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The Rapids and Grass Beer Festival in Buena Vista takes place June 29-July 1 with live music, rafting and a beer tasting. (Photo by Scott Peterson, Courtesy of Rapids and Grass.)

Colorado breweries are reinventing the common beer festival.

Forget table after table of the same beer after beer from the same brewery after brewery every weekend after weekend.

Now imagine this: rafting trips, curated brewery lists, intimate tours and vintage releases. This is the direction a handful of Colorado breweries are taking festivals this summer that are aimed at elevated craft beer fans looking for unique experiences.

The trend in Colorado speaks to the maturity of the state’s craft beer community, as well as the industry’s efforts to maintain excitement as growth in the once-hot market cools.

Avery Brewing is one of them. In its 25th year, the Boulder brewer ditched its top-notch Strong Ale and Sour festivals to try something new this year with the Avery Invitational.

“With so many beer festivals throughout the summer, we felt like there was an opportunity to reinvigorate our festival attendees with something new,” said Avery’s Vanessa Cory. “While Strong and Sour Fest were still selling out every year, they were the same model, sometimes with the same breweries attending every year.”

For the new event the brewery polled its 200-plus team to ask which breweries they wanted to see at a festival and invited the entire list. “We are increasing the number of beers available so that attendees will still get a solid selection of strong and sour beers, but also a lot of hoppy, malty, and experimental beers, too,” Cory added.

Here are five brewery events this summer in Colorado that will cure average beer festival fatigue:

Crooked Stave is showcasing its much-loved fruit beers at its Brighton Boulevard tasting room for “Persica Day.” (Photo courtesy of Crooked Stave.)

Crooked Stave Artisan Beer Project wants to showcase its intricate peach, apricot and plum sour beers so much, it’s pouring them on all 22 of its taps and featuring past vintages and special barrel-aged versions.

The festivities at the Brighton Boulevard tasting room inside The Source start at noon June 2 with “Persica Day,” which celebrates the release of the brewery’s much-hyped golden sour ale made with peaches from Palisade on the Western Slope.

A special glass and 10-ounce pour is $15, and the brewery will release the first bottles, for $28. Brewmaster Chad Yakobson said the 2017 beer uses the same peach varieties and blend as the original in 2011. “We are always striving to recreate that first perfect batch, and this year may just be the year,” he said.

In addition to other special releases, the brewery will sell five of its stock beers, including a pilsner and IPA in cans. Tickets are available the day of the event at the taproom.

The tasting room at the new Avery Brewing facility in Gunbarrel. (Cliff Grassmick, Boulder Daily Camera)

Instead of inviting the typical crowd, Avery hand-picked the breweries it wanted to attend its Invitational. The results are impressive: 75 breweries from all over are expected to attend and pour unlimited sips of 200-plus beers in a commemorative glass. The tasting event also features beer education sessions.

The brewery highlights include Trillium, Short’s, Rhinegeist, Founders, Commonwealth, Brewery Bhavana, Bagby and Almanac, as well as more than 25 beers from Avery, including a few directly from a barrel. The beer list covers the gamut with big barrel-aged imperial stouts, plenty of hazy IPAs and funky sours.

Like Avery’s other festivals, the tickets for the noon event sold out fast.

Weldwerks Brewing is hosting its own festival with invite-only breweries in its home city of Greeley. (Andy Cross, The Denver Post)

Weldwerks Brewing is bringing more than 40 of the best breweries in the country to Greeley to help it raise money for local nonprofits as a part of its inaugural invitational. This is a specially curated list that includes breweries you can’t find in Colorado pouring 100-plus beers you can’t often find anywhere.

The all-star breweries include Casa Agria, Modern Times, Bottle Logic and Rare Barrel from California; The Veil and The Answer from Virginia; J. Wakefield and Funky Buddha from Florida; and other out-of-staters like American Solera, Fremont, Great Notion, Hop Butcher and Toppling Goliath.

The festival features two three hour sessions (noon-3 p.m. and 4:30-7:30 p.m.) with tickets for each at $100. If you can’t make it to the Saturday festival, the day before from 5-10 p.m. Patrick’s Irish Pub in downtown Greeley will host a tap takeover with breweries from the festival.

The Rapids and Grass Beer Festival in Buena Vista features live music and takes place on the banks of the Arkansas River. (Photo by Scott Peterson, Courtesy of Rapids and Grass.)

The beer list for the Rapids and Grass Beer Festival in Buena Vista is impressive enough with Arizona Wilderness, Beachwood Brewing, Jester King, Melvin and Ninkasi, as well as Colorado favorites Outer Range, New Terrain, Ratio Beerworks and Black Project.

But the festival, now in its second year, is about so much more than beer. A welcome party Friday at Jailhouse Craft Beer Bar is followed by two bands at The Beach, an outdoor venue on the banks of the Arkansas River and a free show at the Ivy Ballroom inside the Surf Hotel.

The music continues Saturday during the beer tasting and ends with bluegrass band Rapidgrass at 7:30 p.m. at The Beach. On Sunday, the festival features a 7-mile float down a stretch of class 3 whitewater on the Arkansas River that ends in food, drinks and more live music. The after party at 8 p.m. features headlining band Leftover Salmon.

