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The Club PUBlication  01/31/2022

1/31/2022

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​Study finds that cataract surgery may reduce the risk of dementia
BY NICHOLAS BAKALAR • New York Times

Surgery to remove cataracts, which cause the eye's normally clear lens to become cloudy, can restore vision almost instantaneously.

New research suggests cataract surgery may have another benefit as well: reduced risk for Alzheimer's disease and other forms of dementia.
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For the study, scientists looked at 3,038 men and women with cataracts who were 65 or older and free of dementia at the time of their diagnosis. Of these, 1,382 had cataract surgery, and the rest did not. All of the subjects were part of a decades-long memory study that followed them over decades.

​The researchers found that the overall risk for dementia was 29% lower in those who had cataract surgery compared with those who did not.

The researchers also looked at glaucoma surgery, another type of eye operation that does not restore vision but can help prevent vision loss. It did not affect dementia risk.

The study, in JAMA Internal Medicine, adjusted for age at first diagnosis of cataracts as well as various risk factors for dementia, including a few years of education, smoking, a high body mass index, and hypertension.

The only trait that had a bigger impact on dementia risk than cataract surgery was not carrying a gene called APOE-e4 that is linked to increased risk of Alzheimer's disease.

"The authors were incredibly thoughtful in how they approached the data and considered other variables," said Dr. NathanielA. Chin, an assistant professor of medicine at the University of Wisconsin, was not involved in the study. "They compared cataract surgery to non-vision-improving surgery — glaucoma surgery — and controlled for many important confounding variables." Dr. Chin is the medical director of the Wisconsin Alzheimer's disease Research Center.

"We were astounded by the magnitude of the effect," said the lead author, Dr. Cecilia S. Lee, an associate professor of ophthalmology at the University of Washington.

The authors note that this is an observational study that does not prove cause and effect. But they suggest that this may be the best kind of evidence attainable, since a randomized trial in which only some people are allowed to get cataract surgery would be both practically and ethically impossible.

"People might say that those who are healthy enough to have surgery are healthier in general, and therefore less likely to develop dementia in any case," Dr. Lee said.

"But when we see no association in glaucoma surgery, that supports the idea that it isn't just eye surgery or being healthy enough to undergo surgery, but rather that the effect is specific to cataract surgery."
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The findings bolster earlier research showing that vision loss — as well as hearing loss — are important risk factors for cognitive decline. People who have trouble seeing or hearing, for example, may withdraw from activities like exercise, social interactions, reading, or intellectual pursuits, all of which are tied to a lower risk of dementia.
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The Club PUBlication  01/24/2022

1/24/2022

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​EXERCISE MAY WARD OFF CANCER
By GRETCHEN REYNOLDS • New York Times

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EVE EDELHEIT - NEW YORK TIMES Tens of thousands of cancers in America each year could be prevented by meeting physical activity guidelines

More than 46,000 cancer cases in the United States might be prevented each year if almost all of us walked for about 45 minutes a day, according to an eye-opening new study of inactivity, exercise and malignancies. The study, which analyzed cancer incidence and the physical activity habits of nearly 600,000 American men and women, found that about 3% of common cancers in the U.S. are strongly linked to inactivity. Something as simple as getting up and moving, the findings suggest, might help tens of thousands of us avoid developing cancer.

Already we have evidence that exercise affects cancer risk. In past experiments, physical activity has changed the immune system in ways that amplify the body's ability to fight tumor growth. Exercise can, for example, ramp up the activity of certain immune cells known to target cancer cells. Exercise has also been associated with longer survival in people with certain forms of cancer. A 2016 review in JAMA Internal Medicine concluded that our risks for at least 13 types of cancer, including breast, bladder, blood and rectal cancers, drop substantially if we are physically active, and a separate 2019 report calculated that those reductions could be as high as 69%.

At the same time, many studies show that being inactive raises our risks for various cancers. But scientists know surprisingly little about how those risks translate into actual cases or how many people each year are likely to develop cancers closely linked to moving too little.

For the new study, researchers with the American Cancer Society and Emory University in Atlanta used a type of statistical analysis called P.A.F. to measure the links between cancer and inactivity. P.A.F. stands for population-attributable fraction and is a mathematical way for scientists to estimate how many occurrences of a disease — or drug responses or other biological reactions — within a larger population seem to be the result of a particular behavior or other factor. It can tell us, in essence, how many annual cases of, say, colon cancer — out of all the known instances of the disease each year — can reasonably be laid at the feet of smoking or alcohol or fatty foods or over-sitting.

