covid pandemic – Sociology Eso Science http://www.sociologyesoscience.com/ Thu, 17 Mar 2022 06:03:00 +0000 en-US hourly 1 https://wordpress.org/?v=5.9.3 https://www.sociologyesoscience.com/wp-content/uploads/2021/06/favicon-6-150x150.png covid pandemic – Sociology Eso Science http://www.sociologyesoscience.com/ 32 32 Action Needed to Stop US Child Poverty Rate From Rising Again, Experts Say | American News https://www.sociologyesoscience.com/action-needed-to-stop-us-child-poverty-rate-from-rising-again-experts-say-american-news/ Thu, 17 Mar 2022 06:03:00 +0000 https://www.sociologyesoscience.com/action-needed-to-stop-us-child-poverty-rate-from-rising-again-experts-say-american-news/ The child poverty rate in the United States has improved dramatically due to the expansion of the social safety net during the Covid-19 pandemic, but experts warn that the expiry of these measures could reverse these historical gains . As the pandemic has put pressure on the well-being of millions of children, new measures have […]]]>

The child poverty rate in the United States has improved dramatically due to the expansion of the social safety net during the Covid-19 pandemic, but experts warn that the expiry of these measures could reverse these historical gains .

As the pandemic has put pressure on the well-being of millions of children, new measures have dramatically improved children’s well-being. The child poverty rate has fallen from 14.2% in 2018 to less than 5.6% in 2021, and the extreme poverty rate has been reduced by almost half, according to projections.

“Child poverty in the United States is not inevitable. It’s a choice,” said Lisa Chamberlain, professor of pediatrics at Stanford School of Medicine and co-author of a perspective published Monday in the journal Jama Pediatrics. “It’s not a question of how to do this – it’s a question of political will.”

The Child Tax Credit, the main driver of these changes, has reduced child poverty by about 40%. Starting in July, it provided monthly checks to families. The vast majority of these funds paid for basic necessities, including food, clothing, housing, utilities and education.

Other extensions of the safety net in the pandemic include three stimulus checks, a moratorium on evictions, increased unemployment benefits and more funding for food, through the Supplemental Nutrition Assistance Program (Snap ) and housing.

“The expansion of all of these has really caused a historic decline in child poverty,” Chamberlain said.

Without this support, almost a third of children would live in poverty, according to research.

The benefits “have made a huge difference – not only preventing what could have been the worst-case scenario in terms of rising poverty, but actually leading to dramatically lower poverty rates than we’ve seen for decades. decades,” said policy director Megan Curran. at Columbia University’s Center on Poverty and Social Policy.

The child poverty rate in 2020 was the lowest since the US Census Bureau began measuring in the 1960s, and 2021 may have been even lower, she said. “So that’s huge.”

But the child tax credit expired in January, pushing around 3.7 million children into poverty – a 41% increase from December, according to the centre’s analysis.

“There was basically a cliff between December 2021 and January 2022,” Curran said. “Without the payments, families have certainly suffered over the past two months.”

Families are once again struggling to buy food, pay rent and keep lights on, especially as food and energy costs have risen. “It’s a double whammy they’re taking, which is the loss of payments and the increased prices of these essential commodities as well,” Curran said.

The Build Back Better bill would have extended the credit, but it stalled in the U.S. Senate after opposition from Democratic Sen. Joe Manchin, who cited the child tax credit as one of the reasons he canceled the bill.

There is a huge economic benefit to reducing child poverty, research shows. Poverty can lead to hunger, poor health, poor education and poorer job prospects.

“Not having enough food, not having stable places to live – all of that disrupts their ability to really engage with school,” Chamberlain said. “The ability to engage in the classroom, to engage in their educational process, is what ultimately leads them to their ultimate potential of being able to have a good job and contribute.”

Child poverty costs the United States between $800 billion and $1.1 billion each year due to lost adult productivity and rising health care and criminal justice costs, according to the report. National Academy of Sciences. According to the researchers, poverty reduction programs have strong moral and economic justifications.

“Child poverty actually costs us as a country an incredible amount of money every year,” Curran said. “Dramatically reducing child poverty not only helps children on a personal and family level, it also makes sense economically.”

Some opponents argued that the credit could discourage families from working, but research shows there was no noticeable effect on employment.

In fact, according to the researchers, the money could be used for childcare, allowing parents to work more – especially during the pandemic, when many informal caregivers, such as grandparents, have been lost. due to death and disability.

“The Covid disability numbers for this have been really, really tough – and we’ve seen huge numbers of women leaving the workforce,” Chamberlain said.

With the expiry of the child tax credit, this progress is now in jeopardy.

“I wouldn’t say it negates the gains,” Chamberlain said. “It eliminates our ability to continue to get those gains.”

During the months families received the credit, they had more food, stable housing, less stress — and greater developmental benefits for children.

“If they can keep expanding that, we can keep seeing that happen.”

The program’s immediate success is proof of concept, particularly because it’s unusual for a single policy to show such clear cut gains, Curran said.

“We’ve shown now that all of this – high poverty, rising poverty – is completely reversible,” she said. “We now know what works, and we’ve seen it work.”

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Pet overpopulation is part of the fallout from COVID-19; human society asks for help | News https://www.sociologyesoscience.com/pet-overpopulation-is-part-of-the-fallout-from-covid-19-human-society-asks-for-help-news/ Sun, 13 Mar 2022 00:53:00 +0000 https://www.sociologyesoscience.com/pet-overpopulation-is-part-of-the-fallout-from-covid-19-human-society-asks-for-help-news/ The COVID-19 pandemic has caused the local cat population to plummet, according to Gina Christopher of the Have a Heart Humane Society. Have a Heart was founded in 2010 by Christopher’s parents, Ted and Chelley Kitzmiller. When his mother died in 2016, Christopher stepped up, working with other longtime volunteers, including Ruthanne Jennings, to keep […]]]>

The COVID-19 pandemic has caused the local cat population to plummet, according to Gina Christopher of the Have a Heart Humane Society.

Have a Heart was founded in 2010 by Christopher’s parents, Ted and Chelley Kitzmiller. When his mother died in 2016, Christopher stepped up, working with other longtime volunteers, including Ruthanne Jennings, to keep the organization going.

Christopher and Jennings appealed for help at the March 7 meeting of the Tehachapi City Council.

Speaking during the public comment portion of the meeting, they asked the city to help fund two cat-only spaying and neutering clinics at a cost of $14,000. The clinics would be able to “fix” about 180 cats, Christopher said.

Mayor Phil Smith noted that council could not act as there were no agenda items, but he seemed understanding for the fate of the organization and asked City Manager Greg Garrett to comment. .

Garrett said the city doesn’t want to be in the animal control business and has in fact contracted with Kern County for services. But he added that he knew there were townspeople feeding cats and it was not a healthy situation. He mentioned that Kern County Supervisor Zach Scrivner, who represents the Second District, used funds from his discretionary budget to help with neutering and spaying clinics in Tehachapi. And he said he would discuss the matter with Police Chief Kent Kroeger to see if there was anything to be done.

“County has done an amazing job with Nick Cullen at the helm, but COVID has turned everything upside down,” Garrett said. “Let’s look at that, no promises,” he added.

The problem

Christopher described the issue to council members, noting that:

• Two local veterinary hospitals nearly closed (during the pandemic), increased their prices to nearly $200 to spay a female cat, and appointments are booked three months later.

• Cats come into heat and give birth within 60 days.

• If someone sees a feral cat in their neighborhood, they are unlikely to spend $200 (to the vet) or drive to Bakersfield for a more affordable solution.

• Kern County provides service through Critters Without Litters, but it requires two trips to Bakersfield, one to drop off the cat and one to pick it up the next day.

“With gas at $5 a gallon, that’s no longer an option for Tehachapi residents,” Christopher said.

