Prof Jason invites you to take part in research into abnormal response to exertion

DePaul University, Chicago questionnaire, by Prof Leonard Jason: Abnormal Response to Physical and/or Cognitive Exertion in ME and CFS

We are conducting a research study because we are trying to learn more about the experience of abnormal responses to physical and/or cognitive exertion, which has been referred to as post-exertional malaise (PEM) in past research, in patients with Myalgic Encephalomyelitis (ME) and/or Chronic Fatigue Syndrome (CFS).

Due to an ongoing debate about how to define and measure abnormal responses to physical and/or cognitive exertion, the patient community aided in the development of this questionnaire to try to understand how this symptom effects these patients health. We are asking you to be in the research if you have a diagnosis of ME or CFS, speak English, and are 18 years of age or older.

The survey will include questions about your abnormal responses related to your ME or CFS. We will also collect some personal and demographic information about you, such as age, gender, race, marital status, income, level of schooling, and work status. The full survey can be completed online. If there is a question you do not want to answer, you may skip it.

This study may take 1-2 hours of your time. We understand that this may be difficult to complete, so you may take as many breaks as you’d like, and you may work on this survey over several days. Research data collected from you will be anonymous.

Complete the survey

NB to save part way through scroll right to end and click save there.  It will send a return code.

Read more about the research

DePaul University ME & CFS research team

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Lower regulatory frequency for postural control in patients with FM & CFS

Research article abstract:

Lower regulatory frequency for postural control in patients with fibromyalgia and chronic fatigue syndrome by Omid Rasouli, Ottar Vasseljen, Egil A. Fors, Håvard W. Lorås, Ann-Katrin Stensdotter in PLOS One [Published: April 4, 2018]

As many similar symptoms are reported in fibromyalgia (FM) and chronic fatigue syndrome (CFS), underlying defcits may potentially also be similar. Postural disequilibrium reported in both conditions may thus be explained by similar deviations in postural control strategies.

75 females (25/group FM, CFS and control, age 19–49 years) performed 60 s of quiet standing on a force platform in each of three conditions: 1) firm surface with vision, 2) firm surface without vision and, 3) compliant surface with vision. Migration of center of pressure was decomposed into a slow and a fast component denoting postural sway and lateral forces controlling postural sway, analyzed in the time and frequency domains.

Main effects of group for the antero-posterior (AP) and medio-lateral (ML) directions showed that patients displayed larger amplitudes (AP, p = 0.002; ML, p = 0.021) and lower frequencies (AP, p < 0.001; ML, p < 0.001) for the slow component, as well as for the fast component (amplitudes: AP, p = 0.010; ML, p = 0.001 and frequencies: AP, p = 0.001; ML, p = 0.029) compared to controls. Post hoc analyses showed no significant differences between patient groups.

In conclusion, both the CFS- and the FM-group differed from the control group. Larger postural sway and insufficient control was found in patients compared to controls, with no significant differences between the two patient groups.

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Disequilibrium & orthostatic intolerance in patients with ME (CFS)

Research abstract:

The etiologic relation between disequilibrium and orthostatic intolerance in patients with myalgic encephalomyelitis (chronic fatigue syndrome) by K Miwa, Y Inoue in J Cardiol. 2018 Mar 24. pii: S0914-5087(18)30058-3 [Epub ahead of print]

Highlights:

  • Disequilibrium should be recognized as the important cause for orthostatic intolerance (OI).
  • Most patients with disequilibrium report sitting intolerance as well as OI.
  • Disequilibrium appears to be more influential cause for OI than postural orthostatic tachycardia.

Background:
Orthostatic intolerance (OI) causes a marked reduction in the activities of daily living in patients with myalgic encephalomyelitis (ME) or chronic fatigue syndrome.

Most symptoms of OI are thought to be related to cerebral hypo-perfusion and sympathetic activation. Because postural stability is an essential element of orthostatic tolerance, disequilibrium may be involved in the etiology of OI.

Methods and Results:
The study comprised 44 patients with ME (men, 11 and women, 33; mean age, 37±9 years), who underwent neurological examinations and 10-min standing and sitting tests.