To start, the American Cancer Society scientists first pulled anonymized data from the U.S. Cancer Statistics database about cases, nationally and by state, for all Americans 20 and older between 2013 and 2016. The team focused both on total cancer cases and on seven types of cancer that in past studies had been closely tied in part to activity: stomach, kidney, esophageal, colon, bladder, breast and endometrial tumors.

Next they checked on how much American adults claim to move, based on more than half a million replies to two large federal surveys. The researchers drew responses from adults in every state and grouped them, based on whether or not people met the American Cancer Society recommendations for physical activity. Those guidelines call for, ideally, 300 minutes, or five hours, of moderate exercise, like a brisk walk, every week to reduce cancer risk.

Finally, the researchers adjusted these statistics for body mass and other factors, gathered additional data about cancer risks and plugged the numbers into an equation, which then spit out the P.A.F. for cancers linked to inactivity. That number turned out to be 46,356, or about 3% of all cancers annually (excluding non-melanoma skin cancers).

Stomach cancer was most tied to inactivity, with about 17% of all cases annually attributable to not moving, vs. 4% of bladder cancers.

The good news is that we have the ability to lower these numbers. Exercise could "potentially prevent many cancers in the United States," said Adair K. Minihan, an associate scientist at the American Cancer Society, who led the new study. If everyone in America who can exercise started walking for an hour on weekdays, she said, theoretically the 46,356 cases tied to inactivity should disappear.
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Study: 300 minutes a week of moderate activity can make a difference.
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The Club PUBlication  01/17/2022

1/17/2022

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​AIRTAGS DRAW LOOK FROM LAW OFFICERS
Privacy groups sound alarm on Apple product, as authorities eye the threat that they pose.

By RYAN MAC and KASHMIR HILL New York Times

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Ashley Estrada eventually found an Apple AirTag, which had tracked her movements for four hours, behind her car's license plate, in Eastvale, Calif. Privacy groups sounded alarms about the devices when they were introduced.
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On a Sunday night in September, Ashley Estrada was at a friend's home in Los Angeles when she received a strange notification on her iPhone: "AirTag Detected Near You."
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Ashley Estrada found an Apple AirTag had been tracking her for four hours as she ran errands in Eastville, Calif.
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An Apple AirTag, a 1.26-inch disc with location-tracking capabilities, sells for $29.
​An AirTag is a 1.26-inch disc with location-tracking capabilities that Apple started selling earlier this year as a way "to keep track of your stuff."

​Estrada, 24, didn't own one, nor did the friends she was with. The notification on her phone said the AirTag had first been spotted with her four hours earlier. A map of the AirTag's history showed the zigzag path Estrada had driven across the city while running errands.

"I felt so violated," she said. "I just felt like, who's tracking me? What was their intent with me? It was scary."

Estrada is not alone in her experience. In recent months, people have posted on TikTok, Reddit and Twitter about finding AirTags on their cars and in their belongings. There is growing concern that the devices may be abetting a new form of stalking, which privacy groups predicted could happen when Apple introduced the devices in April.

The New York Times spoke with seven women who believe they were tracked with AirTags, including a 17-year-old whose mother surreptitiously placed one on her car to stay apprised of her whereabouts.

Some authorities have begun to take a closer look at the threat posed by AirTags. The West Seneca Police Department in New York recently warned its community of the tracking potential of the devices after an AirTag was found on a car bumper.

Apple complied with a subpoena for information about the AirTag in the case, which may lead to charges, West Seneca police said.

And in Canada, a local police department said that it had investigated five incidents of thieves placing AirTags on "high-end vehicles so they can later locate and steal them."

Researchers believe AirTags, which are equipped with Bluetooth technology, could be revealing a more widespread problem of techenabled tracking.
They emit a digital signal that can be detected by devices running Apple's mobile operating system.

Those devices then report where an AirTag was last seen.

Unlike similar tracking products from competitors such as Tile, Apple added features to prevent abuse, including notifications like the one Estrada received and automatic beeping. (Tile plans to release a feature to prevent the tracking of people next year, a spokesperson for that company said.) But AirTags present a "uniquely harmful" threat because the ubiquity of Apple's products allows for more exact monitoring of people's movements, said Eva Galperin, a cybersecurity director at the Electronic Frontier Foundation who studies so-called stalkerware.
"Apple automatically turned every iOS device into part of the network that AirTags use to report the location of an AirTag," Galperin said. "The network that Apple has access to is larger and more powerful than that used by the other trackers. It's more powerful for tracking and more dangerous for stalking."

Apple does not disclose sales figures, but the tiny $29 AirTags have proved popular, selling out consistently since their unveiling.  An Apple spokesperson, Alex Kirschner, said in a statement that the company takes customer safety "very seriously" and is "committed to AirTag's privacy and security."  He said the small devices have features that inform users if an unknown AirTag might be with them and that deter bad actors from using an AirTag for nefarious purposes.

