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Jun 27

Mental health awareness and innovation a silver lining? – JD Supra

The novel coronavirus pandemic has put a spotlight on the mental health of workers.

The crisis posed immediate and acute challenges for organisations and workers. In an extremely short period of time, we have all had to navigate periods of isolation and loss of social interactions, new ways of working, constantly changing health messages and much more. The situation is unprecedented in our lifetime. One silver lining of the crisis, however, seems to be an uptick in awareness about and action taken in relation to mental health in the workplace.

The government has recognised that Australians need additional resources and support to flatten the curve of a mental health crisis while tackling the virus and has implemented a number of measures to achieve this goal.

In the context of work, there has long been an obligation on organisations to ensure, so far as is reasonably practicable, the mental health of workers. Officers of organisations have a duty to take reasonable steps to exercise due diligence to ensure that the organisation complies with its health and safety obligations. Workers themselves also owe a duty to take reasonable care for their own health and safety, and to take reasonable care that their acts or omissions do not adversely affect the health and safety of others. Current guidance from SafeWork Australia points to several psychosocial hazards relating specifically to Covid-19 that need to be considered, including isolated work.

With this in mind, many organisations have stepped up their mental health and wellbeing programs and tailored them to the situation at hand during the Covid-19 lockdown, based on expert guidance and in consultation with workers. We have seen organisations implement some great initiatives including:

Here at Seyfarth, the firm has implemented a range of measures to combat isolation, stress and anxiety. For instance, partnering with the Resilience Project to deliver a 10 part digital wellbeing series. As employees of the firm, we have found the evidence based practical strategies about nutrition, exercise and stress extremely useful and will continue to apply them as normal life resumes.

As restrictions ease and the return to work process begins, many risks to health and safety may remain. Until there is a solution to the health crisis in the form of a cure or vaccine, those that can work from home will likely continue to do so and office spaces will not look or operate in the way they did previously. However, every workplace has a different risk profile. It will be important to adopt a risk management based approach and continue to innovate and tailor solutions to the needs of your workforce even as we return to normal work. We are excited to see how Australian workplaces continue to lean into this challenge.

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Mental health awareness and innovation a silver lining? - JD Supra


Jun 27

Developing the college football student-athlete, Part 1 – State Of The U

This is part 1 of a 2 part series on developing the college football student-athlete. I often use the terms that were started by Bill Connelly to describe the three-pronged process of a college football program: acquisition, development, and deployment. Acquisition would be recruiting (and that damn Transfer Portal). Development would be what were going to learn today- its power, movement, and psychology as well as sport specific skills. Deployment is the strategy used on game day.

A coach is supposed to be a teacher and mentor. As were all aware, in the cut-throat world of Division I College Football, mentorship is often transactional rather than transformational. The free labor is used rather than developed. The greater good is forgotten during the quest for fame and fortune. Its unfortunate. The idea of what a coach is supposed to be has fallen to the side, even at the youth levels (see: Friday Night Tykes or read about AAU baseball pitch counts).

If acquisition of talent (read more about acquiring the best players here) didnt matter Bud Elliot wouldnt have spent so much time on the Blue Chip Ratio, 247 Sports and other sites wouldnt have their level of traffic, and there wouldnt be rampant cheating in FBS recruiting. But acquiring the most talented doesnt always mean youre going to win, and if you are lucky enough to have talent overcome culture it wont be a sustained success.

To find The Best you need to have a vision of what the best looks like. What are your criteria? What do you want you team to look like, both on the field and off? When a head coach (or CEO) sits down to write their mission statement it has to mean something to them. From paper, to head, to heart. A head coach needs to define their Core Values and recruit players who match those CVs.

But its also the head coachs job to develop the talent they bring on campus from a high school prospect with potential into a college product, and hopefully an NFL draft pick (never hurts to be NFL U.). To truly be a coach and mentor, you have to be concerned with the mind, body and soul of the student-athlete. Many coaches focus on academics once players are on campus because of APR and public perception- but does it go further than a GPA?

Lets take a look at how to develop athletes off the field (weight room and meeting room) by first looking at what the game of football requires from a physical and energy system standpoint.

Football isnt the military. The consequences are as different as the training. The Navy SEALs dont believe you should train athletes the way you train SEALs and theyre right. You shouldnt. Its not the same and theres hardly a correlation. Do football players stay up for a week straight with little food or water under highest form of stress fearing for their lives every second of every day? Not most.

Also as much as I love using a variety of swear words at different volumes and cadences with ever changing creativity in use- saying them to or in front of someone is a lot different than saying them at someone. Coaches dont have to break them down or weed them out, we have to build them up and develop the whole athlete. Im not saying I havent MFed my share of people but you have to 1- admit you were wrong to the person and 2- work to grow and change.

Football is an anaerobic game played in the Phosphagen energy system. Im not damn scientist but what this basically means is that if the game is played in the PES, why would I try in the Glycolytic energy system or Aerobic oxidative energy system? You shouldnt. This is why Im so firmly against 300-yard shuttle runs, 110-yard sprints and jogging in general when it comes to football. Phosphagen exercises last 5-10 seconds. So typically, those would be 20-60 yard sprints, agility, COD, or sport skill specific workouts

For the coach that yells move move move! he or she is also not training for football re work to rest ratios. Football is played at a 1:7 work to rest ratio. Meaning that if a play lasts 5 seconds (as the average play does) and you rest 35 seconds (the typical rest interval between plays) then you should train with a 1:7 work to rest ratio, too.

Football, essentially, is a 5 second car crash played on one foot and/or with one arm, while off balance and distracted- followed by 35 seconds of standing around. When my players sprint or lift, they are expected to work disciplined and focused on that sprint, lift, or drill before taking a focused rest interval (notice I dont call it a break). We have to train it that way both in the weight room and on the field. If you need a conditioning test youre a shitty coach. Period.

Football also isnt a powerlifting competition nor a body building competition. Having bis and tris is a side effect of training, not something we prescribe into the workout. its something the athlete can do at home, but I dont have the time to program in curls or triceps extensions. Theyll come from pull-ups and other exercises we do program.

Tim Kights Focus 3 podcast is an outstanding resource to learn about being a leader in any type of organization but obviously through college football as a main focus. Hes aligned with THE Ohio State football program and their former coach Urban Meyer. Kights episode 49 on Mental Toughness is one of his best (you can listen above or by clicking here). Well get deeper into Mental Toughness later, but the keyword that comes up the most often is Confidence.

The most important part of being in the weight room is gaining confidence. Being a willing tackler is extremely rare in football. Its like punching someone in the face, everyone says they would do it but will you actually do it when the time comes? Probably not.

So where to begin? Most college off-season programs begin in January. Some programs bring athletes in and put them through a hell morning at 5am the first chance they get in January. Thats quite stupid, and counter-productive (see: jackleg former strength coach from Iowa who almost killed a dozen players). After a football season that hopefully rips from August through late December or even the new year, players are absolutely beaten down. Its like being through a dozen car crashes.

Instead of hell week, be an actual coach who does programming and cares about his/her talent. Recovery is the key to the first 2-3 weeks of a good off-season program. The S&C Coordinator will build a program around getting the players healthy and prepared to phase into the second part of the program which is absolute strength.

I would offer a movement test (and I dont mean running the 20-yard shuttle and the 40-yard dash) to see the flexibility and movement skills of players. Where theyre currently sore, injured, or deficient would be my focal point.

I am firmly against chasing numbers. However, there has to be a baseline strength acquired both by returning players and incoming freshmen. Louisiana Tech S&C Coach Kurt Hester believes that it takes a college athlete two weeks to regain their baseline strength for football. After baseline strength is met, I then begin to shift my focus from absolute strength to power and speed,

As previously said, the game of football is played on both feet (bilateral) or on one (unilateral) and with arms doing completely different actions (ex. shedding a block with the right while making a tackle with the left). So how do S&C coaches train athletes for sport?

Transfer effect. The key phrase is transferring your programming to sports. Not one sport, the weight room should really transfer to all sports. Name a sport specific lift... Im waiting. Now you may program volume and stress differently for different sports but the intensity or exercises themselves are the same.

My method for getting maximum power from athletes is a four day approach if Im lucky and a three day approach if Im not. Well discuss a four day approach here. First of all, no athlete should walk into a weight room after the season is over and just start doing power cleans, clean and jerks, and snatches. There is a system to follow and its progressive both in stress, volume and intensity.

As you can see above, my four day programming would be broken up into cleans, clean and jerks, snatches, and yoga (not shown but whatever). The progressive part is we will build our program from mastering green to yellow to orange to red to purple. We may never even do purple. It takes time and skill and at the high school level we rarely get there with more than 1-2 athletes.

We can progress, too, by taking one exercise and looking at how to start training the body. For instance, during early January recover a kettlebell goblet squat is a better idea than a front squat. Wrists are badly hampered after a season and we can slowly build to that point via unilateral lifts and yoga to get ready. The next progression would be a Zercher Squat. Then we would begin to Front Squat. This is a one month process. You have to have patience but its not like Im insisting on two years.

