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NEW YORK â The generic cialis 20mg online U.S. District Court for the Northern District of New York has entered a consent judgment ordering a Syracuse gas station and convenience store and a Jamesville pizzeria and convenience store and their owner to pay $56,364 in back wages and an equal amount of $56,364 in liquidated damages to 12 employees denied overtime wages.The courtâs action follows an investigation by the departmentâs Wage and Hour Division and litigation by its Office of the Solicitor that concluded Liberty Gas Station and Convenience Store LLC in Syracuse, and Liberty Pizza &. Convenience Inc generic cialis 20mg online. In Jamesville, and operator Huseyin Turan failed to pay workers overtime pay when they worked over 40 hours in a workweek. The workers regularly worked between 50 and 60 hours in a workweek.

The investigation also found the employer failed to keep accurate records in violation of the Fair Labor Standards Act generic cialis 20mg online. Liberty Gas Station and Turan also agreed to pay $7,272 in civil money penalties assessed by the department. The departmentâs investigation and litigation generic cialis 20mg online revealed that the employers â who paid employees only straight time wages â attempted to conceal their failure to pay overtime through multiple schemes. They paid employees by check and cash, grossly understating the amount of hours worked on their payroll records, and required employees to sign false records before distributing their pay. They also paid some employees who worked over a total of 40 hours at both Syracuse and Jamesville locations with separate checks.

Even after litigation began, the employers destroyed time records, resulting in the district judge issuing sanctions against them, ordering that the jury would be instructed to draw an adverse inference against generic cialis 20mg online the employers. ÂPaying only straight-time wages to workers who are entitled to overtime compensation and then trying to evade liability by destroying time records and creating fake documents are egregious violations of the law,â said Regional Solicitor of Labor Jeffrey Rogoff in New York City. ÂThe U.S generic cialis 20mg online. Department of Labor is committed to ensuring workers are properly paid and will pursue all appropriate legal actions, including filing suit in federal court to hold unscrupulous employers accountable for wage theft.â âThe Wage and Hour Division finds violations like these are all too common in the convenience store and gas station industry. Through this scheme to conceal its unlawful pay practices, the employer harmed these essential workers by depriving them of their hard earned wages,â said Wage and Hour District Director Jay Rosenblum in Albany, New York.

ÂThe Wage and Hour Division is available online and by phone to help workers and employers understand their respective generic cialis 20mg online rights and responsibilities under the law.â Workers can call the Wage and Hour Division confidentially with questions â regardless of their immigration status â and the department can speak with callers in more than 200 languages. The divisionâs Albany District Office conducted the investigation. Senior Trial Attorneys Alexander Kondo and generic cialis 20mg online Amy Tai of the New York Regional Office of the Solicitor litigated the case for the department. For more information about the FLSA and other laws enforced by the division, contact the agencyâs toll-free helpline at 866-4US-WAGE (487-9243). Learn more about the Wage and Hour Division, including a search tool to use if you think you may be owed back wages collected by the division..

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ÂTo protect the people of NSW from the evolving erectile dysfunction treatment outbreak, new restrictions will be introduced for the Tamworth Local Government Area (LGA), effective from 5pm today until the beginning of 17 August 2021.Following updated health advice from NSW Chief buy cialis 20mg Health Officer Dr Kerry Chant, stay-at-home orders will apply to all people who live in the Tamworth LGA visit the site or have been there on or after Thursday 5 August. The rules for this area will be the same as those already in place across Greater Sydney, as well as Armidale, Newcastle, Lake Macquarie, Maitland, Port Stephens, Singleton, Dungog, Muswellbrook and Cessnock. Everyone in these areas must stay buy cialis 20mg at home unless they have a reasonable excuse to leave. They also cannot have social visitors in their home from outside their household, including family and friends.

