Knee Replacement: Don't Get It Too Late or Too Early, Study Finds for Silicon Valley Orthopaedics

We agree with Dr. Pagnano’s comments on this study. While patients make the ultimate decision on whether to proceed with total knee replacement, the surgeon should advise patients on their rehab potential and overall health, says Dr. Gay

FREMONT, Calif. (PRWEB) January 17, 2020
In a recent article in USA TODAY, the results of this study, published in The Journal of Bone and Joint Surgery, were detailed. The research suggests that for far too many patients, having a knee replacement procedure is done either too late or too soon. The team at Northwestern University’s Feinberg School of Medicine in Chicago found that 90% of patients who could benefit from the procedure waited too long to have it. Alternatively, about 25% of patients who don’t need the surgery are having it prematurely when the benefit is minimal, and they run the risk of complications. Patients with osteoarthritis in the knee should time the surgery to ensure maximum benefits if they are eligible for knee replacement.
In the article, Dr. Mark Pagnano, who is unaffiliated with the study and a professor and chairman of the Department of Orthopedic Surgery at Mayo Clinic, told USA TODAY that despite advancements in the procedure, some people that should have knee replacement surgery hold on to antiquated notions of its risks and outcomes and put off having it done. However, he also emphasized that there may be serious issues in getting the surgery too early. “There’s a sense among some people that a knee replacement will magically cure any problem that’s related to the knee. Particularly for younger, active patients, they will continue to push for a permanent fix to a problem when perhaps a surgical option is still not in their best interest,” Dr. Pagnan explained.
“We agree with Dr. Pagnano’s comments on this study. While patients make the ultimate decision on whether to proceed with total knee replacement, the surgeon should advise patients on their rehab potential and overall health,” says Dr. Gay.
“At our practice, we spend a great deal of time counseling patients so they can make the most informed decision possible,” explains Dr. Reynolds
At Silicon Valley Orthopaedics, Dr. Nic Gay and Dr. Kerisimasi Reynolds fully understand the implications of having joint replacement surgery and typically only recommend joint replacement when conservative or joint preservation treatments are not viable options for eliminating pain and restoring function. They use indicators such as pain level, joint function, age and x-ray assessment to determine if or when knee replacement is necessary. Dr. Gay and Dr. Reynolds have intimate knowledge of knee anatomy and associated illnesses, providing patients with access to the highest standard of care.
More about Silicon Valley Orthopaedics (SVO):Silicon Valley Orthopaedics (SVO) is located at 39180 Farwell Dr., Suite 110, in Fremont, CA. Dr. Nic Gay and Dr. Kerisimasi Reynolds help patients across San Jose and the Silicon Valley area reach their musculoskeletal health goals at this state-of-the-art practice, utilizing innovative, evidence-based surgical and non-surgical techniques. They provide an accurate diagnosis and appropriate treatment plans to address joint pain so that patients achieve optimum results.
If you are concerned about joint health and would like an expert consultation with a specialist orthopedic surgeon, contact Silicon Valley Orthopaedics (SVO) today. Call (650) 379-4616 to learn more or visit

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Mount Sinai Research Finds that Heterogeneity of Liver Cancer Cells Help Explain Tumor Progression in Patients

