Dr. Vanderwater

Dr. Vanderwater Family Physician : Life-Long Value Investor :I advise and coach private clients upon their request. Office Email
office.vanderwater@barriefht.ca

Congratulations: RVH is an Excellent Teaching Hospital . Keep this up !
07/24/2025

Congratulations: RVH is an Excellent Teaching Hospital . Keep this up !

Howard Madks is an Investing Legend.Buffett loved hus writings. You should too.
07/01/2025

Howard Madks is an Investing Legend.Buffett loved hus writings. You should too.

How Howard Marks consistantly beats the market 🚀

06/23/2025

This May be The Futue of Type 1 Diabetes

ORIGINAL ARTICLE
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Stem Cell–Derived, Fully Differentiated Islets for Type 1 Diabetes
Authors: Trevor W. Reichman, M.D., James F. Markmann, M.D., Ph.D., Jon Odorico, M.D., Piotr Witkowski, M.D., Ph.D. https://orcid.org/0000-0002-4459-6673, John J. Fung, M.D., Ph.D., Martin Wijkstrom, M.D., Fouad Kandeel, M.D., Ph.D., +13 , for the VX-880-101 FORWARD Study Group*Author Info & Affiliations
Published June 20, 2025
DOI: 10.1056/NEJMoa2506549
Copyright © 2025

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Abstract

BACKGROUND

Zimislecel is an allogeneic stem cell–derived islet-cell therapy. Data on the safety and efficacy of zimislecel in persons with type 1 diabetes are needed.
METHODS

We conducted a phase 1–2 study of zimislecel in persons with type 1 diabetes. In part A, participants received a half dose of zimislecel (0.4×109 cells) as a single infusion into the portal vein, with an option for a second half dose within 2 years. In parts B and C, participants received a full dose of zimislecel (0.8×109 cells) as a single infusion. All the participants also received glucocorticoid-free immunosuppressive therapy. The primary end point in part A was safety. The primary end point in part C was freedom from severe hypoglycemic events during days 90 through 365, with a glycated hemoglobin level of less than 7% or a decrease of at least 1 percentage point from baseline in the glycated hemoglobin level at one or more time points between days 180 and 365. Secondary end points in part C included safety and insulin independence between days 180 and 365. Assessment of the primary and secondary end points in part C involved the participants who received the full dose of zimislecel as a single infusion in part B or C. Detection of serum C-peptide during a 4-hour mixed-meal tolerance test was used to assess engraftment and islet function. All the analyses were interim and not prespecified.
RESULTS

A total of 14 participants (2 in part A and 12 in parts B and C) completed at least 12 months of follow-up and were included in the analyses. C-peptide was undetectable at baseline in all 14 participants. After zimislecel infusion, all the participants had engraftment and islet function, as evidenced by the detection of C-peptide. Neutropenia was the most common serious adverse event, occurring in 3 participants. Two deaths occurred — one caused by cryptococcal meningitis and one by severe dementia with agitation owing to the progression of preexisting neurocognitive impairment. All 12 participants in parts B and C were free of severe hypoglycemic events and had a glycated hemoglobin level of less than 7%; these participants spent more than 70% of the time in the target glucose range (70 to 180 mg per deciliter). Ten of the 12 participants (83%) had insulin independence and were not using exogenous insulin at day 365.
CONCLUSIONS

The results of this small, short-term study involving persons with type 1 diabetes support the hypothesis that zimislecel can restore physiologic islet function, warranting further clinical investigation. (Funded by Vertex Pharmaceuticals; VX-880-101 FORWARD ClinicalTrials.gov number, NCT04786262.)
Continue reading this article

The Benefits of Walking and the Risks of Sitting (on our metabolic health)
06/23/2025

The Benefits of Walking and the Risks of Sitting (on our metabolic health)

Most of us sit for 8–10 hours a day, and it’s wrecking our metabolic health. Even if you exercise, long stretches of sitting can spike blood sugar, raise insulin, and increase inflammation. But here’s the good news: Just 2 minutes of light walking every 20–30 minutes can lower blood sugar by...

06/02/2025

Harvard Graduation Speech ( something positive … Link is Below , originally published on Twitter )

05/31/2025

Reading can reduce dementia risk, combat social isolation,and improve well beeing. (Read On ! )

Forget chatbots: Reading can combat loneliness, boost the brain, research shows

In the face of what the WHO has called 'a crisis of social isolation and loneliness,' studies find reading for pleasure, alone or in book groups, has multiple benefits for all ages.
Barbara Jacquelyn Sahakian and Christelle Langley( Researchers: Cognitive Neuroscientists )

5/30/25

One way in which reading may help reduce loneliness is by enhancing our social cognition, which is the ability to understand and connect with others.
Loneliness has become such a widespread problem that Silicon Valley billionaires are now highlighting it to market AI companions, with Mark Zuckerberg recently stating, “The average American has fewer than three friends.”