People still can have one visitor at one time buy cialis 20mg to fulfil carers' responsibilities or provide care or assistance, or for compassionate reasons, including where two people are in a relationship but do not live together. People also cannot enter Tamworth LGA without a reasonable excuse to do so. In relation to the 'singles bubble', an adult in the Tamworth LGA who does not live with another adult can have a social visitor from somewhere in the same LGA. Single people cannot change who their nominated visitor is.There are two exemptions for Tamworth, including that weddings and funerals can take place in the Tamworth LGA buy cialis 20mg until the beginning of 12 August.

After that, weddings will not be permitted and funerals will be limited to 10 mourners. People staying in a caravan park or camping ground in Tamworth on a booking made before today can also continue their buy cialis 20mg stay, provided it is not extended. NSW Health understands this is a difficult time for the community and appreciate their ongoing patience and cooperation. We are asking people not to seek exceptions to the rules, but to ensure they comply with them so we do not see further cases of erectile dysfunction treatment in the community..

ÂTo protect the people of NSW from the evolving erectile dysfunction treatment generic cialis 20mg online outbreak, new restrictions will be introduced for the Tamworth Local Government Area (LGA), effective from 5pm today until the beginning of 17 August 2021.Following updated health advice from NSW Chief Health Officer Dr Kerry Chant, stay-at-home orders will apply to all people who live in the Cialis at walgreens price Tamworth LGA or have been there on or after Thursday 5 August. The rules for this area will be the same as those already in place across Greater Sydney, as well as Armidale, Newcastle, Lake Macquarie, Maitland, Port Stephens, Singleton, Dungog, Muswellbrook and Cessnock. Everyone in these areas must stay at home unless they have a reasonable excuse generic cialis 20mg online to leave. They also cannot have social visitors in their home from outside their household, including family and friends. People still can have one visitor at one time to fulfil carers' generic cialis 20mg online responsibilities or provide care or assistance, or for compassionate reasons, including where two people are in a relationship but do not live together.

People also cannot enter Tamworth LGA without a reasonable excuse to do so. In relation to the 'singles bubble', an adult in the Tamworth LGA who does not live with another adult can have a social visitor from somewhere in the same LGA. Single people cannot change who their nominated generic cialis 20mg online visitor is.There are two exemptions for Tamworth, including that weddings and funerals can take place in the Tamworth LGA until the beginning of 12 August. After that, weddings will not be permitted and funerals will be limited to 10 mourners. People staying in a caravan park or camping ground in Tamworth generic cialis 20mg online on a booking made before today can also continue their stay, provided it is not extended.

NSW Health understands this is a difficult time for the community and appreciate their ongoing patience and cooperation. We are asking people not to seek exceptions to the rules, but to ensure they comply with them so we do not see further cases of erectile dysfunction treatment in the community..

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Credit. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this population.

The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over.

The prevalence of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids.

The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. ÂThe cause of the link between the two conditions remains unclear,â she says.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors on this paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit.

The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumorâs DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors. - Click to Tweet The âmutational burden,â or the number of mutations present in a tumorâs DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows.

The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an . These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma.

The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear.

The higher a cancer typeâs mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer. ÂThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

Itâs one of those things that doesnât sound right when you hear it,â says Hopkins. ÂBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.â Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors.

However, he explains, this cancer type is often caused by a cialis, which seems to encourage a strong immune response despite the cancerâs lower mutational burden. In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs havenât yet been tried.

Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs. ÂThe end goal is precision medicineâmoving beyond whatâs true for big groups of patients to see whether we can use this information to help any given patient,â he says.

Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

Credit her comment is here generic cialis 20mg online. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black generic cialis 20mg online women and is the most common form of permanent alopecia in this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., generic cialis 20mg online assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries.

During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in patients with and without generic cialis 20mg online CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of uterine fibroids generic cialis 20mg online in women with CCCA, compared to age, sex and race matched controls.

Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. ÂThe cause of the link between the two conditions generic cialis 20mg online remains unclear,â she says. However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should generic cialis 20mg online be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors on this paper were Ginette generic cialis 20mg online A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big generic cialis 20mg online an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumorâs DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The âmutational burden,â or the number of mutations present in a tumorâs DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led generic cialis 20mg online by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New England generic cialis 20mg online Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells. As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an .