NEW YORK (PRWEB) January 16, 2020
Many liver cancer tumors contain a highly diverse set of cells, a phenomenon known as intra-tumor heterogeneity that can significantly affect the rate at which the cancer grows, Mount Sinai researchers report. The immune system’s contribution to this heterogeneity can have major clinical implications.
In a study published in January in Nature Communications, the team reported that this heterogeneity—either within the same tumor or between different tumor regions in the same tumor nodule—appears in about 30 percent of patients with hepatocellular cancer (HCC), the most common form of liver cancer, and that some of these tumors grow rapidly by hijacking different gene networks.
“Tumors are a complex ecosystem, and we’re developing for the first time a blueprint of the different ways they can evolve in patients with liver cancer by interacting with the immune system,” says Augusto Villanueva, MD, PhD, Assistant Professor in the Liver Cancer Program at The Tisch Cancer Institute at Mount Sinai, and corresponding author of the study. “By better understanding how tumors progress, we’re learning more about how they adapt to pharmacological pressures, and how they can develop mechanisms of resistance to cancer therapies. This greater awareness will hopefully lead to the identification of biomarkers that can predict which patients will be responsive to treatment.”
Among the clinical implications associated with intra-tumor heterogeneity identified by the research team was the discovery that a single liver cancer biopsy could potentially mischaracterize a liver tumor.
“Some tumors are very homogeneous in terms of their genetic makeup and immune cell infiltration, while others are very heterogeneous,” says Dr. Villanueva. “This means that a biopsy from the same tumor could yield different information depending on where it was taken, and could thus affect clinical decision-making for the patient. That’s why our work aimed at learning how tumors evolve and the different trajectories they can take is so important to future cancer research, as well as to effectively treating the disease.”
As immunotherapy continues to transform cancer research and treatment, one of the most promising areas is liver cancer, which has become the fastest-rising malignancy in the United States in terms of incidence and mortality, responsible for 33,000 new cases annually. Two phase 2 clinical trials using PD-1 immune checkpoint inhibitors, which help the body’s immune system recognize and attack cancerous cells, have achieved unprecedented responses in humans, prompting the Food and Drug Administration to grant them accelerated approval status for second-line treatment of advanced hepatocellular cancer.
More recently, a phase 3 clinical trial combining a PD-1 immune checkpoint inhibitor with an antiangiogenic improved survival compared to the current first-line standard of care, sorafenib. Still, only about 30 percent of patients with HCC are believed to respond favorably to immune checkpoint inhibition—an outcome not uncommon with immunotherapies.
“The immune system imposes significant constraints on liver cancer evolution, and by investigating the interaction of immune cells and cancer cells at the molecular level we’re trying to predict or anticipate mechanisms of tumor resistance,” explains Bojan Losic, PhD, Associate Professor of Genetics and Genomic Sciences, Cancer Immunology Program, at Icahn School of Medicine at Mount Sinai, and lead author of the study. “Our work is particularly relevant considering the remarkable success of immune checkpoint inhibitors in some heterogeneous solid tumors.”
To understand the mechanisms that drive tumor progression on a patient-by-patient basis, the research team from Mount Sinai and other medical centers around the world performed an integrated molecular analysis of gene expression, immune activities, and DNA mutations from multiple regions of the same tumor nodule in 14 liver cancer patients. The study was the first to use single-cell RNA sequencing in multiple regions of the same tumor nodule, and was among the first to assess the contribution of the immune system to liver cancer evolution.
The Mount Sinai-led study consisted of researchers from the University of Sao Paulo School of Medicine in Brazil; the University Medical Center Hamburg-Eppendorf in Hamburg, Germany; Lausanne University Hospital CHUV in Switzerland; Universitat de Barcelona in Spain; Clinica Universidad de Navarra in Spain; Dalhousie University in Halifax, Nova Scotia; and IBM Research.
About the Mount Sinai Health SystemThe Mount Sinai Health System is New York City’s largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai’s vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report’s “Best Medical Schools”, aligned with a U.S. News & World Report’s “Honor Roll” Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report’s “Honor Roll” of top U.S. hospitals; it is one of the nation’s top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology/Neurosurgery, and Orthopedics in the 2019-2020 “Best Hospitals” issue. Mount Sinai’s Kravis Children’s Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology, Mount Sinai St. Luke’s and Mount Sinai West are ranked 23rd nationally for Nephrology and 25th for Diabetes/Endocrinology, and Mount Sinai South Nassau is ranked 35th nationally for Urology. Mount Sinai Beth Israel, Mount Sinai St. Luke’s, Mount Sinai West, and Mount Sinai South Nassau are ranked regionally.
For more information, visit or find Mount Sinai on Facebook, Twitter and YouTube.

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First-of-Its-Kind Study Finds Newark Charters Among the Most Impactful Education Approaches Studied

Study Finds Attending Newark Charters Causes “Large” and “Sustained” Improvement for Students
Press Release – updated: Jan 15, 2020 11:21 EST