Far enough into the weeds at this point? Good. Now lets talk about unilateral lifts. Every workout needs to begin with a warm-up (typically a little movement before five body weight exercises), and I like to then transition into a corresponding series of unilateral lifts.

On a clean day, the unilaterals might be overhead forward lunges, 1-arm dumbbell bent rows, and 1-arm DB push presses. I will set a timer and they players will do 20 seconds on, 10 second rest interval on each side (ha and tha) before transitioning to the next exercise.

Then we get into the bilateral meat and potatoes. On a snatch day we might do snatch grip RDL, snatch grip shrug+pull (3 shrugs and then 3 pulls), a behind the neck (BTN) snatch grip press, before overhead squats. Thus, we are teaching the parts-of-whole every time we enter the weight room.

A more advanced clean workout might have clean grip dead lift, clean grip shrugs, clean grip pulls, barbell bent rows, and front squats. Again, the parts-of-whole. I dont even have to program the core exercise, and will NOT, if I dont feel were ready.

Just like I wouldnt walk out to practice and say, Hey, doot doot doot, go run dat power, fella! I wont say, Hey, go cleans you somethin, either. Im going to teach the kick out, down block, combo and QB/RB mesh for power just like Im going to teach the parts that make up the clean, clean and jerk, and snatch. Just like I would practice power in individual groups, then small group, then the whole offense I will practice the unilateral and bilateral work that accompanies a successful lift.

Psychology is a major aspect in Athletic Performance. From the more general idea of Sports Psychology and sports psychologists down to the smaller details such as character education, transformative coaching, and actual player development (not just a title that really means recruiting assistant).

In all aspects of life, you have to Maslow before you can do whatever it is youre truly attempting to do. What I mean by that is before you can Bloom (read: Teach) or Saban (read: Coach) you have to focus on the student-athletes Hierarchy of Needs. If your new recruit came from an environment with little room for food, water and sleep- theyre not okay. Such and so on up the list until football matters somewhere between Self-Actualization and No Where.

Unless youve done a horrible job of acquisition it shouldnt be a coachs priority to run off players. Thus, were talking about developing athletes into getting their peak performance. I can tell you that there is no learning to be done until the student-athlete (or just student) TRUSTS the coaching staff. The athletes have to believe that you care about them; they dont care what you know until they know you care- cheesy? cliche? Sure. Truth? Yes.

Love is spelled T-I-M-E. You arent going to gain the trust of your players unless you spend time with them. Sometimes that takes grabbing pizza, keeping an open door policy, or having a Madden Tournament. Sometimes that involves explaining your WHY to them and learning about their WHY. Once they trust you, then you can indoctrinate them with your culture.

Urban Meyers culture at Ohio State was in three parts: 1- relentless effort, 2- competitive excellence, 3- power of the unit. From there he has verbal cues the players can take with them. Everyone in his program knows 4 to 6, A to B, plus-2. Its mantra. Every week some character education lesson must be given that reinforces these Core Values.

A true player development coach would follow a student-athlete from initial recruitment through graduation and into their adulthood. They would offer access to job skills training, community counseling, and would be there to make sure players were retained and didnt leave after their freshmen year (common year for players to transfer and students to dropout).

If you have a coherent narrative, and know WHY you coach (purpose) then players will love and trust you. Once that attachment occurs the team can become a program and the program can become a system of culture and excellence.

Its in my professional opinion, as an outsider, that Miami does not have a strong culture in the locker room. Whether thats from observing the collapse in the past three bowl games, from hearing Manny Diaz say that there are culture issues himself, or reading between the lines on early departures to the Pros and the transfer portal open door... its fairly obvious.

In order to improve the culture three things have to occur:

1- The head coach needs to establish a coherent narrative. They must know their WHY and have their purpose, mission and vision in their heart and own it. They have to select Core Values and the Standards of Performance that create behaviors to support their mission.

2- The head coach must believe in that purpose and mission, and communicate it effectively in meeting rooms, on the practice field, in living rooms, on social media, on TV, and over team meals. Everything about that purpose needs to be delivered with clarity, confidence and conviction.

3- The acquisition of talent has to be done with Behavioral Skills and Culture Skills first, and Job Skills second. The head coach is going to have to pass on talent for someone who has a stronger cultural fit aka the best player for that program at that time. This will create a strong culture and locker room where then the head coach can take a risk on someone that doesnt fit the culture but is an elite athlete.

Stay tuned for part 2 of Developing the college football student-athlete.

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Developing the college football student-athlete, Part 1 - State Of The U


Jun 27

Standing Tall – POZ – POZ

Lillibeth Gonzalez, 65, celebrated her 28th HIVersary in early June by dancing in her New York City apartment and chatting with her son and her friends via Zoom. Having survived addiction, domestic violence and the AIDS-related deaths of three siblings, she is doing well today, but living with HIV for 28 years has taken its toll.

There are days I wake up feeling well, and there are days I wake up feeling like Im 90 years old, she says. The good part is that from zero [CD4] T cells, I was able to come up to 1,030, due to the medications. Im healthy enough to work and exercise. When I feel good, I do as much as I can.

People living with HIVnearly half are now 50 or olderare prone to a variety of health conditions as they age. Research has shown that HIV-positive people may experience problems such as cardiovascular disease and non-AIDS-related cancers as much as a decade earlier than their HIV-negative peers.

One of these problems is lipodystrophy, or abnormal body fat distribution. Although not limited to older people, the chances of developing lipo increase with age. These days, lipodystrophy is most often seen among long-term survivors who took older antiretroviral drugs with more side effectsand Gonzalez has taken plenty of them over the years.

Lipodystrophy is often accompanied by metabolic complications, such as diabetes, high cholesterol and hypertension, which raise the risk of cardiovascular disease and other health problems. Whats more, it can lead to emotional distress, reduced adherence to HIV treatment and poorer quality of life.

Gonzalez, who has worked as a community health educator at GMHC for 14 years, after starting out there as a client, struggles with a big belly due to lipo as well as persistent gastrointestinal problems, arthritis and brain fog. But she doesnt let that get her down.

I look at myself in the mirror, and I say, Oh my God! Im getting old! I feel like I look like the man in Despicable Me, with the big stomach and the skinny legs. Ive come to just laugh about everything because I do not want to stress out. Im happy to be 65 and alive. Aging is just something you have to deal with as it comes. My body reminds me every day that Im getting old, but my mind is keeping me young.

What Is Lipo?

Lipodystrophy is an umbrella term that covers both fat loss (known as lipoatrophy), especially in the face, limbs and buttocks, and fat accumulation (known as lipohypertrophy), especially in the belly and breasts. Lipodystrophy was once thought of as body fat redistribution, but it is now understood that these conditions are independentrather than reflecting a shift of fat from one area to anotherand have different causes.

While an individual may experience both, they are almost certainly separate processes, says Marshall Glesby, MD, PhD, a professor of medicine and health care policy and research at Weill Cornell Medical College in New York City.

A gaunt face with sunken cheeks was once a common sign of AIDS, attributable both to overall wasting and the side effects of certain early medications. Although these drugs are no longer widely used and are not recommended in the United States, the facial fat loss they caused may never be fully reversed.

The advent of protease inhibitors and modern combination antiretroviral therapy in the mid-1990s finally enabled people to maintain control of their HIV. But soon after the new drugs arrived, many people who took them started seeing unexpected new health problems, including unusual body shape changes.

People withHIVmay experience wasting as their immune function declines, followed by weight gain as they return to health after starting treatment. But HIV-related lipohypertrophy goes beyond that.

Some people with HIV experience a buildup of fat around the midsection that may have little connection with how much they eat or exercise. Both women and men may experience breast growth (known as gynecomastia when it occurs in men), or they may develop a fat pad on the upper back known as a buffalo hump. A combination of fat loss and gain can give the appearance of a potato on toothpicks.

Fortunately, lipodystrophy is not as common as it used to be. In particular, facial fat loss is seldom seen among people who promptly start treatment with modern antiretrovirals, before they develop serious immune deficiency.

Lipoatrophy is generally something that we see in people who were treated with older drugs like stavudine and zidovudine.It is rarely seen in people who have never been on these older drugs but is also not a problem that typically goes away, says Glesby. Lipohypertrophy, in contrast, is something that still occurs and in many cases may be similar to the abdominal obesity and metabolic syndrome that is relatively common in the general population.

In recent years, theres been a growing recognition that weight gainoften as much as several poundsis common among people starting treatment with modern meds. Black women living with HIV appear to be particularly susceptible. Although this can occur after starting any type of antiretroviral drug, integrase inhibitors and the newer form of tenofovir (tenofovir alafenamide, a component of Descovy and other combination pills) are frequently implicated.

But general weight gain and normal obesity are not the same as lipohypertrophy.

Fat buildup can occur in two different patterns, one of which is linked to more health risks than the other. Subcutaneous fat builds up beneath the skin, often around the abdomen, hips, buttocks and thighs. It is soft and squishy, hence the nickname love handles. People with mostly subcutaneous fat often have a pear-shaped body.

