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Teledermatology reduces dermatology referrals and improves access to specialists

Mish Boyka

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1. Introduction

Teledermatology (TD) is a healthcare tool that has been more frequently used worldwide, especially during the COVID-19 pandemic, due to the recommendations given for months by many governments for the population to stay home. Most medical research focuses on delivering two types of images: real-time (RT) and store-and-forward (SF) images [

1

  • Heffner V.A.
  • Lyon V.B.
  • Brousseau D.C.
  • Holland K.E.
  • Yen K
Store-and-forward teledermatology versus in-person visits: a comparison in pediatric teledermatology clinic.

 

]. In the latter type, the data and images from a patient are collected and sent to a dermatologist to be analyzed at a later time. Real time teledermatology (RT-TD) enables the live communication of data and images between patients and physicians from separate locations [

1

  • Heffner V.A.
  • Lyon V.B.
  • Brousseau D.C.
  • Holland K.E.
  • Yen K
Store-and-forward teledermatology versus in-person visits: a comparison in pediatric teledermatology clinic.

 

]. Store-and-forward teledermatology (SF-TD) improves access to specialty care, provides accurate diagnoses, and reduces time to treatment, resulting in high patient satisfaction [

2

  • O’Connor D.M.
  • Jew O.S.
  • Perman M.J.
  • Castelo-Soccio L.A.
  • Winston F.K.
  • McMahon P.J
Diagnostic accuracy of pediatric teledermatology using parent-submitted photographs: a randomized clinical trial.

 

].

The early detection and timely treatment of severe skin diseases can prevent adverse health outcomes and death. On the other hand, some skin conditions such as mild atopic dermatitis, acne, and fungal infections can be managed within primary care. However, in our country, general physicians may not be trained to diagnose or triage skin diseases and we continuously see unnecessary referrals to dermatologists. If there is a shortage of dermatologists, this creates a problem as appointments are filled by patients who do not need specialty care, limiting the availability of visits for those who do. This results in patients with potentially fatal problems such as melanomas, cutaneous lymphoma, adverse cutaneous drug reactions and pemphigus facing lengthy delays in receiving their diagnosis and treatment. In contrast, those with minor conditions face costs and travel burdens due to unnecessary visits to a dermatologist.

The city of São Paulo has nearly 12 million inhabitants [], and 58% of them depend exclusively on the public health care system []. The demand for public dermatologist consultations in São Paulo is incredibly high, and in July 2017, there were 57,832 individuals waiting for appointments which could take up to one year to obtain []. For this reason, the municipal health department decided to implement a teletriage dermatology project in conjunction with Hospital Israelita Albert Einstein, to shorten the waiting time for a dermatologist appointment, improve access for the patients with severe skin conditions, and eliminate unnecessary dermatology referrals. This main objective of the present study was to analyze the proportion of patients that could be diagnosed and/or treated by teledermatology and their primary care physicians, and how the waiting time for an in-person dermatologist visit was affected by this project.

3. Results

From 57,832 patients waiting for a dermatologist consultation in São Paulo, 30,976 individuals participated in this project (54%). In 2017, the total amount of in-person visits to dermatologists was 192,203 []. Hence, the number of patients’ visits in the project corresponds to 16% of all the “regular” appointments to dermatologists in a year. There were more female (39,046; 68%) than male (18,786; 32%) individuals waiting for a consultation with a dermatologist (2:1 proportion). 54% of the women in the waiting list attended to the project versus 52% of the men. The lowest rate of attendance was among children and young adults up to 24 years of age (

55,624 lesions were reported over the course of this project. Each lesion was photographed from three different angles. Therefore, around 166,000 images were evaluated. The mean number of lesions photographed per person was 1.8. The female patients had a mean of 1.86 lesions photographed per person, and the male patients had a mean of 1.6. The photograph quality was classified as “poor” for 613 lesions (1839 images; 1.1%), and dermatologists referred those patients for in-person appointments. The remaining 55,011 lesions were diagnosed and referred to one appropriate care unit.

Bleeding occurred in only 11% of the lesions, but pruritus was fairly common (43%). The head and neck were the main sites for the lesions (52%), and most of the cases had over three years since the onset (53%).

Next, we assessed the 10 most common diseases presented by our subjects according to sex (Fig. 2A) and whether they were referred to biopsy, an in-person dermatologist, or back to the general physician (Fig. 2B).

Fig. 2

Fig. 2The 10 most common skin conditions presented by the patients who participated in the teletriage project, categorized according to sex (A) and referrals (B), from July 2017 to July 2018 in the city of São Paulo.

There were substantial differences in the most common disorders between the two sexes. The women commonly presented melanocytic nevus (p < .0001), seborrheic keratosis (p = .0024), melasma (p < .0001), onychomycosis (p < .0001), acrochordon/other benign neoplasia (p < .0001), and solar lentigo (p < .0001). The male subjects primarily presented acne (p < .0001), atopic dermatitis (p < .0001) and epidermoid cysts (p < .0001). There was no difference in sex for the patients with xerosis (p=.899).

Four of the 10 most frequent lesions—melanocytic nevus, seborrheic keratosis, acrochordon, and cysts—belonged to the benign tumor group. One was an inflammatory process (acne), one was a fungal infection (onychomycosis), two were pigmentary disorders (melasma and solar lentigo), and two were in the eczema spectrum (atopic dermatitis and xerosis). They accounted for 24,238 lesions, corresponding to 44% of the total. 79% of those patients were sent back to their general physicians with recommendations and/or treatment plans, as shown in Fig. 2B. Only 1% was referred for biopsy, mostly for melanocytic nevi, and the remaining 20% were sent to dermatologists for in-person appointments.

Fig. 3 shows the distribution of the teledermatologists’ referrals. 53% of the cases could be addressed by teledermatology through primary care attention; 4% of them were directly sent to biopsy, and 43% were sent to an in-person dermatologist. This teletriage led to a 78% of reduction in the mean waiting time for in-person dermatologist visits (from 6.7 months before the launch of project, calculated over the period from April to June 2017 to 1.5 by the end of the project, calculated over the period from June to August 2018). This information was obtained directly from municipal health department staff during the implementation and closure meetings.

Fig. 3

Fig. 3The proportions of patients referred to biopsy, in-presence dermatologists, and general physicians by the teledermatologists in the teletriage project from July 2017 to July 2018 in the city of São Paulo.

To understand which pathologies led to each referral, we assessed the 10 most frequent diagnoses sent to biopsy, an in-person dermatologist, or back to the general physician (Fig. 4). The biopsy was the teledermatologist’s choice in only 3% of all the lesions. Malignant tumors (basal cell carcinoma, squamous cell carcinoma, and melanoma) and premalignant lesions (actinic keratosis- AK) accounted for 42% of the 1912 biopsy referrals, which was the first choice for 72% to 89% of such cases. Benign lesions such as melanocytic nevus, seborrheic keratosis, solar lentigo, and acrochordon were responsible for 16% of this type of referral, although biopsy was the teledermatologists’ option for this group only in 4% of the times.

Fig. 4

Fig. 4The 10 most frequent causes for referrals to biopsy, in-presence dermatologists, and back to physicians among patients who participated in the teletriage project from July 2017 to July 2018 in the city of São Paulo.

31% of the lesions were referred to in-person dermatologists. Benign proliferations (melanocytic nevus, seborrheic keratosis, and cysts) were among the top 10 diseases, accounting for 15% of this in-person dermatologist referral. Two infectious diseases, warts and molluscum, were also frequently referred to in-person dermatologists (10%). Acne, vitiligo, psoriasis, and atopic dermatitis accounted for 15% of these referrals, and AK alone was responsible for 4%. We found that over 80% of the AK and warts, 56% of the epidermoid cysts, 33% of the acne and melanocytic nevus, 28% of the AD, 94% of the molluscum, 60% of psoriasis, and 78% of vitiligo patients were referred to in-person dermatologists.

The dermatoses most referred to general physicians were: xerosis (98%), solar lentigo (96%), seborrheic dermatitis (90%), melasma (88%), onychomycosis (88%), acrochordon/other benign neoplasia (88%), seborrheic keratosis (81%), atopic dermatitis (72%), and the melanocytic nevus (62%).