NEWARK, N.J., January 15, 2020 ( – The New Jersey Children’s Foundation is celebrating the release of a new study by a researcher at Boston University’s Wheelock School of Education and the Manhattan Institute. According to Associate Professor Marcus Winters, the study found that “enrollment in Newark charter schools that participate in the common enrollment system tends to lead to a large improvement in math and reading scores,” and that the effect is even larger at the city’s two largest charter school networks – KIPP Newark and North Star Academy. The study also found that “attending a Newark charter school has a larger positive effect than 80% of other educational interventions that have been recently studied using an experimental design.”
“This research presents unequivocal, scientific proof that Newark’s charter schools work and are helping children learn more, faster,” said Kyle Rosenkrans, Executive Director of the New Jersey Children’s Foundation. “For years, charter school educators have toiled to build schools that reflect the genius of their students, while the question of whether this was good for Newark children has been hotly debated among politicians, pundits, and journalists. The scientific evidence is in, and this study should end the debate over whether this has been good for children – the answer is a resounding yes,” Rosenkrans added.
The study is the first randomized control trial-like analysis attempting to measure the effect of attending Newark’s charter schools. Winters employed a gold-standard “direct assignment” design for his study that used the district’s common enrollment lottery system data to eliminate factors like parental involvement and student demographics as a potential alternative explanation for the stand-out performance of Newark’s charter schools. The author also noted that this study adds to the evidence on the effectiveness of urban charter schools to improve student learning and suggests that this effectiveness continues even as the urban charter sectors get larger.
In Newark, the charter sector has grown from educating just 7 percent of the students in 2006 to an estimated 38% in 2019 and could reach 50% in future years. Relations between the city’s district and charter schools have radically improved in recent years, but the study comes at a time when tensions have resurfaced during a recent debate over whether to close four Newark charter schools.
Key findings of the study include:
● “Enrollment in a Newark charter school that participated in the common enrollment system leads to large improvements in math and English language arts (ELA) test scores, on average.”
● “The benefits of charter school enrollment do not appear to vary meaningfully depending on a student’s race, gender, or qualification for free lunch – though these estimates are based on smaller sample sizes and are thus less precise.”
● Learning gains were even more pronounced when the study isolated students in the city’s two largest charter school networks – KIPP Newark and Uncommon Schools – North Star Academy.
● “The magnitude of the impact from attending a Newark charter school is comparable to those found in prior research on charters in Boston and Denver… “attending a Newark charter school has a larger effect than 80 percent of other educational interventions that have been studied using an experimental design,” according to a paper by Brown University Professor Matthew Kraft.
About the New Jersey Children’s Foundation:
The New Jersey Children’s Foundation is a nonprofit organization aimed at promoting a fact-based discussion about public education in Newark. Our mission is to invest in people, programs, and partnerships that will improve public education systems by putting the interests of children first. Our vision is that every child will break down the walls of inequity through the creation of high-quality public education systems. Our theory of change is that when communities are armed with accurate information about public education and given the tools to act, cities will demand great schools for every student.
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Contact: Matthew Frankel, MDF Strategies,917.617.7914,
Source: New Jersey Children’s Foundation

Expansive Survey of More Than 450 Finance and Accounting Professionals Finds Improving Productivity, Reducing Human Error and Refocusing Staff Time on Strategic Work Are Top Expected Outcomes of Financial Automation

Exclusive Report, “The Financial Automation Imperative”, from Invoiced and CFO Dive Reveals That Difficulty Staying Competitive Is The #1 Risk Of Waiting Too Long to Adopt Financial Automation Technology; A Plurality (46%) of Respondents Expect a Possible Economic Recession To Make Adopting Financial Automation Even More Important
Press Release – updated: Jan 15, 2020 08:00 CST

AUSTIN, Texas, January 15, 2020 ( – A new survey of more than 450 finance and accounting professionals conducted by Invoiced and CFO Dive finds at least 50% say improving productivity, reducing human error and refocusing staff time on strategic work are the top expected outcomes of financial automation. In addition, difficulty staying competitive is cited as the #1 risk of waiting too long to adopt financial automation technology.
The study, entitled “The Financial Automation Imperative”, also reveals many new insights on perspectives, plans and priorities for financial automation such as:
Cash flow related automation technologies (Accounts Receivable and Accounts Payable) have the highest adoption levels at 49% and 47% respectively. These two areas also earned the highest satisfaction levels among those using them, indicating strong maturity relative to other categories of financial automation.
The ability to integrate with other systems is cited as the most important decision driver when considering purchasing financial automation technology.
Reporting/forecasting and accounts receivable are the top automation priorities with 45% and 44% of respondents respectively indicating those categories as high or very high priority.
The biggest challenges in adopting financial automation technology are finding vendors that meet requirements, securing budget and making time and bandwidth for implementation.
Reporting/forecasting is the category of automation most likely to see an increase in spending in 2020.
Cryptocurrency is overwhelmingly viewed as the most overhyped financial technology.
The full report can be downloaded for free here.
“This new research suggests that 2020 will be a year of acceleration in the adoption of financial automation technology,” said Jared King, Co-Founder and Chief Executive Officer for Invoiced. “The attitudes and intentions uncovered in the report show that finance and accounting professionals are set on embracing automation, but are just as interested in doing so carefully and successfully,” he added.
“While digital transformation can lead to higher productivity and therefore fewer employees, organizations that don’t adapt to the sweeping changes we see impacting all industries and professions are bound to contract in any case, leading to headcount reductions no matter what,” Robert Freedman, Editor of CFO Dive, said.
The Financial Automation Imperative study was fielded in November and December 2019 and published in January 2020. The study is based on online survey responses from 459 U.S. finance and accounting professionals.
About InvoicedInvoiced is an award-winning platform for helping businesses get paid faster, stop wasting time on collections and provide a better payment experience for customers. With thousands of customers in 92 countries and nearly $50 billion in receivables processed, Invoiced is pioneering the field of accounts receivable automation. Based in Austin, Texas, Invoiced is the #1 rated A/R automation platform on G2 Crowd, a 2020 Cloud Awards Finalist and an official member of Forbes Finance Council. For more information visit
About CFO DiveCFO Dive provides in-depth journalism and insight into the most impactful news and trends shaping finance. The newsletters and website cover topics such as financial reporting, compliance, technology, risk management, leadership, and more. CFO Dive is a leading publication operated by Industry Dive. Our business journalists spark ideas and shape agendas for 7+ million decision-makers in competitive industries. Visit CFO Dive at
Contact:Adam Weinroth​Chief Marketing Officer for 380-0174
Source: Invoiced