Visceral fat builds up inside the abdomen and surrounds the internal organs. This extra fat pushes up against the muscles of the abdominal wall, resulting in a taut, hard belly. People with mostly visceral fat typically have an apple-shaped body and a larger waistline in relation to the size of their hips. This type of fat can be harder to reduce with diet and exercise.

While obesity and lipo both lead to large abdomens, people with normal obesity usually have pinchable fat under the skin and rolls of soft fat on their belly. HIV-associated hypertrophy, in contrast, is distinguished by the kind of fat that causes a hard belly.

In some cases, fat buildup can be severe enough to cause pain, limit movement or interfere with sleep. A protruding hard belly is especially worrisome because of its link to other health problems, including heart disease. And along with its physical effects, lipodystrophy can also lead to emotional distress and loss of self-esteem. (Click here to read The Stigma of Lipo.")

This has changed my life in a terrible way, Gonzalez says. I used to model, so I was always a size 4 in clothing. But I saw my stomach growing and growing. The clothes that I liked didnt fit me. I didnt know how to shop for a size 10, 12 or even a 14. I got up to a size 14, but only because of my stomach. Its the only thing thats huge. My legs, hands and arms are slim.

What Causes Lipo?

Four decades into the HIV/AIDS epidemic, experts still do not fully understand the causes of lipodystrophy or the best ways to manage it.

Older individuals are more likely to develop lipo. Men are more likely to experience fat loss, while women more commonly have fat buildup in the belly or breasts. People who have lived with HIV or used antiretrovirals longer, those who have a high viral load before starting treatment and those with low CD4 countsespecially if they ever had advanced immune suppression with very low CD4sare also at greater risk.

In the case of lipoatrophy, the biggest culprits are first-generation nucleoside reverse transcriptase inhibitors, especially AZT (Retrovir or zidovudine) and d4T (Zerit or stavudine). These drugs are toxic to the mitochondria, the tiny energy-producing powerhouses in cells, and can damage fat cells known as adipocytes.

Fat buildup was initially blamed on early protease inhibitorsit was once dubbed Crix belly after Crixivan (indinavir), one of the first drugs in this classwhich can cause metabolic abnormalities that contribute to fat gain. But it soon became clear that this was not the whole story.

We do not fully understand the causes of lipohypertrophy, Glesby says. Unlike lipoatrophy, there are not clear associations with use of specific antiretroviral drugs or classes of drugs. There are multiple hypotheses about the causes.

HIV infection itself can lead to body fat changes. The virus can trigger chronic inflammation, raising the risk of health conditions including heart, liver and kidney disease. Inflammatory cytokines, or chemical messengers produced by immune cells, can alter metabolism in ways that promote fat buildup.

Fat doesnt just take up space in the body. Rather, it is active tissue that produces cytokines and hormones of its own. Hormones made by fat tissue include estrogen, adiponectin (which regulates glucose and fat metabolism) and leptin (which controls appetite). Some of the cytokines released by fat cells can cause further inflammation, which, in a vicious cycle, can lead to more fat buildup.

HIV-related lipo often goes hand in hand with other metabolic abnormalities, such as insulin resistance, diabetes, high cholesterol and hypertension, collectively known as metabolic syndrome. It has been linked to health problems ranging from cardiovascular disease to dementia as well as to a higher risk of death. Visceral fat can sometimes accumulate inside the liver and other organs. Over time, fatty liver disease can lead to cirrhosis and liver cancer.

HIV can also affect hormones. For example, it has been linked to lower production of growth hormone by the pituitary gland in the brain or reduced responsiveness to it. This hormone helps build muscle and break down fat, and low levels can lead to excess belly fat.

Some experts think the seesaw effect of immune system damage caused by HIV, followed by immune reconstitution after starting treatment, also contributes to lipodystrophywhich helps explain why it occurs more often in those who have had low CD4 counts. Alterations in the gut microbiome related to HIV or antiretroviral drugs may also play a role, according to Glesby.

In addition, genetic traits, lifestyle factors such as diet and exercise and being overweight or having normal obesity can affect the likelihood of developing lipodystrophy. But for reasons that remain unclear, many people with HIV who appear to be at risk never develop lipo.

Managing Lipo

Suppressing HIV viral load, getting CD4 counts back into normal territory and adopting a healthy lifestyle are great for overall health, but they may not fully reverse body fat changes due to lipo. Lost facial fat, in particular, can be very difficult to restore, leaving a lasting legacy for long-term survivors.

People starting antiretrovirals for the first time or switching regimens should have their body weight and fat distribution monitored regularly, as its easier to address lipo early rather than trying to reverse facial fat loss or belly fat buildup later.

The first step in managing lipodystrophy is a comprehensive checkup and discussion with your doctor. This can help determine which specific factors are contributing to your body fat changes and distinguish lipo from other conditions, including normal obesity. Your clinician will want to know about your HIV treatment history, diet, exercise, sleep, smoking, alcohol consumption and recreational drug use.

Your doctor will likely feel your belly to see whether its hard or soft and measure your waist and hips to calculate your waist-to-hip ratio. Having a bigger waistline relative to the size of the hips can be a sign of lipo. CT, MRI or DEXA imaging scans may help show how fat is distributed in the body.

Your clinician may run blood tests for metabolic or hormonal abnormalities. These include tests for blood sugar (glucose), lipids such as cholesterol and triglycerides, and certain hormones. An overactive thyroid can lead to weight loss, while a sluggish thyroid can cause weight gain. Cushing syndrome, caused by high levels of the stress hormone cortisol, can lead to body fat changes that look like lipo. These conditions can be treated with medications.

If youre taking older antiretrovirals that can cause lipoatrophy, you and your doctor may want to switch to newer medications with fewer side effects. This is often a good idea anyway, because modern meds are more convenient and may do a better job of controlling HIV. But while stopping problematic meds can halt further facial fat loss, it generally doesnt reverse existing lipoatrophy. And changing HIV regimens does not seem to have much effect on lipohypertrophy, according to Glesby.

Your provider will likely suggest lifestyle changes, such as improving your diet, getting more exercise, getting enough sleep and quitting smoking. A combination of regular cardiovascular exercise and strength training to build muscles is key. Experts recommend at least 30 minutes of moderate-intensity activity at least five times a week. Stick with a diet and exercise program for at least six months to give it time to work.

Dietary modifications and exercise are important as general health measures to reduce cardiovascular risk, and they may specifically have an impact on lipohypertrophy, though there is a shortage of good data on this, Glesby says. Those with access to a registered dietitian could benefit from devising a tailored, balanced diet to reduce calories.

However, lifestyle changes alone are often not enough to alleviate lipodystrophy. If thats the case, adding medical treatments might help.

The medications Egrifta (tesamorelin) and Serostim (somatropin) may be helpful, especially if lipo is related to low growth hormone levels.

The Food and Drug Administration (FDA) approved Egrifta in 2010 to reduce excess belly fat in HIV-positive people with lipodystrophy. Its self-administered as an injection under the skin of the belly, usually once daily. The newer formulation approved last year, Egrifta SV, is easier to prepare, does not require refrigeration and can be administered with a smaller needle.

Egrifta is a growth hormonereleasing factor analogue, meaning it mimics a natural hormone produced in the brain that triggers the release of growth hormone. Clinical studies showed that it reduced visceral hard belly fat by up to 18%, on average; some people have a better response than others. However, lost belly fat usually returns within a few months after stopping treatment. Recent research has shown that Egrifta can also reduce liver fat in HIV-positive people with non-alcoholic fatty liver disease, but it is not approved for this purpose.

I took the shots for about six months, and it helped, Gonzalez says. This is a treatment that you must continue taking for the rest of your life, and I dont know if I want to continue injecting my stomach for the rest of my life. My stomach was getting a little sore. So I changed my diet, and people are telling me that my stomach has gone down more. I exercise. And I might ask my doctor to prescribe Egrifta again.

The older drug Serostim is a synthetic version of growth hormone approved by the FDA in 1996 to treat HIV-related wasting. Studies suggest it may also reduce visceral abdominal fat. Like Egrifta, it is administered as a daily injection.

Other medications may be used to manage the metabolic problems that often accompany lipodystrophy and reduce the risk of cardiovascular disease and other health problems. For example, Glucophage (metformin) may be prescribed to control blood sugar, and statins may be used to lower cholesterol levels. Some studies have found that Glucophage may help reduce visceral belly fat as well.

For some people, surgical approaches may be the answer. For those with lipoatrophy, facial fillers may be used to fill out sunken cheeks and smooth deep smile lines. In some cases, a fat graft can be transferred to the face from another part of the body.

Sculptra (poly-L-lactic acid) and Radiesse (calcium hydroxylapatite) are injectable synthetic fillers that stimulate the body to produce collagen to fill in the empty space. Both are approved by the FDA for treating facial lipoatrophy in people with HIV. The effects of Radiesse are apparent right away, while Sculptra builds up over a few months and lasts longer, typically around two to three years. While these fillers are broken down by the body over time, Bellafill (bovine collagen plus a synthetic filler) is semipermanent.

Liposuction, which uses a suction technique to remove fat tissue, may be an option for reducing excess breast fat or a buffalo hump. But it is not a safe way to remove visceral fat deep within the abdomen.

