Coaching on-court, cannabis


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Naomi Osaka of Japan returns a shot to Sloane Stephens of the United States during their women's singles match at the WTA tennis tournament in Singapore on Monday, Oct. 22, 2018. (AP Photo/Vincent Thian)

Naomi Osaka of Japan returns a shot to Sloane Stephens of the United States during their women's singles match at the WTA tennis tournament in Singapore on Monday, Oct. 22, 2018. (AP Photo/Vincent Thian)


The on-court coaching debate trending in Singapore

By SANDRA HARWITT

Associated Press

Monday, October 22

SINGAPORE (AP) — Monica Seles isn’t a fan of on-court coaching. Lindsay Davenport can see the benefits. Jennifer Capriati is right in the middle.

The three tennis greats took part in a news conference Monday at the WTA Finals to discuss the topic, which made plenty of headlines after Serena Williams was penalized for on-court coaching during the U.S. Open final.

The WTA Tour has allowed limited on-court coaching since 2008, while the men’s tour and Grand Slam tournaments don’t permit any coaching during matches.

“My feeling is, as a former player, I personally don’t like the on-court coaching,” Seles said. “I think as a player at the highest level in your profession, you should be able to think for yourself. My dad always used to say before I stepped on court two things: ‘Move your feet and think.’”

Patrick Mouratoglou, the longtime coach of Serena Williams, last week posted a letter on social media supporting on-court coaching. He indicated his opinion derives from the recent incident at the U.S. Open when he was caught signaling from his courtside box to Williams to move forward.

As a rule, Williams doesn’t use the on-court coaching option at WTA tournaments and denied seeing Mouratoglou’s signal in New York, which he admitted to doing during that loss to Naomi Osaka.

“Coaching is a vital component of any sporting performance,” Mouratoglou said in his letter. “Yet, banning it almost makes it look as if it had to be hidden or as if it was shameful.”

Davenport, who has had an on again-off again coaching relationship with Madison Keys the past few years, said there are merits to on-court coaching but flaws exist.

“I think another topic to that whole conversation is is that like another advantage to the top players?” Davenport said. “What about all the players maybe ranked, I don’t know where that number is, 60 and below, that can’t afford a coach every week?”

Capriati isn’t completely convinced, but she’s not against it either.

“I’m kind of on the fence about it,” Capriati said. “Part of it is when you’re there, I mean how much can a coach do at that point? If you need a coach at that point, I think you’re kind of lost.

“Then I thought about myself and playing, it could have maybe made all the difference in the world.”

Sascha Bajin, who was a hitting partner for Williams for eight years, is now the head coach for Osaka. He is also not a fan of the concept but he dutifully went on court when Osaka called for a consultation midway through the first set against Sloane Stephens on Monday.

“If I have to look back why I started with this sport it was because my father and my mother wanted to teach me something,” Bajin said. “I was learning to overcome problems myself. I think something beautiful about this sport is that it’s really only you and to be a good problem-solver.”

Raemon Sluiter, a former top-50 player who now coaches Kiki Bertens, said on-court coaching provides less-than-appealing optics for the public.

“I think our main purpose, I’m talking as a WTA standpoint or women’s tennis standpoint, or even women’s standpoint, you want to show them as strong as they are,” Sluiter said. “I think a lot of times when the coaches come on court, they are not necessarily used as a help line but more as an ambulance.”

More AP tennis: https://apnews.com/tag/apf-Tennis and https://twitter.com/AP_Sports

The Conversation

Why health apps are like the Wild West, with Apple just riding into town

October 18, 2018

Author: Michael L. Millenson, Adjunct Associate Professor of Medicine, Feinberg School of Medicine, Northwestern University

Disclosure statement: Michael L. Millenson receives funding from the Gordon and Betty Moore Foundation.

The heart rate monitor built into the new Apple Watch has sparked sharp debate over its risks and benefits, even though the feature was cleared by the Food and Drug Administration.

But out of the spotlight, the FDA has been doing away with regulatory action altogether on many diagnostic health apps targeting consumers, seeking to accelerate digital health adoption by defining many of these as “low risk” medical devices.

As the number of mobile health apps surged to a record 325,000 in 2017, app performance is going largely unpoliced, leading to what’s been dubbed a “Wild West” situation. Unfortunately for health consumers, the public can’t rely on the research community to play the role of sheriff.

When colleagues and I recently examined the medical literature on direct-to-consumer diagnostic apps in a study published in Diagnosis, we repeatedly found studies marred by bias, technological naïveté or a failure to provide crucial information for consumers. There was also a glaring lack of studies with actual consumers to see how they use these apps and what the impact on individual health, whether for better or worse, might be.