The event is priced a la carte with the beer festival tickets at $50 for general admissions and $75 for VIP. The rafting trip is $60 a person.

Casey Brewing and Blending in Glenwood Springs is one of the state’s best breweries, but to get to the tasting room, you need a ticket. (Photo courtesy of Casey Brewing.)

Troy Casey’s brewery on the Western Slope won massive hype from the start and soon became a national cult favorite. The beers are often pricey and hard to find, and the brewery’s tasting room is only open certain times on the weekend and requires a ticket.

But Casey is opening it’s doors for its four-year anniversary party in July. For three days, the brewery will offer three different tasting sessions and tours that include a custom glass, special tastes and the opportunity to buy some of its most exclusive bottles.

The intimate experience and chance to interact with the brewer lends a deeper appreciation for the hand-crafted nature of Casey’s old-world farmhouse ales. It’s an experience you don’t get at most brewery parties or festivals.

The tickets for each session are $10 and the price for bottles ranges north of $30.

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For a dish described by none other than Jane Grigson as “the most famous and travestied of all fruit puddings”, peach melba crops up surprisingly seldom on modern menus: you’re more likely to find it as a flavour of yoghurt or ice-cream than as a dessert in its own right. Originally created by the great French chef Auguste Escoffier during his spell in charge of the kitchens at the Savoy in London, and named in honour of opera star Dame Nellie Melba, in residence at the hotel while performing at Covent Garden, its fame quickly spread beyond the confines of WC2 – helped along, no doubt, by the immense celebrity of both parties.

Yet the dish stands on its own merits, too: this glorious combination of tangy peach and softer, sweeter raspberry brings out the best in both fruits, which are taken to even greater heights by the cool, creamy pleasures of vanilla ice-cream. As the great man himself wrote, “Pêche Melba is a simple dish,” but he went on to warn that “any variation … ruins the delicate balance of its taste.” Is the world’s first master chef right – or, 125 years after its creation, could this classic do with updating?

Poach a peach

At the height of summer, you might well get away with using raw peaches, so ripe they need nothing in the way of sugar, as Margaret Costa suggests in her Four Seasons Cookery Book, but given the rarity of this occurrence in the UK, it makes sense to have a contingency plan. In any case, lovely as fuzzy peach skins are, Escoffier would never have allowed them past the pass. He calls for the fruit to be blanched and then dunked into iced water, so the skins can be slipped off and the fruit simply sugared to draw out its juices, although Bruno Neveu, former pastry chef at the Ritz-Escoffier cooking school in Paris, poaches them, too, perhaps because raw peaches are judged to have a little too much in the way of texture to allow elegant consumption.

Bruno Neveu’s peach melba uses poached fruit.



Bruno Neveu’s peach melba uses poached fruit.

Poaching the fruit in syrup is fairly standard in modern recipes, although the medium varies: Nigel Slater counsels moderation with the sugar: “Too often, they come out cloyingly sweet.” He also adds a squeeze of lemon juice and a twist of peel, as does Diana Henry, who suggests making the syrup with dry white wine rather than water. Barbara Cartland, whose pink-jacketed masterwork, The Romance of Food, the best present I’ve received in the past 12 months, shows no such restraint, and indeed, it pays off: the fruit isn’t in the syrup long enough to become sickly (five minutes to Henry’s 15-20), which means it remains pleasingly firm, too.

Diana Henry makes the syrup with dry white wine.



Diana Henry makes the syrup with dry white wine.

Hugh Fearnley-Whittingstall tops his peaches with sugar and butter, and bakes them instead in his River Cottage Fruit Every Day: it does indeed make them “extra rich and toffeeish”, but also leaves them rather mushy – and none of us is quite sure how we feel about hot peaches (see also crumble), although he reckons the contrast in temperature is “a key factor in this gorgeous pud”.

Hugh Fearnley-Whittingstall’s version is topped with sugar and butter, and he bakes the fruit.



Hugh Fearnley-Whittingstall’s version is topped with sugar and butter, and he bakes the fruit.

We all enjoy Escoffier’s blanched and sugared peaches: they still have the juicy, plump texture of the ripe fruit, as well as being far more economical with the sugar. If your peaches are really under-ripe, however, I’d recommend poaching them for about five minutes in a syrup made from 150g sugar and 300ml water, perhaps with some lemon zest, vanilla or even a bay leaf if you’re feeling daring.

Picking and peeling

Slater claims that “peaches need to be poached with their skins on”, but both Cartland and Richard Olney disagree. They must have more patience than me, however (or, in Cartland’s case, a personal chef, Nigel Gordon), because a ripe peach is a pain indeed to peel. Much easier to blanch them as Escoffier and Neveu recommend.

The variety of peach is more important than one might think: both Grigson and Henry prefer a white-fleshed fruit, but these tend to lack the acidity that plays off so nicely against the other ingredients: a standard yellow peach is both easier to come by and works better (save the white kind for bellinis). Nectarines, which I also try, seem to hang on to their skins more jealously than their furry cousins.