Breast reduction surgery is another option for those whose breasts have swelled enough to cause pain or limit movement.

However, the cost of medications, fillers and surgery for lipo can be a barrier, as many insurers consider them to be cosmetic.

My doctor recommended Egrifta injections, but Medicaid did not approve them. I had to wait till I was over 65, when Medicare kicked in, Gonzalez says. Medicaid hardly approves anything, and its so difficult to find a doctor who accepts Medicaid. Thats why people are falling out of care, and it gets me very angry. I wish I could do something about this health system.

The manufacturers of Egrifta and Serostim offer patient assistance programs to help cover medication costs and insurance co-pays. Medicare covers Radiesse and Sculptra for people who experience depression due to HIV-related facial lipoatrophy. Some people have managed to obtain coverage for lipo procedures by having their doctor classify them as reconstructive.

Managing lipodystrophy can be challenging, and you and your doctor may have to try a variety of approachesor a combination of thembefore finding a solution.

Today, Gonzalez draws on her own experiences to help other people with HIV deal with the challenges of aging. Helping others is what helps me, she says.

Im on the long-term survivors page on Facebook. We discuss everything. I talk about my lipodystrophy and how Ive managed it, Gonzalez says. I advise them to make sure they have a great rapport with their health care team. Look for what is best for you. You are the client.

What I can tell long-term survivors is that if weve come this far, we can continue living a healthy, happy life, she continues. What I offer them is to maintain a healthy mind, body and soul. Its so important that you have a healthy spirit because your spirit is whats going to lead you.

Alicia Green assisted with reporting for this article.

Link:
Standing Tall - POZ - POZ


Jun 27

Boyertown senior center awarded $76,847 grant to buy new air-conditioning system – Reading Eagle

The state Department of Aging on Wednesday awarded a $76,847 grant tothe Center at Spring Street, Boyertown, to buy a new air-conditioning system.

We are so happy to receive the grant, said Charlene Wysocki, grants administrator for Boyertown Area Multi-Service Inc. a nonprofit providing services for seniors. The seniors like to get out of the heat and into the air conditioning.

Wysocki said the agency applied for the grant in November to replace the aging air conditioning in the 15-year-old building at 200 W. Spring St.

The seniors have not been doing any activities at the center since March due to the coronavirus.

However, she said, the center is providing 150 grab-and-go lunches daily on weekdays.

Wysocki said the center does not plan to reopen on Friday, when the county moves to the green phase of Gov. Tom Wolf's reopening plan.

She said the center is working with the county to ensure all proper protocols are in place to prevent the spread of the coronavirus before reopening.

We want to make sure we are doing everything the right way before we reopen, she said.

The Boyertown center was one of 60 community centers throughout the state to receive a total of $2 million in grants funded through the Pennsylvania Lottery.

Senior community centers play an immense role for older Pennsylvanians by assisting them with aging in place, Wolf said in a release. The grants will empower these centers to make their desired changes to further benefit regular attendees while attracting a new generation of participants.

Aging Secretary Robert Torres said as the country returns to a sense of normalcy, older Pennsylvanians may be eager to return to their local senior community centers for the activities they enjoyed prior to the stay-at-home orders.

There are more than 500 senior community centers throughout Pennsylvania that provide a variety of offerings, such as nutritious meals, educational opportunities, transportation services, financial and insurance counseling and exercise programs.

Read more here:
Boyertown senior center awarded $76,847 grant to buy new air-conditioning system - Reading Eagle


Jun 27

US Has Warned Azerbaijan Over War Games – Armenian Weekly

The State Department has warned Azerbaijan about the lack of transparency in large scale military exercises, but discounted Congressional Armenian Caucus assertions that the $120 million in U.S. military aid to Baku could be used against Armenia and Artsakh.

WASHINGTON, DC In response to a Congressional Armenian Caucus inquiry regarding Azerbaijans May 18-22 war games, the State Department, this week, revealed that it has warned Azerbaijan regarding its lack of transparency regarding large-scale military exercises, reported the Armenian National Committee of America (ANCA).

We welcome the news that the State Department has warned Azerbaijan over its large-scale military exercises and encourage increased U.S. vigilance against Bakus reckless arms build-up, military escalation, and cross-border attacks against both Artsakh and Armenia, said ANCA Executive Director Aram Hamparian. However, in light of President Aliyevs own stated intentions, the fungible nature of security assistance, and the resources that U.S. aid frees up in Bakus military budget, we do take strong issues with the patently false assertion that the $120 million U.S. aid package to Azerbaijan does not violate Section 907 by contributing to its offensive capabilities. The U.S. military aid package to Azerbaijan represents a clear cut violation of Section 907.

The June 23rd Department of State letter, signed by Assistant Secretary for Legislative Affairs, Mary Elizabeth Taylor, states that The United States has conveyed its concerns to Azerbaijan previously about the lack of transparency regarding large-scale exercises and will continue to highlight with Azerbaijan, bilaterally and at OSCE meetings, the importance of complete and timely notification of military activities in accordance with VD11 commitments, particularly annual notification of at least one exercise or activity in the absence of any that exceed Chapter V thresholds. However, the letter notes that after reviewing the available information, to date the United States has not determined that the Azerbaijani military exercises that concluded on May 22 at any point exceeded VD 11 notification thresholds.

Further still, the letter discounts concerns about the possible use U.S. military assistance to Azerbaijan against Armenia, stating, The United States reviews such assistance thoroughly to ensure it will not undermine or hamper ongoing efforts to negotiate a peaceful settlement between Armenia and Azerbaijan and will not be used for offensive purposes against Armenia.

Congressional Armenian Caucus Co-Chair Frank Pallone (D-NJ) disputed that assertion in a May 20th letter, addressed to both the State Department and Pentagon, that raised alarms about Bakus reckless escalation during the global COVID-19 pandemic. The aid appears to have allowed Azerbaijan to shift resources toward offensive capabilities and further threaten Armenian lives and regional stability as the Co-Chairs of the Congressional Caucus on Armenian Issues warned in letters sent to you in September and November of 2019. We cannot allow Azerbaijan to use the global coronavirus pandemic as cover for these dangerous military operations, stated the Congressional Armenian Caucus letter, which, in addition to Rep. Pallone, was cosigned by Congressional Armenian Caucus Co-Chair Jackie Speier (D-CA), Vice-Chairs Gus Bilirakis (R-FL) and Adam Schiff (D-CA) and Representatives Judy Chu (D-CA), Katherine Clark (D-MA), Jim Costa (D-CA), T.J. Cox (D-CA), Anna Eshoo (D-CA), Raja Krishnamoorthi (D-IL), James Langevin (D-RI), Carolyn Maloney (D-NY), Grace Napolitano (D-CA), Linda Sanchez (D-CA), Albio Sires (D-NJ), Tom Suozzi (D-NY), and Juan Vargas (D-CA). A separate letter on this same subject was sent to the OSCE Minsk Group Co-Chairs.

Azerbaijans Armed Forces held large-scale offensive tactical military exercises from May 18th to 22nd, featuring, according of official announcements, massive artillery, air, and high-precision weapons. The Armenian Defense Ministry condemned the exercises noting that they exacerbate the security environment in the region, under the conditions of a global imperative for joint actions against the COVID-19 pandemic and despite the call for UN Secretary-General Antonio Guterres to establish a global ceasefire.

In May of this year, the ANCA issued an online call to action urging Americans to contact Congress to raise concerns that Baku risks starting a regional war amid a global pandemic with these actions and ongoing sniper attacks along the Artsakh and Armenia lines of contact.

The full text of both letters is provided below.

#####

State Department Response to Congressional Armenian Caucus Letter Regarding Azerbaijani Military Exercises

June 23, 2020

The HonorableFrank Pallone, Jr.House of RepresentativesWashington, DC 20515

Dear Mr. Pallone:

Thank you for your May 20 letter regarding military exercises conducted by the Republic of Azerbaijan from May 18-22, 2020. As a co-chair of the Organization for Security and Cooperation in Europe (OSCE) Minsk Group, the United States remains strongly committed to helping the opposing sides achieve a lasting, peaceful settlement to the Nagorno-Karabakh conflict, based on the Helsinki Final Act principles of refraining from the threat or use of force, the territorial integrity of states and the equal rights and self-determination of peoples.

Maintaining stability along the Line of Contact separating Armenian and Azerbaijani forces, as well as the Armenia-Azerbaijan international border, remains a key focus of the Minsk Group Co-Chairs discussions with the sides. In their recent public statements and ongoing consultations, including video conferences with the Armenian and Azerbaijani Foreign Ministers April 20-21, 2020, and May 18-19, 2020, the United States and other Minsk Group Co-Chairs stressed the importance of observing the ceasefire strictly and refraining from provocative actions in the current environment. They also called on the sides to take concrete measures to reduce tensions further. U.S. officials in Washington and in the South Caucasus region also have emphasized these points directly with Armenian and Azerbaijani interlocutors.

