card with a contactless transaction, rather than having to enter a PIN.

To avoid infecting other people, stay home if you have any symptoms or suspect you might have been in contact with a person who has tested positive.

What should cafes and restaurants be doing?

Regulations about the number of patrons allowed in cafes and restaurants vary between states and territories. But there are certain common rules of thumb.

First, tables need to be spaced at reasonable distances. This allows patrons to be outside others’ 1.5-metre breathing zones and also takes into account the potential effect of air conditioning.

While COVID-19 doesn’t appear to be spread through air conditioning systems, they do boost air flow. This means droplets may travel a little further than 1.5 metres. This spacing will also reduce the number of people in the venue at the same time.

Some venues overseas are using plastic screens to separate diners to try to reduce the risk of person-to-person spread. This should not be used as a substitute for correct distancing if there is sufficient space.

Tables and chairs need to be sanitised, using a chemical sanitiser such as diluted bleach, between patrons.

Cutlery and tableware cannot be left ready on the table. They must be stored to prevent contamination in the kitchen and brought to the patron with their meal. Afterward, they need to be cleaned and sanitised as usual.

Disposable cutlery should never be left out for self-service; it should only be provided with food or on request.

All frequently touched surfaces must be regularly sanitised—including door handles, refrigerator and freezer doors, taps, light switches, hand rails, PIN pads and touch screens.

Staff must maintain safe distances from patrons at all times and must never be allowed to work if they have respiratory symptoms or are suspected to have had contact with a COVID-19 positive person.

We need to be vigilant

Coronavirus cases in most states and territories are now very low. So, the chance of coming into contact with an infectious person is unlikely and is why restrictions are now gradually being lifted.

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The analysis of copper levels in blood facilitates diagnosis of Alzheimer’s disease

In biology, it is well-known that every living organism is triggered by the DNA that encodes various protein molecules, which in turn perform all the necessary biological functions, and it might seem that nothing else is needed to sustain the life of an organism.

However, where and how the energy comes from to synthesize complex molecules or, for example, to maintain the body temperature of complex organisms is unclear. It is known that the human body needs oxygen to produce energy, but the fact that all organisms need the trace element copper as a catalyst for safe consumption of oxygen is less known.

Head of the Research Group of Metalloproteomics, Professor Peep Palumaa, says, “Scientists, more specifically biochemists, have known about the importance of copper in human body for a long time, but even they do not know, for example, how this element reaches from our food to the right destinations, i.e. various copper enzymes.”

This pathway is not safe, because if copper ions (as effective catalysts) are uncontrolled, dangerous radical side reactions can be triggered in the presence of oxygen derivatives like superoxide and hydrogen peroxide, leading to oxidative stress and related diseases including atherosclerosis, various forms of cancer and neurodegenerative diseases, including Alzheimer’s and Parkinson’s disease. Oxidative stress can also lead to accelerated ageing of an organism.

An important environment through which copper ions are transported in the body is blood. The primary function of blood is to transport molecules and ions from the digestive tract to the tissues. The reverse process occurs in blood when excessive amounts of substances accumulate in the tissues that can become toxic to the body. There are many transport proteins that could presumably transport copper in blood, but data on real transporters and their copper-binding affinities have been very controversial so far.

The scientists of the Research Group of Metalloproteomics from TalTech Department of Chemistry and Biotechnology in cooperation with the Swedish pharmaceutical company Wilson Therapeutics AB investigated the proteins and ligands transporting copper ions in blood and their binding affinity. To this end, the research group developed a new approach based on liquid chromatography and ICP MS (a trace element analysis technique). The study showed that copper ions are primarily bound only to two proteins in the blood—about 75% to ceruloplasmin, which binds copper ions very strongly, almost irreversibly, and about 25% to serum albumin, which binds copper ions with picomolar affinity. In addition to proteins, a small proportion of copper ions are also bound to histidine and other free amino acids in the blood. The results of the study also demonstrated that the previously presumed copper transporter alpha-2 macroglobulin does not bind copper ions.

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