Despite its name, peach melba is as much about the raspberries as it is the peaches. Both are essential



Despite its name, peach melba is as much about the raspberries as it is the peaches. Both are essential. Photograph: Dan Matthews for the Guardian

If you can’t find any peaches – and Escoffier is clear that this must be made with “tender and very ripe peaches” – but have a yearning for a peach melba all the same, Olney allows that “home-canned peaches are respectable”, and I suspect he would also have given top-quality jarred fruit the grudging nod. The tinned kind tend to be watery and overcooked, but I can highly recommend the “hand-peeled Miraflores” fruit from Spanish brand El Navarrico, and no doubt other equally good versions are available.

Red sauce

The special genius of this dish, for me, is the vivid red raspberry sauce that clings to the peeled peaches like a new and sweeter skin – again, you might get lucky and find fruit so stupidly ripe that it needs little more than crushing and sieving before use, but it’s more likely that you’ll need to sweeten it. Most recipes call for caster or icing sugar, which dissolves more easily in the pureed fruit, but Cartland uses currant jelly and kirsch, and Slater some of the poaching syrup, which feels like a clever way of putting it to use if you have it (if you go down the poaching road, leftover syrup is also very nice with some cold white wine or soda water).

Currant jelly has a certain tang to it that helps to bring out the flavour of the berries, but Fearnley-Whittingstall’s lemon juice tastes fresher to us. (Again, Olney comes to the rescue of out-of-season cooks, advising the use of frozen raspberries that “still recall the flavour of the fresh”: make sure you defrost them first, though, or you’ll end up with a loose sorbet.)

Unfortunately, you do need to sieve the sauce: this sounds like a faff, and you’ll lose a little of the flesh along the way – although they are edible, raspberry seeds are not terribly nice once isolated from their natural home, and also have an irritating tendency to lodge themselves in the teeth. Fearnley-Whittingstall’s recipe, which folds whole fruit into the sauce at the end, gives it the texture of the fresh berries and the heightened flavour of a puree.

The ice-cream and extras

Cartland, the woman who spawned a thousand slender, willowy heroines, doesn’t even hint at the forbidden pleasures of ice-cream in her recipe, but Escoffier is explicit: the dish must start with a silver timbale full of vanilla ice-cream, and it’s hard to improve upon that idea, although we are rather taken with Henry’s alternative of lightly sweetened creme fraiche, especially if well chilled; I suspect a scoop of proper frozen yoghurt (not the low-fat variety) would also be delicious. Try to use an ice-cream that isn’t too sweet: it shouldn’t overwhelm the fruit.

Olney argues that peach melba “depends on three things only for it to rank among the finest of classical French desserts: the honesty of the ice-cream, flavourful peaches that have been freshly poached in a syrup containing only water and sugar, and a sauce that is nothing but a puree of fresh raspberries. The best whipped cream in the world only detracts. The only acceptable refinement is the sprinkling of a few sliced fresh almonds over the surface.” And while I may disagree on several points, he’s right about the almonds at least: they add a very gratifying crunch of which I’m sure Escoffier himself would have approved, if only he’d wasted less time chasing celebrities.

Perfect peach melba

Prep 5 min
Cook 20 min (+ 1 hr steeping)
Serves 4

4 ripe peaches
4 tbsp sugar
2 tbsp flaked almonds
300g raspberries (thawed if frozen)
1 tbsp icing sugar
1 tsp lemon juice
8 scoops good vanilla ice-cream

Blanch the peaches in a pan of boiling water for a minute, then lift them out with a slotted spoon and dunk into iced water. Once they’re cool enough to handle, slip off their skins, cut in half and discard the stones.

Put the peach halves in a shallow dish, sprinkle over the sugar, then set aside for about an hour, preferably in the fridge, turning once. Meanwhile, toast the almonds until lightly golden and leave to cool.

3  Scatter sugar over the blanched, skinned peach halves and leave to sit for an hour or so



Scatter sugar over the blanched, skinned peach halves and leave to sit for an hour or so.

Photographs: Dan Matthews for the Guardian.

Whizz two-thirds of the raspberries with the icing sugar and a tablespoon of lemon juice, then adjust to taste and push through a fine sieve to make a smooth sauce. Stir in the remaining 100g raspberries and put in the fridge until you’re ready to eat.

Puree most of the raspberries – save the rest to finish – then pass through a fine sieve to remove the seeds.



Puree most of the raspberries – save the rest to finish – then pass through a fine sieve to remove the seeds.

To serve, put two peach halves in each dish and top with a scoop of vanilla ice-cream. Pour the sauce over the top and finish with a sprinkling of flaked almonds.

Peach melba: a retro classic, or a fussy French waste of perfectly good fruit? Will you come out in defence of Hugh’s hot peaches – and what else can you do with peaches while they’re both abundant and cheap?

  • Food styling: Iona Blackshaw

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“Cycling far?” asks a woman in the bakery as a group of us queues for coffee and sausage rolls, as well as an all-important receipt to prove we passed through Tewkesbury.

“Er … London to Wales,” replies a cyclist behind me. A pause. “And back.” It must be hard not to look smug – he’s probably been dying for someone to ask him that all day.