The United States is a strong proponent of adherence to arms control agreements and arrangements, including the commitments set out in the 2011 Vienna Document on Confidence- Building and Security-Building Measures (VD11). The value of arms control agreements and arrangements is diminished if participating States do not implement their obligations and commitments fully. After reviewing the available information, to date the United States has not determined that the Azerbaijani military exercises that concluded on May 22 at any point exceeded VD 11 notification thresholds. The State Department, in coordination with the Department of Defense, will continue to address any concerns regarding the actions of partners and co-participants in such agreements and arrangements through diplomatic engagement and will detail its findings in the Report on Adherence to and Compliance with Arms Control, Nonproliferation, and Disarmament Agreements and Commitments, submitted to Congress annually pursuant to 22 U.S.C. 2593a. The United States has conveyed its concerns to Azerbaijan previously about the lack of transparency regarding large-scale exercises and will continue to highlight with Azerbaijan, bilaterally and at OSCE meetings, the importance of complete and timely notification of military activities in accordance with VD11 commitments, particularly annual notification of at least one exercise or activity in the absence of any that exceed Chapter V thresholds.

The United States attaches great importance to strengthening its partnerships with both Armenia and Azerbaijan. These partnerships have advanced U.S. national security priorities, including the Resolute Support Mission, where Armenian and Azerbaijani forces serve alongside NATO forces in Afghanistan and for which Azerbaijan provides critical overflight access. The DoD maritime and border security cooperation programs with Azerbaijan, funded through a U.S. Building Partner Capacity program, are in the national interests of the United States, Azerbaijan, and other partners in the region as these borders are areas of significant concern for potential movement of terrorists, weapons of mass destruction, illicit narcotics, and other unlawful trafficking. Moreover, these programs increase Azerbaijans capability to counter threats to its critical energy infrastructure, which provides a critical alternative to Russian and Iranian energy resources for Western markets. The United States reviews such assistance thoroughly to ensure it will not undermine or hamper ongoing efforts to negotiate a peaceful settlement between Armenia and Azerbaijan and will not be used for offensive purposes against Armenia. These program activities do not occur at or near the international border between Armenia and Azerbaijan or the Line of Contact. The nature of the training and equipment provided (e.g., radars, patrol boats, diving gear, x-ray scanners, underwater surveillance, and visit, board, search, and seizure capabilities), is such that it does not contribute to the offensive capabilities of Azerbaijan and cannot be misused to threaten Armenia or regional stability.

The people of the region deserve to live in peace and security. The U.S. commitment to helping the sides achieve a lasting, peaceful settlement to this long-standing conflict is resolute, and we will remain actively engaged through the Minsk Group process.

We hope this information is helpful to you. Please let us know if we may be of further assistance.

Sincerely,

Mary Elizabeth TaylorAssistant Secretary of StateBureau of Legislative Affairs

=======================

Text of Congressional Letter to Secretary of State Pompeo and Secretary of Defense Esper

Dear Secretaries Pompeo and Esper:

We are gravely concerned about the military exercises reported to be held by the Republic of Azerbaijan from May 18 to 22, 2020. These exercises are dangerous, violate diplomatic agreements and have the potential to destabilize security in the South Caucasus at a time when the COVID-19 global pandemic has taken hundreds of thousands of lives and threatened the health of many more. We strongly urge the Department of State and the Department of Defense to condemn these egregious actions taken by the Azerbaijani military.

Even in normal circumstances, these exercises would be unacceptable due to their offensive nature and the failure to follow diplomatic notification practices. On May 14, the Azerbaijani Defense Ministry released information describing military exercises that would take place from May 18 to 22. Azeri reports state that the exercises are expected to include 10,000 servicemen, 120 artillery and armored vehicles, 200 missile systems, 30 aviation units, and various unmanned aerial vehicles. The failure to provide adequate notification as prescribed under the 2011 Vienna Document and the size of the exercises demonstrates Azerbaijani President Aliyevs intention of further aggravating historical tensions with the Republic of Armenia and Nagorno Karabakh.

We are especially concerned that over $100 million in security assistance the United States has sent to Azerbaijan over the last two years through the Section 333 Building Partner Capacity program has emboldened the Aliyev regime. This taxpayer funding defies almost two decades of parity in U.S. security assistance to Armenia and Azerbaijan. The aid appears to have allowed Azerbaijan to shift resources toward offensive capabilities and further threaten Armenian lives and regional stability as the Co-Chairs of the Congressional Caucus on Armenian Issues warned in letters sent to you in September and November of 2019.

We cannot allow Azerbaijan to use the global coronavirus pandemic as cover for these dangerous military operations. We urge you to immediately condemn the reckless actions of the Azerbaijani military and to work with our allies and international partners to halt the provocative actions being taken by the Aliyev Regime.

We look forward to your prompt reply to this request.

Sincerely,

The Armenian National Committee of America (ANCA) is the largest and most influential Armenian-American grassroots organization. Working in coordination with a network of offices, chapters and supporters throughout the United States and affiliated organizations around the world, the ANCA actively advances the concerns of the Armenian American community on a broad range of issues. To learn more, visit http://www.anca.org.

See the article here:
US Has Warned Azerbaijan Over War Games - Armenian Weekly


Jun 27

The latest on the coronavirus outbreak for June 25 – CBC.ca

Canada's proportion of COVID-19 deaths in long-term care double the average of other countries, study shows

A new study found the proportion of Canadian COVID-19 deaths that have occurred in long-term care facilities is about twice the average of rates from other developed countries. The analysis released Thursday by the Canadian Institute for Health Information (CIHI) provided a damning snapshot of senior care as of May 25, when long-term care residents made up 81 per cent of all reported COVID-19 deaths in the country compared to an average of 42 per cent among all countries studied.

The data compares Canada's record to that of 16 other countries in the Organization for Economic Co-operation and Development (OECD). The proportion of long-term care deaths ranged from less than 10 per cent in Slovenia and Hungary to 31 per cent in the United States to 66 per cent in Spain. At 5,324, the reported number of long-term care deaths in Canada was near the average but data varied widely among countries: from 28 in Australia to 30,000 in the U.S., with more than 10,000 in France, Italy, Spain and the United Kingdom. Researchers point to limitations that prevent some comparisons countries vary in COVID-19 testing and reporting practices, and in their definition of long-term care. In addition, COVID-19 cases are often under-reported and in the case of Italy, data was available from only 52 per cent of the nursing homes operating in the country.

Nevertheless, Tracy Johnson, CIHI's director of health systems analysis and emerging issues, said the data offers valuable insight into a tragedy many families, caregivers and residents have been trying to illustrate since the pandemic began. Johnson said countries that implemented additional long-term care precautions at the same time as standard stay-at-home orders including Australia, Austria and Slovenia had fewer long-term care infections and deaths. Johnson said the findings suggest such measures could be key to mitigating the impact of a possible second wave but for now, she notes several of Canada's hardest-hit facilities are still grappling with the devastating fallout of existing infections. "Even if all of these [measures are instituted], there will be other folks who will die because some people are infected right now, still, and the outbreaks are still ongoing," she said. "Some of the control measures though will probably help to at least keep the rates the same as they are."

The contrast in long-term care deaths is even more stark between provinces and territories, according to the report, which notes long-term care deaths represented more than 70 per cent of all COVID-19 deaths in Quebec, Ontario and Alberta and 97 per cent of all deaths in Nova Scotia. There were none in Newfoundland and Labrador, Prince Edward Island, New Brunswick and the territories at the time of the study. Two long-term care residents have since died in New Brunswick. Dr. Roger Wong, clinical professor of geriatric medicine at the University of British Columbia, said the numbers are "very concerning" and point to long-standing systemic problems that include inadequate staffing and resources and inconsistent standards. "There needs to be a fundamental reprioritization, focusing attention and resources, time and effort into the sector right away. Because I can tell you that what COVID-19 has shown us in terms of a major lesson is a fragmentation [of] seniors' care," said Wong, who is part of a federal task force working on national recommendations on how best to help long-term care homes battle COVID-19.

Following the report's release, Prime Minister Justin Trudeau floated the idea of bringing in national standards and reopening the Canada Health Act to address some of the vulnerabilities the pandemic has exposed in long-term care homes while accusing provincial governments of having "failed to support seniors." "I think one of the things that is very clear is our current system of supporting seniors across this country has not worked," Trudeau said. "What this recent report has shown, and quite frankly what this pandemic has shown from the very beginning, is that the job isn't being adequately done in long-term care centres across the country." Long-term care homes fall under provincial jurisdiction, but the prime minister said the federal government is willing to work with the provinces to address the problems in long-term care. The issue likely will be raised this evening during the weekly call between the prime minister and the premiers.

Click below to watch more from The National

Quebec stops publishing daily COVID-19 data despite leading country in number of cases

Quebec's Health Ministry said it will only provide weekly reports about COVID-19, rather than providing a daily rundown of the situation. The Health Ministry and the province's public health institute, INSPQ which had also been publishing daily updates will only publish the data on their respective websites every Thursday, the first of them being July 2. The ministry will also be sending out a news release with the figures on that day every week.