We also categorized the most frequent skin disorders according to age (Fig. 5). We observed that atopic dermatitis, xerosis, and melanocytic nevus were the major concerns in children up to 12 years of age. Adolescents and young adults (13–24 age group) mainly had acne, atopic dermatitis, xerosis, and melanocytic nevus. The adult population (25–64 age group) was the largest population in the study and showed many cases of melasma (in this study, a problem almost exclusively faced by adults) and melanocytic nevus. The population over 65 years of age reported seborrheic keratosis, solar lentigo, onychomycosis, and other benign proliferations such as epidermoid cysts and acrochordon.

Fig. 5

Fig. 5The 10 most common skin conditions presented by the patients who participated in the teletriage project, categorized according to age, from July 2017 to July 2018 in the city of São Paulo.

Next, we assessed how many patients were medicated through teledermatology and the most frequent groups of medications prescribed by the teledermatologists (Fig. 6A and B). 18,979 patients (64%) were medicated. Emollient was the most frequent prescription (24%). Topical corticosteroids and antifungals shared the second position with 20% each, followed by sunblock (19%) and topical anti-acne medications (5%). Over-the-counter products such as emollients and sunblock were responsible for 43% of the prescriptions.

Fig. 6

Fig. 6The proportions of the patients medicated (A) and classes of drugs prescribed (B) during the teletriage project from July 2017 to July 2018 in the city of São Paulo.

4. Discussion

Our study included over 30,000 patients and 55,000 lesions from the general population of a big city with a high demand for public dermatologists, thereby presenting robust data. We found that 53% of the skin lesions could be triaged using SF-TD, and, with diagnostic hypothesis and treatment suggestions directed to the patients’ primary care physicians, referrals for in-person dermatologist were avoided in 57% of the cases. Another benefit was the option to refer the patients to the biopsy unit before the dermatologist’s visit, optimizing the time available for more severe diagnostics such as skin cancer. Assessing the 10 most frequent causes for teletriage, according to demographic data, and their referrals and treatments resulted in innovative and important new data.

In our view, the presence of 54% of all the individuals called for this project was reasonable. There may be multiple reasons for this attendance level, such as: 1) patients were waiting for so long in the waiting list that their disease improved or went away by itself, 2) they looked for a dermatologist in the private care setting (popular clinics); 3) they look for help directly with the pharmacist; 4) although they were referred to a dermatologist, the dermatoses did not bother the patient as much to participate in the project. All these reasons can lead to a bias in our study, although the remaining 31,000 individuals are still a robust part of our population. The patients’ participation increased with age, with the 60–69 age group having the highest levels; perhaps this was because retirees have more spare time to visit the doctor and may also be more concerned about health issues than the younger age groups. A more significant number of female patients waiting for a consultation with a dermatologist was expected because, in our culture, more women than men searching for healthcare in general. There was no difference in the attendance rate between the sexes. TD is still a new initiative in the country for patients as well as physicians, and for a pioneer project like this, involving a significant number of people was a challenge that we believe was overcome. Few TD works have had as many participants and covered as many types of skin diseases as ours. Most of the TD articles published so far focus on one disease (such as melanoma) or a single class of diseases (such as malignant tumors) [

7

  • Kroemer S.
  • Frühauf J.
  • Campbell T.M.
  • et al.
Mobile teledermatology for skin tumour screening: diagnostic accuracy of clinical and dermoscopic image tele-evaluation using cellular phones.

 

,

8

  • Ferrándiz L.
  • Ruiz-de-Casas A.
  • Martin-Gutierrez F.J.
  • et al.
Effect of teledermatology on the prognosis of patients with cutaneous melanoma.

 

,

9

  • Bruce A.F.
  • Mallow J.A.
  • Theeke L.A
The use of teledermoscopy in the accurate identification of cancerous skin lesions in the adult population: a systematic review.

 

].

The head and neck were the most common sites for the lesions. This may be due to aesthetic reasons (raising the patient’s concern) and/or chronic UV exposure, a common cause of skin conditions in Brazil since it is located in the tropical and subtropical regions of the southern hemisphere where solar radiation is quite elevated and ozone concentrations are naturally lower. The Ultraviolet Index (UVI) of Brazil reaches the highest UVI scales determined by the WHO—i.e., very high (UVI between 8 and 10) or extreme (UVI higher than 11)—and damages human health [

10

Solar ultraviolet radiation: properties, characteristics and amounts observed in Brazil and South America.

 

].

The time of onset of over three years in many patients indicated that the lesions were either indolent and of low concern or the public health system was not efficient enough to supply dermatological medical services for the population; it may even be a combination of these aspects.

There were differences between sex and skin conditions. Benign proliferations such as melanocytic nevus and acrochordon raised more concerns in women while men were more affected by epidermoid cysts. Women showed more pigmentation disorders such as melasma and solar lentigo. Melasma is closely associated with female hormones, being much more frequent in women [

11

  • Handel A.C.
  • Lima P.B.
  • Tonolli V.M.
  • Miot L.D.
  • Miot H.A
Risk factors for facial melasma in women: a case-control study.

 

], and solar lentigo occurred in both the sexes but seemed to bother men less. Onychomycosis was also more frequent in women, probably due to trauma at manicure and pedicure practices, which is more common among women than men in Brazil [

12

Onychomycosis in clinical practice: factors contributing to recurrence.

 

]. Atopic dermatitis was more prevalent in men, in whom the severity seemed to be more significant [

13

  • Holm J.G.
  • Agner T.
  • Clausen M.L.
  • Thomsen S.F
Determinants of disease severity among patients with atopic dermatitis: association with components of the atopic march.

 

]. Acne was also a major cause of consultation for men [

14

  • Skroza N.
  • Tolino E.
  • Mambrin A.
  • et al.
Adult acne versus adolescent acne: a retrospective study of 1,167 patients.

 

].

The diseases also differed between the various age groups, but our results were in accordance with the medical literature. As examples: melanocytic nevus and xerosis appeared to be a significant concern throughout the life spans of the patients [

15

  • Uludağ A.
  • Kılıc S.O.
  • Isık S.
  • et al.
Prevalence of skin disorders in primary and secondary school age children in Canakkale, Turkey: a community-based survey.

 

]; acne was primarily a disease among the teenagers and young adults [

14

  • Skroza N.
  • Tolino E.
  • Mambrin A.
  • et al.
Adult acne versus adolescent acne: a retrospective study of 1,167 patients.

 

]; melasma was almost exclusively present in the adult group [

11

  • Handel A.C.
  • Lima P.B.
  • Tonolli V.M.
  • Miot L.D.
  • Miot H.A
Risk factors for facial melasma in women: a case-control study.

 

]; atopic dermatitis was prominent in children []; and benign proliferations (cysts, seborrheic keratosis, and acrochordons), solar lentigo, and onychomycosis occurred most often in adults and older people [

12

Onychomycosis in clinical practice: factors contributing to recurrence.

 

,

17

  • Buendía-Eisman A.
  • Arias-Santiago S.
  • Molina-Leyva A.
  • et al.
Outpatient dermatological diagnoses in spain: results from the national DIADERM random sampling project.

 

].

We found that TD could triage the patients’ skin conditions without an in-person consultation in 57% of the cases (53% referrals back to the physician and 4% biopsy referrals), leading to an excellent reduction for referrals to an in-person dermatologist visit. This indicates that most skin conditions in our primary care setting are of low complexity and, therefore, SF-TD could be helpful in reducing the number of referrals to in-person dermatologist. This finding reinforces the feasibility and the importance of teledermatology in this context, helping the general physicians to manage such conditions and optimizing medical hours and costs, especially in the public system. This project proved to be a well-defined, structured, scalable process with standardized collection and fairness of care, which might promote the democratization of access to dermatology for underprivileged patients. We believe that this project and its findings could be replicated in wider populations, such as our entire country or even in other countries. In another Brazil’s state, Santa Catarina, a SF-TD program has been also in place for 12 years, reducing referrals to in-person dermatologists by 44% [

18

  • von Wangenheim A.
  • Nunes D.H
Creating a web infrastructure for the support of clinical protocols and clinical management: an example in teledermatology.