Some 130 of us are doing just that. We’ve been over the Chilterns and through picture-postcard Cotswold villages. Soon we’ll labour up the 24% ramp of Yat Rock, whizz down the Wye valley to Chepstow, nip into Wales and cross back into England over the old Severn bridge. Then it’s up past the Somerset monument, across the North Wessex Downs, over the Chilterns again and we’re done. At 407km, the London-Wales-London ride does have a truly epic feel.


This is my first taste of audax: a noncompetitive form of long-distance cycling that traces its history to the 1890s, not long after the invention of the modern bicycle. I was expecting old men on steel-framed bikes with calves cast from iron and glasses held together with gaffer tape, cake and clipboards in dusty village halls, and checkpoints on bleak petrol station forecourts. Only part of that was true.

A few years ago I wouldn’t have been far wrong. The London-Wales-London ride had been running for decades under the name of Severn Across, and until recent years the average turnout was around 35 riders.

But ultra-distance cycling has surged in popularity. Just as runners who have tackled a few regular marathons might think “what now?” and have a go at an ultramarathon, increasing numbers of cyclists are looking for something more than a 100-mile sportive. This appears to be down partly to self-supported races like the Transcontinental across Europe and the 6,800km Transamerica, partly to the profile of riders like the late Mike Hall and partlyto that familiar human urge to try for a little bit more.

Riders before the start of London-Wales-London 2018.



Riders before the start of London-Wales-London 2018. Photograph: the5milecyclist

Spend any time looking into ultra-distance and audax events and you’ll soon hear about the 1,200km Paris-Brest-Paris and the 1,400km London-Edinburgh-London, which are both held every four years.

Last year, organiser Liam FitzPatrick rebranded the Severn Across ride as London-Wales-London. This year the event sold out in under eight hours. FitzPatrick opened a waiting list but closed it once he had another 75 names. The flow of emails from disappointed riders continued right up to the big day.

So what I got when I arrived at Chalfont St Peter community centre at 6am on a bright May Saturday morning was a lot of fit cyclists, some expensively cut Lycra and merino, a clutch of carbon bikes … and the odd crusty old-timer.

Riders cross back into England over the old Severn bridge.



Riders cross back into England over the old Severn bridge.

Conscious that it’s all too easy to overdo it early on – a lesson learned from a few ultramarathons – I pottered along comfortably enough to the first checkpoint at Woodstock after 70km. I was somewhat surprised to be greeted by a full fry-up – some of the old reputation clearly still rings true – but I’d missed breakfast so wasn’t complaining.

There is time to chat to fellow riders, so I struck up conversations, asking people about their setups (lots had dynamo hubs to generate electricity for lights and GPS units) and trying to pick up ideas for future events. Many are aiming for Paris-Brest-Paris next year, and a fair few tackled London-Edinburgh-London in 2017. The growth of ultra-distance cycling can be seen in the participation numbers for that event: 29 starters in 1989, 1,500 last year.

A completed brevet card. Some controls are staffed; others are ‘free’ (riders collect a receipt) or ‘information’ (riders answer a question).



A completed brevet card. Some controls are staffed; others are ‘free’ (riders collect a receipt) or ‘information’ (riders answer a question).

FitzPatrick had warned me before the event that the mental challenge could be tougher than the physical. “What makes it difficult isn’t so much the speed, it’s that you’ve got time to think,” he said. “If your thighs hurt or you’ve got saddle sores then you might have another eight hours of this, grinding you down. When it’s three in the morning, when you’ve had a couple of punctures, when it’s cold and wet … that’s when it gets to you.”

His advice for finishing successfully was to pay extra attention to staying hydrated (easy to forget on long events) and not to spend too long riding alone, especially at night.

Following his first suggestion, I stopped to refill my water bottles outside the three staffed checkpoints – which meant I did spend some time on godforsaken petrol station forecourts. For the second, I teamed up with fellow rider Alex Kew when we found ourselves at the same pace.

It’s not always easy to know when to hold back or when to press on, but I eased off when he was struggling up Yat Rock; he paid that back many times once he’d recovered. As a time trialist, Alex couldn’t help himself every time we hit a long straight A-road – he was on the front, head down, powering away, and all I had to do was stick to his back wheel. The miles flew by.

Darkness fell. Surrounded by silence but for the whirr of wheels and the sound of breathing, we negotiated gravelly, potholed single-track roads at 30mph with just a pair of small lights to fight the pitch-black night. The company took a lot of stress out of it.

London-Wales-London is not a race (technically it’s a randonné). Riders are free to complete the 407km at whatever speed they want so long as they average 15-30kph. That made the earliest allowable finish 10.30pm; the latest was 9am the next day.

London-Wales-London riders feed up.



London-Wales-London riders feed up. Photograph: the5milecyclist

With no serious mechanicals, Alex and I rolled into Chalfont just before midnight. The fastest riders – including world 24-hour time trial champion Jasmijn Muller – were back before it got dark. The last rolled in at 8.20am.

London-Wales-London (or Chalfont-Chepstow-Chalfont, as one wag had it) certainly lives up to its epic new name. Whether you’re an old-school audaxer or someone dressed head to toe in Rapha with a fetish for sleeping in bus shelters, it’s a welcoming way to explore.

And it’s an antidote to overblown sportives. Rolling in after 407km, we got our brevet cards stamped and tucked into warming bowls of homemade daal. There were no spectators lining the finish chute, no bag of freebies, no medals – but it was all the better for it.