The move from daily to weekly updates appears to make Quebec the province to be providing data less frequently than any other Canadian province, despite leading the country in number of cases. Prime Minister Justin Trudeau addressed the change in his daily news conference on COVID-19, saying it's up to each province to decide how transparent it needs to be. He also said that Quebec still has a "significant number of cases" every day, and a significant number of deaths every day. "I certainly hope that Premier [Franois] Legault would continue to be transparent and open with Quebecers and indeed with all Canadians as he has been from the very beginning," Trudeau said.

The decision was first announced in a news release on Fte nationale, the province's annual holiday. In a follow-up email, Marie-Claude Lacasse, a Health Ministry spokesperson, said the "decision was made due to the evolving epidemiological situation, which is stabilizing." The government announcement appeared to take the INSPQ off guard. A notice on its website Tuesday said it would begin limiting its updates to weekdays only, rather than seven days a week. But on Thursday, following the Health Ministry's announcement, it said it, too, would only provide a weekly update. A spokesperson referred any questions to the Health Ministry. The number of daily cases and deaths in Quebec has declined in recent weeks, and the government has allowed most businesses to reopen, including restaurants, gyms and shopping malls, but bars remain closed.

Read more about what's happening in Quebec

U.S. watchdog details COVID-19 response failings

Incomplete and inconsistent testing data reported by the Centers for Disease Control and Prevention make it more difficult to know the COVID-19 infection rate in the United States and take informed decisions on reopening communities, a U.S. government watchdog said. The report issued by the Government Accountability Office on Thursday marked the first review of the U.S. government's response to the coronavirus pandemic, and made recommendations to lawmakers how to improve the fight to come out of the crisis.

The report detailed difficulties the Internal Revenue Service (IRS) had in determining individual eligibility for stimulus cheques. The challenges included delivering payments to those who did not file tax returns the past two years as well as those without bank accounts or with limited internet access. Crucially, the report said, the Treasury Department rushed to get stimulus cheques out and did not avail itself to third-party data such as death records maintained by the Social Security Administration that the IRS in ordinary times utilizes. "According to the Treasury Inspector General for Tax Administration, as of April 30, almost 1.1 million payments totalling nearly $1.4 billion US had gone to decedents," the report said. Additionally, "the absence of complete and consistent COVID-19 testing data reported through May 31, 2020, has made it more difficult to track and know the infection rate, mitigate the effect of infections and inform decisions on reopening communities."

The level of transparency around U.S. government spending to fight the pandemic has been a contentious issue between various watchdogs and government agencies. According to the watchdog, the U.S. government has set aside $2.6 trillion worth of spending to fight the pandemic, but spending so far is unknown as all agencies are not required to report their expenditures until July 2020. The report also said the country is missing a national aviation-preparedness plan for infectious diseases; as part of its recommendations to U.S. lawmakers, the watchdog said it is urging them to take legislative action to require the Transportation Department to work with others to develop a national plan. It also criticized the Small Business Association for failing to give detailed descriptions of loans made in its data, and not outlining plans to review loans worth less than $2 million. "SBA to date has failed to provide information critical to our review," the watchdog said.

Read more about what's happening in the U.S.

Students can earn up to $5,000 this summer for volunteer service amid pandemic

The federal government launched a new program today aimed at encouraging students to volunteer in the fight against COVID-19 more than two months after first announcing it, and just in time for those who haven't been able to find a summer job. Post-secondary students will be eligible to earn up to $5,000 this summer through a new volunteer service grant.

The Canada student service grant is available for a range of volunteer work, including mask making, tutoring, researching animal behaviour and designing exercise programs for seniors. The grant will be worth between $1,000 and $5,000, depending on the number of hours completed. For every 100 hours worked, a student is eligible for $1,000, which means someone must volunteer 500 hours to receive the full grant. The program opens today and runs until Oct. 31, 2020. Only students and recent graduates 30 years old and younger can enrol; applicants must be enrolled part-time or full-time in a recognized post-secondary education program in the spring, summer or fall of 2020, or must have completed post-secondary studies in December 2019 or later.

Back in April, Prime Minister Justin Trudeau announced the creation of the Canada student service grant a way of giving students who can't find summer jobs a chance to earn some money while volunteering in "national service" activities related to fighting the pandemic. The grant program was part of a multi-pronged, $9-billion investment by the federal government to cushion the economic impact of the pandemic on young people. Ever since, students and organizations that rely on volunteers have been anxiously awaiting details, worried that the window for their summer activities was rapidly narrowing. Today's launch of the "I want to help" https://www.jobbank.gc.ca/volunteer online platform provides details on the grant.

Read more about the program

How Canada could avoid a 2nd wave of COVID-19

The first wave of COVID-19 is subsiding in Canada, with daily case numbers and hospitalizations falling to rates not seen since the beginning of the pandemic. Predictions on when a second wave of COVID-19 could hit have ranged from the fall and winter months of this year when flu season traditionally starts to early next year, similar to the way the pandemic began, writes CBC's Adam Miller. But experts say the likelihood of a second wave isn't set in stone, and Canada could instead see several smaller waves in the coming months or avoid a second wave altogether especially if we keep our guard up.

"There's actually nothing preordained about a second wave," said Steven Hoffman, director of the Global Strategy Lab and a global health law professor at York University in Toronto who studies pandemics. "We might have a second wave, we might have a third, fourth and fifth wave we might not have a second wave at all." Dr. Isaac Bogoch, an infectious disease physician and scientist with Toronto General Hospital, said instead of one cohesive second wave, we'll likely face smaller outbreaks in the coming months that will need to be clamped down on quickly. "We're basically going to be trying to rapidly identify small outbreaks as soon as possible, quelling those small outbreaks and preventing them from snowballing into larger outbreaks and a larger epidemic," he said.

The largest risk factor for another wave of infection is connected to the fact that most Canadians are susceptible to COVID-19 simply because they haven't had it. Canada's Chief Public Health Officer Dr. Theresa Tam said almost 2.5 million Canadians have been tested for COVID-19, with an average of about four per cent testing positive and more than 100,000 confirmed cases. "We have very small penetration of this disease in our society," said Raywat Deonandan, a global health epidemiologist and an associate professor at the University of Ottawa. "That means the vast majority are still susceptible, and if they are susceptible, then it doesn't take a whole lot for something to trigger another explosive growth." For that reason, Deonandan said there is a mathematical probability that another wave of infection is possible, but it may be less severe based on what we've learned about how to control the virus in the past six months.

St. John's fitness instructor finds international success from her basement during pandemic

Gill Whelan had long thought about crushing the barriers to fitness classes by moving online. It took the COVID-19 pandemic to push her to do it. Now the St. John's fitness instructor is thriving from the comfort of her own home, with a following of more than 700 clients and no plans to change it up if and when COVID-19 is a thing of the past.

"The pandemic just allowed me the time to create the content and push it out there," Whelan told CBC News. While gyms in Newfoundland and Labrador are allowed to open as of today, when the province moves to Alert Level 2 of the phased economic reopening, Whelan said some people who fear the virus will inevitably not come back at all. There are also the regular barriers to joining a gym scheduling, social anxiety and cost.

She realized very early in her online venture that people enjoy working out from the comfort of their own home. "I told myself, if I could get a good group of 20 people to work with me in this fashion, it would be a huge success. But in the first month we had 120 participants." The following quickly grew to 700 people from all across Canada, some in the United States and the United Kingdom. Whelan livestreams her class on Zoom at 6 a.m. NT, and has about 250 people join her each morning. The classes are then posted on a private Facebook group where the rest of the members can access it throughout the day.

Read the full story about the online classes

Send us your questions

Still looking for more information on the outbreak? Read more about COVID-19's impact on life in Canada, or reach out to us at covid@cbc.ca.

If you have symptoms of the illness caused by the coronavirus, here's what to do in your part of the country.

For full coverage of how your province or territory is responding to COVID-19, visit your local CBC News site.

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Read more from the original source:
The latest on the coronavirus outbreak for June 25 - CBC.ca


Jun 15

I tried Chloe Ting’s 2-Week Shred Challenge so you don’t have to – The Post

Believe me when I tell you: I hate working out. I find it so tedious, especially trying to come up with a routine that targets what I want to work on without making me feel bored day after day. Ive tried several different methods, but nothing seems to keep my motivation alive.

I heard a lot of people trying Chloe Tings workout programs. For those of you who dont know, Chloe Ting is an Australian trainer who posts free workout programs on her YouTube channel. By visiting her website, people can choose challenges like the four-week shred, 25 day hourglass, five weeks booty or three weeks lean arms. Once I heard about the trending workouts, I decided to give it a try.

I chose one of the shorter, more intense workouts to start: the two-week shred challenge. Now Ive tried fad workouts before, but Ive never seen any results. I will admit this is partially because of my body type but also because Ive never seen a fad workout that had impactful results.

Chloe Tings two-week shred is one that I would actually recommend. The program never takes more than an hour per day and sometimes is as short as 25 minutes. Not only is it not a huge time commitment, but there are actually good results. After just two weeks of no more than four videos per day, I see definition in my abs and an overall more toned image of my entire body.

Two of the videos, you do consistently every day. The first is a full body HIIT workout that lasts about 13 minutes, and the second is an ab workout that lasts about 10 minutes.