These medicines have had remarkable success in treating some types generic cialis 20mg online of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better generic cialis 20mg online than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect generic cialis 20mg online the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear.

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of generic cialis 20mg online thousands of tumor samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer typeâs mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than generic cialis 20mg online half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer.

ÂThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive. Itâs one of those things generic cialis 20mg online that doesnât sound right when you hear it,â says Hopkins. ÂBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.â Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, generic cialis 20mg online Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a cialis, which seems to encourage a strong immune response despite the cancerâs lower mutational burden.

In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs havenât yet generic cialis 20mg online been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might generic cialis 20mg online be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs. ÂThe end goal is precision medicineâmoving beyond whatâs true for big groups of patients to see whether we can use this information to help any given patient,â he says.

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AdvertisementContinue reading the main storySupported cialis online visa byContinue reading the main storyPhys EdHow Weight Training May Help With Weight ControlPeople who regularly do muscle-strengthening exercises are about 20 to 30 percent less likely to become obese over time than people who do not.Credit...Neil Hall/EPA, via ShutterstockJuly 7, 2021Lifting weights a few times a week might help us stave off obesity, according to an interesting new study of resistance exercise and body fat. It shows that people who regularly complete muscle-strengthening exercises of any kind are about 20 cialis online visa to 30 percent less likely to become obese over time than people who do not, whether they also work out aerobically or not.The findings indicate that weight training could be more consequential for weight control than many of us might expect, and a little lifting now may keep us lighter, later.The incidence of obesity in America is rising, with about 40 percent of adults currently meeting the standard criteria for obesity. That number is expected to increase to more than 50 percent by the end of this decade.Unfortunately, few of us will drop any added pounds, long term, once we gain them. Most people who shed more than cialis online visa about 5 percent of their body weight regain it within five years.The most effective way to deal with obesity, then, is probably to prevent it. And regular exercise can help in that regard.

Many studies show that people who often walk, jog, cycle, swim or otherwise work out aerobically tend to gain less weight with age than sedentary people and are at cialis online visa lower risk of becoming obese.But far less has been known about whether weight training likewise influences weight. Some past research hints that resistance training helps people cialis online visa retain muscle mass while people are trying to lose weight. But whether it might also check long-term weight gain and avert obesity has not been clear.So, for the new study, which was published in June in PLOS Medicine, researchers at Iowa State University in Ames, Iowa, and other institutions, decided to look into the relationship, if any, between weights and waistlines. They began by turning to the large and useful database compiled for the Aerobics Center Longitudinal Study, a famous undertaking that had tracked the medical, health and fitness status of tens of thousands of patients cialis online visa who visited the Cooper Clinic in Dallas between 1987 and 2005. The men and women had gone through extensive testing during repeated visits to the clinic over the years.Now, the Iowa researchers pulled the records for almost 12,000 of the participants, most of them middle-aged.

None of them were obese, based on their B.M.I., when they first cialis online visa joined the Aerobics Center study. (B.M.I., or body mass index, indirectly estimates body fat, based on your height and weight. You can check yours online here.)These particular men and women had completed the typical array of health and fitness measurements during their visits to the clinic and also filled out an exercise questionnaire cialis online visa that asked, among other issues, about weight training. Did they ever engage in âmuscle-strengthening exercises,â it inquired, and if so, how often cialis online visa and for how many minutes each week?. The researchers then began crosschecking, comparing peopleâs weights and other measurements from one clinic visit to the next.

Based on cialis online visa B.M.I., about 7 percent of the men and women had become obese within about six years of their first visit to the clinic.But B.M.I. Is a loose approximation of body composition and not always an accurate measure of obesity. So the researchers also checked changes to peopleâs cialis online visa waist circumferences and their body-fat percentage to determine if they had become obese. By the yardsticks of a waist circumference greater than 40 inches for men and 35 for women, or a body-fat percentage above 25 percent for men and 30 percent for women, as many as 19 percent of participants developed obesity over the years.Weight lifting, however, changed those outcomes, the researchers found, substantially lowering the risk that someone would become obese, by any measure. Men and women who reported strengthening their muscles a few times a week, for a weekly total of one to two hours, were about 20 percent less likely to become obese over the years, cialis online visa based on B.M.I., and about 30 percent less likely, based on waist circumference or body-fat percentage.The benefits remained when the researchers controlled for age, sex, smoking, general health and aerobic exercise.