Symptoms of OI were detected in 40 (91%) patients and those of sitting intolerance were detected in 30 (68%). Among the 40 patients with OI, disequilibrium with instability on standing with their feet together and eyes shut, was detected in 13 (32.5%) patients and hemodynamic dysfunction during the standing test was detected in 19 (47.5%); both of these were detected in 7 (17.5%) patients.

Compared with 31 patients without disequilibrium, 13 (30%) patients with disequilibrium more prevalently reported symptoms during both standing (100% vs. 87%, p=0.43) and sitting (92% vs. 58%, p=0.06) tests. Several (46% vs. 3%, p<0.01) patients failed to complete the 10-min standing test, and some (15% vs. 0%, p=0.15) failed to complete the 10-min sitting test.

Among the seven patients with both hemodynamic dysfunction during the standing test and disequilibrium, three (43%) failed to complete the standing test. Among the 6 patients with disequilibrium only, 3 (50%) failed while among the 12 patients with hemodynamic dysfunction only, including 8 patients with postural orthostatic tachycardia, none (0%, p=0.02) failed.

Conclusion:
Patients with ME and disequilibrium reported not only OI but also sitting intolerance. Disequilibrium should be recognized as an important cause of OI and appears to be a more influential cause for OI than postural orthostatic tachycardia in patients with ME.

Link: https://www.ncbi.nlm.nih.gov/pubmed/29588088

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Residential care savings limit increases in Wales

Welsh Government news post, 9 April 2018: Residential care savings limit increases in Wales

From today, people in Wales are able to keep up to £40,000 of their money before they need to self-fund the full cost of their residential care, the Welsh Government has confirmed.

A capital limit determines whether a person pays for the full cost of their residential care, or whether they receive financial support towards the cost from their local authority.

The Welsh Government’s Programme for Government commits Ministers to increasing this capital limit used by local authorities who charge for residential care from £24,000 to £50,000 during the current Assembly term.

The capital limit in Wales is the highest in the UK. In England, people with capital and savings above £23,250 have to fund all of their own residential care.

The increase is being delivered in a phased approach, starting in April 2017 when the limit was increased to £30,000. The capital limit has today increased further from £30,000 to £40,000.

There are up to 4,000 care home residents who pay for the full cost of their care. Around 450 care home residents have already benefitted from the increase last year, with a steady increase in this number expected.

Social Care Minister, Huw Irranca-Davies said:

“This is the second step in delivering one of our top six ‘Taking Wales Forward’ commitments to more than doubling the amount of capital a person in residential care can retain without having to use this to pay for their care.

“From today, the capital limit is rising from £30,000 to £40,000, thereby allowing residents to retain a further £10,000 of their hard earned savings and other capital to use as they wish. By the end of the currently Assembly, the limit will be raised to £50,000.

“This is another firm example of this Welsh Government delivering its commitments to the people of Wales”

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Did a Multiple Sclerosis study give us clues about ME/CFS & FM?

Simmaron Research blog post, by Cort Johnson, 19 March 2018: Did a Multiple Sclerosis study give us clues about ME/CFS and Fibromyalgia?

Why should a blog focused on chronic fatigue syndrome (ME/CFS) and fibromyalgia (FM) be interested in multiple sclerosis? Because some distinct similarities exist between the three diseases, and when diseases like ME/CFS and FM aren’t getting much research, sometimes it pays to pay attention to diseases that are. You never know what insights might open up.

For the record, while multiple sclerosis is not as disabling as ME/CFS (yes – studies indicate that ME/CFS is more disabling than MS), MS is considered one of the most fatiguing diseases known.  (Dr. Light’s study actually found more fatigue in MS but much less post-exertional malaise ME/CFS.)

A “Fatigue” Disorder No More? – What Multiple Sclerosis Taught Us About Fatigue and Chronic Fatigue Syndrome

Additionally, MS like ME/CFS and FM, mostly strikes women in mid-life. Plus, having mononucleosis/glandular fever increases the risk of coming down with either ME/CFS or MS and one suspects, FM as well.  Infections often trigger relapses in both MS and ME/CFS. Pregnancy also often brings a respite for women with either MS or ME/CFS (often unfortunately followed by a relapse.) Central nervous system involvement is present in all three diseases. In fact, Simmaron’s spinal fluid study found similar levels of immune dysregulation in ME/CFS and multiple sclerosis.