“Have a Heart Humane Society works tirelessly to help address the overpopulation of cats and dogs in our community,” she said. “We spent $65,750 in 2021 alone to rent the SNIP bus for 10 clinics.” With around 60 to 70 pets “fixed” in each clinic, that amounted to a total of around 650 pets fixed in 2021, she said.

“At $100 per pet on average, it’s pricey, but it’s the only game in town,” Christopher added. “I shudder to think of how many pets would roam freely in Tehachapi if we hadn’t funded these clinics.”

Since 2018, the organization has spent $165,000 to host low-cost neutering and spaying clinics, she said. Most of the money comes from fundraising, including sales at the Rescued Treasures resale store (next to Domino’s at 1121 W. Valley Blvd.).

“We also adopted around 220 kittens and 185 dogs in 2021,” Christopher said. “I get five to eight calls and emails a day from local residents looking for low-cost neutering and spaying services and people looking to rehome kittens who have just ‘showed up’ on their property. I can’t handle this volume of cats and kittens.

Claudia Elliott is a freelance journalist and former editor of Tehachapi News. She lives in Tehachapi and can be contacted by email: claudia@claudiaelliott.net.

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Cardiac Marker Analyzer Market to Generate Massive Revenue in Coming Years: Roche, Beckman Coulter, Siemens Healthineers https://www.sociologyesoscience.com/cardiac-marker-analyzer-market-to-generate-massive-revenue-in-coming-years-roche-beckman-coulter-siemens-healthineers/ Fri, 04 Mar 2022 19:08:32 +0000 https://www.sociologyesoscience.com/cardiac-marker-analyzer-market-to-generate-massive-revenue-in-coming-years-roche-beckman-coulter-siemens-healthineers/ Cardiac Marker Analyzer Market: Intense Competition but Strong Growth and Extreme Valuation This press release was originally distributed by SBWire Edison, NJ – (SBWIRE) – 04/03/2022 – The global Cardiac Marker Analyzer market is expected to reach US$4.75 billion by 2027. Cardiac Marker Analyzer represents a diagnostic paradigm that provides a high sensitivity and reliable […]]]>

Cardiac Marker Analyzer Market: Intense Competition but Strong Growth and Extreme Valuation

This press release was originally distributed by SBWire

Edison, NJ – (SBWIRE) – 04/03/2022 – The global Cardiac Marker Analyzer market is expected to reach US$4.75 billion by 2027. Cardiac Marker Analyzer represents a diagnostic paradigm that provides a high sensitivity and reliable information in minutes. Cardiac biomarkers widely used as an integrated diagnostic approach for cardiovascular diseases include CK-MB, troponins I and T, myoglobin, BNP, IMA, and a few others. Preventing heart disease by monitoring heart conditions via cardiac biomarker testing is the profound approach to obtaining rapid results for immediate diagnosis and treatment.

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Cardiac biomarkers are used as risk stratification for various cardiovascular diseases (CVD), including myocardial infarction, congestive heart failure, acute coronary syndrome (ACS), among others. It is ideal for point-of-care testing and laboratory use. Factors such as the increasing incidence of cardiovascular disease, the rapid increase in the geriatric population, increasing funding from public-private organizations for cardiac biomarker research, and ongoing clinical trials for the identification of novel cardiac biomarkers drive market growth. However, factors such as technical issues with sample collection and storage and issues with regulatory and reimbursement systems are some of the major factors hindering the growth of this market.

The study includes analysis of market shares and profiles of players such as Alere (now Abbott), Abbott Point of Care, Quidel Corporation, Roche, Beckman Coulter, Siemens Healthineers, Response Biomedical, Boditech, Lifesign, LSI Medience Corporation , CardioGenics Holdings Inc., Trinity Biotech.
Impact of COVID-19 on the Global Cardiac Marker Analyzer Market

The COVID-19 outbreak has become a global stress test. As the number of people infected with the virus continues to rise around the world, uncertainties about global economic growth are growing. The COVID-19 disease has infected approximately 392 million people worldwide. Overall, the death toll has reached 5,745,435 according to the latest statistics from Worldometers (as of February 5, 2022). The number continues to grow and the duration of the pandemic is still difficult to predict. COVID-19 pandemic has limited the Cardiac Marker Analyzer Market growth, by social restrictions and other precautionary measures taken in response to the COVID-19 pandemic. However, as governments began to lift social restrictions, the negative revenue trend of these companies began to level off and stabilize before the third quarter of 2020. In the coming years, doctors are expected to witness a increasing influx of patients, hence driving the cardiac marker analyzer market.

The Cardiac Marker Analyzer covered in the report is as follows:

Triage MeterPro Analyzer, The i-STAT System, Cobas h 232 POC System, Access 2 Immunoassay System, Stratus CS Analyzer, RAMP 200, RAMP Reader, i-chroma DUO Analyzer, DXpress Reader Analyzer, PATHFAST Analyzer, QL Care Analyzer , Meritas POC Analyzer

Revenue and Sales Estimation – Historical revenue and sales volume are presented and other data is triangulated with top-down and bottom-up approaches to forecast the complete market size and to estimate forecast figures for key regions covered in the report as well as classified and well-recognized types and end-use industry.

SWOT Analysis on Cardiac Marker Analyzer Readers
In additional analysis of players market share, in-depth profiling, product/services and business overview, the study also focuses on BCG matrix, heatmap analysis, FPNV positioning as well as SWOT analysis to better correlate market competitiveness.

Demand from leading companies and government agencies is expected to increase as they seek more information on the latest scenario. See the Demand Determinants section for more information.

Regulatory analysis
– Local system and other regulations: regional variations in laws relating to the use of the Cardiac Marker Analyzer
– The regulations and their implications
– Other compliances

You have a question ? Ask Our Expert @: https://www.htfmarketreport.com/enquiry-before-buy/3936178-global-cardiac-marker-analyzer-market-20

FIVE FORCES AND PESTLE ANALYSIS:

In order to better understand the state of the market, an analysis of the five forces is carried out, including the bargaining power of buyers, the bargaining power of suppliers, the threat of new entrants, the threat of substitutes, the threat of rivalry.

– Policy (Political policy and stability as well as trade, fiscal and fiscal policies)
– Economic (Interest rate, employment or unemployment rate, cost of raw materials and exchange rate)
– Social (changing family demographics, education levels, cultural trends, shifts in attitudes and changes in lifestyles)
– Technological (Evolution of digital or mobile technology, automation, research and development)
– Legal (Labour legislation, consumer law, health and safety, international and commercial regulations and restrictions)
– Environmental (Climate, recycling procedures, carbon footprint, waste disposal and sustainability)

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Heatmap analysis, financial and detailed 3-year profiles of key and emerging players: Alere (now Abbott), Abbott Point of Care, Quidel Corporation, Roche, Beckman Coulter, Siemens Healthineers, Response Biomedical, Boditech, Lifesign, LSI Medience Corporation, CardioGenics Holdings Inc., Trinity Biotech

Geographically, the following regions as well as national/local markets listed are fully investigated:
– APAC (Japan, China, South Korea, Australia, India, and Rest of APAC; Rest of APAC is further segmented into Malaysia, Singapore, Indonesia, Thailand, New Zealand, Vietnam, and Sri Lanka)
– Europe (Germany, UK, France, Spain, Italy, Russia, Rest of Europe; Rest of Europe is further segmented into Belgium, Denmark, Austria, Norway, Sweden, Netherlands, Poland, Republic Czech, Slovakia, Hungary and Romania)
– North America (United States, Canada and Mexico)
– South America (Brazil, Chile, Argentina, Rest of South America)
– MEA (Saudi Arabia, United Arab Emirates, South Africa)

Some Excerpts from Global Cardiac Marker Analyzer Market Research Table of Contents

Global Cardiac Marker Analyzer Market Size Market Share (Sales) by Type (Product Category) in 2022
Cardiac Marker Analyzers Market by Application/End Users
Global Cardiac Marker Analyzer Sales and Growth Rate
Cardiac Marker Analyzer Competition by Players/Suppliers, Region, Type and Application
Cardiac Marker Analyzer table (volume, value, and sale price) defined for each geographical region defined.
Supply Chain, Sourcing Strategy and Downstream Buyers, Industry Chain Analysis
……..and see more in full table of contents

Check Full Report Details @ https://www.htfmarketreport.com/reports/3936178-global-cardiac-marker-analyzer-market-20

Thank you for reading this article; HTF MI also offers custom research services providing targeted, comprehensive and personalized research based on customer objectives. Thank you for reading this article; you can also get individual chapter wise section or region wise report like Balkan, China, North America, Europe or Southeast Asia.