Q4 2019 KnowBe4 Finds Security-Related and Giveaway Phishing Email Subject Lines Get the Most Clicks

KnowBe4 Q4 2019 Phishing Report Infographic

As identifying phishing attacks from legitimate emails becomes trickier, it’s more important than ever for end users to look for the red flags and think before they click. -Stu Sjouwerman, CEO, KnowBe4

TAMPA BAY, Fla. (PRWEB) January 15, 2020
KnowBe4, the provider of the world’s largest security awareness training and simulated phishing platform, revealed the results of its Q4 2019 top-clicked phishing report.
The results found that simulated phishing tests with an urgent message to check a password immediately were most effective, with 39% of users falling for it. Social media messages are another area of concern when it comes to phishing. Within the same report, KnowBe4’s top-clicked social media email subjects reveal that LinkedIn messages are the most popular at 55%, followed by Facebook at 28%.
“With more end users becoming security-minded, it’s easy to see how they fall for phishing scams related to changing or checking their passwords,” said Stu Sjouwerman, CEO, KnowBe4. “They should be especially cautious if an email seems to good to be true, such as a giveaway. As identifying phishing attacks from legitimate emails becomes trickier, it’s more important than ever for end users to look for the red flags and think before they click.”
In Q4 2019, KnowBe4 examined tens of thousands of email subject lines from simulated phishing tests. The organization also reviewed ‘in-the-wild’ email subject lines that show actual emails users received and reported to their IT departments as suspicious. The results are below.
Top 10 General Email Subjects
    Change of Password Required Immediately 26%
    Microsoft/Office 365: De-activation of Email in Process 14%
    Password Check Required Immediately 13%
    HR: Employees Raises 8%
    Dropbox: Document Shared With You 8%
    IT: Scheduled Server Maintenance – No Internet Access 7%
    Office 365: Change Your Password Immediately 6%
    Avertissement des RH au sujet de l’usage des ordinateurs personnels 6%
    Airbnb: New device login 6%
    Slack: Password Reset for Account 6%
*Capitalization and spelling are as they were in the phishing test subject line.
**Email subject lines are a combination of both simulated phishing templates created by KnowBe4 for clients, and custom tests designed by KnowBe4 customers.
When investigating ‘in-the-wild’ email subject lines, KnowBe4 found the most common throughout Q4 2019 included:
    SharePoint: Approaching SharePoint Site Storage Limit
    Microsoft: Anderson Hauck has shared a Whiteboard with you
    Office 365: Medium-severity alert: Unusual volume of file deletion
    FedEx: Correct address needed for your package delivery on [[current_date_0]]
    USPS: Your digital receipt is ready
    Twitter: Your Twitter account has been locked
    Google: Please Complete the Required Steps
    Cash App: Your Account Has Been Closed
    Coinbase: Important Please Resolve Error Now
    Would you mind taking a look at this invoice?
*Capitalization and spelling are as they were in the phishing test subject line.
**In-the-wild email subject lines represent actual emails users received and reported to their IT departments as suspicious. They are not simulated phishing test emails.
For more information on KnowBe4, visit
About KnowBe4KnowBe4, the provider of the world’s largest security awareness training and simulated phishing platform, is used by more than 30,000 organizations around the globe. Founded by IT and data security specialist Stu Sjouwerman, KnowBe4 helps organizations address the human element of security by raising awareness about ransomware, CEO fraud and other social engineering tactics through a new-school approach to awareness training on security. Kevin Mitnick, an internationally recognized cybersecurity specialist and KnowBe4’s Chief Hacking Officer, helped design the KnowBe4 training based on his well-documented social engineering tactics. Tens of thousands of organizations rely on KnowBe4 to mobilize their end users as the last line of defense.

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