People who worked out aerobically cialis online visa and lifted weights were much less likely to become obese. But so were those who lifted almost exclusively and reported little, if any, aerobic exercise.The results suggest that âyou can get a lot of benefit from even a littleâ weight training, says Angelique Brellenthin, a professor of kinesiology at Iowa State, who led the new study.Of course, the study was observational and does not prove that resistance training prevents weight gain, only that they are linked. It also did not consider peopleâs diets, genetics or health attitudes, any of which could affect obesity risk.Perhaps most important, it cialis online visa does not tell us how muscle strengthening influences weight, although it is likely that resistance training builds and maintains muscle mass, Dr. Brellenthin says. A metabolically active tissue, muscle burns calories and slightly cialis online visa increases our metabolic rate.

Interestingly, the desirable effect of adding muscle mass may also explain why fewer cialis online visa lifters avoided obesity when the researchers used B.M.I. As a measure. B.M.I. Does not differentiate muscle from fat, Dr. Brellenthin points out.

If you add muscle with weight training, your B.M.I. Can rise.Still, the primary message of the study is that some weight training likely helps, over time, with weight control. ÂSo, my advice would be to fit in a few body weight exercises before or after your usual daily walk,â Dr. Brellenthin suggests. Or join a gym or an online class.

Or try one of Wellâs easy, at-home resistance-training routines, like the 7-Minute Standing Workout.AdvertisementContinue reading the main storyAdvertisementContinue reading the main storySupported byContinue reading the main storyWhat to Look for in a Physical TherapistNot all P.T.s are created equal. Find a professional who values evidence over anecdote.In some instances, physical therapy can be as effective as surgery, as indicated by one study on meniscal tears. Other research is exploring its effectiveness in partial rotator cuff tears.Credit...Getty ImagesJuly 6, 2021Thereâs been a quiet revolution taking place in the field of physical therapy. In the early 2000s, you could go to five different physical therapists for an injury and receive five different treatment plans. Some would have advised targeted exercises to strengthen muscles or classic treatments, like heat and cold packs.Others might have relied on âvoodoo treatmentsâ like uasound, lasers and electrotherapy, despite the fact that experts werenât really sure how â or even if â they worked.

Today, many of those techniques have been set aside as the science has slowly accumulated that they donât accelerate healing. You may still find them in some offices, however, as the field has struggled with a lack of uniformity and a lingering reputation for pseudoscience, leaving patients unsure whom to trust.Take uasound, for instance. The technique has been used in physical therapy since the 1950s to treat everything from back pain to ankle sprains using high-frequency sound waves to speed the healing process. As early as the 1990s, uasoundâs efficacy started to be debunked, with few studies showing any clinical benefit, but itâs taken over 20 years for the technique to finally fall out of favor with practitioners.âThereâs very little, if any, evidence that uasound does anything at all,â said Bruce Greenfield, a professor in the department of rehabilitation medicine at Emory University. ÂBut P.T.s are using it, and theyâre charging for it, and theyâre getting reimbursed for it â basically for a technique thatâs not effective.

Is that fraud?. I donât know.âOver the last 15 years, leaders in the physical therapy field have worked to shed this reputation, improving standards and consistency. Theyâve developed systems to diagnose and classify injuries and turned to scientific research to create evidence-backed treatment guidelines. ÂThatâs how you change the face of the profession,â said David Wert, an associate professor of physical therapy at the University of Pittsburgh. ÂUsing evidence and applying interventions for folks that are meaningful.âA Shift From Passive to Active TreatmentOriginally, physical therapy was largely based on the use of treatments like heat and ice to ease peopleâs pain and aid healing.