Contact us :
Craig Francis (Public Relations and Marketing Manager)
HTF Market Intelligence Consulting Private Limited
Unit #429, Parsonage Road Edison, NJ
New Jersey United States – 08837
Telephone: +1 (206) 317 1218
[email protected]

For more information on this press release, visit: http://www.sbwire.com/press-releases/cardiac-marker-analyzer-market-will-generate-massive-revenue-in-coming-years-roche -beckman-coulter-siemens-healthineers-1354224.htm

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EXCLUSIVE World Bank seeks approval for $350m loan to Ukraine within days – sources https://www.sociologyesoscience.com/exclusive-world-bank-seeks-approval-for-350m-loan-to-ukraine-within-days-sources/ Tue, 01 Mar 2022 18:36:00 +0000 https://www.sociologyesoscience.com/exclusive-world-bank-seeks-approval-for-350m-loan-to-ukraine-within-days-sources/ A participant stands near a World Bank logo at the International Monetary Fund – World Bank Annual Meeting 2018 in Nusa Dua, Bali, Indonesia, October 12, 2018. REUTERS/Johannes P. Christo Join now for FREE unlimited access to Reuters.com Register WASHINGTON, March 1 (Reuters) – The World Bank is pushing for “fast track” approval of an […]]]>

A participant stands near a World Bank logo at the International Monetary Fund – World Bank Annual Meeting 2018 in Nusa Dua, Bali, Indonesia, October 12, 2018. REUTERS/Johannes P. Christo

Join now for FREE unlimited access to Reuters.com

WASHINGTON, March 1 (Reuters) – The World Bank is pushing for “fast track” approval of an additional $350 million loan for Ukraine within days to provide emergency funding for its efforts defense against Russian invasion, sources familiar with the plans said. .

The expansion of an existing loan would provide “fiscal support” to Ukraine, leaving no restrictions on how President Volodymyr Zelenskiy’s government can spend it, the sources told Reuters.

One of the sources said the loan could be ready for board consideration as soon as the end of this week, while another said next week was also possible, with disbursement coming within days. following approval.

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They said the plan had strong support within the World Bank’s 25-member board, despite objections from Russia’s executive director. The United States and its Western allies control an overwhelming majority of the development lender’s voting shares.

The decision to quickly transfer money to Ukraine has become more urgent at the World Bank since Russia invaded the country last week. World Bank President David Malpass told Zelenskiy in Munich on Feb. 19 that the organization was preparing a disbursement of $350 million by the end of March, followed by other funding plans. Read more

A World Bank spokesperson declined to provide details of the plan, but said: “We are currently preparing a fast-disbursing financing package for Ukraine, which we hope to present to our board for consideration. in the next few days”.

The sources described the disbursement as a “top-up” that would effectively double $350 million Development Policy Loan granted to Ukraine on 17 December to support reforms aimed at fostering greater competition in the economy, land reforms and access to credit for small farmers.

The plan would bring World Bank lending to Ukraine in the past year alone to over $1.5 billionincluding loans for COVID-19 response and vaccinations, power grid improvements and education.

It wouldn’t add anything to Ukraine’s political commitments, and by expanding an existing loan, the bank can move to board approval much faster than if it were to start a whole new loan process with new ones. program goals, the sources said. Part of the supplement funds may come from bilateral donor countries.

As Russia’s invasion force in Ukraine grows, one of the sources said the $350m disbursement could be withheld if Zelenskiy’s government is toppled before the handover is ready .

“If on the day of disbursement there is concern that the funds will be misused, they will not be disbursed,” one of the sources said. “Unless the bank is sure that the funds will return to the Ukrainian government, they will not be disbursed, until the very last moment.”

Since the start of the COVID-19 pandemic in early 2020, the World Bank has provided a total of $2.3 billion in loans for budget support, health responses, vaccinations and investment projects.

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Reporting by David Lawder; Editing by Leslie Adler

Our standards: The Thomson Reuters Trust Principles.

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CASTLE BIOSCIENCES INC Management report and analysis of the financial situation and operating results. (Form 10-K) https://www.sociologyesoscience.com/castle-biosciences-inc-management-report-and-analysis-of-the-financial-situation-and-operating-results-form-10-k/ Mon, 28 Feb 2022 23:39:10 +0000 https://www.sociologyesoscience.com/castle-biosciences-inc-management-report-and-analysis-of-the-financial-situation-and-operating-results-form-10-k/ You should read the following discussion and analysis of financial condition and results of operations together with our consolidated financial statements and related notes included elsewhere in this Annual Report on Form 10-K. This discussion and other parts of this Annual Report on Form 10-K contain forward-looking statements that involve risk and uncertainties, such as […]]]>
You should read the following discussion and analysis of financial condition and
results of operations together with our consolidated financial statements and
related notes included elsewhere in this Annual Report on Form 10-K. This
discussion and other parts of this Annual Report on Form 10-K contain
forward-looking statements that involve risk and uncertainties, such as
statements of our plans, objectives, expectations and intentions. Our actual
results, performance or achievements could differ materially from any future
results, performance or achievements discussed in these forward-looking
statements. Factors

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Contents

that could cause or contribute to such differences include, but are not limited to, those discussed in the section entitled “Risk Factors”.

Overview


Castle Biosciences is improving health through innovative tests that guide
patient care. For the diseases that our portfolio of tests cover, we believe the
traditional approach to developing a treatment plan for cancers and other
diseases using clinical and pathology factors alone is inadequate and can be
improved by incorporating the personalized information our diagnostic and
prognostic tests provide.

We currently market five proprietary MAAAs, designed to answer clinical
questions in dermatologic cancers, UM and BE. Our revenue is primarily generated
by our DecisionDx®-Melanoma risk stratification test for cutaneous melanoma and
our DecisionDx®-UM risk stratification test for UM.

The foundation of our business is our dermatologic cancer franchise, and our
lead product is DecisionDx-Melanoma, a proprietary risk stratification GEP test
that predicts the risk of metastasis, or recurrence for patients diagnosed with
invasive cutaneous melanoma, a deadly skin cancer. In the management of
melanoma, as with nearly all diseases, treatment plans are directed by patient
risk-stratification. This test has two distinct, complementary clinically
actionable uses. The first revolves around predicting the likelihood of having a
SLN negative biopsy result so that physicians and patients can discuss the risk
and benefit of undergoing the SLNB surgical procedure. The second use is to
inform the appropriate treatment plan during the initial five years
post-diagnosis, regardless of the decision to undergo or avoid invasive SLNB
surgery. In a typical year, we estimate approximately 130,000 patients are
diagnosed with invasive cutaneous melanoma in the United States. We launched
DecisionDx-Melanoma in May 2013. Based on the substantial clinical evidence that
we have developed, we have received Medicare coverage for DecisionDx-Melanoma,
which represents approximately 50% of the addressable patient population for
this test.