This echoes what the World Health Organization has called a crisis of social isolation and loneliness. They report that about 25% of older adults are socially isolated and 5%-to-15% of adolescents are lonely. But a variety of research—including our own—suggests reading may be a much better solution than chatbots.

Human interaction is no doubt hugely important. A study published in 2023 found that it only takes around five close friends for children and adolescents to thrive, giving them better brain structure, cognition, academic performance and mental health.

Having fewer than five close friends may not provide enough social contact. But larger numbers are less likely to be close friends. The dilemma of technology frequently means that despite some people having vast numbers of friends on social media, they are not close friends and so do not provide the social support needed.

Similarly, chatbots may not provide the type of face-to-face social interaction that people need to flourish. During the pandemic lockdowns, a study found that face-to-face communication was far more beneficial for mental health than digital communication.

But how can reading help us to feel less lonely and have better wellbeing?

A recent survey from The Queen’s Reading Room, the charity and book club of Queen Camilla, and other surveys, have found that reading fiction and other books significantly reduces feelings of loneliness and improves wellbeing.

Another charity, The Reader, conducted a survey of approximately 2,000 participants and found that this was especially true among young adults. Among those aged 18-to-34, 59% said reading made them feel more connected to others and 56% of those felt less alone during the pandemic.

Another survey of over 4,000 participants in conjunction with the University of Liverpool found that reading offers powerful benefits, serving as a top method for reducing stress. In addition, participants reported that reading encouraged personal growth, such as improving health, picking up hobbies and boosting empathy, with 64% of readers having a better understanding others’ feelings.

Reading and the brain
Indeed, scientific research looking at book clubs and shared reading back this up, finding notable emotional and social benefits of reading. For example, students reported greater connection (42.9%) to others, deeper understanding of others’ experiences and beliefs (61.2%) and reduced loneliness (14.3%) as a result of reading.

The surveys above all rely on people reporting how they feel, rather than an objective measure. But there are also findings from objective measures of the brain, including neuroimaging. A systematic review of 11 intervention studies showed that shared reading among older adults improved wellbeing and helped alleviate loneliness and social isolation.

boy reading on white couch
Children who read for pleasure early in life were found to have better brain structure, cognition, academic achievement, longer sleep duration and better mental health, the authors' research showed.
One way in which reading may help reduce loneliness is by enhancing our social cognition, which is the ability to understand and connect with others.

A neuro-imaging study of young adults found that reading fiction, particularly passages with social content, activated areas of the brain involved in social behaviour and emotional understanding, such as the dorsomedial prefrontal cortex. This brain region was also linked to the stronger social cognition seen in frequent fiction readers, suggesting a neural pathway through which reading fosters greater social connectedness.

Reduced dementia risk
Importantly, reading may also reduce the risk of dementia. One study of 469 people aged 75 and over, with no dementia at baseline, were followed up for 5.1 years. Among leisure activities such as playing board games, playing musical instruments and dancing, reading was associated with a 35% reduced risk of dementia.

A number of studies have similarly shown that engaging in cognitively stimulating activities, such as reading, can slow cognitive decline and reduce the risk of dementia.

Our own research also showed the benefits of reading for pleasure early in life. In a large sample of over 10,000 children in the Adolescent Brain Cognitive Development (ABCD) Study, we found that those children who read for pleasure early in life had better brain structure, cognition, academic achievement, longer sleep duration and better mental health—including lower symptoms of inattention, stress and depression—when adolescents. Importantly, they also had less screen time and better social interactions.

Read: Loneliness is killing us

So, while AI and chatbots can enhance our lives in many ways, they are not a solution to everything. We know that while technology has many benefits, it has also produced many unforeseen problems. Let’s solve problems of loneliness and social isolation through reading and book clubs. Reading is also a great way to improve brain structure, cognition and wellbeing.The Conversation

Barbara Jacquelyn Sahakian is a professor of clinical neuropsychology and Christelle Langley a postdoctoral research associate in cognitive neuroscience, both at the University of Cambridge.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Acting as Your Own Navigator in an Underresourced and Overwhelmed Healthcare SystemWhat every patient needs to know to a...
05/21/2025

Acting as Your Own Navigator in an Underresourced and Overwhelmed Healthcare
System

What every patient needs to know to act as their own navigator ( written by Dr Kim Alexander)

Dr. Kim Alexander
They say that if you want something done right, ask a busy person.

Dr. Teresa Purzner may be the ultimate example of that. She paused her neurosurgical residency at the University of Toronto in 2021 to get a PhD at Stanford creating new drugs for pediatric brain tumours.