The app will see you now?

Interactive diagnostic apps now go well beyond “Dr. Google” keyword searches. They promise personalized information on whether a nagging symptom can likely be relegated to self-care or whether a visit to the doctor’s office or even the emergency room may be needed. Some of these apps become so popular that they have been downloaded tens of millions of times.

To understand whether the promising nature of these apps is backed up by the evidence, we searched both the peer-reviewed literature and nonacademic sources. The disturbing unreliability of that evidence for the average consumer is starkly visible when you consider apps that “advise” (a carefully chosen word) whether you might have skin cancer.

There are hundreds of cancer-related apps. Perhaps because melanoma rates have been rising for decades and it’s one of the most common young adult cancers, the largest group of articles we found focused on dermatology apps. One of the most prominent is Skin Scan.

If you’re a physician or reasonably savvy consumer, Google Scholar provides the easiest access to evidence-based information. One of the first results that pops up is a 2013 article entitled, “Skin Scan: A demonstration of the need for FDA regulation of medical apps on iPhone.” If that title suggests a certain lack of objectivity, the problem isn’t limited to dermatology. We also found an orthopedist examining whether a symptom checker could “guess” the right diagnosis, and an ear, nose and throat doctor investigating whether an app could diagnose his own patients as well as he could.

That Skin Scan study sounding the alarm on regulation warned of a substantial potential for harm. Yet a separate study of the same app published online two years later was much more positive. Did app developers pour in improvements, or was it that the first researchers used their own skin growth photos while the second group used the smartphone’s images?

The answer is unclear. More broadly, however, researchers often seemed unaware of the impact of basic technological distinctions such as whether an app relied on user answers to questions, “crowdsourced” answers to others or used inputs from a smartphone’s camera and sensors.

More troubling was researchers’ lack of understanding of the public’s pressing need for reliable information. So, for instance, a study of four smartphone apps found that their sensitivity in detecting malignant skin lesions ranged from 7 percent to 98 percent. Yet the researchers chose not to identify any of the apps by name. Similarly, few studies mentioned cost (CrowdMed, for example, charges users a minimum of USD $149 per month), and those that did sometimes gave only a price range for a group of apps.

With scientific evidence sparse, consumers are left to rely upon online reviews – which, as a just-published study of popular blood pressure apps warned, can be dangerously wrong.

Or there’s always a random web search.

In the case of Skin Scan, my search found that in July the company that developed the app reported a melanoma detection sensitivity of 96 percent. That “report,” however, was part of a trade publication interview with SkinVision CEO Erik de Heus as the company announced it had raised another $7.6 million from investors.

Three years ago, a National Academy of Medicine report on diagnostic error called upon professionals to direct patients to reliable online resources. However, we found that search terms used by the National Library of Medicine’s PubMed Life Sciences search engine have lagged the digital health revolution, and medical journals do a hit-or-miss job of simply indexing every app mentioned in an article. The English National Health Service has launched an Apps Library to cut through the confusion, but there’s no similar resource in this country.

Is there a way to bring some order, if not law?

Some web-savvy researchers at sites like iMedicalApps are advising physicians about apps they can use themselves or others they can trust to recommend to their patients. Others trying to bring law and order to the wide-open health app field have suggested various frameworks, such as combining stakeholders’ expertise in collaborative health app rating teams. The goal would be to get innovators, policymakers and evidence-generators to jointly help corral confusing and contradictory information.

And as the debate over using Apple Watch data to measure heart health shows, FDA approval alone doesn’t remove the risk of consumers jumping to the wrong conclusion about what the information they’re receiving actually means. Nonetheless, as the pioneering stage of health apps starts to settle into the medical mainstream, the health of the American public requires apps and devices we know we can trust.

The Conversation

Legal weed: What your kids need to know

Updated October 16, 2018

Author: Geraint Osborne, Professor of Sociology, University of Alberta

Disclosure statement: Geraint Osborne received funding from the Social Sciences and Humanities Research Council (2011-2015) and Augustana Campus of the University of Alberta (2004-5).

Partners: University of Alberta provides funding as a founding partner of The Conversation CA.

Weed, pot, grass, marijuana — or cannabis to use the proper terminology — is now legal in Canada, after 95 years of prohibition. Anyone over the age of 18, or 19 depending on the province, can now walk into a store and buy up to 30 grams of regulated product.

While most Canadians approve of this new policy, many also believe the law will fail to stop more children using the drug and the legal age should be 21. After all, cannabis use among Canadian minors, under prohibition, has been declining over the past decade.