Simmaron’s Spinal Fluid Study Finds Dramatic Differences in Chronic Fatigue Syndrome

Lastly, check out an amazing story where an ME/CFS patient misdiagnosed with MS responded to an MS drug with a complete remission of her symptoms – A Chronic Fatigue Syndrome/POTS Patient Responds to a Multiple Sclerosis Drug – What Does It Mean?

Read the full article for a discussion of how research into the hormonal and autoimmune components of MS might through light on ME/CFS

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Much can be done to ease ‘CFS’ symptoms – US 2018 Clinician Summit reports

Reports from the 2 day ME/CFS Clinician Summit 2018 held in Salt Lake City Utah.

1. Bateman Horne Center blog post, by Stephanie Griffin, 12 March 2018: A consensus-driven ME/CFS clinician coalition takes shape

The primary outcomes are two-fold.

First, an evidence-based paper on diagnostic and treatment methods to be published in a peer-reviewed medical journal and

Secondly, to produce a paper for the research community focused on clinician guided treatment trials, identification of possible illness subsets, and observations of illness presentation.

There are many other goals to accomplish through this effort. Most notably, encouraging clinicians and researchers into the field and the most efficient and effective ways to mainstream the illness within the medical community.

Consensus was reached among this group of expert ME/CFS clinicians to collaborate on the denouncement of the PACE trial and the importance of language. A dialogue ensued resulting in the consensus to always use ME/CFS and not only “Chronic Fatigue Syndrome” alone which has allowed for disbelief, misconceptions and stigmas to persist.

Read the full article for more about the goals, outcomes and participants

2. Medscape blog post, by Miriam E Tucker: Much can be done to ease ‘Chronic Fatigue Syndrome’ symptoms

The article covers: Assessment; Tests; Treatments; Help with additional needs such as disability verification and aids; and the importance of Validating the illness.

Extracts:

 “One of the messages I’d like to send to physicians is not to have an all-or-nothing approach to this illness, but to break it down into its parts, and see what you can get hold of with the history, objective markers, and clinical intuition. And then, it’s not unreasonable to try some things that are not harmful or expensive,” Bateman told Medscape Medical News…

Assessing functional capacity is key, Bateman said.

“It’s an illness that impairs people’s ability to function in their daily lives. Clinicians need to ask about function, and what happens when people exert themselves both physically and cognitively.”

One revealing question is, “What would you be doing now if you weren’t ill?” Typically, as opposed to depressed patients, those with ME/CFS will have a laundry list. “Our patients are trapped in bodies that don’t work,” Bateman said. “They’re desperate to do more.”

Medications that were endorsed by a majority of the panel include low-dose naltrexone for patients with pain and cognitive dysfunction, low-dose beta blockers or fludrocortisone for those exhibiting orthostatic intolerance, and intravenous Ig for patients with a variety of immune dysfunction indications including low IgG or IgA or recurrent infections.

Also universally viewed as critical for primary management of ME/CFS is the concept of adaptive pacing. With it, patients learn to conserve their limited energy by carefully adapting their activity so as not to exceed their anaerobic thresholds and thereby precipitate a “crash.” One helpful website to offer patients is the CFIDS & Fibromyalgia Self-Help Program website.

In general, much of the approach involves thinking outside the box, and sometimes borrowing from other fields, Bateman said. For example, she points to data suggesting that amantadine may improve fatigue and cognition in multiple sclerosis. “There’s no reason we can’t give [patients with ME/CFS] a trial of amantadine. Just making these cross-connections is very helpful.”…

Read the full article

3. Video: Dr. Bateman’s Summary of Clinicians’ Summit March 2-3, 2018

 

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SEID/CFS is common in sleep centre patients with hypersomnolence

Research abstract:

Systemic exertion intolerance disease/chronic fatigue syndrome is common in sleep centre patients with hypersomnolence: A retrospective pilot study, by Caroline Maness, Prabhjyot Saini, Donald L. Bliwise, Victoria Olvera, David B. Rye, Lynn M. Trotti in J Sleep Res. 2018 Apr 6:e12689 First published: 6 April 2018  [Epub ahead of print]

Symptoms of the central disorders of hypersomnolence extend beyond excessive daytime sleepiness to include non-restorative sleep, fatigue and cognitive dysfunction. They share much in common with myalgic encephalomyelitis/chronic fatigue syndrome, recently renamed systemic exertion intolerance disease, whose additional features include post-exertional malaise and orthostatic intolerance.