On August 31, 2020, we commercially launched our SCC proprietary GEP test,
DecisionDx®­SCC, for use in patients with one or more risk factors (also
referred to as "high-risk" SCC). On November 2, 2020, we commercially launched
our proprietary GEP test for difficult-to-diagnose melanocytic lesions,
DecisionDx® DiffDx™-Melanoma for use in patients with a melanocytic lesion and
uncertainty related to the malignancy of the lesion. We believe that these two
additional skin cancer tests address areas of high clinical need in
dermatological cancer and, together, represent an estimated addressable
population of approximately 500,000 patients in the United States.

We further expanded our commercially available dermatologic portfolio in May
2021 when we acquired the myPath Laboratory from Myriad Genetics, Inc. for a
cash purchase price of $32.5 million. myPath Melanoma is a clinically validated
GEP test that addresses the same unmet clinical need as our DecisionDx
DiffDx-Melanoma test. Today, we offer both our myPath Melanoma test and our
DecisionDx DiffDx-Melanoma test under an offering that we refer to as our CDO of
molecular testing solutions. By offering both of these tests in a single
offering, we believe we have demonstrated the ability to improve the test result
performance for patients with difficult-to-diagnose melanocytic lesions.

In 2021, we announced the launch of our innovative pipeline initiative to
develop a genomic test aimed at predicting response to systemic therapy in
patients with moderate to severe psoriasis, atopic dermatitis and related
inflammatory skin conditions. In the U.S. alone, there are approximately 18
million patients diagnosed with psoriasis and atopic dermatitis. Approximately
450,000 of these patients annually are eligible for systemic therapies. If
successful, this inflammatory skin disease pipeline test has the potential to
add approximately $1.9 billion to our current estimated U.S. TAM. In 2021, we
initiated a 4,800 patient, prospective, multi-center clinical study to develop
and validate this pipeline test and have 50 committed centers, out of the
initial target of 50. Based upon our current development and validation
timelines, we expect to commercialize this pipeline test by the end of 2025.

In addition to our dermatologic franchise, we also market a test for patients
diagnosed with UM, a rare cancer of the eye. DecisionDx®-UM is a proprietary,
risk stratification GEP test that predicts the risk of metastasis for patients
with UM. We believe DecisionDx-UM is the standard of care in the management of
newly diagnosed UM in the majority of ocular oncology practices in the United
States. We launched DecisionDx-UM in January 2010. Based on the substantial
clinical evidence that we have developed, we received Medicare coverage for
DecisionDx-UM, which represents approximately 50% of the addressable patient
population.

In December 2021, we extended our commercial portfolio of proprietary tests into
the gastroenterology market through our acquisition of Cernostics and the
TissueCypher® platform. The TissueCypher platform focuses on unlocking, in the
case of the initial test for use in patients with BE, the importance of the
location of the expression of proteins or lack thereof within the morphology of
the disease (also known as spatialomics). This "spatialomic" information is then
interpreted using artificial intelligence approaches to predict the likelihood
of progression to high-grade dysplasia and/or esophageal cancer in patients with
non-dysplastic, indefinite or low-grade dysplasia BE. We believe the addition of
expertise in the spatialomics area

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positions us for continued growth and success in diagnostics, complementing our first-to-market dermatology franchise and our proprietary test for MU.


The number of test reports we generate is a key indicator that we use to assess
our business. A test report is generated when we receive a sample in our
laboratory, and then the relevant test information is entered into our
Laboratory Information Management System, the expression of the biomarkers is
measured, then a proprietary algorithmic analysis of the combined biomarkers is
performed to generate a report providing the results of that analysis, which is
sent to the clinician who ordered the test. The numbers of GEP test reports
delivered by us during the years ended December 31, 2021 and 2020 are presented
in the table below:

                                                                 

Proprietary dermatological GEP tests

                                DecisionDx-
                                  Melanoma                 DecisionDx-SCC(1)                 CDO(2)                Dermatologic Total            DecisionDx-UM              Grand Total
Q1 2021                             4,060                           527                          218                      4,805                         337                     5,142
Q2 2021                             5,128                           784                          627                      6,539                         468                     7,007
Q3 2021                             5,505                           934                          913                      7,352                         375                     7,727
Q4 2021                             5,635                         1,265                          904                      7,804                         438                     8,242
For the year ended December
31, 2021                           20,328                         3,510                        2,662                     26,500                       1,618                    28,118

Q1 2020                             4,574                             -                            -                      4,574                         361                     4,935
Q2 2020                             3,008                             -                            -                      3,008                         306                     3,314
Q3 2020                             4,404                            57                            -                      4,461                         318                     4,779
Q4 2020                             4,246                           428                           73                      4,747                         410                     5,157
For the year ended December
31, 2020                           16,232                           485                           73                     16,790                      
1,395                    18,185



(1) We commercially launched DecisionDx-SCC on August 31, 2020.

(2)Includes DecisionDx DiffDx-Melanoma, which we marketed on
November 2, 2020and myPath Melanoma, which we began offering following our acquisition of Myriad myPath Laboratory on May 28, 2021. We offer both myPath Melanoma and DecisionDx DiffDx-Melanoma as part of our CDO.


For the year ended December 31, 2021, our dermatologic test report volume
increased by 57.8%, reflecting growth in DecisionDx-Melanoma as well as the full
year availability of DecisionDx-SCC and DecisionDx DiffDx-Melanoma (now offered
as part of CDO). For a discussion of how we recognize revenue derived from our
GEP tests, refer to "Net Revenues" under "Components of Results of Operations"
below.

The principal focus of our current commercial efforts is to educate clinicians
and pathologists on the value of our molecular diagnostic testing products
through our direct sales force in the U.S. In dermatology, we began 2020 with 32
outside sales territories. In the third quarter of 2020, we expanded our
dermatologic commercial team to create a dedicated sales force of ten
territories to support the launch of our DecisionDx Diff-Dx Melanoma test to
dermatopathologists. During the first half of 2021, we folded this dedicated
team into our existing sales team and completed a further expansion, bringing
our dermatologic sales force to the mid-60s. In connection with our acquisition
of Cernostics in December 2021, we hired an initial commercial team of
approximately 14 outside sales territories, along with commensurate internal
sales associates and medical science liaisons, to support our launch of the
TissueCypher Barrett's Esophagus Assay. This dedicated team focuses on
gastroenterology specialists that diagnose and manage patients with BE. However,
we will continue to evaluate our mix of outside sales territories, inside sales
support, marketing and medical affairs in the context of our dermatologic tests
and gastroenterology tests and adjust our investments based upon these
evaluations.

We continue to see new clinicians order our dermatologic tests for the first
time. For the year ended December 31, 2021, we saw approximately 1,938 new
ordering clinicians for our dermatologic tests compared to 1,396 during the same
period of 2020. Total ordering clinicians for our dermatologic tests were
approximately 5,900 for the year ended December 31, 2021.

For more information about the metrics we disclose, see “Information About Certain Metrics” below.


In developing our DecisionDx-SCC and DecisionDx DiffDx-Melanoma tests, we
believed that in addition to addressing significant unmet clinical needs, we
would see strategic opportunities for leverage, as many of the clinicians
currently ordering DecisionDx-Melanoma would likely be the same clinicians who
would find value in these other skin cancer tests. For example,

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we found that for the year ended December 31, 2021, approximately 78% of all
clinicians ordering DecisionDx-SCC had also ordered our DecisionDx-Melanoma test
during that same period.

We bill third-party payors and patients for the tests we perform. The majority
of our revenue collections is paid by third-party insurers, including Medicare.
We have received LCDs, which provide coverage for our DecisionDx-Melanoma,
myPath Melanoma and DecisionDx-UM tests that meet certain criteria for Medicare
and Medicare Advantage beneficiaries, representing approximately 60 million
covered lives. In 2022, DecisionDx-UM has received coverage from United
Healthcare that will represent approximately 43 million covered lives. A
''covered life'' means a subscriber, or a dependent of a subscriber, who is
insured under an insurance carrier's policy.