So how should we talk to kids and teenagers about this new legal drug? What can parents do now that legalization is the new reality?

This is a question that I — as a cannabis researcher and father of 18-year-old twin boys — take very seriously, and for good reason. Globally, cannabis is the most available and most used illegal substance. Canadian youth have had some of the highest use rates in the world, even while it was an illegal substance.

The good news is that parents have many tools at their fingertips to protect their children and teens. Here, I offer six steps to help you navigate this tricky terrain.

1. Start family discussions early

The best defence against any kind of drug abuse is knowledge and education. Being properly informed about drugs is central to the harm reduction approach to drugs that is slowly gaining momentum across Canada and other parts of the world.

This approach recognizes that drug abuse is a public health and education problem, not a crime problem. Much of our successes in combating drinking and driving, and reducing cigarette smoking, have come through information and education initiatives.

Education starts at home. And it should begin as early as possible, with age- appropriate language like that used in It’s Just a Plant, a book designed for parents who want to talk to their children about cannabis.

Discussing cannabis with your child should be no different than discussing alcohol and nicotine. A frank conversation about all substances, both legal and illegal, is essential to preventing the abuse of any drug among our youth.

2. Find evidence-based information

Parents do need to educate themselves about drugs, rather than relying on their own personal experiences or media scare stories. There is a great deal of research available on cannabis and other drugs. But this wealth of information can understandably be overwhelming.

Drug Free Kids Canada is a registered charity offering offers resources for parents to talk to their kids and teens about drugs.

Fortunately, there are a number of informative and reliable online sources available to Canadian parents, such as the Canadian Centre on Substance Use and Addiction, Drug Free Kids Canada and the Centre for Addiction and Mental Health.

3. Explain addiction and brain damage

Kids need to know that cannabis is not harmless. And that it has become much more potent over the years. The best decision, like with all legal and illegal substances, is abstinence. Undoubtedly, from a health perspective, if people can get through life without using caffeine, tobacco, alcohol and other drugs, they are better off.

However, because we live in a society saturated with drugs (just check out the beer and pharmaceutical ads on television or the long coffee shop lineups), we need to be pragmatic.

Our children will be exposed to many drugs throughout the course of their lives, including cannabis. They may decide to experiment or use more regularly. So they need to know what the potential harms are, as well as the potential benefits. They also need to know the differences between use and abuse.

A free online learning module from the Canadian Centre on Substance Use explains the effects of cannabis use during adolescence.

While much more research is required, the key health concerns with cannabis are addiction, mental illness, damage to the developing brain, driving while intoxicated and cardiovascular disease.

4. Talk about socializing, creativity and sex

Besides discussing the harms associated with the abuse of cannabis, parents need to have an honest discussion about why people use it — without relying on outdated stereotypes or stigmatizing users. This can be more difficult for parents who don’t use cannabis themselves as they may think that such a discussion will encourage use.

But by explaining why and how people use cannabis, parents can demystify the drug. They can demonstrate that, like alcohol, cannabis can be used responsibly by most people in a variety of social contexts.

This “normalizing” of cannabis reduces its status as a choice for the rebellious. It makes the formerly mysterious and taboo drug rather boring and mundane. This may help explain why cannabis use by youth in Colorado has not increased significantly since the drug was legalized.

So why do people use cannabis recreationally?

For centuries, people all over the globe have used cannabis for many reasons. The research has found that — like alcohol users — most use cannabis as a rational choice to enhance certain activities.

When used properly, it can help with relaxation and concentration, making many activities more enjoyable. Eating, listening to music, socializing, watching movies, playing sports, having sex and being creative are some things some people say cannabis makes more enjoyable.

Sometimes people use cannabis to enhance spiritual experiences or to make mundane tasks like chores more fun. But most importantly, most users recognize that there’s a time and place for use and have integrated it into their lives without forgoing their daily obligations and responsibilities.

5. Teach responsible cannabis use

The responsible use of cannabis is identical to the responsible use of alcohol. The key principles are: understand the effects of cannabinoid concentration – especially THC and CBD – and terpene concentration; avoid mixing with other drugs; use in a safe environment; use in moderation; don’t let use interfere with responsibilities; and don’t use in contexts that may endanger the lives of others, such as driving while under the influence.

Many of the health concerns relating to cannabis are associated with heavy chronic use or, in other words, abuse of the drug. As with most things in life, moderation is key. Moderation — in frequency and amount — is important for the responsible use of any substance.