 

]. A similar project with 500 patients found 72% of patients with no need for in-person dermatologists [

19

  • McAfee J.L.
  • Vij A.
  • Warren C.B
Store-and-forward teledermatology improves care and reduces dermatology referrals from walk-in clinics: a retrospective descriptive study.

 

]. In our project, we had the benefit of directly referring patients for biopsies, which was a new improvement in relation to the previous two studies. One study from Spain showed that two of the main advantages of TD were prioritization in cancer screening and reduction in the number of face-to-face visits, in agreement with our findings [

20

  • Romero G.
  • de Argila D.
  • Ferrandiz L.
  • et al.
Practice models in teledermatology in Spain: longitudinal study, 2009–2014.

 

]. Other study in Cabo Verde, Africa, also reported the benefits of telemedicine, reducing the referrals for in-person consultations by 65% [

21

  • Azevedo V.
  • Latifi R.
  • Parsikia A.
  • Latifi F.
  • Azevedo A
Cabo verde telemedicine program: an update report and GFN of 2,442 teleconsultations.

 

]. A systematic review for the use of TD in rural areas showed that it can improve the access to dermatological care, as we believe our study also did [

22

  • Coustasse A.
  • Sarkar R.
  • Abodunde B.
  • Metzger B.J.
  • Slater C.M
Use of teledermatology to improve dermatological access in rural areas.

 

]. The shortened in the waiting time (a 78% reduction) for patients requiring treatments for potentially lethal diseases, such as melanoma and other severe skin malignancies and diseases, is an important outcome of our work that, as far as we know, has not been evaluated before in previous studies.

The results from the biopsy referrals were as expected: basal cell carcinoma and squamous cell carcinoma were the two most prevalent skin cancers among our studied population and were frequently biopsied before surgery to confirm the diagnostics and choose the best treatments. Melanomas are responsible for less than 5% of all skin cancers, but they are the most significant causes of death among them [

23

  • Jemal A.
  • Siegel R.
  • Ward E.
  • et al.

 

]. The rate of biopsies for our subjects’ melanomas was not as high as the other two skin cancers, maybe because the first treatment choice is an excisional biopsy and not the incisional biopsy, which was offered in this project [

24

  • Pavri S.N.
  • Clune J.
  • Ariyan S.
  • Narayan D
Malignant melanoma: beyond the basics.

 

]. Therefore, teledermatologists could have preferred to refer the patients with suspected melanoma for in-person dermatologists, not directly to biopsy. While frequent in our population, actinic keratosis, can be treated by various methods, including physical and chemical treatments, and is commonly not biopsied unless the presence of squamous cell carcinoma is suspected [

25

  • Callen J.P.
  • Bickers D.R.
  • Moy R.L

 

]. On the other hand, in our experience in the Brazilian public health system, benign lesions such as melanocytic nevus, seborrheic keratosis, solar lentigo, and acrochordon are seldom biopsied, generally to exclude malign lesions, and epidermoid cysts are usually excised without a prior biopsy.

Referrals for in-person dermatologists were typically for benign proliferations: melanocytic nevus, seborrheic keratosis, cysts, warts, and molluscum. Some of the melanocytic nevus and seborrheic keratosis patients could have received a different referral if dermoscopy had been a part of the project, especially in the more atypical lesions [

26

  • Ferrándiz L.
  • Ojeda-Vila T.
  • Corrales A.
  • et al.
Internet-based skin cancer screening using clinical images alone or in conjunction with dermoscopic images: a randomized teledermoscopy trial.

 

].

Warts and molluscum are treated with liquid nitrogen, chemical compounds, or surgery—options that can only be performed during in-presence visits. Dermatologists are trained to palpate cysts and might find teledermatology insufficient in some cases. Patients with actinic keratosis are usually sent to dermatologists to perform dermoscopy for ruling out invasive squamous cell carcinoma and treatment reasons. Most of the cases of acne, vitiligo, psoriasis, and atopic dermatitis sent to dermatologists were probably moderate to severe as the majority was sent back to their general physicians.

The great majority of patients referred back to general physicians were for simple conditions such as xerosis, onychomycosis, melasma, solar lentigos, seborrheic dermatitis, and seborrheic keratosis. With proper orientations and suggestions, the treatments could be managed by them using teledermatology. This differs from a study conducted in Africa, where infectious diseases and eczema were mostly diagnosed, and in Spain, where actinic keratosis, basal cell carcinoma, and melanocytic nevus were the primary causes for dermatologist consultations [

17

  • Buendía-Eisman A.
  • Arias-Santiago S.
  • Molina-Leyva A.
  • et al.
Outpatient dermatological diagnoses in spain: results from the national DIADERM random sampling project.

 

,

27

  • Faye O.
  • Bagayoko C.O.
  • Dicko A.
  • et al.
A teledermatology pilot programme for the management of skin diseases in primary health care centres: experiences from a resource-limited country (Mali, West Africa).

 

].

It was important for the primary care physicians to know the prevalence of the diseases based on age. This information is especially useful for directing measurements to prevent diseases and orient the population. Emollients and sunblock were the two most frequently prescribed treatments, have few side effects and excellent benefits, potentially preventing many of the prevalent lesions that were diagnosed in this project.

There are limitations to teletriage in dermatology and it is not intended to replace in-person visits with dermatologists. The fact that you can receive multiples photographs of parts of the body and head, and not to examine the person as a whole, makes the diagnosis more challenging. There is also the fear of missing important lesions, such as skin cancer. As our contact was with another physician and not directly to the patient in this project, we expected the physician to follow-up the lesions and request a new evaluation if necessary. Also, some important impressions that would help to corroborate the diagnosis, such as feeling the skin texture cannot be done. However, in a previous study, we have shown that the impossibility to palpate the lesion was classified as a low or medium level of interference in the work of the teledermatologists, and that, after working with SF-TD, they became much more confident in teledermatology [

28

  • Giavina Bianchi M.
  • Santos A.
  • Cordioli E
Dermatologists’ perceptions on the utility and limitations of teledermatology after examining 55,000 lesions.

 

]. We did not evaluate racial/ethnicity and other socioeconomic characteristics of the population studied, which could provide some valuable information. The project manager had to face a variety of technical issues, such as delay in the process of uploading images and reports made by the teldermatologists; problems with internet connection in the hospitals and missing data or photographs leading to some patients’ recall. The teledermatologists encountered other problems, as blurry pictures, wrong framing of images, and lack of dermoscopy to assist in the diagnosis of many dermatoses.

SF-TD can be an effective tool for reducing referrals of common skin conditions among the general population to dermatologists. It can provide numerous benefits, such as optimizing in-person visits for patients with serious/complex skin conditions, and quickly and conveniently addressing common skin conditions with the primary care physician. This can save resources, working days and patient transportation. Knowledge of the most common skin conditions and treatments encountered in primary care can inform public health policies for the prevention of diseases, and help train physicians on how to address such cases

Business

LPL Financial to Acquire Waddell & Reed’s Wealth Management Business and Enter Into Long-Term Partnership With Macquarie

becker blake

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on

Macquarie to acquire Waddell & Reed Financial, Inc. and upon closing sell
Waddell & Reed’s wealth management business to LPL Financial for $300 million

Long-term partnership between LPL Financial and Macquarie will provide existing
Waddell & Reed advisors and clients with continuity, as well as longer-term opportunities through partnership with a leading international asset manager

SAN DIEGO, Dec. 02, 2020 (GLOBE NEWSWIRE) — LPL Financial Holdings Inc. (Nasdaq: LPLA) (“LPL Financial” or “LPL”), a leading U.S. retail investment advisory firm, independent broker-dealer, and registered investment advisor (RIA) custodian, today announced it has entered into an agreement with Macquarie Asset Management (“Macquarie”), the asset management division of Macquarie Group (ASX: MQG; ADR: MQBKY), to acquire the wealth management business of Waddell & Reed Financial, Inc. (NYSE: WDR) (“Waddell & Reed”), upon completion of Macquarie’s acquisition of all of the issued and outstanding common shares of Waddell & Reed. Additionally, LPL and Macquarie have agreed to enter into a long-term partnership, with Macquarie becoming one of LPL’s top tier strategic asset management partners.