Palmetto, the MAC responsible for administering MolDX, the program that assesses
molecular diagnostic technologies, issued a final expanded LCD for
DecisionDx-Melanoma, effective November 22, 2020. With this expanded LCD and the
accompanying billing and coding articles, we estimate that a significant
majority of the DecisionDx-Melanoma tests performed for Medicare patients will
meet the coverage criteria. Noridian, the MAC responsible for administering
claims for laboratory services performed in Arizona, has adopted the same
coverage policy as Palmetto and also issued an expanded final LCD for
DecisionDx-Melanoma, effective December 6, 2020.

Separately, Palmetto issued a final LCD for DecisionDx-UM, which became
effective in July 2017, and Noridian issued a similar LCD that became effective
in September 2017. The Noridian LCD provides for coverage to determine
metastatic risk in connection with the management of a patient's newly diagnosed
uveal melanoma and to guide surveillance and referral to medical oncology for
those patients. Similar to cutaneous melanoma, the median age at diagnosis for
uveal melanoma is estimated at 58-62 years old, therefore the Medicare eligible
population represents close to 45% of the addressable market.

On May 17, 2019, CMS determined that DecisionDx-UM meets the criteria for
"existing advanced diagnostic laboratory test" status, also referred to as
"existing ADLT" status. For 2020, our rate was set by Noridian, our local MAC,
but effective in 2021 our rate is set annually based upon the median private
payor rate for the first half of the second preceding calendar year. Our rate
for 2021 was $7,776 and will remain at $7,776 for 2022, in each case based on
the calculation of the median private payor rate.

Also, on May 17, 2019, CMS determined that DecisionDx-Melanoma meets the
criteria for "new ADLT" status. Accordingly, from July 1, 2019 through March 31,
2020, the Medicare reimbursement rate was equal to the initial list price of
$7,193. From April 1, 2020 through December 31, 2021, the rate was also $7,193,
which was calculated based upon the median private payor rate for
DecisionDx-Melanoma from July 1, 2019 to November 30, 2019. CMS has informed us
that the rate for 2022 will continue to be $7,193, based on the median private
payor rate.

myPath Melanoma is currently covered under a MolDX LCD policy through Noridian
that oversees laboratories in both Utah and Arizona. Noridian issued an LCD that
became effective in June 2019. On September 6, 2019, myPath Melanoma was
approved as a new ADLT. The rate for 2022 will be $1,950.

TissueCypher is performed in our Pittsburgh, Pennsylvania laboratory and falls
under the Medicare jurisdiction that is managed by Novitas. Novitas previously
reviewed TissueCypher and we are receiving payments for claims according to the
CLFS. For 2022, CMS published in its CLFS a payment amount of $2,513 for the
test.

Beginning in 2023, the rates for DecisionDx-Melanoma, DecisionDx-UM, and myPath
Melanoma tests will be set annually based upon the median private payor rate for
the first half of the second preceding calendar year. For example, the rate for
2023 will be set using median private payor rate data from January 1, 2021 to
June 30, 2021.

In the second quarter of 2020, we submitted our technical assessment dossier for
DecisionDx-SCC to Palmetto and Noridian. The dossier was accepted as complete in
the third quarter of 2020. In early 2021, we submitted our technical assessment
dossier for DecisionDx DiffDx-Melanoma. The dossier was accepted as complete in
the first quarter of 2021. We expect that draft LCDs for DecisionDx-SCC and
DecisionDx DiffDx-Melanoma could potentially be posted by the end of the second
quarter of 2022 resulting in potentially final LCDs effective in 2023. However,
there is no assurance that the timing of any draft or final LCD will match our
expectations or our historical experience with LCDs for our other tests.

In the second quarter of 2021, Palmetto and the other MACs that participate in
the MolDX program posted a revised draft LCD for DecisionDx-Melanoma. The draft
LCD includes commentary about two publications regarding the clinical utility of
GEP tests and was posted to give providers an opportunity to comment. Each of
the draft LCDs include an assessment stating that the MAC does not believe that
the new data is sufficient to change the coverage criteria. We have submitted
comments on the draft LCD. The comment period on the last of these draft LCDs
closed on August 8, 2021. We are unable to predict when the final draft LCD will
be posted.

Since becoming a public company, we have financed our operations with the
revenue generated from the sale of our products, proceeds from our July 2019
IPO, follow-on public offerings of common stock in June 2020 and December 2020
and bank debt, which has since been repaid in full. We believe that our existing
cash and cash equivalents and anticipated cash generated

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from sales of our products will be sufficient to fund our operations for the
next 12 months and into the foreseeable future. However, we have based these
estimates on assumptions, including those related to the impact of COVID-19 on
our financial condition, that may prove to be wrong, and could result in us
depleting our capital resources sooner than expected.

Our net (loss) income may fluctuate significantly from period to period,
depending on the timing of our planned development activities, the growth of our
sales and marketing activities and the timing of revenue recognition under ASC
606. We expect our expenses will increase substantially over time as we:

•conducting clinical studies to generate evidence in support of our current and future product candidates;

•execute our marketing strategy for our current and future commercial products;

•pursue our ongoing and planned development of new products in our pipeline;

•seek to discover and develop additional product candidates;

•hire additional scientific and research and development personnel; and

• add additional operational, financial and management information systems and personnel.


Furthermore, we expect to continue to incur additional costs associated with
operating as a public company, including significant legal, accounting, investor
relations and other expenses.

Impact of the COVID-19 pandemic


We are continuing to closely monitor the impact of the COVID-19 pandemic on our
business and taking proactive efforts designed to protect the health and safety
of our workforce, continue our business operations and advance our corporate
objectives. We are providing the following update with respect to the impact of
COVID-19 on our business:

•We have maintained, and expect to continue to maintain, uninterrupted business
operations with adequate access to reagents and consumables needed for testing
patient samples and normal turnaround times for our delivery of test reports. We
have continued to maintain our previously implemented adjustments to our
operations designed to keep employees safe and comply with federal, state and
local guidelines, including those regarding social distancing.

•Following the onset of the COVID-19 pandemic, we experienced declines in orders
and test report volume. For example, in the second quarter of 2020, test reports
delivered for our lead product, DecisionDx-Melanoma, decreased 18.5% compared to
the second quarter of 2019. For the year ended December 31, 2020, our growth in
DecisionDx-Melanoma test report volume was 4.5%, compared to year-over-year
growth of 29.1% for the year ended December 31, 2019. Our analysis of
third-party data indicates that cutaneous melanoma diagnoses for the year ended
December 31, 2020 were down approximately 20% compared to the year ended
December 31, 2019. In the first quarter of 2021, test reports delivered for
DecisionDx-Melanoma decreased by 11.2% compared to the first quarter of 2020. We
believe these decreases in our test report volume were linked to delays and/or
cancellations in patient visits, resulting in fewer diagnostic biopsies and thus
a reduction in the number of diagnoses of cutaneous melanoma in response, as
well as the cumulative impact on promotional responsiveness as a result of
reduced sales calls per day and in-person sales call during the COVID-19
pandemic.

•We saw positive trends in orders and test report volumes in the second, third,
and fourth quarters of 2021. In the second, third and fourth quarters of 2021,
test reports delivered for DecisionDx-Melanoma increased by 70.5%, 25.0% and
32.7%, respectively, compared to the same quarters in 2020.

•Our commercial team uses a combination of in-person, virtual, and non-personal
promotional and educational efforts. Since the beginning of 2021, we have seen
improvements in the number of promotional calls per day, as well as a continued
shift from virtual to in-person sales calls. During the three-months ended
December 31, 2021, in-person sales calls accounting for over 90% of all calls
during such period. However, we have not yet achieved pre-COVID-19 levels of
calls per day per sales representative.