We sought to determine the frequency and correlates of systemic exertion intolerance disease in a hypersomnolent population.

One-hundred and eighty-seven hypersomnolent patients completed questionnaires regarding sleepiness and fatigue; questionnaires and clinical records were used to assess for systemic exertion intolerance disease. Sleep studies, hypocretin and cataplexy were additionally used to assign diagnoses of hypersomnolence disorders or sleep apnea. Included diagnoses were idiopathic hypersomnia (n = 63), narcolepsy type 2 (n = 25), persistent sleepiness after obstructive sleep apnea treatment (n = 25), short habitual sleep duration (n = 41), and sleepiness with normal sleep study (n = 33).

Twenty-one percent met systemic exertion intolerance disease criteria, and the frequency of systemic exertion intolerance disease was not different across sleep diagnoses (p = .37). Patients with systemic exertion intolerance disease were no different from those without this diagnosis by gender, age, Epworth Sleepiness Scale, depressive symptoms, or sleep study parameters.

The whole cohort reported substantial fatigue on questionnaires, but the systemic exertion intolerance disease group exhibited more profound fatigue and was less likely to respond to traditional wake-promoting agents (88.6% versus 67.7%, p = .01).

Systemic exertion intolerance disease appears to be a common co-morbidity in patients with hypersomnolence, which is not specific to hypersomnolence subtype but may portend a poorer prognosis for treatment response.

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Circulating extracellular vesicles as potential biomarkers in CFS/ME

Research abstract:

Circulating extracellular vesicles as potential biomarkers in chronic fatigue syndrome/ myalgic encephalomyelitis: an exploratory pilot study, by Jesús Castro-Marrero, Esther Serrano-Pertierra, Myriam Oliveira-Rodríguez, Maria Cleofé Zaragoza, Alba Martínez-Martínez, María del Carmen Blanco-López & José Alegre in Journal of Extracellular Vesicles Volume 7, 2018 – Issue 1  [Published online: 22 Mar 2018]

Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME) is an acquired, complex and multisystem condition of unknown etiology, no established diagnostic lab tests and no universally FDA-approved drugs for treatment.

CFS/ME is characterised by unexplicable disabling fatigue and is often also associated with numerous core symptoms. A growing body of evidence suggests that extracellular vesicles (EVs) play a role in cell-to-cell communication, and are involved in both physiological and pathological processes. To date, no data on EV biology in CFS/ME are as yet available.

The aim of this study was to isolate and characterise blood-derived EVs in CFS/ME. Blood samples were collected from 10 Spanish CFS/ME patients and 5 matched healthy controls (HCs), and EVs were isolated from the serum using a polymer-based method. Their protein cargo, size distribution and concentration were measured by Western blot and nanoparticle tracking analysis. Furthermore, EVs were detected using a lateral flow immunoassay based on biomarkers CD9 and CD63.

We found that the amount of EV-enriched fraction was significantly higher in CFS/ME subjects than in HCs (p = 0.007) and that EVs were significantly smaller in CFS/ME patients (p = 0.014). Circulating EVs could be an emerging tool for biomedical research in CFS/ME.

These findings provide preliminary evidence that blood-derived EVs may distinguish CFS/ME patients from HCs. This will allow offer new opportunities and also may open a new door to identifying novel potential biomarkers and therapeutic approaches for the condition.

Read full article

More about extracellular vesicles

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Curb on zero-hour care worker contracts and ‘call clipping’

Welsh Government announcement, 2 April 2018: New requirements to ensure care workers are treated fairly come into force

New requirements to ensure care staff who look after people in their own homes are treated fairly and people receiving care experience the best possible services come into force today, the Welsh Government has confirmed.