Through its subsidiaries, Waddell & Reed has provided investment management and wealth management services to clients throughout the U.S. since 1937. Today, investment products are distributed under the Ivy Investments ® brand, as well as through independent financial advisors associated with Waddell & Reed, Inc. As of September 30, 2020, Waddell & Reed’s wealth management business had assets under administration of approximately $63 billion, up 10% year-over-year.

Dan Arnold, President and Chief Executive Officer of LPL Financial said: “Waddell & Reed advisors are highly experienced and well-respected throughout the industry. They are a terrific fit both culturally and strategically, and we welcome them to the LPL family. Looking ahead, we expect our capabilities and resources will benefit their practices and help them unlock additional value and growth. Additionally, we look forward to deepening our long-term partnership with Macquarie, which will help us preserve unique aspects of the Waddell & Reed advisor experience while also positioning us to explore additional long-term opportunities together.”

Philip J. Sanders, Chief Executive Officer of Waddell & Reed, said: “Over the past few years, we have been focused on leveraging our strong heritage as the foundation for transforming our firm into a more diversified and growth-oriented financial services enterprise. The long-term partnership between LPL and Macquarie as part of this transaction accelerates that transformation and ultimately will benefit our clients and independent financial advisors while delivering significant value to our stockholders.”

Martin Stanley, Head of Macquarie Asset Management, said: “The addition of Waddell & Reed Financial and our enhanced partnership with LPL will significantly increase our ability to grow and invest in our combined business for the benefit of our clients. Ivy Investments’ complementary investment capabilities will provide diversification to Macquarie Asset Management’s capabilities and client base. The consideration offered reflects the quality of Waddell & Reed’s business and the future benefits of our partnership with LPL.”

Shawn Lytle, President of Delaware Funds by Macquarie and Head of Macquarie Group in the Americas, added: “This transaction is an important step forward in our growth strategy for Delaware Funds by Macquarie. The acquisition of Waddell & Reed’s asset management business and our partnership with LPL significantly strengthens our position as a top 25(1) US actively managed, long-term, open-ended mutual fund manager across equities, fixed income and multi asset solutions.”

The transaction has been approved by the Boards of Directors of LPL Financial, Macquarie Group, and Waddell & Reed and is expected to close in the middle of 2021, subject to regulatory approvals, Waddell & Reed stockholder approval, and other customary closing conditions.

LPL Financial posted an investor presentation with an overview of the transaction on its Investor Relations page at investor.lpl.com.

Centerview Partners LLC served as exclusive financial advisor and Ropes & Gray LLP served as exclusive legal advisor to LPL in connection with the transaction.

About LPL Financial
LPL Financial (https://www.lpl.com) is a leader in the retail financial advice market, the nation’s largest independent broker/dealer(+) and a leading custodian (or provider of custodial services) to RIAs. We serve independent financial advisors and financial institutions, providing them with the technology, research, clearing and compliance services, and practice management programs they need to create and grow thriving practices. LPL enables them to provide objective guidance to millions of American families seeking wealth management, retirement planning, financial planning and asset management solutions.

(+)Based on total revenues, Financial Planning magazine June 1996-2020.

Securities and Advisory Services offered through LPL Financial LLC, a Registered Investment Advisor. Member FINRA/SIPC. We routinely disclose information that may be important to shareholders in the “Investor Relations” or “Press Releases” section of our website.

About Waddell & Reed Financial
Through its subsidiaries, Waddell & Reed Financial, Inc. has provided investment management and wealth management services to clients throughout the United States since 1937. Today, Waddell & Reed Financial distributes its investment products through the unaffiliated channel under the Ivy Investments® brand (encompassing broker/dealer, retirement, and registered investment advisors), its wealth management channel (through independent financial advisors associated with Waddell & Reed, Inc.), and its institutional channel (including defined benefit plans, pension plans, endowments and subadvisory relationships). For more information, visit ir.waddell.com.

About Macquarie Asset Management
Macquarie Asset Management (MAM) is Macquarie’s asset management business. MAM is a full-service asset manager, providing investment solutions to clients across a range of capabilities including infrastructure & renewables, real estate, agriculture, transportation finance, private credit, equities, fixed income, and multi-asset solutions. As of September 30, 2020, MAM had $A554.9 billion of assets under management. MAM has over 1,900 staff operating across 20 markets in Australia, the Americas, Europe and Asia. MAM has been managing assets for institutional and retail investors since 1980 in Australia and 1929 in the US, through a predecessor firm, formerly known as Delaware Investments.

(1) Source: Assets under management as of Sept. 30 – Based on data represented in Strategic Insight and Morningstar. Data includes ICI Method of Sales: Salesforce, Institutional and Retirement. Data excludes Variable Insurance Products, Closed End Funds, ETFs, passive mutual funds, Money Market Funds, Delaware Pooled Trusts, and Optimum Funds.

Forward-Looking Statements
Statements in this press release regarding LPL Financial Holdings Inc. (together with its subsidiaries, including LPL Financial LLC, the “Company” or “LPL Financial”) and its potential growth, business strategy and plans, including the expected benefits of Macquarie Group’s acquisition of Waddell & Reed Financial, Inc. (together with its subsidiaries, “Waddell & Reed”) and LPL Financial’s acquisition of Waddell & Reed’s wealth management business and partnership with Macquarie Group, as well as any other statements that are not related to present facts or current conditions or that are not purely historical, constitute forward-looking statements. These forward-looking statements are based on the historical performance of the Company and Waddell & Reed and the Company’s plans, estimates and expectations as of December 2, 2020. Forward-looking statements are not guarantees that the future results, plans, intentions or expectations expressed or implied by the Company will be achieved. Matters subject to forward-looking statements involve known and unknown risks and uncertainties, including economic, legislative, regulatory, competitive and other factors, which may cause levels of assets serviced, actual financial or operating results, levels of activity or the timing of events to be materially different than those expressed or implied by forward-looking statements. In particular, the Company can provide no assurance that the assets reported as serviced by financial advisors affiliated with Waddell & Reed (“Waddell & Reed Advisors”) will translate into assets serviced by LPL Financial, that Waddell & Reed Advisors will join LPL Financial, or that the benefits that are expected to accrue to LPL Financial, Waddell & Reed, Macquarie Group and their respective advisors and stockholders as a result of the transactions described herein will materialize. Important factors that could cause or contribute to such differences include: failure of the parties to satisfy the closing conditions applicable to the acquisitions described herein in a timely manner or at all, including the completion of the acquisition of Waddell & Reed by Macquarie Group, obtaining the required stockholder and regulatory approvals, and the retention by Waddell & Reed of minimum assets prior to closing; disruptions to the parties’ businesses as a result of the announcement and pendency of the transactions, difficulties and delays in recruiting Waddell & Reed Advisors or onboarding the clients or businesses of Waddell & Reed Advisors; the inability by the Company to sustain revenue and earnings growth or to fully realize revenue or expense synergies or the other expected benefits of the transactions, which depend in part on the Company’s success in onboarding assets currently served by Waddell & Reed Advisors; disruptions of the Company’s or Waddell & Reed’s business due to transaction-related uncertainty or other factors making it more difficult to maintain relationships with its financial advisors and their clients, employees, other business partners or governmental entities; the inability to implement onboarding plans and other consequences associated with acquisitions; the choice by clients of Waddell & Reed Advisors not to open brokerage and/or advisory accounts at LPL Financial or move their assets from Waddell & Reed to LPL Financial; unforeseen liabilities arising from the acquisition of Waddell & Reed’s wealth management subsidiaries; changes in general economic and financial market conditions, including retail investor sentiment; fluctuations in the value of assets under custody; effects of competition in the financial services industry, including competitors’ success in recruiting Waddell & Reed Advisors; and the other factors set forth in Part I, “Item 1A. Risk Factors” in the Company’s 2019 Annual Report on Form 10-K and any subsequent SEC filing. Except as required by law, the Company specifically disclaims any obligation to update any forward-looking statements as a result of developments occurring after the date of this press release, even if its estimates change, and you should not rely on those statements as representing the Company’s views as of any date subsequent to the date of December 2, 2020.