•Our future results will be dependent upon the extent and duration of the
COVID-19 crisis, including the emergence and spread of variants of the virus,
such as the Omicron variant, and government restrictions, which are beyond our
control. Although state and local government restrictions put in place to slow
the spread of the virus have been eased in certain locations, restrictions may
be reinstated from time to time in various regions depending on the
circumstances, potentially impacting the flow of future patient visits as well
as access to our sales targets. Even with the easing of state and local
restrictions and the availability of vaccinations, patient visits and diagnoses
of cutaneous melanoma may be impacted by continued apprehension regarding
possible exposure to the virus. For example, our

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analysis of third-party data indicates that cutaneous melanoma diagnoses during
the year ended December 31, 2021 remain approximately 11% below the pre-COVID,
2019 levels.

•We continue to believe our cash, cash equivalents and anticipated cash to be
generated from sales of our products, will be sufficient to fund our operations
for the next 12 months and into the foreseeable future.

As conditions are continuously evolving, we are unable to predict how our future
test report volume will be impacted, or the extent to which our results of
operations, financial condition or cash flows will be impacted, by the COVID-19
pandemic, or other future public health crises. Accordingly, the test report
data presented above is not necessarily indicative of our results of operations
that can be expected for future periods. For more information on the potential
impact of the COVID-19 pandemic on our business, see the risk factors included
under "Risks Related to Our Business" and the other risk factors included in
Part I, Item 1A., "Risk Factors," of this Annual Report on Form 10-K.

Factors affecting our performance

We believe that several important factors have had and which we believe will continue to have an impact on our operating performance and results of operations, including:


•Report volume. We believe that the number of reports we deliver to physicians
is an important indicator of the growth of adoption among the healthcare
provider community. Our revenue and costs are affected by the volume of testing
and mix of customers. Our performance depends on our ability to retain and
broaden adoption with existing prescribing physicians, as well as attract new
physicians. In the near term, our report volume may be negatively impacted by
ongoing developments of the COVID-19 pandemic as discussed above.

•Reimbursement. We believe that expanding reimbursement is an important
indicator of the value of our products. Payors require extensive evidence of
clinical utility, clinical validity, patient outcomes and health economic
benefits in order to provide reimbursement for diagnostic products. Our revenue
depends on our ability to demonstrate the value of our products to these payors.

•Gross margin. We believe that our gross margin is an important indicator of the
operating performance of our business. Higher gross margins reflect the average
selling price of our tests, as well as the operating efficiency of our
laboratory operations.

•New product development. A significant aspect of our business is our investment
in research and development activities, including activities related to the
development of new products. In addition to the development of new product
candidates, we believe these studies are critical to gaining physician adoption
of new products and driving favorable coverage decisions by payors for such
products.

Information about some metrics

The following provides additional information about certain measures we have disclosed in this MD&A and Analysis of Financial Condition and Results of Operations.


Test reports delivered for DecisionDx-Melanoma, DecisionDx-SCC, myPath
Melanoma/DecisionDx DiffDx-Melanoma, DecisionDx-UM and TissueCypher Barret's
Esophagus Assay represents the number of completed test reports delivered by us
during the reporting period indicated. The period in which a test report is
delivered does not necessarily correspond with the period the related revenue,
if any, is recognized, due to the timing and amount of adjustments for variable
consideration under ASC 606. We use this metric to evaluate the growth in
adoption of our tests and to measure against our internal performance
objectives. We believe this metric is useful to investors in evaluating the
volume of our business activity from period-to-period that may not be
discernible from our reported revenues under ASC 606. We also sometimes present,
on a limited basis, data on the number of orders received. We believe order data
can provide additional insight on current demand trends, particularly during the
COVID-19 pandemic and with respect to new product launches, when considered in
conjunction with test report volume. However, orders received in a particular
period do not necessarily correspond with actual delivered test reports or
reported revenues for the same period or subsequent periods.

New ordering clinicians for our dermatologic tests represents the number of
clinicians who ordered a dermatologic test from us for the first time during the
reporting period specified. Our dermatologic tests consist of
DecisionDx-Melanoma, DecisionDx-SCC and our CDO. We believe this metric is
useful in evaluating the effectiveness of our sales and marketing efforts in
establishing new relationships with clinicians and increasing the adoption of
our suite of dermatologic tests. We also believe this metric provides useful
information to investors in assessing our ability to expand the use of our
dermatologic tests. Since this metric is based upon the reporting period in
which an order is placed, it does not necessarily correspond to the reporting
period in which a test report was delivered or revenue was recognized.

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Components of operating results

Net income


We generate revenues from the sale of our products. Currently, our revenues are
primarily derived from the sale of DecisionDx-Melanoma and DecisionDx-UM. We
bill third-party payors and patients for the tests we perform.

Under ASC 606, we recognize revenue at the amount we expect to be entitled,
subject to a constraint for variable consideration, in the period in which our
tests are delivered to the treating physicians. We have determined that our
contracts contain variable consideration under ASC 606 because the amounts paid
by third-party payors may be paid at less than our standard rates or not paid at
all, with such differences considered implicit price concessions. Variable
consideration is recognized only to the extent it is probable that a significant
reversal of revenue will not occur in future periods when the uncertainties are
resolved. Variable consideration is evaluated each reporting period and
adjustments are recorded as increases or decreases in revenues. Variable
consideration for Medicare claims that are not covered by an LCD, including
those claims subject to approval by an ALJ at an appeal hearing, is deemed to be
fully constrained due to factors outside our influence (i.e., judgment or
actions of third parties) and the uncertainty of the amount to be received is
not expected to be resolved for a long period of time. For these fully
constrained claims, we generally recognize revenue in the period the uncertainty
is favorably resolved, if at all. Due to potential future changes in Medicare
coverage policies and appeal cycles, insurance coverage policies, contractual
rates and other trends in the reimbursement of our tests, our revenues may
fluctuate significantly from period-to-period. Additionally, our ability to
recognize revenue for our recently launched tests, DecisionDx-SCC and DecisionDx
DiffDx-Melanoma, is dependent on the development of reimbursement experience and
coverage decisions for these tests. Due to limited reimbursement experience, we
are currently recognizing revenues for these two tests on the basis of actual
cash collections.

Our ability to increase our revenues will depend on our ability to further
penetrate our target markets, and, in particular, generate sales through our
direct sales force, develop and commercialize additional tests, obtain
reimbursement from additional third-party payors and increase our reimbursement
rate for tests performed.

Cost of sales (excluding amortization of acquired intangible assets)


The components of our cost of sales are material and service costs associated
with testing samples, personnel costs (including salaries, bonuses, benefits and
stock-based compensation expense), electronic medical record set up costs, order
and delivery systems, shipping charges to transport samples, third-party test
fees, and allocated overhead including rent, information technology costs,
equipment and facilities depreciation and utilities. Costs associated with
testing samples are recorded when the test is processed, regardless of whether
and when revenues are recognized with respect to that test. As a result, our
cost of sales as a percentage of revenues may vary significantly from
period-to-period because we do not recognize all revenues in the period in which
the associated costs are incurred. We expect cost of sales in absolute dollars
to increase as the number of tests we perform increases. Additionally, we expect
cost of sales to increase with the expansion of laboratory capacity and staffing
in advance of the anticipated growth of our recently launched tests.

Gross margin and gross margin percentage are key indicators we use to assess our
business. See the table in "Results of Operations-Comparison of the years ended
December 31, 2021 and 2020" for details.