The new requirements are part of the Welsh Government’s wider efforts to support the delivery of high quality social care which is focused on the individual and the personal outcomes they want to achieve.

The new regulations support good employment practices by addressing the use of zero-hours contracts. From today, providers are required to give domiciliary care workers a choice of contract after a three month period of employment.

The regulations also place requirements on these providers to ensure that time allocated for travel and care is clearly and transparently set out, so that care time and therefore the quality and continuity of care is not eroded by the need to travel between visits.

Social Care Minister, Huw Irranca-Davies said:

“The new regulations coming into force today are designed to support continued improvement in the care sector in Wales. They offer staff in the social care sector a fairer deal and help to safeguard the quality of care and support which people receive in their own homes.

“There is a very clear link between the use of zero-hours contracts and a reduced quality of care, due to issues around the continuity of care and communication between workers and those they support. These measures will ensure workers are offered a choice of contractual arrangements.

“Requiring providers to distinguish clearly between travel time and care time when arranging services, will also improve the experience of people needing care. Doing so will help tackle ‘call-clipping’, ensuring people’s care and support time is not eroded by travel time between visits.

“The registration of domiciliary care workers will provide the public with confidence that care workers have the appropriate skills and qualifications to do their jobs in a professional, compassionate manner.

“I’m pleased the Welsh Government has been able to act to ensure people receiving care experience the best possible care, and to ensure fairness for social care staff across Wales.”

 The Welsh Government has also opened Social Care Wales’ workforce register to include domiciliary care workers, as part of its ongoing commitment to professionalise the workforce. This will ensure care workers receive the recognition and support they deserve from the Welsh Government, Care Inspectorate Wales, and their employers.

These requirements are part of a package of measures put in place by the Welsh Government and partners to raise the profile and status of the workforce, so that social care is recognised as an attractive and valued career.

The regulations flow from the Regulation and Inspection of Social Care (Wales) Act 2016, which sets the new legal framework for the regulation and inspection of social care services and reforms the regulation of the social care workforce in Wales.

Domiciliary support is at the very heart of the system, and domiciliary care workers play a vital role in supporting people to maintain their independence and live at home. There are estimated to be approximately 19,500 domiciliary care workers in Wales, delivering around 260,000 hours of care a week to 23,000 people.

BBC news report: Curb on zero-hour care worker contracts and ‘call clipping’

Caring in the home – Wales in figures:

  • 336 care providers
  • 18,000 workers
  • 80% of workers are female
  • 43,000 service users
  • 75% care to elderly people
  • 13.1m domiciliary care hrs a year
    Manchester Metropolitan University, 2016
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Forward ME group writes to the Science Media Centre

ME Research UK blog post, 5 April 2018: Forward-ME Group Letter – Science Media Group

Forward-ME Group Letter

Forward-ME Group Chair, The Countess of Mar, has written on behalf of the members of the Group to the Chief Executive of the Science Media Centre asking for the SMC “to retract and replace your factsheet on CFS/ME, published on 21 March 2018”.

The letter continues that the factsheet, entitled “CFS/ME – The illness and the controversy” “……. includes numerous inaccuracies and distortions; it denigrates patients and some doctors; it fails to reflect the numerous peer reviewed papers, published since the release of some of the raw data from the trial following legal action, which demonstrate serious defects in the PACE trial, and it fails to take into account the extensive research from the USA published since 2014. This will all have been available to you.”

The full text of the letter is as follows –

“Re: Science Media Centre Factsheet – CFS/ME – The illness and the controversy.

On behalf of Forward-ME I write to ask you to retract and replace your factsheet on CFS/ME, published on 21 March 2018, following the publication of a paper by Dr Carolyn Wilshire of the University of Wellington, New Zealand, which found that the findings of the Principal Investigators of the PACE trial were ‘not robust’ and showed ‘no long-term benefits’.

The factsheet includes numerous inaccuracies and distortions; it denigrates patients and some doctors; it fails to reflect the numerous peer reviewed papers, published since the release of some of the raw data from the trial following legal action, which demonstrate serious defects in the PACE trial, and it fails to take into account the extensive research from the USA published since 2014. This will all have been available to you.