Investor Relations:
Chris Koegel
617-897-4574
Chris.Koegel@lpl.com

Media Relations:
Jeffrey Mochal
704-733-3589
Jeff.Mochal@lpl.com

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First Responder Announces Proposed Transaction with Airbeam Wireless Technologies

Mish Boyka

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/Not for distribution to U.S. news wire services or dissemination in the United States/

Homegrown Canadian Disruptor Enters 5G-Edge Technology Race
Proposed Entity to Build Innovative Technology Stack for Smart Cities

VANCOUVER, BC, Nov. 30, 2020 /CNW/ – First Responder Technologies Inc. (“First Responder” or the “Company”) (CSE: WPN) (OTCQB: WPNNF) (FWB: 3WK), a leading developer of public safety and security technologies, is pleased to announce that it has entered into a letter of intent dated November 27, 2020 (the “LOI“), which sets out the basic terms and conditions for the acquisition (the “Acquisition“) by the Company of all of the issued and outstanding common shares in the capital of Airbeam Wireless Technologies Inc. (“Airbeam“) in exchange for common shares in the capital of the Company (the “First Responder Shares“). The Acquisition is expected to be structured as a reverse takeover and will constitute a “fundamental change” for the Company pursuant to the rules and policies of the Canadian Securities Exchange (the “Exchange“). The Acquisition is an arm’s length transaction. Upon successful completion of the Acquisition, it is anticipated that the resulting entity (the “Resulting Issuer“) will continue the combined businesses of Airbeam and First Responder under a name to be determined by the parties.

Creating a Canadian National Leader in Emerging 5G-Edge Enabled Smart City Technologies

Over the past decade, governments, privacy commissioners and industry have been working together to develop a roadmap to realize the potential of 5G for the development of Smart Cities in North America, and around the world. The Acquisition proposes to create a Canada-based leader in this important sector, with privacy at the core of the Resulting Issuer’s approach to product development.

As a result of the Acquisition, the Resulting Issuer is expected to develop and sell a complete Canadian-owned technology solution – chip, hardware, software and services – that could reduce Canadian dependence on foreign-owned 5G networking hardware and software.

The combination of Airbeam’s 60GHz millimeter wave (“MMW“) chipset, and Smart City networking hardware and services, together with First Responder’s innovative AI-enabled weapons detection camera and Wi-Fi-based concealed weapons technology, may create a new capability in the public safety and security segment, an important and fast emerging segment of the Smart City vertical. This new public safety infrastructure developed by First Responder, and powered in the future by Airbeam’s 60GHz chipset, may then be utilized as “edge networking nodes” as 5G networks densify, which can offer wireless backhaul, edge computing and networking capabilities to overcome anticipated bottlenecks in the current infrastructure.

“Airbeam remains one of the few independent 60GHz MMW chipset and system solutions available in the market. Combining Airbeam’s technology and highly experienced leadership team with First Responder’s executive team, advisory council and capital markets vehicle, creates a unique opportunity to develop a full stack technology offering that may enable an industry leader to emerge in North America in the 5G-Edge networking and public safety segment of the Smart City vertical,” said Dr. Karim Arabi, Chairman of Airbeam.

In the future, the Resulting Issuer anticipates developing unique hybrid appliances, which may combine some or all of 5G small cell, edge compute, wireless backhaul, computer vision and AI capabilities, which may enable new and unique Smart City applications to be developed for transportation, municipal infrastructure and public safety that have the potential to directly impact daily life in North American cities and beyond. Given the privacy concerns that attend to such capabilities, the Resulting Issuer is expected to continue a process started by First Responder that will integrate privacy considerations from the earliest stages of product inception, and work with third-party privacy advocacy groups and privacy commissioners to ensure that the benefits of this new capability also preserve the privacy and liberty of North American and international customers.

“In the GFN of First Responder’s management, this is an exciting opportunity for Canada and Canadians to potentially replace dependence on foreign 5G networking hardware and software at the edge, with a homegrown solution to develop 5G hardware, software and integrated solutions, which may be the foundational technology for Smart Cities of the 21st century, in North America, and around the world” said Robert F. Delamar, CEO of First Responder and proposed CEO of the Resulting Issuer.

About Airbeam

Airbeam is a private company existing under the laws of British Columbia and is based in Richmond, British Columbia. There are currently 64,551,545 common shares in the capital of Airbeam (the “Airbeam Shares“), 3,500,000 restricted shares, 1,000,000 restricted share units and 669,999 common share purchase warrants outstanding.

Airbeam is a developer of 5G-enabled Smart City technologies, which sells a proprietary 60 GHz millimeter wave (“MMW“) chipset, hardware and software, which cost in excess of $110 million USD to develop by a leading semiconductor company from which it was acquired.

As of the date hereof, no meaningful financial information has been prepared by Airbeam. Airbeam will prepare audited financial statements in the near future and the Company will provide a summary of significant financial information in due course.

Proposed Acquisition

The Company and Airbeam have entered into the LOI, which sets out certain terms and conditions pursuant to which the proposed Acquisition will be completed. The transaction terms outlined in the LOI are subject to the parties successfully entering into a definitive agreement (the “Definitive Agreement“) in respect of the Acquisition on or before February 12, 2021 or such other date as the Company and Airbeam may mutually agree.

The LOI also contemplates other material conditions precedent to the closing of the Acquisition (the “Closing“), including the completion of a bridge financing to raise minimum aggregate gross proceeds equal to such amount required to fund First Responder until the completion of the Acquisition (the “Bridge Financing“), the completion of a concurrent financing to raise minimum aggregate proceeds equal to such amount required to provide the Resulting Issuer with sufficient working capital for a minimum of 12 months following the completion of the Acquisition (or such other amount as may be agreed upon by the parties) (the “Concurrent Financing“), customary due diligence, compliance with all applicable regulatory requirements and receipt of all necessary regulatory, corporate, third-party, board and shareholder approvals being obtained, including the approval of the Exchange. There can be no assurance that the Acquisition will be completed as proposed, or at all.

It is anticipated that the Closing will involve, among other things, the following steps, which may be amended if the parties mutually agree that such form would better satisfy their objective (including but not limited to, tax efficiency to the parties):

  • prior to the closing of the proposed Acquisition, the Company will consolidate its share capital on a basis to be determined by the parties (the “Consolidation“);
  • the shareholders of Airbeam will receive post-Consolidation First Responder Shares in exchange for their Airbeam Shares pursuant to an exchange ratio to be determined by the parties;
  • completion of the Bridge Financing of First Responder securities to be priced in the context of the market;
  • completion of the Concurrent Financing of Airbeam securities or First Responder securities, as may be agreed upon by the parties, to be priced the context of the market but in no event less than the offering price of the Bridge Financing;
  • receipt of all director, shareholder and regulatory approvals relating to the Acquisition and the Concurrent Financing, including, without limitation, the approval of the Exchange; and
  • each of the parties shall have executed, delivered and performed their respective covenants as outlined in the Definitive Agreement, and all representations and warranties of each party contained in the Definitive Agreement shall be true and correct at the time of Closing.

Certain of the First Responder Shares issuable pursuant to the Acquisition may be subject to the escrow requirements of the Exchange and to hold periods as required by applicable securities laws.

The Company and Airbeam, as applicable, may pay finder’s fees in connection with the Bridge Financing, the Concurrent Financing and the Acquisition up to the maximum permitted under the policies of the Exchange.

The Resulting Issuer – Summary of Proposed Directors

It is currently anticipated that certain of the current officers and directors of the Company will resign from their respective positions with the Company.

Following the Closing, the board of directors of the Resulting Issuer is expected to consist of seven (7) directors, four (4) of which will be nominees of Airbeam and three (3) of which will be nominees of the Company.

Dr. Karim Arabi, current Chairman of Airbeam, and Mr. Wayne Lloyd, current President of Airbeam are expected to become directors of the Resulting Issuer.  Robert Delamar is expected to be Chief Executive Officer and a director the Resulting Issuer.  Naresh Singhal is expected to be Chief Technology Officer, but not a director of the Resulting Issuer, with other officers to be determined in due course by the board of directors of the Resulting Issuer.