"If users ever feel their safety is at risk, they are encouraged to contact local law enforcement who can work with Apple to provide any available information about the unknown AirTag," Kirschner said.  Police could ask Apple to provide information about the owner of the AirTag, potentially identifying the culprit.

But some of the people who spoke with the Times were unable to find the AirTags they were notified of and said police do not always take reports of the notifications on their phones seriously.

Estrada, who received the notification while in Los Angeles, found the quartersized tracker lodged in a space behind the license plate of her 2020 Dodge Charger. She posted a video of her ordeal on TikTok, which went viral.

"Apple probably released this product with the intent to do good, but this shows that the technology can be used for good and bad purposes," Estrada said.

Estrada said she was told by a Los Angeles police dispatcher that her situation was a nonemergency and that if she wanted to file a report she would have to bring the device with her to the station in the morning. She didn't want to wait and disposed of it after taking several photos.

A spokesperson for the Los Angeles police told the Times that the department had not heard of cases in which an AirTag had been used to track a person or a vehicle.  But Estrada said that after she posted her TikTok video, an Apple employee, acting on his or her own, contacted her. The employee was able to connect the AirTag to a woman whose address was in central Los Angeles.

Another woman was notified by her iPhone that she was being tracked by an "unknown accessory" after leaving her gym in November. When she got home, she called the police.  The woman, Michaela Clough of Corning, Calif., was told that a report could only be filed if someone showed up at her home and that Apple's notifications were not enough proof that she was being stalked. She later got in touch with an Apple customer service representative who was able to disconnect the device from Clough's iPhone. The device never was found.

"I was terrified and frustrated that there was nothing I could do about it," Clough said, noting that she hadn't returned to her gym since. "For a good week there, I just stayed home."

AirTags and other products connected to Apple's locationtracking network, called "Find My," trigger alerts to unknown iPhones they travel with.  The AirTag product page on Apple's website notes that the devices are "designed to discourage unwanted tracking" and that they will play a sound after a certain amount of time of not detecting the device to which they are paired.

In June, after concerns about stalking were raised, Apple pushed an update to AirTags to cause them to start beeping within a day of being away from their linked devices, down from three days. Still, "they don't beep very loudly," Galperin said.

A person who doesn't own an iPhone might have a harder time detecting an unwanted AirTag. AirTags aren't compatible with Android smartphones.

Earlier this month, Apple released an Android app that can scan for AirTags — but you have to be vigilant enough to download it and proactively use it.

Apple declined to say if it was working with Google on technology that would allow Android phones to automatically detect its trackers.

People who said they have been tracked have called Apple's safeguards insufficient.  Estrada said she was notified four hours after her phone first noticed the rogue gadget. Others said it took days before they were made aware of an unknown AirTag.
​
According to Apple, the timing of the alerts can vary depending on the iPhone's operating system and location settings.
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The Club PUBlication  01/10/2022

1/10/2022

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Sleep apnea device maker doubles sales
Inspire’s implantable neurostimulator is only one on market.
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Sleep apnea device maker doubles sales
By BURL GILYARD burl.gilyard@startribune.com

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Inspire Medical Systems Inc. makes an implantable device to treat sleep apnea, but the company's financials are far from sleepy.

The Golden Valley-based company announced Tuesday after market close that its 2021 revenue would be between $233 million and$233.4 million, a robust increase of about 102% over the previous year.  In 2016, the company tallied just $16.4 million in revenue. The preliminary numbers for 2021 represent a 1,300% increase in its sales over the last five years. It ranks among the fastest-growing public companies in Minnesota.

The company said its rapid growth is fueled by high consumer demand and low — or no — competition from other device makers.  Inspire developed the firstever implantable neurostimulation device to treat obstructive sleep apnea. No one else has created a similar product and brought it to market. In its niche, Inspire Medical has zero competition.
"We are the only ones doing this," said Tim Her-bert, Inspire's chief executive.

Other companies have competing products in development, but they are still several years away from approval by the U.S. Food and Drug Administration (FDA), he said.

Until now, sleeping masks have been the standard treatment for sleep apnea. These mask devices provide continuous positive airway pressure (CPAP), but many patients find them uncomfortable.
Beyond the comfort factor, Herbert said the Inspire implant is also more effective.

The company recently received FDA approval for a Bluetooth-enabled patient remote control that pairs with the implanted device.  Inspire has been able to avoid many of the pandemic challenges faced by its medical technology peers, like delayed elective surgeries.  "How we're able to continue to grow is we are outpatient surgery," said Herbert.  "We don't take up hospital beds."