Practitioners have also been quick to adopt technologies like laser therapy, which purportedly travels through skin and cells to increase energy production in mitochondria (the powerhouse of the cell) to accelerate recovery. But a treatmentâs effect on a cell in a petri dish doesnât necessarily translate to a patient in the clinic. The most recent â and some say most definitive â study on the technique shows no benefit over a placebo.Over the past two decades, studies and meta-analyses (like the one conducted on uasound) have revealed that these types of passive treatments, where patients lie down on a table and have a therapy performed on them, actually do very little. And in some cases, they can even slow down recovery.For example, ice has long been used to reduce swelling after an injury by constricting blood vessels in the area, which prevents blood and inflammatory cells from reaching the damaged tissue. But those blood and inflammatory cells are also a necessary part of the healing process, and restricting them with a cold pack or ice bath can delay or even prevent recovery.When compared head-to-head, active exercise-based therapies are both less expensive and more effective than passive ones.

In some instances, exercise is even as effective as surgery. In one study of 350 patients who had meniscal tears, there was no difference after six months between the patients whoâd had surgery and those whoâd used active physical therapy. Other research is currently exploring whether the same might be true for partial rotator cuff tears.Instead, whatâs emerged from decades of research as a clear winner â whether itâs used to treat low back pain or frozen shoulder or knee ligament injuries â is good old-fashioned exercise.âWe have gotten quite a bit more evidence for the effectiveness of exercise in both facilitating recovery and also protecting people from different kinds of injuries or diseases,â said James Gordon, chair of the division of biokinesiology and physical therapy at the University of Southern California. Marilyn Moffat, a professor of physical therapy at New York University, agreed, saying that for every type of patient seen by physical therapists, âwhether itâs patients with cardiovascular disease, whether itâs patients with diabetes, whether itâs patients with orthopedic problems or fibromyalgia or neuromuscular disorders or falls or frailty or obesity, the literature out there in terms of exercise interventions is so strong for every single one.âChanging the Field, SlowlyThese days, most physical therapists recognize that treatments should consist of exercises that improve strength and flexibility, as well as ergonomic adjustments to peopleâs work or workout routines to prevent future injuries. However, some practitioners argue that passive treatments still have their place and they are still taught in physical therapy doctorate programs.James Irrgang, chair of the physical therapy department at the University of Pittsburgh, said he wasnât surprised there is still a gap between what evidence shows is effective and what some clinical practices do.

Across medicine, it traditionally takes 17 years for research to make its way to the clinic. As a result, Dr. Irrgang said that much of the emphasis in physical therapy now is on implementation. ÂHow do we get the clinicians to adhere to the best available evidence?. ÂHe hopes the answer is through education.

In 2006, Dr. Irrgang â who at the time was the president of the Academy of Orthopaedic Physical Therapy â helped develop guidelines in the form of a report card for diagnostic and treatment techniques commonly used by physical therapists, based on the best scientific evidence.Some techniques, like doing exercises to increase quadriceps strength after an A.C.L. Tear, get an A. Others, like using electrotherapy to improve heel pain for plantar fasciitis, get a D.What to Look for in a Physical TherapistSo how can you tell if your P.T. Is relying on the best science?.

During your first visit, the physical therapist will evaluate your symptoms, level of pain, how you move and your limitations for range of motion, strength and balance. That will become the basis of a diagnosis. This is not a medical diagnosis. The physical therapist wants to know what is limiting the function of, say, your knee, via muscle weakness or joint stiffness.Dr. Moffat said that this initial appointment is a good time to decide whether you want to work with the physical therapist.

ÂThe most important thing is what the therapist does with their initial exam,â she said. ÂDo they really take the time initially to examine whatâs going on and then determine whatâs most appropriate for that patient?. ÂAfter the evaluation, the treatment they recommend should be evidence-based, drawing from the clinical practice guidelines, but it should also be tailored to your individual limitations and goals. It should also be active, incorporating strengthening and stretching exercises.Itâs important for the physical therapist to be empathetic and honest about what your course of treatment will entail, because the process can be painful. Whether or not you like your practitioner can also make a big difference in how you see the outcome.