The following is a brief description of the known directors and officers of the Resulting Issuer who have been identified as of the date hereof:

Dr. Karim Arabi – Chairman

Dr. Arabi is a seasoned executive with extensive leadership experience in the semiconductor and telecommunications industry. Previously, VP of R&D at Qualcomm, Dr. Arabi also held a diverse portfolio of other roles there, such as head of the ASIC research department responsible for Advanced Wireless and Computing Technologies, and VP of Engineering, Mobile SoC Design. He also served as VP, Engineering at Dialog Semiconductor, working on semiconductor products for mobile devices. Dr. Arabi has had several successful technology exits in the semiconductor sector most recently commercializing an innovative power supply chipset for mobile devices enabling higher efficiency and more compact products.

Wayne Lloyd – Director

Mr. Lloyd is an entrepreneur and technology executive with extensive capital markets experience. Mr. Lloyd currently serves as the Chief Executive Officer of Tracesafe Inc., is founder of Consensus Core, and has extensive experience scaling start-ups, special situation investing, and completing complex M&A transactions in the technology sector.  Mr. Lloyd has helped raise millions in capital to grow businesses and has a proven track record of attracting world class talent to start-up ventures. Mr. Lloyd earned a CFA charterholder designation in 2015.

Robert Delamar – Chief Executive Officer

Mr. Delamar is a lawyer and high technology CEO with almost 20 years of experience developing and leading technology companies in Silicon Valley and around the world. After starting his career in Silicon Valley, Robert returned to Vancouver to complete law school at UBC and articled at Blake, Cassels & Graydon in Vancouver. He was called to the bar of British Columbia in 2004.  Immediately after his call to the bar, Mr. Delamar left Vancouver to work in the high-tech corridor situated outside of Washington, DC, where he worked at a mobile satellite networking company in a business development role, and co-founded a social media start-up.  Following a brief return to Canada to practise law as a civil litigator, in 2011 he was recruited to serve as founder and CEO of a video streaming technology start-up company, owned by a major Latin American media and telecommunications conglomerate, which through a series of transactions became UUX, Inc., which was later acquired by Spain’s Agile Content, SA. While at UUX, Inc., Mr. Delamar led a sales effort focused on major international mobile telecoms companies. Between 2014 and 2016 Robert split his time between Vancouver and Silicon Valley, where he co-founded and served as CEO of a green refinery development company, and served as Co-CEO of a peer-to-peer networking company.  In July of 2019 Mr. Delamar accepted the appointment as CEO and member of the board of directors for First Responder Technologies Inc.

Naresh Singhal – Chief Technology Officer

Mr. Singhal has more than 30 years of experience in the technology industry in a variety of domains and industry verticals. He completed a B.S. (Honors) in Electronics and Communications Engineering from National Institute of Technology, India, and professional development coursework from Stanford University. He holds one technology patent, with several others pending. Mr. Singhal started his career as a Scientist with India’s Defense Research & Development Organization (“DRDO“), where he led some prestigious defense projects. After the DRDO, Mr. Singhal moved to the United States and worked at a number of different startups. At Entrisphere Inc. (“Entrishphere“), he built Network Management Systems for next generation optical networking products. Entrisphere was acquired by Ericsson and helped Ericsson get a foothold in the wireline business, selling these products to the major Regional Bell operating companies AT&T, Verizon and BellSouth, in response to a multi-billion dollar request-for-proposal. Subsequently Mr. Singhal led engineering at streaming media startup Sezmi, which went through several acquisitions and mergers before becoming UUX Inc.. As VP of Engineering at UUX, he helped create the world’s first truly converged internet TV as-a-service platform, that combined linear (live) television and Over-the-Top television in an intuitive multi-device user experience. Most recently, Mr. Singhal was Chief Technology Officer at Trunomi, a fintech startup building technology for privacy and data rights management, in response to regulations like the EU General Data Protection Regulation, amid increasing concerns about how corporations misuse personally identifiable information.

Further details concerning the management and directors of the Company will be provided in a comprehensive press release when the parties enter into the Definitive Agreement and in the disclosure document to be prepared and filed in respect of the Acquisition.

Trading in First Responder Shares

Trading in the Company’s shares has been halted in compliance with the policies of the Exchange. Trading in the Company’s shares will remain halted pending the review of the proposed Acquisition by the Exchange and satisfaction of the conditions of the Exchange for resumption of trading. It is likely that trading in the shares of the Company will not resume prior to Closing.

Disclosure and Caution

Further details about the proposed Acquisition, the Bridge Financing, the Concurrent Financing and the Resulting Issuer will be provided in a comprehensive press release when the parties enter into the Definitive Agreement and in the disclosure document to be prepared and filed in respect of the Acquisition. Investors are cautioned that, except as disclosed in the disclosure document, any information released or received with respect to the Acquisition may not be accurate or complete and should not be relied upon.

All information provided in this press release relating to Airbeam has been provided by management of Airbeam and has not been independently verified by management of the Company.

As the date of this press release, the Company has not completed a Definitive Agreement with Airbeam and readers are cautioned that there can be no assurances that a Definitive Agreement will be executed, or that the Acquisition will be completed.

No securities regulatory authority has either approved or disapproved of the contents of this news release. The securities of the Company have not been, nor will they be, registered under the United States Securities Act of 1933, as amended, or any state securities laws, and may not be offered or sold in the United States, or to or for the account or benefit of any person in the United States, absent registration or an applicable exemption from the registration requirements. This press release shall not constitute an offer to sell or the solicitation of an offer to buy any common shares in the United States, or in any other jurisdiction in which such offer, solicitation or sale would be unlawful.

On behalf of the Board of Directors,

Robert F. Delamar

Robert F. Delamar, CEO

First Responder Technologies Inc.
915 – 700 West Pender Street
Vancouver, BC. V6C 1G8
[email protected]
+1-604-227-9821

About First Responder Technologies Inc.

First Responder Technologies Inc. (the “Company“) is a technology development company that commercializes academic and internally developed intellectual property for use in the public safety market. The Company is developing a WiFi-based technology, based in part, on academic research licensed from Rutgers, the State University of New Jersey (“Rutgers“) that can be used to detect concealed weapons. The Company’s threat detection technology line of business was created to capture a significant portion of the global weapons detection systems market, and in particular, the global perimeter security detection market. In the Company’s view, WiFi–based threat detection technology may be utilized by a wide range of facilities, including schools, places of worship, shopping centres and theatres, to not only make their premises secure, but also reduce their cost of security, from the interior of a facility to the perimeter.

For more information visit: www.firstrespondertech.com or follow us on Twitter, LinkedIn and Facebook.

CAUTION REGARDING FORWARD-LOOKING INFORMATION

Certain statements contained in this news release may constitute forward–looking information, including statements relating to the completion of the Acquisition, the proposed business of the Resulting Issuer, the completion of the Bridge Financing, the completion of the Concurrent Financing, the proposed directors and officers of the Resulting Issuer, the completion of the Consolidation, shareholder, director and regulatory approvals, and future press releases and disclosure. Forward–looking information is often, but not always, identified by the use of words such as “anticipate”, “plan”, “estimate”, “expect”, “may”, “will”, “intend”, “should”, and similar expressions. Forward–looking information involves known and unknown risks, uncertainties and other factors that may cause actual results or events to differ materially from those anticipated in such forward–looking information. The actual results of the Company, Airbeam or the Resulting Issuer could differ materially from those anticipated in this forward–looking information as a result of regulatory decisions, competitive factors in the industries in which the Company and Airbeam operate, prevailing economic conditions, changes to the Company or Airbeam’s strategic growth plans, and other factors, many of which are beyond the control of the Company and Airbeam. Each of the Company and Aiream believe that the expectations reflected in the forward–looking information are reasonable, but no assurance can be given that these expectations will prove to be correct and such forward–looking information should not be unduly relied upon. Any forward–looking information contained in this news release represents the Company and Airbeam’s expectations as of the date hereof, and is subject to change after such date. Each of the Company and Airbeam disclaim any intention or obligation to update or revise any forward–looking information whether as a result of new information, future events or otherwise, except as required by applicable securities legislation.

Neither the Canadian Securities Exchange nor its Regulation Services Provider (as that term is defined in the policies of the Canadian Securities Exchange) accepts responsibility for the adequacy or accuracy of this release.

SOURCE First Responder Technologies Inc.