Other workouts are rotated throughout, like the lower body workout that targets your butt and your legs, and the arms and core workout. Theres also another ab workout called 11 line abs that works on definition and even an Ariana Grande abs video that pairs music with exercise.

The workouts are not (I repeat, not) easy for someone who is out of shape. Thats how I started: completely out of shape and needing multiple breaks throughout the workout. I will say, as the days continued, they got somewhat easier. Whats important is to make sure you are eating well and getting good rest because without both of those, the workouts will continue to be extremely difficult on your body.

The best part about Chloe Tings two-week shred is not the physical results, but the mental ones. I feel so good about myself and my health after just two weeks. I feel like Im doing something thats pretty easy and non-time consuming that makes me stay active and healthy. In addition, the discipline I had to practice to keep up with the workout program over two weeks was very helpful in my everyday life and satisfying to know I accomplished that goal. My physical results were small, but my mental results were everything.

If you dont want to just take my word for it, here are some YouTube videos of girls with all different body types trying Chloe Tings workouts and the results they found:

@rileyr44

rr855317@ohio.edu

Originally posted here:
I tried Chloe Ting's 2-Week Shred Challenge so you don't have to - The Post


Jun 15

Senior Living Industry Confronts New Infection Control Reality – Senior Housing News

Infection control procedures in senior living have come under intense scrutiny during the coronavirus pandemic.

With the immediate crisis and response in the rearview mirror, providers are now turning to keeping their communities safe for the long haul, and are applying the lessons learned responding to the virus as states across the country gradually reopens.

Tighter infection control procedures will be paramount moving forward, because the virus shows no signs of being eliminated and new Covid-19 hotspots are emerging in states that were not initially impacted by the virus or were slow to implement shutdowns. Fourteen states and Puerto Rico recently recorded their highest seven-day averages of new Covid-19 cases since the pandemic started, according to Washington Post data analysis.

Additionally, providers must ensure that communities are in compliance with federal and state infection control guidelines. Those state protocols, however, vary widely, according to a May report from The Journal of Post-Acute and Long-Term Care Medicine (JAMDA). Thirty-two states list infection control as a training component for staff in residential care and assisted living facilities, but the requirements vary by state.

Ten states include language in their infection control policies specifically surrounding epidemics and reporting disease outbreaks to state and local public health departments. Six states directly reference general resident isolation practices for communicable diseases within their infection control policies, and only Massachusetts and Oregon have pandemic preparedness included in their infection control guidelines.

Having responded quickly to the pandemic, Asbury Communities plans on maintaining vigilance for the foreseeable future, Senior Vice President of Health Care Services and Operations Henry Moehring told Senior Housing News. The Frederick, Maryland-based nonprofit operator operates eight CCRCs in Maryland, Pennsylvania and Tennessee.

[Our] vigilance is still very strong and needs to be strong, he said.

Denver-based Solera Senior Living recently enlisted a third-party partner to help draft and implement infection control policies, with an eye toward balancing resident safety and engagement.

Asbury responded quickly to the pandemic because it was able to adapt its communicable disease outbreak plan, which includes guidelines for isolating one or more residents testing positive for a virus, identifies residents and caregivers who have been in close contact with those infected, and institutes protocols for securing entry points, community areas and shared amenities.

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Asbury aggressively communicated the need to practice social distancing, proper hand washing, the importance of wearing masks and especially staying at home to its residents and staff.

This has resulted in positive results around compliance with procedures, as well as an increase in self-regulation among frontline staff on proper wearing of personal protective equipment (PPE).

As time has gone by and the states are relaxing some of their restrictions, we find we still have stringent guidelines from CMS around skilled nursing appropriately, [as well as] around assisted living, and we continue to to hold those barriers up pretty high to protect those residents that are the most vulnerable, Moehring said.

Protocols such as hand washing have always been an important part of infection protocols, and will certainly continue to be prioritized going forward, Pathway Health Director of Education Sue LaGrange told SHN. Based in Lake Elmo, Minnesota, Pathway Health provides management and consulting services to clients in the long-term and post-acute care industries.

What has changed since the pandemic disrupted the industry are some of the directions for optimizing PPE, due to supply and demand imbalances.

Some facilities have been able to access an adequate supply of PPE, [but] there are still facilities that are using alternatives because when this pandemic started, they started with conventional [safety equipment], and then went to contingency, and then went to crisis, LaGrange said.

Asbury is ensuring that all of its communities have adequate PPE stock. Last year, the operator hired Jeremy Leonard as its supply chain program director. He sits in on Asburys daily system-wide Covid Call which is the Covid leadership team at the home office and the community leadership teams, gauging what each facility needs in PPE, tracking down suppliers, and shifting inventory between communities if necessary to ensure proper levels.

In its focus on maintaining greater PPE stockpiles going forward, Asbury is not alone. Louisville, Kentucky-based Atria Senior Living which operates 216 communities has even secured a warehouse to serve as a distribution hub.

Asbury is also storing specific medical equipment across its buildings, based on use and need, and is cleaning and disinfecting equipment according to CDC and manufacturers guidelines. This ensures rapid deployment when needed, and minimizes the risk of cross-contamination.

As the pandemic has settled into a period of relative stability, Asbury has been able to obtain new medical supplies, which will be vital for testing residents, staff and visitors moving forward.

Reopening protocols, like infection control procedures, also vary widely by state. As a result, providers will err on the side of caution when relaxing access restrictions, and determining what amenities will reopen. Facility lockdowns have exacerbated feelings of isolation and loneliness among senior housing residents these past few months, and providers are cognizant that communal amenities, dining and other group outings are as much social endeavors as functional. Walking a line between wellness and health is critical moving forward.

Asbury is practicing social distancing with its residents for group activities as the pandemic persists, and has limited dining to room service. As more states progress with their reopening plans, the provider is partnering with foodservice vendor, Sodexo, on a review of its dining operations to determine how to reopen dining rooms in a safe manner. The provider has also switched to HEPA filters in its HVAC systems, in hopes of reducing the transmission of viruses through air ducts.

Were looking at the layout of our dining rooms, the [feasibility of] buffets. In the short term, you probably wont see them again, just because of the risk, Moehring said.

In addition, Asbury is ramping up testing of staff, residents and essential visitors to establish baselines of its communities exposures to the virus, which will in turn inform the decisions on what parts of its campuses to reopen.

Weve seen success with things like outdoor activities [and] exercise programs where youre limiting the group, people are wearing masks and you have them physically spaced out. Those are the things that we can build on, he said.

Other providers are turning to third parties to ramp up their infection control protocols. Solera Senior Living enlisted the services of a group, The Covid Consultants, a group of infectious disease doctors and nurses based out of Rose Medical Center in the companys home base of Denver, Solera CEO Adam Kaplan said during a recent appearance on SHN TALKS.

The Covid Consultants conducts site visits of businesses, assesses weaknesses and pain points in a building and operations, establishes guidance for safe reopenings, executes the plan and follows up with clients to update the plans with new CDC and state guidance as it becomes available.

For Solera, outsourcing infection control allows the provider to turn its attention to other pressing issues, and helps to strengthen the companys culture. Additionally, having a dedicated infection control company on hand helps build trust between the provider, its residents and families that their well-being and safety is top priority.

Were senior housing leaders, but were not infection control experts. At some point, weve got to get beyond spending 90% of our time and energy on infection control. That was a decision that I think was a very smart, prudent one, and one that I had done earlier, Kaplan said.

In one example of how Covid Consultants has helped, Kaplan described a visitor questionnaire that Solera has been using, based on CDC recommendations. On that form, visitors were being asked whether they had recently traveled to or been in an area considered high-risk for Covid-19. This is a vague question, the Covid Consultant reviewer noted, saying that in her opinion, everywhere is high risk for the coronavirus at the moment.

So, she responded yes to that question, and therefore would have been barred from entering the Solera building.

Thats an example of something where the CDC had good intentions, but now things have changed, and we just need to modify this form to provide more clarity, Kaplan said.

Another benefit of working with a third-party expert could potentially be in protecting senior living providers from litigation. This was not on Kaplans mind when Solera began working with The Covid Consultants, but Kaplan already has seen insurance costs go up, and he believes that the threat of litigation related to Covid-19 is real. Working with respected third-party infection control experts could reasonably reassure residents, families and others.

I think being able to say, weve engaged a third party, this is their expertise, this is how theyve advised us I think that will provide a little more validity, Kaplan said.

For all these reasons, he thinks that securing third-party infection control partners will become much more commonplace within senior living.

If this was not a lasting change, I would be shocked, he said.

Infection protocols continue to evolve as more information about Covid-19 is learned from the CDC, state and local public health departments.

On a federal level, the Environmental Protection Agency (EPA) updated its List N of approved disinfectants that meet the agencys criteria against SARS-CoV-2 the virus that causes Covid-19.

This list is essential for providers to revisit frequently, in order to find replacement disinfectants due to vendor shortages, LaGrange told SHN. This can be the difference between proper disinfecting of items such as reusable dining supplies or medical equipment.