The comhepany added 81 more U.S. implanting centers to its network last quarter, more than it forecast.  

The procedure takes 90 minutes. It has the same basic technology as a pacemaker and is powered by a lithium battery which lasts 11 years.
"Importantly, our robust pace in the opening of new centers includes a growing number of [Ambulatory Surgical Centers] , which continue to increase at a higher rate than the addition of hospitals,"  Herbert said in the financial news release.
​
Inspire went public at $24 a share in April 2018. It closed Wednesday at about $237 a share, an impressive 887% increase in just three-and-a-
half years.  The financial results are preliminary and unaudited.
The company will report full financial results on Feb. 8.  But like many growth companies, Inspire Medical has yet to post a profit.
For the first nine months of 2021, Inspire reported revenue of $155 million and a net loss of $39.65 million.

The sleep apnea market is big. It's a relatively common condition in the U.S. that affects more than 30 million Americans, according to the American Sleep Apnea Association.  Untreated, it can lead to more serious conditions such as heart failure, high blood pressure and strokes.
Inspire Medical grew out of med-tech giant Medtronic in 2007.  Herbert had worked at Medtronic in a variety of management roles, including product development and clinical research.
"This is a therapy that we were not able to fund inside Medtronic. In partnership with Medtronic, we created a new company," said Herbert.
He said that Medtronic still owns a "very small" stake in the company.
"[It] started with just myself down in my basement," recalled Herbert. The company now has more than 500 employees. Herbert has been CEO since the company's inception.  Inspire began selling the product in Europe in 2011 and in the U.S. in 2014.

Herbert said that in December the company marked treating its 20,000th patient with its unique system.  Inspire Medical's treatment is available in 48 states and throughout Europe.  Herbert said that the company will soon see the first implant for cases in Japan and is looking to expand further into Asia.


Burl Gilyard • 612-673-4756
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The Club PUBlication  01/03/2022

1/3/2022

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​Telescope may offer a cosmic payoff​
Scott Gillespe, Editor, Editorial pages
Star Tribune, MPLS

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James Webb Space Telescope

If all goes well, James Webb will deliver wonders never seen before on earth.
Like many other packages delivered on Dec. 25, a new telescope arrived in space Saturday with some assembly required.

The gradual unfolding of the James Webb Space Telescope, currently en route to its station 930,000 miles from Earth, is high drama. The long years of development, complete with the invention of several new technologies and the investment of billions of dollars, now depend for their success on many things going right.

With hundreds of things that could go wrong on its 29-day journey, Webb — which is named after the man who led NASA from 1961 to 1968 — represents a gamble of appropriately astronomical proportions.  But the potential payoff is cosmically huge as well.

"This telescope will be able to see back in time significantly farther than other telescopes can," said James Flaten, associate director of NASA's Minnesota Space Grant Consortium. "Being so much bigger than anything else that's available, it will be able to see things that aresignificantly fainter, and hence things that are significantly farther away. Which basically means significantly older."

In conversation with an editorial writer, Flaten pointed out that Webb's light-gathering mirror, at 6.5 meters across, is significantly larger than that of the Hubble SpaceTelescope, which measures just 2.4 meters. But Webb has another advantage: its ability to see infrared light. That will allow it to peer through the veil of dust that obscures some regions of space.

"A whole bunch of stuff that we currently can't see well at all will become visible," he said. "And considering how large it is, it can see significantly fainter things, and hence it can see things that are older. The reason being that the older something is, the farther away it is and the fainter it is."

A NASA tracking tool shows the projected timetable for various benchmarks in the telescope's mission. By now, Webb has cleared the moon's orbit and will soon deploy its multilayered sunscreen and unfold the goldcoated mirror. A specially designed cooling system will keep the observatory cold enough to pick up infrared light from distant targets.

It's all delicate, and critical, and inaccessible to any conceivable repair if something should go wrong. Webb's eventual position, balanced between the gravitational influences of Earth and the sun, is four times farther away than the moon. NASA could, and did, send crews to repair Hubble, but Webb will be on its own.

Assuming all goes well, Webb will show us wonders; but as Flaten noted, "it's a little hard to say what they will be." No one has seen the universe as it looked quite so fresh from the Big Bang. And Webb should be able to give us a much better look at planets outside our solar system — even allowing scientists to determine the contents of any atmospheres they find.

Flaten cautioned that Webb is not designed to search for life elsewhere in the universe, although it should be able to find indications of liquid water or other conditions that might make life more likely. Of course, other kinds of life may turn out to thrive in environments that we would consider hostile.
It's all a question of your perspective.
​
And if Webb does what it's designed to do, our perspective may be about to change.
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