For further information: Please Contact: General Inquiries: [email protected]; Investor Relations: Lyle McLennan, [email protected]; Media Contacts: Jeff Rutledge, [email protected]

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Here’s how technology has evolved over the past two decades

Mish Boyka

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<p> The humble fungus turned out to be quite a sage and agreed to share a few pieces of invaluable advice with the <em>Homo sapiens</em> species.</p><p>
In the summer, I went camping with my friends. On the first day after our arrival, I woke up early to take a walk and pick some chanterelles for breakfast. As bad luck would have it, however, I left my glasses in the tent, and without them, I struggle to tell mushrooms apart. Still, I resolved to carry on, and having collected a handful of becapped specimens I returned to our camp.
</p><p>
My friends, still fast asleep, did not take me up on my breakfast offer, so I ate my tofu and mushroom scramble alone. And seeing the effect it had on me, I quickly realized I had accidentally collected some mushrooms from the <em>Psilocybe</em> genus. This little mishap was a surprise, but I didn’t let it throw me off balance – I let the psilocybinous song carry me away. And now, I shall report on the places I visited and the things I saw. If I find the right words, that is.</p><p>The ground began to rumble, or maybe rather stir and writhe, as if there was a gargantuan snakelike creature breathing underneath its surface. A low murmur and chemiluminescent glow seeped from between patches of moss and foliage. Greenish tentacles glimmered in the murky ground, twisting and turning, and showed me the way towards the heart of the forest. I recognized those viridescent threads to be mycelium, made of the hyphae that are the basis of fungi’s organization system, whereas the glow seemed to be caused by luciferins – a protein capable of emitting light as the result of an enzymatic reaction. Once this mycological phenomenon dawned on me, I was no longer anxious and walked ahead.</p><p>As I was forcing my way through the thicket, in my mind I tried to systematize all the information about fungi I have learned. They are a kingdom that belongs to the group of eukaryotes, which encompasses all cellular organisms that pack their genetic material into chromosomes kept in their cells’ nuclei. This makes them quite similar to humans, which convinced me even more that I could trust the call that beckoned me forward, especially since those organisms boast ancient evolutionary history. The oldest fossils that have been identified as remnants of fungi are estimated to be around one billion years old, which indisputably proves the primaeval nature of the wisdom that summoned me.</p><p>With every step that brought me closer to the heart of the land, I could hear the commotion of heated dispute grow louder around me. Then I remembered a certain theory linking the consumption of hallucinogenic mushrooms by the ancestors of contemporary humans with the development of our consciousness. If not for the phenomenon of synaesthesia, the meaning of the conversations I heard would surely have been lost on me. After all, fungal communication happens noiselessly, with the aid of chemical substances that flow through the mycelium. Luckily, I could feel the vibrations of the ground and electromagnetic impulses, catching even the tiniest of signal molecules so that I understood everything that was being said.</p>

<p>I finally arrived at an arena shaped like an ascocarp, the fruiting body of the sac fungi. In the stalls sat tens of thousands of various species of fungi, with the elders occupying the seats at the top of the assembly hall, chaired by the Hatter who looked strikingly similar to the well-known and liked Jersey cow mushroom.</p><p>Silencing the crowd, he announced:</p><p>”Welcome, human, son of mycelium.”</p><p>”Greetings to you, my brothers,” I answered kindly, filled with a feeling of unity with all the organisms that surrounded me.</p><p>”Your current state is no accident. You have been chosen from all the <em>Homo sapiens</em> to help us solve the most pressing problems of the modern world. Are you ready to serve our cause?”</p><p>”If you’re talking about the same problems that gnaw at my mind every day, I will be happy to help,” I said to him, but felt that I had addressed each and every fungus individually, as they were an inseparable entity.</p><p>”We know your thoughts, but it might be more anthropomorphic-friendly to allow you to express your worries about the state of the world verbally. As a kingdom of sage species, we have decided to try and save our shared motherland. The only one we all have.”</p><p>”It would be very helpful if I did a quick recap of what we know about you. Please, don’t get me wrong. In my current state, nothing is certain, and such a historic exchange deserves to be fully comprehended by both sides.”</p><p>”We know what you mean. And we would very much like to know what you, humans, think of us exactly.”</p><p>”As far as I’m aware, you were classified as plants for a long time. Your ability to move is far from impressive, and you seem to be well-rooted in the soil. Even mycelium is deceptively similar to plant roots. What is it that makes you different from other kingdoms of the living world?”</p><p>”Actually, some of us can move at a rather speedy pace, and several characteristics differentiate us from plants. First, we have no tissue. Our bodies are made entirely of thickly weaved mycelium. Also, we are heterotrophs, meaning that we absorb nutrition from other organisms, namely decomposing organic matter. Of course, we help it decompose through releasing our digestive enzymes into the environment. This ability makes us the main cleaners of the natural world. We can also feed parasitically, hunt, and cooperate with autotrophic organisms.”</p><p>”But you are not only what you eat?”</p><p>”We are also different from other organisms on a biochemical level. We have our cell walls just like plants do, and they serve the same purpose – to protect the inside of the cell. Interestingly, however, the main ingredient of our walls is not cellulose, as it happens for plants, but chitin, a polysaccharide also found in the exoskeletons of various insects. It’s easy to tell us apart from animals because we use ergosterol instead of cholesterol to build our cellular membrane. But actually, on a genetic level, we are more closely related to animals than we are to plants.”</p><p>”And I imagine this genetic similarity must be the reason for the brotherly feeling that overwhelms me so. I have heard some rumours about the largest organism on our planet. They say it’s a fungus that weighs 440 tonnes! I must say, I find it quite hard to comprehend. If that were true, its cap would be visible from space.”</p><p>”You are taking it a little too far. Cap-and-stem fungi are called mushrooms. They are the fruiting bodies of a fungus. Its essence that is mycelium remains hidden underground and only grows above it to reproduce. It is the mycelium of our stumpy brother that you believe to be the largest living organism. Unfortunately, he could not make it to our meeting. He is a little listless due to his impressive age and bulk. Nobody can remember it very well, but he claims to be more than 2500 years old.”</p><p>”Please, do send him my regards. There is another question I must ask you, though. I have heard a lot about some pioneer species, capable of preparing a low-grade environment for being populated with more demanding species, including herbaceous plants. That makes it just one step away from a fully-developed ecosystem.”</p><p>”Thanks to the wide range of enzymes we produce, we can decompose next to everything! We are not intimidated by rocky areas and conflagration sites. Mycelium and spores can be found even by receding glaciers and in the desert. By processing unwelcoming environments, we create a layer of fertile ground on which life can thrive. It was thanks to us that the first plants could populate dry land. But enough about us. Now it’s time to discuss the problems you have caused for the Earth, and which we can solve. Ask ahead.”</p><p>”You have been around for a long time, so you must be familiar with the history of fossil fuels. We use them as our energy source. We do it by burning them, and while doing so, we release greenhouse gases into the atmosphere. Recently, this has become a burdensome issue for our civilization. What should we do?”</p><p>”Forests sponge up more than one-third of all CO2 emitted by the plunderous consumption culture of the current era, aptly named the Anthropocene. Plants absorb CO2 and transform it into biomass in the process of photosynthesis. And while we fungi do not photosynthesize, our role in the accumulation of CO2 could hardly be overstated. By establishing symbiotic relationships with plants, we increase the speed of their growth and improve their quality of life. When your scientists compare the efficiency of CO2 ‘cleaning’ in a forest with a low level of mycorrhiza – that is the coexistence of plants and fungi – and a forest with a high level of such interaction, it becomes clear that fungi-rich ecosystems manage this task much better. We must, however, bring another issue to your attention. CO2 is not the only by-product of your activity. Pollution caused by nitrogen compounds is also very impactful, and we aren’t very fond of them. Take care of us, and we will take care of you.”</p><p>”I shall do whatever I can to convince my people. And speaking of fossil fuels, another issue comes to mind. When we extract and transport petroleum, we sometimes cause spills that pollute the environment. Do you have any advice in this department?”</p><p>”It is but a simple matter. We have several families in our ranks who can digest the hydrocarbons that make up this black gore. Other living organisms can use the products of its decomposition. Not only do we purify contaminated soil, but we can also cooperate with plants that grow there, and help them survive. In the right conditions, petroleum waste could become incubators of earth.”</p><p>”It seems that some of our most pressing ecological issues could be tackled with fungal power. But we also have other problems at hand. Human life is becoming longer than ever, and as we age, our health begins to deteriorate. We suffer from all sorts of ailments, from cancers to metabolic diseases, such as diabetes. Could fungi heal us?”</p><p>”Oh, dear human, you surely know that many medicines are produced with the use of fungi. Baker’s yeast, which you have been using for years to make bread, wine and beer, is also used in micro-factories.”</p><p>”That is true. We discovered the genome <em>Saccharomyces cerevisiae</em>, which allowed us to understand many biological processes. The similarities between human and fungal cells are staggering. This species of yeast is a model organism, commonly used in scientific research. We can even use yeast to produce insulin, a hormone that is indispensable in treating diabetes, one of our civilization’s diseases.”</p><p>”I am proud of you humans. But remember that you have brought upon yourselves so many of those problems that you are so proud of fixing.”</p><p>”You’re right, and many of them remain unsolved.”</p><p>”I won’t tell you not to worry, but do not abandon hope. We fungi are very fond of Russian literature. One of us, the chaga mushroom that grows on birches, is the protagonist of Aleksandr Solzhenitsyn’s novel<em> Cancer Ward</em>. An infusion made of this arboreal growth has incredibly potent healing abilities: it regulates blood pressure, relieves stomach ulcers, and it can even stop the development of some neoplastic cells. It is also used to treat HIV-positive patients.”</p><p>”I have read this book, and I’d hardly consider the chaga its main character.”</p><p>”Do you want our help or not?”</p><p>”I’m sorry.”</p><p>”It doesn’t matter. Our time is almost up. I can feel the serotonin receptors in your body are almost depleted. In a few moments from now, we will no longer be able to communicate. But do take these leaflets with you, they contain some useful information and interesting facts. Whether you choose to use them and save our shared home or not, is your decision. Goodbye, human, and remember: we are always with you, inside you, and around you. Farewell!”</p><p>*</p>