The factsheet states: “CFS/ME is highly controversial with longstanding disagreements between the mainstream medical community and campaigners about its cause and treatment”. It also states that “amongst the mainstream medical research community, CFS/ME and NICE recommend management that is not especially controversial.”

These claims are patently inaccurate. The mainstream medical community in the USA concluded that the “campaigners” have actually been correct about the nature of the condition, stating that “ME/CFS is a serious, chronic, complex systemic disease” (Academy of Medicine), that it is not a primary psychological disease in aetiology” (National Institutes of Health). They state that guidance for managing ME/CFS should include a “declaration that the disease is not the result of fear-based avoidance of activity”, and a clear indication that the disease is not a psychiatric or somatoform disorder” (Chronic Fatigue Syndrome Advisory Committee of the Department of Health and Human Services). There certainly is controversy and disagreement at this time, but that disagreement is not between professionals and “campaigners”. It is between professionals in the UK and professionals elsewhere.

The factsheet claims that: “After sustained pressure from activists the CDC has removed mention of CBT and GET from its website”. This, too, is patently inaccurate and even a cursory investigation of the facts would make that clear. The CDC changed its recommendations at the urging of the Academy of Medicine, the National Institutes of Health, the Department of Health and Human Services, and the Agency for Healthcare Quality and Research, all of whom emphatically agree that the CDC’s former recommendations – that is, the current NICE recommendations – lack evidence based support.

The author of the factsheet states that existing evidence in favour of CBT and GET is “cited by the scientific community”, as if there are no reputable members of the scientific community, and no reputable health policy authorities who disagree. They go on to state that “those who disagree …. cite review articles and reanalyses of trial data published in low impact factor journals such as The Journal of Health Psychology and Fatigue: Biomedicine, Health and Behaviour”.

It is concerning that a reputable resource like the Science Media Centre would publish such a grossly inaccurate claim, one that can be so readily overturned. Those who disagree with the evidence for CBT and GET cite the extensive investigations of the US governmental health authorities. In particular they cite the Agency for Healthcare and Research Quality Publication No. 15-E001-EF, “Diagnosis and Treatment of Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome”. That document is readily available online and a quick investigation will reveal that it offers a very long and detailed list of unscientific practices and biases in the research that claims to support CBT and GET. There are a great many such reports by US governmental health organisations. It is unacceptable for the Science Media Centre to write as if these investigations did not take place; as if these documents do not exist – and it is unacceptable not to note that, by comparison, the professional reputations of these organisations far outstrip those of the PACE trial researchers.

The reality is that at this time there are no US governmental health authorities who agree that the PACE trial is “good quality”. It is absurd for any “Factsheet” on ME/CFS to overlook this fact.

Your Trustees’ Report for the year ended 31 March 2016 gives among the SMC objectives its overall goal to help to achieve the aim of the House of Lords Science and Technology Committee which sought to renew public trust in science “by working to promote more balanced, accurate and rational coverage of the important science, health and environment stories that appear in the media.” In the case of the promotion of the science relating to CFS/ME the Science Media Centre have singularly failed in its objectives over many years.

If you are not prepared to retract this factsheet I regret that we have no option but to report our concerns to the Charity Commission.

I look forward to hearing from you shortly.

Yours sincerely

Countess of Mar, Chairman – Forward-ME

Copy to: Professor Jonathan Baker, Chair of Trustees. ”

By way of background information, the Science Media Centre (a registered charity) has as its stated mission “To provide, for the benefit of the public and policymakers, accurate and evidence-based information about science and engineering through the media, particularly on controversial and headline news stories when most confusion and misinformation occurs.”

It states that it provides “journalists with what they need in the timeframe they need it, from interviews with leading experts to timely press briefings on topical issues. We provide journalists with information about science and its related disciplines, making it easier for them to get access to the best evidence and expertise. Given our focus on science in the headlines, the SMC works mainly with science and news journalists in the UK’s national news outlets.” The Centre sends out quotes from experts, statistical analyses of scientific studies and Factsheets, in addition to running regular press briefings on the latest hot topic.

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