Recent research suggests that many cannabis users, like alcohol users, use responsibly. If parents reinforce the importance of responsible use, their children will be far less likely to suffer the harms associated with cannabis.

6. Just say “know,” not “no!”

History has shown us that the war on drugs has been an abysmal failure. Prohibition hasn’t prevented people — young or old — from using drugs. Prohibition created a black market, gang wars, corruption and dangerous products.

A harm reduction approach to cannabis regulates a safer quality product and focuses on informing people about the potential risks and benefits of cannabis use. Educating our youth about cannabis and responsible use — through talking with them and listening to them — will be far more effective and safer than trying to stop them using it.

When it comes to kids and weed, it’s better to say “know” than “just say no!”

More Americans Than Ever Want Marijuana Legalized. Lawmakers Should Listen.

Nearly two-thirds of Americans want cannabis to be legal — but marijuana arrests are going up, not down.

By Paul Armentano | October 24, 2018

Over 60 percent of Americans — including majorities of Republicans, independents, and Democrats — believe that the adult use of marijuana ought to be legal. And an estimated 20 percent of Americans now live in a state where cannabis use by those over the age of 21 is permitted.

Nonetheless, newly released FBI data reports that, nationwide, marijuana arrests rose for the second consecutive year — and significantly outpace the total number of annual arrests for all violent offenses.

Of the nearly 660,000 marijuana-related arrests made by law enforcement in 2017, the last year for which data is available, 91 percent (599,000) of them were for possession violations—– not trafficking, cultivation, or sales. In the Midwest and South, nearly half of all drug possession arrests are for marijuana-related violations.

Despite rapidly changing public opinion in favor of the plant’s legalization and regulation, many states continue to punish marijuana law offenders in a draconian manner.

In Florida, for instance, the possession of 20 grams or more of cannabis is classified as a felony offense, punishable by a year in prison, a $1,000 fine, and a permanent loss of voting rights.

In Arizona, possessing any amount of marijuana may be prosecuted as felony, punishable by up to two years in prison and a whopping $150,000 fine. In Texas, which reports some 63,000 marijuana possession arrests annually, offenders face up to six months in jail.

In Oklahoma, growing a single cannabis plant may be punishable by life in prison.

The stigma and lost opportunities stemming from a marijuana possession arrest linger long afterward. These punishments include the potential loss of one’s professional license, student aid, driving privileges, and voting rights.

In some jurisdictions, a marijuana arrest can result in the loss of child custody, or even the ability to adopt a child — all for an activity that over half of American adults acknowledge having engaged in at some point in their lives, and that more than 60 percent of voters believe should no longer be a crime.

The disconnect between voters’ attitudes toward marijuana policy and the law itself is only becoming more pronounced.

Since 2000, public support for legalizing cannabis has nearly doubled, while over 90 percent of voters believe that physicians ought to be able to legally recommend it to their patients. Nonetheless, few politicians at either the state or federal level are willing to seriously consider legislation to enact legal reforms.

In fact, federal law continues to deny that the plant possesses any “accepted medical utility in the United States,” and maintains that cannabis belongs in the same category as heroin — a “flat Earth” fantasy that woefully fails to pass the smell test.

At the state level, eight of the nine states that have legalized marijuana use for adults have done so by direct voter initiatives.

In short, advocates who seek to change the legal status of marijuana have had little choice but to amend the law themselves, without the assistance or the support of their elected officials.

This must change.

While some jurisdictions, like Michigan and North Dakota — where voters in November will decide on statewide ballot measures legalizing the plant’s possession and use by adults — allow for direct democracy, in many others this path isn’t an option.

In these latter states, people have little choice but to demand better from their elected representatives. If our marijuana laws can’t keep up with changing public attitudes, the people who make those laws may soon find themselves replaced by those who will.

Paul Armentano is the Deputy Director of NORML — the National Organization for the Reform of Marijuana Laws. He’s the author of The Citizen’s Guide to State-By-State Marijuana Laws (Whitman Press, 2015). Distributed by OtherWords.org.

Naomi Osaka of Japan returns a shot to Sloane Stephens of the United States during their women’s singles match at the WTA tennis tournament in Singapore on Monday, Oct. 22, 2018. (AP Photo/Vincent Thian)
https://www.sunburynews.com/wp-content/uploads/sites/48/2018/10/web1_121617491-d481ab4e6dfe4a8687f609d6a2f85ba2.jpgNaomi Osaka of Japan returns a shot to Sloane Stephens of the United States during their women’s singles match at the WTA tennis tournament in Singapore on Monday, Oct. 22, 2018. (AP Photo/Vincent Thian)
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