<p>When I came to, I was lying in a beautiful forest clearing, a handful of leaflets in my fist. The mycelium’s hyphae, which seemed to have coiled around my body, were now receding back into the depths of the fungal world. The clearing looked like an endlessly pulsating mandala, in which the fate of our planet was written. It is up to us whether and how we read them. Fungi are a vast, diverse kingdom, and scientists will need many more years to explore them. They have the potential to solve a number of issues that haunt our civilization. Will we accept the helping stem that they are offering?</p><p>For a few more minutes, I daydreamed. I pondered the challenges that loom over humanity. The thoughtless destruction of our environment. Of the natural magic that seems to be the key to the door of perception and survival. Then I heard the voices of my friends and of the fungi that live within them calling me. They didn’t want to believe my story, but I very much hope that at least some of the fungal wisdom can seep through and into the thallus of <em>Homo sapiens</em>. After all, they gave me leaflets!</p><h3><em>LEAFLETS</em></h3><h3>Decontamination of flat surfaces</h3><p>Another nuclear reactor failure? Are the usual cleaning methods not good enough? Is your kitchen covered in radioactive ash? Or perhaps only cockroaches have survived, and you don’t know whom you should call for help? Try the slimy spike-cap!</p><p>This inconspicuous clammy mushroom is capable of absorbing huge amounts of the radioactive isotope caesium-137, thus immobilizing it. The mushrooms can then be picked and burned in a controlled environment, creating radioactive ash, which enables a much easier way of storing or further processing. The concentration of caesium-137 in the slimy spike-cap can be up to 10,000 times higher than in the environment around it. So put on your hazmat suit and go sporulate some mushrooms.</p><h3>Psylololo</h3><p>Psst! Looking for some mystical experiences? Fancy feeling at one with nature and the shamans that surround you? Or maybe you’re after vivid, colourful hallucinations? Come and join the <em>Psilocybe</em> circle, where colours have flavours, and all existential dread fades away!</p><p>Psilocybin, produced by our clever little brothers, has been known to humanity since the dawn of time. It is suspected to have contributed to the development of human consciousness and to have helped shape our spirituality, leading to the creation of religion. Today, it is used mostly for recreational purposes and in <a href=”https://przekroj.pl/en/society/leaving-your-ego-behind-tomasz-stawiszynski” target=”_blank”>therapy.</a> They say that once the door of perception is open and we see things as they really are, everything else will fall into place. We don’t promise that we can save the world, but it’s worth giving us a chance. Under specialist supervision, of course!</p>

<h3>Mushroom meat</h3><p>Are animal-borne diseases giving your civilization grief again? Has factory farming finally been recognized as animal violence? Perhaps you disagree with the concept of using animals as a source of protein in your diet, but you cannot imagine life without a tasty burger? The answer is already here: Quorn, the meat substitute made of <em>Fusarium venenatum</em>!</p><p>This spelling nightmare is, in fact, a delicious mushroom that grows in a sterile bioreactor, where it needs glucose and nitrogen to grow, and is later enriched with vitamins and mineral compounds. The final product is rich in proteins and fibre, has very little saturated fats, and has an exceptionally low track record of allergic reactions. On top of it, Quorn’s carbon footprint is 80% lower than beef’s. So far, the mushroom is known mainly in the West, but its popularity is growing fast – we can expect to see it on our plates sooner rather than later.</p><h3>Will work for food</h3><p>Reliable and hardworking fungus is looking for employment as polyethene waste utilizer. The issue of excessive amounts of plastic waste in the environment is prevalent, and humans are still looking for new ways to utilize them. My brother <em>Aspergillus terreus</em><em> </em>and I, <em>A. sydowii</em>, will happily take it upon ourselves to solve this pressing issue. Can work under challenging conditions with no special equipment required – we produce all of our enzymatic instruments ourselves, and they are perfect for softening and decomposing polymers. We would also like to use this opportunity to recommend the services of our good friend the oyster mushroom, who specializes in the production of environmentally-friendly biodegradable materials that could soon replace the outdated plastics. Feel free to get in touch.</p><h3>Yeast looking for eukaryote</h3><p>I am one of the best-known organisms on the planet, so how come we haven’t met yet? Tired of sexless germination, I am looking for the possibility of genetic recalibration to enrich my genome and establish a stable romantic relationship.</p><p>My full name is <em>Saccharomyces cerevisiae</em>, although I prefer to be called yeast. My career in the baking industry took off back in the times of the pharaohs. I’m still in touch with my friends and acquaintances in that part of the world, so if we get to know each other better, we can go for an exotic trip with a local guide. The baking business turned out to be very lucrative, but I didn’t see it as much of a challenge, which pushed me to keep expanding my horizons. Maintaining my signature freshly-baked bread scent, I tried my hand at alcohol fermentation. But don’t think me some shady moonshiner! I am a master of biochemical transformations, which I can prove with my vast portfolio of carbohydrates that I change into energy and ethanol. I’m comfortable with oxygen, but oxygen-free environments are also perfectly fine.</p><p>Being a fungus of success, I could never sit back for too long. I decided to try my hand at science next. I was hired as a model organism – not that I had to try very hard, considering my impressive skill set. A single-cell organism capable of growing in all kinds of conditions, a master of mitosis, who easily adapts to molecular modifications, has a lot in common – genetically at least – with more complex eukaryotes, including humans. In short, I am your perfect candidate. My academic interests include synthesizing medicines and hormones, ageing research, unveiling the secrets of cellular divisions and their accompanying DNA repairs, and intensification of mitochondrial mysteries. Lately I have become an avid fan of astrobiology, having visited the circumterrestrial orbit, and am planning a flight to the heliocentric orbit next. And while my genetic information isn’t exactly a scientific enigma, I still have a delicious secret or two to share. If you think you might be interested, swipe right. We’ll have a pastry, brew some wine, and if there’s a spark, we can try some conjugation.</p><p><em>Translated from <a href=”https://przekroj.pl/nauka/mysli-maslaka-tomasz-sitarz” target=”_blank” rel=”noopener noreferrer”>the Polish</a> by Aga Zano</em></p><p>Reprinted with permission of <a target=”_blank” href=”https://przekroj.pl/en/” rel=”noopener noreferrer”>Przekrój</a>. Read the <a href=”https://przekroj.pl/en/science/the-magic-of-mushrooms-tomasz-sitarz” target=”_blank”>original article.</a></p>

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