Research and development


Research and development expenses include costs incurred to develop our genomic
tests, collect clinical samples and conduct clinical studies to develop and
support our products. These costs consist of personnel costs (including
salaries, bonuses, benefits and stock-based compensation expense), prototype
materials, laboratory supplies, consulting costs, regulatory costs, electronic
medical records set up costs, costs associated with setting up and conducting
clinical studies and allocated overhead, including rent, information technology,
equipment depreciation and utilities. We expense all research and development
costs in the periods in which they are incurred. We expect our research and
development expenses to increase in absolute dollars as we continue to invest in
research and development activities related to developing enhanced and new
products.

We expect to use a portion of our cash and cash equivalents to further support
and accelerate our research and development activities, including three
important studies that are underway to support our DecisionDx-Melanoma test. The
first is the PERSONALize study, in which we are evaluating DecisionDx-Melanoma
for interactions with adjuvant therapies. The second is the CONNECTION study,
which is collecting long-term outcomes for up to 10,000 patients who have been
tested with DecisionDx-Melanoma. The third is the DECIDE study, which is
designed to determine the association of GEP test results with SLNB surgical
decisions in patients eligible for SLNB as well as to track outcomes for
patients who did and did not undergo SLNB. Also, as noted above, we recently
initiated a 4,800 patient, prospective, multi-center clinical study to develop,
validate and bring to market a pipeline test aimed at predicting response to
systemic therapy in patients with moderate to severe psoriasis, atopic
dermatitis and related inflammatory skin conditions. We have also initiated two
additional disease studies for pipeline tests for new indications.

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Selling, general and administrative expenses


Selling, general and administrative ("SG&A") expenses include executive, selling
and marketing, legal, finance and accounting, human resources, billing and
client services. These expenses consist of personnel costs (including salaries,
bonuses, benefits and stock-based compensation expense), direct marketing
expenses, audit and legal expenses, consulting costs, training and medical
education activities, payor outreach programs and allocated overhead, including
rent, information technology, equipment depreciation, and utilities. We expect
continued increases in SG&A expenses related to compliance with the rules and
regulations of the SEC and Nasdaq (in particular as we no longer qualify as an
emerging growth company and a smaller reporting company, and have become a large
accelerated filer), investor relations activities and additional insurance
expenses. Other administrative and professional services expenses within SG&A
are expected to increase with the scale of our business, but selling and
marketing-related expenses are expected to increase significantly, consistent
with our growth strategy.

Amortization of acquired intangible assets

The amortization of acquired intangible assets is mainly associated with the technology developed.

Other exploitation products

Other operating revenue consists of automatic payment received from HHS for provider relief funds pursuant to the CARES Act.

interest income

Interest income consists primarily of income on cash and cash equivalents, primarily money market funds.

Interest charges

Interest expense is primarily attributable to borrowings under our term debt, which was fully repaid in December 2020and also includes the related amortization of debt discounting and issuance costs.

Loss on extinguishment of debt

The loss on extinguishment of debt relates to the prepayment of our term loan facility in December 2020.

Income tax expense (benefits)


In connection with our acquisition of Cernostics in December 2021, and taking
into consideration the additional deferred tax liabilities resulting from such
acquisition, we determined that a portion of our valuation allowance should be
reduced, which was reflected in our income tax benefit for the year ended
December 31, 2021. Our consolidated financial statements do not reflect any
federal or state income tax benefits attributable to the net losses we have
incurred, due to the uncertainty of realizing a benefit from those items. As of
December 31, 2021, we had federal NOL carryforwards of $99.4 million, of which
$43.5 million will begin to expire in 2030 if not utilized to offset federal
taxable income, and $55.9 million may be carried forward indefinitely. Also, as
of December 31, 2021, we had state NOL carryforwards of $67.5 million, which
begin to expire in 2028 if not utilized to offset state taxable income.

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Operating results


Certain prior year amounts in the tables below have been reclassified to conform
to the current year presentation. Specifically, we no longer present gross
margin on the face of our financial statements and therefore the cost of sales
line is now presented within the operating expenses section. This
reclassification had no impact on operating loss, loss before income taxes or
net loss.

Comparison of the years ended December 31, 2021 and 2020

The following table summarizes our results of operations for the periods indicated (in thousands, except percentages):

                                                          Years Ended December 31,
                                                          2021                    2020                         Change
Net revenues                                      $      94,085               $  62,649          $  31,436                  50.2  %
Operating expenses and other operating income:
Cost of sales (exclusive of amortization of
acquired intangible assets)                              15,822                   9,685              6,137                  63.4  %
Research and development                                 29,646                  13,256             16,390                 123.6  %
Selling, general and administrative                      86,738                  48,132             38,606                  80.2  %
Amortization of acquired intangible assets                1,958                       -              1,958                    NA(1)
Other operating income                                        -                  (1,882)             1,882                 100.0  %
Total operating expenses, net                           134,164                  69,191             64,973                  93.9  %
Operating loss                                          (40,079)                 (6,542)           (33,537)               (512.6) %
Interest income                                              68                     373               (305)                (81.8) %
Interest expense                                             (1)                 (2,634)             2,633                 100.0  %
Loss on extinguishment of debt                                -                  (1,397)             1,397                 100.0  %

Loss before income taxes                                (40,012)                (10,200)           (29,812)               (292.3) %
Income tax (benefit) expense                             (8,720)                     84             (8,804)                   NM(2)
Net loss                                          $     (31,292)              $ (10,284)         $ (21,008)               (204.3) %




(1) NA = Not applicable
(2) NM = Not meaningful

The following table shows the amount of stock-based compensation expense reflected in the above line items (in thousands):


                                                               Years Ended 

the 31st of December,

                                                              2021                   2020               Change

Cost of sales (excluding amortization of acquired intangible assets)

                                      $        2,058          $     1,049          $    1,009
Research and development                                         4,522                1,492               3,030
Selling, general and administrative                             15,160                5,768               9,392
Total stock-based compensation expense                  $       21,740      

$8,309 $13,431




The following table provides a disaggregation of net revenues by type (in
thousands):

                           Years Ended December 31,
                              2021                 2020         Change
Dermatologic(1)      $      85,753              $ 57,646      $ 28,107
Other(2)                     8,332                 5,003         3,329
Total net revenues   $      94,085              $ 62,649      $ 31,436



(1) Dermatologic includes DecisionDx-Melanoma, DecisionDx-SCC and CDO. (2)Other mainly consists of DecisionDx-UM.

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The following table presents the calculation of gross margin (in thousands,
except percentages):

                                                               Years Ended December 31,
                                                            2021                       2020               Change
Net revenues                                          $     94,085                $    62,649          $   31,436
Less: Cost of sales (exclusive of amortization of
acquired intangible assets)                                 15,822                      9,685               6,137
Less: Amortization of acquired intangible assets             1,958                          -               1,958
Gross margin                                          $     76,305                $    52,964          $   23,341
Gross margin percentage                                       81.1   %                   84.5  %             (3.4) %


Net Revenues

Net revenues increased by $31.4 million, or 50.2%, to $94.1 million for the year
ended December 31, 2021, primarily due to higher revenues from our dermatologic
tests, which increased by $28.1 million. The higher dermatologic test revenue
was primarily attributable to higher volume from DecisionDx-Melanoma, which
increased 25.2%, higher per-unit revenues for DecisionDx-Melanoma, which reflect
the expanded LCD for the test that became effective in the fourth quarter of
2020, and increased revenues from DecisionDx-SCC and our CDO. We believe the
higher test report volume for DecisionDx-Melanoma during the year ended
December 31, 2021 reflects the relaxing of COVID-19 restrictions, and the
related positive impacts on the flow of patient visits, as well as the effects
of our sales force expansions discussed above. Revenues from other tests
(non-dermatologic) contributed $3.3 million to the overall increase in net
revenues for the year ended December 31, 2021. This increase was principally due
to the significantly higher Medicare rate for DecisionDx-UM that became
effective January 1, 2021 and, to a lesser extent, the effect of a 16.0%
increase in DecisionDx-UM test report volume. We believe the higher test report
volume for DecisionDx-UM during the year ended December 31, 2021 is due in part
to patients making up for missed eye exams from 2020 due to COVID-19 impacts.
Net revenues include positive revenue adjustments related to tests delivered in
previous periods, associated with changes in estimated variable consideration,
of $3.3 million for the year ended December 31, 2021 compared to $0.2 million
for the year ended December 31, 2020. The year-over-year increase is primarily
attributable to favorable adjustments related to the settlement and collection
during the year ended December 31, 2021 of certain groups of receivables from
prior years.