According to one meta-analysis, patients consistently rated their physical therapists based on how much they liked them as people, not on whether or not they got better.And if you find yourself in a clinic where passive therapies like heat packs or uasound seem to be the main approach to treatment, âFind another place to go,â Dr. Gordon said. Those treatments may be useful for temporarily reducing pain or inflammation, âbut they are not therapeutic in and of themselves. They are adjuncts to treatment.âThis approach to physical therapy may not use lasers or cryocompression pants or whatever the hot new toy is, and it requires work on the patientâs part, but it does work.âI think we are improving what we do, but I think itâs an evolution,â said Dr. Gordon, whoâs been practicing physical therapy for over 40 years.

Incremental, evidence-based advances are âhaving an impact, but itâs not sexy. Itâs not a new robotic thing. Itâs hard to put it on the seven oâclock news. But it is truly a revolution in health care.âDana Smith is a health and science writer based in Durham, N.C. Her work has appeared in The Atlantic, The Guardian, Scientific American, STAT and more.AdvertisementContinue reading the main story.

AdvertisementContinue reading generic cialis 20mg online the main storySupported byContinue reading the main storyPhys EdHow Weight Training May Help With Weight ControlPeople who regularly do muscle-strengthening exercises are about 20 to 30 percent less likely to become obese over time than people who do not.Credit...Neil Hall/EPA, via ShutterstockJuly 7, 2021Lifting weights a few times a week might help us stave off obesity, according to an interesting new study of resistance exercise and body fat. It shows that people who regularly complete muscle-strengthening exercises of any kind are about 20 to 30 percent less likely to become obese generic cialis 20mg online over time than people who do not, whether they also work out aerobically or not.The findings indicate that weight training could be more consequential for weight control than many of us might expect, and a little lifting now may keep us lighter, later.The incidence of obesity in America is rising, with about 40 percent of adults currently meeting the standard criteria for obesity. That number is expected to increase to more than 50 percent by the end of this decade.Unfortunately, few of us will drop any added pounds, long term, once we gain them. Most people who shed more than about 5 percent of their body weight regain it within five years.The most effective way to deal with obesity, then, is probably generic cialis 20mg online to prevent it.

And regular exercise can help in that regard. Many studies show that people who often walk, jog, cycle, swim or otherwise work out aerobically tend to gain less weight with age generic cialis 20mg online than sedentary people and are at lower risk of becoming obese.But far less has been known about whether weight training likewise influences weight. Some past research hints that resistance training helps people retain muscle mass while people are trying generic cialis 20mg online to lose weight. But whether it might also check long-term weight gain and avert obesity has not been clear.So, for the new study, which was published in June in PLOS Medicine, researchers at Iowa State University in Ames, Iowa, and other institutions, decided to look into the relationship, if any, between weights and waistlines.

They began by turning to the large and useful database compiled for the Aerobics Center Longitudinal Study, a famous undertaking that had tracked the medical, health and fitness status of tens of thousands of patients who visited the Cooper Clinic in Dallas between 1987 generic cialis 20mg online and 2005. The men and women had gone through extensive testing during repeated visits to the clinic over the years.Now, the Iowa researchers pulled the records for almost 12,000 of the participants, most of them middle-aged. None of them were generic cialis 20mg online obese, based on their B.M.I., when they first joined the Aerobics Center study. (B.M.I., or body mass index, indirectly estimates body fat, based on your height and weight.

You can check yours online here.)These particular men and women had completed the typical array of health and fitness measurements during their visits to the clinic and also filled out generic cialis 20mg online an exercise questionnaire that asked, among other issues, about weight training. Did they ever engage in âmuscle-strengthening exercises,â it inquired, and if so, how often and for how many minutes generic cialis 20mg online each week?. The researchers then began crosschecking, comparing peopleâs weights and other measurements from one clinic visit to the next. Based on B.M.I., about 7 percent of the men and women had become obese within about six years of their first visit to generic cialis 20mg online the clinic.But B.M.I.