London-Wales-London 2019 will run on 4 May



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As Boston sweltered in beautiful, summery weather Tuesday, one of the Back Bay’s outdoor dining spots was empty. Doretta Taverna and Raw Bar, the Greek restaurant with the red brick patio opposite the Park Plaza hotel, closed its doors for good on Monday, a restaurant representative confirmed.



”After a great run at 79 Park Plaza, located in The Heritage on the Garden, we’re sad to announce that we will be closing Doretta Taverna and Raw Bar at the end of May,” owner and Chef Michael Schlow said in a statement.

Schlow, who launched his career at Café Louis in the former Louis Boston superstore on Newbury Street, built his culinary and business reputation at the now-shuttered Radius in the Financial District. In 2003, he opened the Italian-styled Via Matta with former partner Christopher Myers, now of Myers + Chang. In 2015, Schlow switched Via Matta to Doretta.

With Doretta’s closure, Schlow is unlikely to be idle. His restaurant empire includes the Mexican-styled Tico in the Back Bay, and the Italian-themed Alta Strada in Wellesley and at Foxwoods. He has several restaurants in hotels in Washington, D.C., one in the Dartmouth Hotel in Hanover, New Hampshire, and one in the Sunset Marquis hotel in Los Angeles.

Chef Michael Schlow. —Suzanne Kreiter/Globe staff

“As a company we will continue to focus on creative, hospitality driven concepts and will stay true to our commitment of trying to provide the very best experiences for our guests and our staff,” Schlow said his statement, in which he also thanked his now former landlord Ron Druker, owner of The Heritage on the Garden, as well as the former Doretta and Via Matta staff.

“We’ve called this location home from more than 15 years and words cannot properly express our gratitude to all of the incredibly talented hospitality professionals that we have had the great pleasure to work with over the years,” Schlow wrote. “We’ve made life-long friends here and want to sincerely thank all of the many wonderful guests who allowed us to share a small piece of their lives with them.”

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WASHINGTON (AP) — President Donald Trump is overstating progress against the opioid epidemic, claiming “the numbers are way down” despite an increase of opioid-related deaths and overdoses in his first year in office.

A look at his comments during a political rally in Nashville on Tuesday night:

TRUMP: “We got $6 billion for opioid and getting rid of that scourge that’s taking over our country. And the numbers are way down. We’re getting the word out — bad. Bad stuff. You go to the hospital, you have a broken arm, you come out, you’re a drug addict with this crap. It’s way down. We’re doing a good job with it. But we got $6 billion to help us with opioid.”

THE FACTS: Opioid prescriptions are down; deaths and other indicators of the epidemic are up, according to the latest statistics, from 2017. And those developments have nothing to do with the $6 billion approved by Congress because that money is for this year and next.

Trump didn’t specify what numbers he was talking about. But according to data released in April, prescriptions for opioid painkillers filled in the U.S. fell almost 9 percent last year, the largest drop in 25 years. The total dosage of opioid prescriptions filled in 2017 declined by 12 percent because more prescriptions were for a shorter duration, fewer new patients started on them and high-dose prescriptions dropped. The numbers are from health data firm IQVIA’s Institute for Human Data Science.

But legal prescriptions are only one front of the epidemic.

Drug overdose deaths involving opioids rose to about 46,000 for the 12-month period ended October 2017, up about 15 percent from October 2016, according to the Centers for Disease Control and Prevention. The numbers are preliminary because of continuing cause-of-death investigations later in the reporting period. They could go higher.

Other measures from the CDC also point to increasing severity of the problem last year.

For example, emergency department visits for overdoses of opioids — prescription pain medications, heroin and illicitly manufactured fentanyl — rose 30 percent in the U.S. from July 2016 to September 2017. Overdoses shot up 70 percent in the Midwest in that time while increasing by 54 percent in large cities in 16 states.

“Getting rid of that scourge” is the intent but the numbers don’t show it fading.

___

Associated Press writers Mike Stobbe in New York and Carla K. Johnson in Seattle contributed to this report.

___

https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

https://www.cdc.gov/vitalsigns/opioid-overdoses/

___

Find AP Fact Checks at http://apne.ws/2kbx8bd

Follow @APFactCheck on Twitter: https://twitter.com/APFactCheck

EDITOR’S NOTE _ A look at the veracity of claims by political figures

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An individual, or couple, may dream of having a child their entire adult life. For many, this can be a challenging journey. The reasons that some individuals or couples struggle with conceiving may be many factors.

The CDC reports that nearly 7.3 million women in the United States between the ages of 15-44 years have used infertility services. More than 12 percent of women between these ages report difficulties carrying a pregnancy to term or becoming pregnant; that’s approximately 1 out of 8 women living in America.

There are several reasons for infertility. These can include reasons related to the man, the woman, or both.

The good news is that there are more people seeking treatment for challenges with fertility. The reasons are many and include awareness, greater access to care, and advances in medical technologies.

While fertility challenges are relatively common, the emotional toll that accompanies unsuccessful attempts to conceive, or miscarriage, is often not discussed. Research studies have shown that couples suffering from infertility may have higher rates of depression and anxiety. Research also suggests that failed in vitro fertilization (IVF) cycles may affect a woman’s self-esteem and further exacerbate depression.