She had the first of her three children during her PhD and created Cerebelly baby food to support early brain development. Her brand can now be found in over 14,000 stores across North America.

These days Dr. Purzner works at Queen’s University as a neurosurgeon. She is studying patients with the most deadly brain tumour, glioblastoma multiforme (GBM). GBM patients have a median survival of only eight months and less than 5% survive to five years. It’s the brain cancer that killed beloved Canadian singer Gord Downie. When she looked at surgical outcomes in Kingston she noticed that many patients were lost to follow-up or weren’t able to complete their treatments.

They redesigned their system with nurse navigators acting as a primary point of contact for any questions the patient may have, then coordinating with the rest of the care team to ensure treatment schedules are followed.

When patients can access a navigator we see huge benefits: in Kingston 40% more patients received surgery within provincial targets, delays to radiation therapy have been reduced by 40%, and post-op MRIs are now being performed on time for 89% of patients.

What do you want your patients to know about how to navigate the healthcare system? I’ve made my own list here. You are welcome to cut and paste and modify it to create your own patient handout. Helping patients navigate medical systems is good for everybody.

Here’s what I think every patient needs to know to act as their own navigator:

In Ontario, your specialist is required to respond within two weeks of receiving the referral from your family doc. They might call with an appointment time, or reach out to tell you that their wait times are one year and you should hear from them in nine months with more information. Either way, if two weeks have passed and you haven’t heard anything it’s time to be a squeaky wheel. Check with your family doc to make sure the fax was sent, then call the specialist. If they don’t pick up the phone, go in person to the office. If the waitlist is long, ask when you should check in next with them.
ALWAYS, EVERYWHERE, ASK TO BE ON THE CANCELLATION LIST. This can shorten your wait from months to days. If you’ve got an MRI booked, ask the receptionist at your family practice for the phone number of the booking office at your hospital. Call them and ASK TO BE ON THE CANCELLATION LIST. If you’re trying to get a hip replaced, tell the receptionist you’ll be ON THE CANCELLATION LIST for a surgery date.
If you’ve had a devastating diagnosis and are connected with a cancer centre, you probably have access to some kind of navigator. When you talk to the receptionist to book your first appointment, ask them about patient resources like social workers or nurse practitioners. If you don’t get resources from the booking team, ask your surgeon or oncologist. If no one knows, try talking to the Patient Experience office at the hospital. Put these people on your speed dial.
Keep your own records. Get yourself a three-ring binder with pockets to hold papers until you get home to your three-hole punch. For each medical problem make a tab and in each section write down the name of your specialist, what tests they’ve ordered, what the results were and what the follow-up plan is. Imaging tests generally have results within a few days and biopsies generally take about a month. Make an appointment with your doc to discuss the results, that way if the lab forgets to send the results you’re there to prompt them to call the lab and get it faxed over. After the appointment, ask the receptionist to print a copy for your files.
Activate your voicemail and check it regularly. Call the doctor back to confirm your appointment. Check your cellphone settings to make sure you don’t block calls from unknown numbers, and pick up the phone when you see a blocked number—that’s how your doc calls when we sit down at 10 p.m. to do our charting and see urgent results.
If you have a chronic illness, ask to see the Palliative Care team as soon as possible. People think palliation is only for dying people, but really they are specialists in quality of life. They have time and expertise to help you get the best resources for the best care.
If your condition changes, keep us updated. So often patients make do at home as things get worse and worse, but options change when things go downhill so call your family doc or specialist to be reassessed if things are new or worse. Agony is optional! If you’re on the waitlist for a specialist and you have to go to ER, go the the ER at the hospital your specialist works at. The ER doc can either admit you to hospital for the doc to see in the morning, or send you home with an urgent office consult within a few days.
If it’s an option, go to ER at 7:30 a.m. It’s nice and quiet and the fresh day shift team is at optimal efficiency.
If you’re nervous about following your doctor’s advice, don’t just ignore it. Write down your questions and make another appointment to discuss. One of the big questions to ask is “can I try it for a few months and stop if I don’t like it?” If it doesn’t work, come on back in so we can try something else. Everything that we try gives us more information. Be patient with us while we figure out what works best for you.
Last year at drkimalexander.com I wrote about pain and how to advocate for yourself with a healthcare team. Visit the website to read the article

Canadians are nice and we don’t like to make a fuss, but it’s too easy to fall between the cracks. Complex systems fail in complex ways, and I don’t want anyone to suffer as a result.

Dr. Kim Alexander is a Canadian Gynecologist, S*xual Health Expert and S*x Educator. Taking a sisterly approach to S*x Ed she is smart, savvy ,and shameless.

05/14/2025

Will There Ever be Another Warren Buffett ?

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