Is a loose approximation of body composition and not always an accurate measure of obesity. So the researchers also checked changes to peopleâs generic cialis 20mg online waist circumferences and their body-fat percentage to determine if they had become obese. By the yardsticks of a waist circumference greater than 40 inches for men and 35 for women, or a body-fat percentage above 25 percent for men and 30 percent for women, as many as 19 percent of participants developed obesity over the years.Weight lifting, however, changed those outcomes, the researchers found, substantially lowering the risk that someone would become obese, by any measure. Men and women who reported strengthening their muscles a few times a week, for a weekly total of one to two hours, were about 20 percent less likely to become obese over the generic cialis 20mg online years, based on B.M.I., and about 30 percent less likely, based on waist circumference or body-fat percentage.The benefits remained when the researchers controlled for age, sex, smoking, general health and aerobic exercise.

People who worked out aerobically and lifted weights were much less likely to become generic cialis 20mg online obese. But so were those who lifted almost exclusively and reported little, if any, aerobic exercise.The results suggest that âyou can get a lot of benefit from even a littleâ weight training, says Angelique Brellenthin, a professor of kinesiology at Iowa State, who led the new study.Of course, the study was observational and does not prove that resistance training prevents weight gain, only that they are linked. It also did not consider peopleâs diets, genetics or health attitudes, any of which could affect obesity risk.Perhaps most generic cialis 20mg online important, it does not tell us how muscle strengthening influences weight, although it is likely that resistance training builds and maintains muscle mass, Dr. Brellenthin says.

A metabolically active tissue, muscle burns calories generic cialis 20mg online and slightly increases our metabolic rate. Interestingly, the desirable effect of adding muscle mass may also explain why fewer lifters avoided obesity generic cialis 20mg online when the researchers used B.M.I. As a measure. B.M.I.

Does not differentiate muscle from fat, Dr. Brellenthin points out. If you add muscle with weight training, your B.M.I. Can rise.Still, the primary message of the study is that some weight training likely helps, over time, with weight control.

ÂSo, my advice would be to fit in a few body weight exercises before or after your usual daily walk,â Dr. Brellenthin suggests. Or join a gym or an online class. Or try one of Wellâs easy, at-home resistance-training routines, like the 7-Minute Standing Workout.AdvertisementContinue reading the main storyAdvertisementContinue reading the main storySupported byContinue reading the main storyWhat to Look for in a Physical TherapistNot all P.T.s are created equal.

Find a professional who values evidence over anecdote.In some instances, physical therapy can be as effective as surgery, as indicated by one study on meniscal tears. Other research is exploring its effectiveness in partial rotator cuff tears.Credit...Getty ImagesJuly 6, 2021Thereâs been a quiet revolution taking place in the field of physical therapy. In the early 2000s, you could go to five different physical therapists for an injury and receive five different treatment plans. Some would have advised targeted exercises to strengthen muscles or classic treatments, like heat and cold packs.Others might have relied on âvoodoo treatmentsâ like uasound, lasers and electrotherapy, despite the fact that experts werenât really sure how â or even if â they worked.

ÂBut P.T.s are using it, and theyâre charging for it, and theyâre getting reimbursed for it â basically for a technique thatâs not effective. Is that fraud?. I donât know.âOver the last 15 years, leaders in the physical therapy field have worked to shed this reputation, improving standards and consistency. Theyâve developed systems to diagnose and classify injuries and turned to scientific research to create evidence-backed treatment guidelines.

ÂThatâs how you change the face of the profession,â said David Wert, an associate professor of physical therapy at the University of Pittsburgh. ÂUsing evidence and applying interventions for folks that are meaningful.âA Shift From Passive to Active TreatmentOriginally, physical therapy was largely based on the use of treatments like heat and ice to ease peopleâs pain and aid healing. Practitioners have also been quick to adopt technologies like laser therapy, which purportedly travels through skin and cells to increase energy production in mitochondria (the powerhouse of the cell) to accelerate recovery. But a treatmentâs effect on a cell in a petri dish doesnât necessarily translate to a patient in the clinic.