Saltz.jpg

Dr. Samantha Saltz is a PGY-5 (5th-year post-graduate resident) at the University of Miami Miller School of Medicine Department of Psychiatry and Behavioral Sciences.

For all these reasons, and more, a fertility center often becomes a second home to those in treatment. The center takes that emotional journey with their patients.

It is not uncommon for a woman in fertility treatment to attend an appointment at her fertility center every two to three days. Juggling work, personal lives, families, and often times other children, may make this journey feel like an endless uphill climb. It can be too much to bear; it can make the strongest of us break. This makes it important to be willing to seek mental health treatment early on.

There is sometimes a misconception that women who are trying to conceive shouldn’t see a psychiatrist out of fear of being prescribed medications that could interfere with pregnancy. But an evaluation by a mental health professional does not necessarily mean that you will be prescribed medication — medication is not always indicated. Risks and benefits need to be weighed to determine whether medication is indicated. Ultimately, this decision involves the patient, the patient’s significant other, the psychiatrist, and the fertility team.

Non-pharmacologic treatments are also available to those trying to conceive. Data has shown that many women may benefit from regular support groups and sharing their experiences with other people. Alternative treatments like acupuncture may be recommended. We also recommend techniques like mindfulness, breathing exercises and other relaxation techniques.

When a woman is unable to carry a child, adoption is an option. There is also a possibility that a couple can utilize a surrogate, or gestational host, to help carry the baby. This is a great option for gay men, as well.

According to Dr. Michael Jacobs, “A gestational host is a third party for reproduction that has no biological relationship with the egg or sperm used to carry the pregnancy.” Surrogates are sometimes family members or friends of those trying to conceive. Other times, the surrogate is a person who is paired up with a couple or individual through an agency who specializes in finding surrogates for families.

Finding the person who will be a surrogate can also be a stress-provoking experience for an individual or couple. There are many factors that need to be considered when choosing a surrogate. For example, it’s important that those trying to conceive consider the kind of relationship they want with the surrogate during and after a pregnancy, as well as their personal and religious beliefs regarding pregnancy, multiple births and abortion. Discussing this with a therapist or support group may be helpful for some couples.

While the psychological consequences of infertility can be challenging, the dream of having a child often motivates families to push forward with fertility treatments or to pursue adoption. We encourage those trying to conceive to make regular appointments with their reproductive endocrinologists, primary care physicians, therapists, psychiatrists and specialists. Families should also commit to a lifestyle involving good nutrition and healthy levels of exercise. Whether a family has a child naturally, with the assistance of reproductive technology, or through adoption, every child is a miracle. By taking a proactive approach to treating the mental and physical symptoms of infertility, the sometimes-challenging journey to reaching that miracle will be that much easier.

If you are struggling with mental health challenges secondary to infertility, call 305-243-6400 to schedule an appointment with a mental health specialist. The University of Miami Health System offers a clinic specifically dedicated to women’s health.

Dr. Samantha Saltz is a PGY-5 (5th-year postgraduate resident) at the University of Miami Miller School of Medicine Department of Psychiatry and Behavioral Sciences. For more information, visit umiamihospital.com/specialties/psychiatry or call 305-355-9028.

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Roseanne Barr appeared to blame Ambien, a prescribed sleeping pill, for the racist tweet that ultimately led to her popular ABC show “Roseanne” to be canceled on Tuesday by ABC.

In a series of now-deleted tweets, Barr said it was late and she was on the drug when she wrote the tweet about former President Barack Obama’s aide Valerie Jarrett. Barr’s tweet said Jarrett, who is African-American and born in Iran, is like the “muslim brotherhood & planet of the apes had a baby.”

“Guys I did something unforgiveable so do not defend me,” she wrote in one post and then deleted Tuesday night. “It was 2 in the morning and I was Ambien tweeting-it was memorial day too-i went 2 far & do not want it defended-it was egregious Indefensible. I made a mistake I wish I hadn’t but…don’t defend it please. ty.”

Many social media users slammed Barr’s defense. Sanofi, one of the pharmaceutical companies that makes Ambien, tweeted Wednesday, “People of all races, religions and nationalities work at Sanofi every day to improve the lives of people around the world. While all pharmaceutical treatments have side effects, racism is not a known side effect of any Sanofi medication.” 

However, other celebrities have also blamed Ambien for strange tweets and odd behavior. Here is what you need to know about Ambien, as well as its common side effects and other celebrities who have taken it.

What is Ambien?

Ambien

Roseanne Barr appeared to blame the drug Ambien for her racist tweet that got her show canceled.

Ambien is a drug sold by Sanofi and is also distributed under other names by NovaDel Pharma Inc. and Meda Pharmaceuticals Inc. The drug is used to treat adults diagnosed with insomnia, which is the inability to fall and stay asleep, according to the U.S. Food & Drug Administration. Ambien can be taken as an oral tablet, an oral spray, under-the-tongue tablet or an extended-release tablet.

What are the common side effects of Ambien?