[These] chemicals have been reviewed to make sure that theyre meeting the requirements needed for reducing the spread of Covid-19, she said.

Asbury is maintaining consistency in its clinical education program. Director of Clinical Education Martha Gurzick oversees education for clinical staff all across the system, ensuring that guidelines are uniform across the portfolio. If tweaks do need to be made to conform with a campus physical limitations, those changes can be made between Gurzick and local leadership.

The materials are prepared. Its not something that each community has to draft or download, Moehring said.

Asburys campuses are staffed with designated infection preventionists registered nurses serving as conduits between Gurzicks office and frontline staff to ensure that appropriate equipment is on hand and is used appropriately, across the campuses and all shifts. They also work with the clinical team at the system level so that Asburys infection control protocols are consistent.

Nursing staffs across Asburys campuses have taken the lead in implementing infection controls. Each community participates in the companys Nurse Practice Council, run by Gurzick and Vice President of Clinical Excellence Skip Margot. The Council reviews protocols and communicates changes and updates to associates on the front line.

They are managing the front line and they do it very well. Its about the relationship that that leader or manager has with those associates, Moehring said.

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Senior Living Industry Confronts New Infection Control Reality - Senior Housing News


Jun 15

The Salvation Army Kroc Center is reopening with limited activities – – KUSI

SAN DIEGO (KUSI) The Salvation Army Kroc Center in San Diego, California is excited to share that the doors of The Kroc Center will reopen at 6am on Monday, June 15, 2020, for the first time in over three months.

Changes have been made throughout the facility to ensure the health and safety of Kroc Center members, staff and guests. All Kroc Center employees will be wearing masks, and Kroc members and guests are also strongly encouraged to wear them to help protect each other as well as vulnerable populations. Fitness & Aquatic capacities will be limited according to social distancing mandates and in consideration of activity participation.

The facility operating hours will be divided into 90-minute blocks, followed by 30-minute gaps for staff to perform deep cleaning and preparation for the next group of users. Staff will have their temperature screened before coming into work and Kroc Center members will be asked to verbally acknowledge positive responses to a pre-visit questionnaire. Social distancing will be enforced by rearrangement of machines and marked line queues and waiting areas.

Cleaning and Sanitizing is the most important thing that we are addressing, said Major Rick Peacock, Salvation Army Corps Officer and Executive Director. The great news is that we already had an exceptionally high standard of disinfecting in the center.

Activities that will be available in the initial phase of reopening include cardio, strength and circuit equipment in the Fitness Center, Competition Pool Lap Swimming and Recreation Pool water walking and independent exercise. The Kroc Center will have a Seniors 62+ Only dedicated block of time in the morning for those who are healthy and pass a pre-entry questionnaire check. Virtual group exercise classes will also be available;Live Group Exercise classes are slated to begin near late June/early July.

Locker rooms will be closed for the time being. Members are encouraged to come ready to work out and swim and plan to go home to get ready for the rest of their day. Swimmers may use the outdoor showers for required pre-swim rinsing.

The Wave B phase of reopening will expand operations to include the following programs and amenities: Adult Group Exercise classes, private and small group music, swim, Ice and Dance classes; personal training (scheduling based on ability to safely maintain distancing between trainer & client). The following programs are slated to resume in future Waves: Playcare and Tiny Tikes, Corner Zone parties (limited capacity), Youth Sports Leagues, and Senior-focused classes and programs.

Kroc Center staff are very excited to see members come through the doors beginning Monday, June 15. We ask your patience and generous spirit with this short-lived change in operations.

For more information about the different reopening waves, hours of operation, and more, please visit sd.kroccenter.org.

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The Salvation Army Kroc Center is reopening with limited activities - - KUSI


Jun 15

Get Out And Walk To Slow The Aging Process And Even Reverse It – YouAreUNLTD

Why some scientists call walking the new superfood capable of reversing aging and boosting health

Spanish explorer Ponce de Len spent years sailing around the world looking for the Fountain of Youth. But according to the latest research, he might have found it if he had searched on foot. While the benefits of walking are well known from reducing blood pressure to lessening the risk of chronic diseases such as diabetes new scientific findings say walking is a powerful tool capable of slowing the aging process and even reversing it.

walking is a powerful tool capable of slowing the aging process

Data published by the Mayo Clinic in the medical journal Cell Metabolism showed that aerobic exercise that included brief sprints (aka high-intensity interval training) can reverse age-related impairment of the mitochondria important cell structures that provide 90percent of the energy needed to sustain life and organ function.

Among study participants aged 65to80, mitochondrial function improved by a whopping 70percent. Lead author of the study, Sreekumaran Nair, said, Based on everything we know, theres no substitute for these exercise programs when it comes to delaying the aging process. These things we are seeing cannot be done by any medicine.

walking is an ideal antidote to sitting, a major health hazard afflicting many adults

Earth shattering was the term used to describe the results. You might want to forget about your kale salads and pomegranate juice; the new superfood just may be walking. Along with its cell reparation abilities, walking is an ideal antidote to a major health hazard afflicting many aging adults sitting, which increases the risk of everything from high blood pressure and cholesterol levels to death. In fact, physical inactivity is the fourth leading risk factor for global mortality.

Regular walking leads to enhanced mood and reduced anxiety and depression, while helping to offset fatigue and, to some degree, even symptoms of pain. No gym membership required! The newest way to supersize its benefits is to make walking a total body workout: You can add hand weights to build muscle strength, which is lost through aging, or use walking poles, boosting the number of calories burned and improving the tone of the bodys core.

The benefits of walking complement all spectrums of health including physical, psychological and social well-being

Walking is the most common form of physical activity with many obvious, and not so obvious, health benefits, says Dr. Agnes Coutinho, a registered kinesiologist and acting head of the kinesiology program at University of GuelphHumber, Toronto. The benefits of walking complement all spectrums of health including physical, psychological and social well-being.

Some of the benefits are immediate (lowered blood sugar, for example), while others are more long term and can fend off common age-related illnesses, such as obesity, high cholesterol, vascular stiffness, joint pain, inflammation and mental stress. Thats plenty of incentive to start putting take a walk on your to-do list now.

But how much do you need to walk in order to reap health benefits? It all depends on your personal goal. The Canadian Society for Exercise Physiology says that adults of all ages should accumulate a minimum of 150minutes of aerobic physical activity per week. This activity should be moderate to vigorous intensity (causing you to breathe harder and sweat a little), and can be performed in bouts of 10minutes or more, says Dr. Coutinho.

Based on this recommendation, a goal to maintain good health could include 30-minute walks at least five days per week.

Although the Canadian Physical Activity Guidelines (PDF) recommend moderate to vigorous intensity, such as brisk walking, again, it all depends on personal goals. Everyone should do what they can regardless of their current level of fitness.

High-profile walkers include stars such as Brooke Shields, Sheryl Crow, Madonna, Julia Roberts and Suzanne Somers, and supermodels Heidi Klum and Elle Macpherson. Toronto-born celebrity fitness trainer Harley Pasternak, who has whipped the bodies of Lady Gaga, Bono and Jennifer Hudson into shape, calls walking the most effective form of exercise.

For those with arthritis in the knee or hip, one option is to try ACTIVATOR poles, designed by an occupational therapist for patient rehabilitation in long-term conditions such as multiple sclerosis, spinal ailments and Parkinsons, as well as recovery after hip or knee surgery. Urban poling has been shown to reduce impact on knee and hip joints, improve walking speed and increase muscle strength, which can prevent falls.

Urban poling has been shown to reduce impact on knee and hip joints

Walking devotee Bob Ferguson, discovered first-hand the benefits of using poles. In the past I had difficulty walking to the park just half a block away. But with these poles I walked five times farther, he says. It only took me about 25steps to get my stride, and off I went. Walking was an exercise I definitely needed but was not getting. It gave me stability and confidence. When I got home I felt like I could take on the world.

To maximize the health benefits of walking, the key is to do it regularly, according to Dr. Coutinho. Also consider incorporating walking poles to engage the upper body.

When we walk we use only the lower part of our body. When we add poles we engage our abdomen, back, shoulders and arm muscles burning more calories and creating a resistance workout for the muscles in both the upper and lower body, with every step, she says. Adding poles provides a better cardio-respiratory workout, activates core muscles and has a greater effect on lowering blood sugar.

The key to long-term success is setting your own pace

The key to long-term success is setting your own pace literally! For those with arthritis or other conditions that may limit the ability to walk, taking it slower is definitely better, because a slower pace may reduce stress on the joints. Everyone should do what they can; anything is better than nothing, but all within personal limits, says Dr. Coutinho. A brisk walk for 60minutes will burn a similar amount of calories to jogging for 30minutes. The goal is to keep moving.

If you need a bit more motivation, consider this: Walking may add as much as seven years to your life, according to the European Society of Cardiology, based on evidence of study participants who walked for 20minutes daily for six months.

Looking for a longer, healthier life? Just walk this way

Check out this YouTube video from Urban Poling on the benefits of incorporating ACTIVATOR poles into your walking routine:

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Get Out And Walk To Slow The Aging Process And Even Reverse It - YouAreUNLTD



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