The most recent â and some say most definitive â study on the technique shows no benefit over a placebo.Over the past two decades, studies and meta-analyses (like the one conducted on uasound) have revealed that these types of passive treatments, where patients lie down on a table and have a therapy performed on them, actually do very little. And in some cases, they can even slow down recovery.For example, ice has long been used to reduce swelling after an injury by constricting blood vessels in the area, which prevents blood and inflammatory cells from reaching the damaged tissue. But those blood and inflammatory cells are also a necessary part of the healing process, and restricting them with a cold pack or ice bath can delay or even prevent recovery.When compared head-to-head, active exercise-based therapies are both less expensive and more effective than passive ones. In some instances, exercise is even as effective as surgery.

In one study of 350 patients who had meniscal tears, there was no difference after six months between the patients whoâd had surgery and those whoâd used active physical therapy. Other research is currently exploring whether the same might be true for partial rotator cuff tears.Instead, whatâs emerged from decades of research as a clear winner â whether itâs used to treat low back pain or frozen shoulder or knee ligament injuries â is good old-fashioned exercise.âWe have gotten quite a bit more evidence for the effectiveness of exercise in both facilitating recovery and also protecting people from different kinds of injuries or diseases,â said James Gordon, chair of the division of biokinesiology and physical therapy at the University of Southern California. Marilyn Moffat, a professor of physical therapy at New York University, agreed, saying that for every type of patient seen by physical therapists, âwhether itâs patients with cardiovascular disease, whether itâs patients with diabetes, whether itâs patients with orthopedic problems or fibromyalgia or neuromuscular disorders or falls or frailty or obesity, the literature out there in terms of exercise interventions is so strong for every single one.âChanging the Field, SlowlyThese days, most physical therapists recognize that treatments should consist of exercises that improve strength and flexibility, as well as ergonomic adjustments to peopleâs work or workout routines to prevent future injuries. However, some practitioners argue that passive treatments still have their place and they are still taught in physical therapy doctorate programs.James Irrgang, chair of the physical therapy department at the University of Pittsburgh, said he wasnât surprised there is still a gap between what evidence shows is effective and what some clinical practices do.

ÂHe hopes the answer is through education. In 2006, Dr. Irrgang â who at the time was the president of the Academy of Orthopaedic Physical Therapy â helped develop guidelines in the form of a report card for diagnostic and treatment techniques commonly used by physical therapists, based on the best scientific evidence.Some techniques, like doing exercises to increase quadriceps strength after an A.C.L. Tear, get an A.

Others, like using electrotherapy to improve heel pain for plantar fasciitis, get a D.What to Look for in a Physical TherapistSo how can you tell if your P.T. Is relying on the best science?. During your first visit, the physical therapist will evaluate your symptoms, level of pain, how you move and your limitations for range of motion, strength and balance. That will become the basis of a diagnosis.

This is not a medical diagnosis. The physical therapist wants to know what is limiting the function of, say, your knee, via muscle weakness or joint stiffness.Dr. Moffat said that this initial appointment is a good time to decide whether you want to work with the physical therapist. ÂThe most important thing is what the therapist does with their initial exam,â she said.

ÂDo they really take the time initially to examine whatâs going on and then determine whatâs most appropriate for that patient?. ÂAfter the evaluation, the treatment they recommend should be evidence-based, drawing from the clinical practice guidelines, but it should also be tailored to your individual limitations and goals. It should also be active, incorporating strengthening and stretching exercises.Itâs important for the physical therapist to be empathetic and honest about what your course of treatment will entail, because the process can be painful. Whether or not you like your practitioner can also make a big difference in how you see the outcome.

Gordon, whoâs been practicing physical therapy for over 40 years. Incremental, evidence-based advances are âhaving an impact, but itâs not sexy. Itâs not a new robotic thing. Itâs hard to put it on the seven oâclock news.

But it is truly a revolution in health care.âDana Smith is a health and science writer based in Durham, N.C. Her work has appeared in The Atlantic, The Guardian, Scientific American, STAT and more.AdvertisementContinue reading the main story.