Ambien has a number of side effects including nausea, memory loss, anxiety, confusion, rapid heartbeat, diarrhea, appetite loss, aggression, impaired vision, inability to concentrate and addiction, according to American Addiction Centers. The center said it was possible for a person prescribed Ambien to become addicted and dependent on the drug despite advertising itself as the opposite.

People who abuse the drug have been known to crush the drug to snort it or mix it in an alcoholic drink. When Ambien is mixed with alcohol, the effects of the drug can be enhanced. There have been numerous reports of people not recalling what happened once they were under the influence of the drug, such as sleepwalking and sleep driving.

Why does the FDA warn those taking Ambien?

In 2013, the Food and Drug Administration ordered drugmakers to lower doses for Ambien and other sleeping pills following studies that suggested patients “face a higher risk of injury due to morning drowsiness,” CBS News reported.

The studies showed that some people who took the drug felt drowsy in the morning, which could impair their driving. The research found the drug was still present in a patient’s bloodstream at a high enough level to interfere with their driving. The FDA required drugmakers to cut the dose in half for women and for the immediate-release tablets. The drug takes longer to leave women’s bodies than men’s.

Which other celebrities have blamed Ambien for strange incidents?

Former U.S. Congressman Patrick J. Kennedy II speaks during a rally in support of the People's Mojahedin Organization Of Iran (PMOI), also known as the Mujahadin-e-Khalq (MEK), in Stockholm April 6, 2013. Hundreds of Iranian demonstrators rallied in Stockholm to demand for more protection from the United Nations (UN) for their group members in Iraq. REUTERS/Fredrik Persson/Scanpix Sweden (SWEDEN - Tags: POLITICS CIVIL UNREST) 
ATTENTION EDITORS - THIS IMAGE HAS BEEN SUPPLIED BY A THIRD PARTY. IT IS DISTRIBUTED, EXACTLY AS RECEIVED BY REUTERS, AS A SERVICE TO CLIENTS. SWEDEN OUT. NO COMMERCIAL OR EDITORIAL SALES IN SWEDEN. NO COMMERCIAL SALES - GM1E9461NUM01

Former House Rep. Patrick J. Kennedy said he took Ambien not too long before crashing his car into a barricade.

 (Reuters)

Former House Rep. Patrick J. Kennedy crashed his car into a security barricade close to the U.S. Capitol in 2006 and said he had taken Ambien not too long before the accident. He claimed he had not been drinking, CBS News reported.

SpaceX founder Elon Musk smiles at a press conference following the first launch of a SpaceX Falcon Heavy rocket at the Kennedy Space Center in Cape Canaveral, Florida, U.S., February 6, 2018. REUTERS/Joe Skipper - HP1EE2700LUOA

Elon Musk went on a Twitter spree after claiming he had drank red wine and consumed Ambien.

 (Reuters)

Tesla CEO Elon Musk went on a Twitter rampage in June 2017, Mashable reported. He started the series of tweets by discussing his excitement over a Tesla shareholder meeting and went from there. He admitted to having a “little red wine, vintage record, some Ambien … and magic!” He tweeted a year earlier that he has learned that “tweeting on Ambien isn’t wise.”

May 13, 2018; Ponte Vedra Beach, FL, USA; Tiger Woods plays his shot from the 18th tee during the final round of The Players Championship golf tournament at TPC Sawgrass - Stadium Course. Mandatory Credit: Jasen Vinlove-USA TODAY Sports - 10834541

Tiger Woods was under the influence of Ambien during a DUI arrest in 2017.

 (Reuters)

Embattled golf star Tiger Woods was arrested for a DUI in 2017 after deputies found the athlete parked on the side of the road, asleep. During a sobriety test, Woods slurred, couldn’t walk a straight line and appeared “out of it.” A toxicology test showed Woods had a number of prescription drugs in his system, including Ambien.

Director Sean Penn poses during a photocall for the film "The Last Face" in competition at the 69th Cannes Film Festival in Cannes, France, May 20, 2016. REUTERS/Jean-Paul Pelissier   - LR1EC5K11ZRYX

Sean Penn admitted to being on Ambien during Stephen Colbert’s late-night talk show.

 (Reuters)

Academy Award-winning actor Sean Penn admitted to being on Ambien during an appearance on “The Late Show with Stephen Colbert” in March, People reported.

“I’m doing well,” Penn told Colbert. “You’ve inherited a little of the Ambien I had to take to get to sleep after a red-eye last night.”

Fox News’ Sasha Savitsky and Gregg Re contributed to this report.

 

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Public health officials are trying to contain a multistate outbreak of hepatitis A that is spreading rapidly between people via close personal contact, not a contaminated food source.

The outbreak is being driven by high rates of infection among homeless people and drug users, who are unlikely to seek out or have access to health care. Close proximity among people in unsanitary living conditions also is fueling the spread of viral disease.

In Michigan, 837 cases have been documented since 2016. Of those, 80 percent of the infected have been hospitalized, and 27 people have died.

Last year, Southern California saw a large outbreak — particularly in San Diego County, which recorded 20 deaths, 588 infections and 403 hospitalizations.

“There’s been very much a shift, starting in 2015 or 2016, in the kinds of hepatitis A outbreaks that we’re seeing in the country,” said Jay Fiedler, an epidemiologist with the Michigan Department of Health and Human Services. “We’re now seeing these larger community-acquired outbreaks, and that’s very much what they saw in San Diego, in Utah. It’s what we’re seeing in Michigan.”

Hepatitis A is highly contagious and spread by ingesting feces-contaminated food or liquids.

Typically, health departments investigating an outbreak can pinpoint the source as an infected food worker or food item, and treat those people who were in close contact. In August 2016, a multistate outbreak of hepatitis A was linked to tainted frozen strawberries from Egypt.

But this latest outbreak took health officials by surprise. When health workers couldn’t tie the rising infection rates to a specific source, they focused on communities with conditions that fuel viral spread.

“I can’t specifically say that it is tied directly to the increase in opioid use or the opioid epidemic in the country right now,” Mr. Fiedler said. “I would say the two are correlated, but I don’t have direct proof of evidence.”

While the specific strain of hepatitis A is different between San Diego, Utah and Michigan, outbreak infections are traveling across state-lines in the Midwest.

In Nashville, Tennessee, the Metro Public Health Department said a rising number of infections are consistent with outbreaks in Indiana, which in turn blamed its increasing infections on a larger outbreak in Louisville, Kentucky.

West Virginia is the latest state to record an increase in infections, with a total of 121 cases since January, including 84 hospitalizations and one death. The strain identified in the state is linked to cases in Kentucky and California, the state health department said on its website.

The virus causes inflammation of the liver, but not everyone gets symptoms, which can present anywhere between five and 50 days after infection. Symptoms include fever, fatigue, nausea, loss of appetite, yellowing of the eyes (jaundice), stomach pains, vomiting, dark urine, pale stools and diarrhea.

“With hepatitis A being very infectious and having a long incubation period, it makes it very good at spreading person-to-person this way,” Mr. Fiedler said.

At least three vaccines are highly effective, but there are “constrained supplies” at the Centers for Disease Control and Prevention, meaning states requesting doses are given a limited amount.

“We have very much experienced the vaccine constraint that’s in place from CDC,” Mr. Fiedler said. “We have had to do certain things in terms of prioritizing.”

This means offering the vaccine for free to the most at-risk populations: the homeless, injection and non-injection drug users, men who have sex with men, people recently in prison, individuals co-infected with hepatitis C and those in the food service industry.

While most of the hepatitis A vaccines require multiple dosages, health officials are advising that at least one dose offers enough protection.

Awareness among the general public is low, said Mr. Fiedler, who urged people to get vaccinated if they’ve been exposed.

“The vaccine is very safe and its very effective and we cannot urge people enough to use it when it’s appropriate for you,” he said.

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(Reuters Health) – Middle-aged adults who feel stressed, powerless or overworked on the job may be more likely to develop mental health problems in the coming years than more contented coworkers, a recent study suggests.

For the study, researchers examined data from questionnaires completed by 6,870 workers in the UK who, at age 45, had never been diagnosed with depression, anxiety or other common mental illnesses. Overall, about one-third reported having little control over what they did at work and slightly more than one-fourth described their jobs as very demanding and stressful.

By age 50, workers who reported high levels of job strain five years earlier were more than twice as likely to be diagnosed with mental health disorders as the people who had low-stress jobs, researchers report in The Lancet Psychiatry.

With demanding jobs, workers were 70 percent more likely to develop a mental illness by age 50, the study also found. And people who reported having little control over their work were 89 percent more likely to be diagnosed with psychological disorders.

“Several studies published over the past decade have suggested a link between workplace stress and poor mental health outcomes amongst employees,” said lead study author Samuel Harvey, head of the workplace mental health research program at the Black Dog Institute at the University of New South Wales in Australia.

“However, it has always been difficult to work out which came first: difficult work situations or mental health problems – the classic chicken or egg situation,” Harvey said by email.

While the current study wasn’t a controlled experiment designed to prove that work problems directly cause mental health issues, the fact that none of the workers had any psychological issues at the start of the study period suggests that the job difficulties came first, Harvey said.

Even though the study focused on middle age, all of the participants had been followed since birth, allowing researchers to account for a variety of circumstances growing up that might influence the odds that a person would experience job strain or mental health problems.

“We were able to develop the most precise picture to date of the possible reasons an individual’s working conditions could impact their mental health,” Harvey said. “When accounting for non-workplace factors like stressful life events, illness, IQ and early life, the results indicate that people with higher job demands, lower job control and higher job strain were still more likely to develop mental illness by age 50, regardless of sex or occupational class.”

While the exact ways that job strain might cause mental illness aren’t clear, stress is a known risk factor for psychological problems as well as a wide range of other chronic health issues like heart disease, diabetes and obesity, said Dr. Sabir Giga, author of an accompanying editorial and a researcher at Lancaster University in the UK.

“For individual workers, it’s important to recognize that persistent and long-term stress could lead to physical and mental health conditions,” Giga said by email.

“Demanding jobs may be unavoidable,” Giga added. “But we can make changes in our lives that allow more control and flexibility in how much we work and the way we do it.”

SOURCE: bit.ly/2H7Kqfc and bit.ly/2GrijYl The Lancet Psychiatry, online May 10, 2018.

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