Cost of sales (excluding amortization of intangible assets acquired)


Cost of sales (exclusive of amortization of acquired intangible assets) for the
year ended December 31, 2021 increased by $6.1 million, or 63.4%, compared to
the year ended December 31, 2020, primarily due to higher personnel costs due to
additional headcount in our laboratory testing operations, and increased costs
of supplies and services, attributable to the higher activity levels. The
additional personnel costs included a year-over-year increase in stock-based
compensation expense of $1.0 million. Due to the nature of our business, a
significant portion of our cost of sales expenses represent fixed costs
associated with our testing operations. Accordingly, our cost of sales expense
will not necessarily increase or decrease commensurately with the change in net
revenues from period to period. We expect our cost of sales (exclusive of
amortization of acquired intangible assets) to continue to increase in future
periods as we hire additional laboratory personnel and related resources to
support our expected growth in volume for our dermatologic, GI and pipeline
tests

Gross margin


Our gross margin percentage was 81.1% for the year ended December 31, 2021,
compared to 84.5% for the same period in 2020. The decrease was largely due to
amortization expense associated with our acquired intangible assets. In the near
term, we expect that our gross margin percentage will decline as we invest in
additional laboratory personnel and related resources to support the anticipated
growth in our report volumes for tests in advance of obtaining reimbursement
coverage. Additionally, our gross margin percentage will be negatively impacted
by amortization of intangible assets associated with recent acquisitions.

Research and development


Research and development expenses increased by $16.4 million, or 123.6%, for the
year ended December 31, 2021, compared to the year ended December 31, 2020,
primarily due to increases in personnel costs and costs incurred in our clinical
studies. Approximately 55% of the increase is attributable to higher personnel
costs, due to expansions in headcount in support of our growth, including higher
stock-based compensation expense of $3.0 million compared to 2020. Approximately
27% of the increase was attributable to higher costs for clinical studies,
including costs related to the PERSONALize, CONNECTION and DECIDE studies as
well as our recently initiated a 4,800 patient, prospective, multi-center
clinical study to develop, validate and bring to market a pipeline test for
inflammatory skin diseases. Also, during the year ended December 31, 2021, we
expanded evidence supporting our portfolio of tests with 15 peer-reviewed
publications and initiated our collaboration with

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NCI/SEER. We plan to continue to increase our research and development expenditures as we fund ongoing evidence development for our existing products as well as additional pipeline programs.

Selling, general and administrative expenses


SG&A expense increased by $38.6 million, or 80.2%, for the year ended
December 31, 2021 compared to the year ended December 31, 2020. Approximately
67% of the increase is attributable to higher personnel costs, particularly due
to increased headcount, which includes salaries, stock-based compensation and
bonuses. We expanded our sales organization headcount in the third quarter of
2020 in preparation for the commercial launch of our DecisionDx DiffDx-Melanoma
test and further expanded our sales team during the first and second quarters of
2021, bringing our dermatology-facing commercial team to the mid-60s. The higher
personnel costs also reflect expanded headcount in our administrative support
functions. Stock-based compensation expense included in SG&A expense was $15.2
million for the year ended December 31, 2021 compared to $5.8 million for the
year ended December 31, 2020. The remainder of the increase in SG&A expense was
primarily associated with training events, travel, professional fees and other
general increases. The higher expenses for training events and travel reflect
both a higher headcount as well a return to more in-person activities in 2021 as
result of easing of COVID-19 restrictions.

Amortization of acquired intangible assets


Amortization of acquired intangible assets was $2.0 million for the year ended
December 31, 2021 and was entirely associated with amortization of developed
technology attributable to the acquisitions of Myriad myPath, LLC and Cernostics
in May 2021 and December 2021, respectively. There was no such amortization
during the year ended December 31, 2020. Amortization of acquired intangible
assets is projected to be approximately $6.7 million for the year ending
December 31, 2022, but may increase in the future to the extent we complete
additional acquisitions.

Other exploitation products


Other operating income of $1.9 million for the year ended December 31, 2020
consisted entirely of the automatic payment received from HHS pursuant to the
CARES Act for provider relief funds. We initially recognized income attributable
to the payment in the second quarter of 2020 based on our expectation of meeting
the requirements to retain the funds. However, due a change in requirements of
the program in the third quarter of 2020, we reversed this income. However, in
the fourth quarter of 2020, a legislative change was enacted affecting the
program, under which we concluded it is reasonably assured we will qualify to
retain the funds. Accordingly, we recognized the income again in the fourth
quarter of 2020. There were no similar transactions during the year ended
December 31, 2021. See Note 2 to the consolidated financial statements for
additional information.

interest income

Interest income decreased by $0.3 million for the year ended December 31, 2021compared to the year ended December 31, 2020due to lower interest rates, despite our higher average cash and cash equivalent balances.

Interest charges


Interest expense was essentially zero for the year ended December 31, 2021
compared to $2.6 million for the year ended December 31, 2020. The decrease is a
result of the early termination and repayment of all amounts due on our term
loan facility in December 2020.

Loss on extinguishment of debt


We recorded an extinguishment loss of $1.4 million during the year ended
December 31, 2020 related to the early repayment and termination of our term
loan facility. The extinguishment loss was attributable to the write-off of the
unamortized discount and issuance costs as well as early termination and
prepayment fees. There were no similar transactions during the year ended
December 31, 2021.

Income tax expense (benefits)


Income tax (benefit) expense was $(8.7) million for the year ended December 31,
2021 compared to $0.1 million for the year ended December 31, 2020.
Substantially all of the income tax (benefit) in the year ended December 31,
2021 was attributable to a reduction in our valuation allowance on net deferred
tax assets resulting from our acquisition of Cernostics in December 2021.
Specifically, we took into consideration the additional deferred tax liabilities
resulting from the acquisition and determined that a portion of our existing
valuation allowance should be reduced to offset this liability. Other than this
item, the recorded income tax (benefit) expense includes minimal amounts because
in both the years ended December 31, 2021 and 2020, the income tax benefit of
the net loss was largely offset by corresponding changes in the valuation
allowance on net deferred tax assets, as we have determined that it is more
likely than not that these benefits will not be realized.

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Stock-based compensation expense


Stock-based compensation expense, which is allocated among cost of sales,
research and development expense and SG&A expense, totaled $21.7 million for the
year ended December 31, 2021 compared to $8.3 million for the year ended
December 31, 2020, which we attribute in part to the addition of 144 employees
in 2021, a 71.6% increase from 2020. We expect material increases in stock-based
compensation expense in future periods, reflecting additional awards outstanding
due to expected growth in our headcount. As of December 31, 2021, the total
unrecognized stock-based compensation cost related to outstanding awards was
$99.3 million, which is expected to be recognized on a straight-line basis over
a weighted-average period of 3.3 years.

Cash and capital resources

Sources of liquidity


Our principal sources of liquidity are our cash and cash equivalents and cash
generated from the sale of our products. As of December 31, 2021 and 2020, we
had cash and cash equivalents of $329.6 million and $409.9 million,
respectively. In addition to the revenue generated from the sale of our
commercial products, we have financed our operations through our IPO in July
2019, two follow-on public offerings of common stock in June 2020 and December
2020, and a $25.0 million secured term loan credit facility, which we repaid in
full in December 2020.

On December 14, 2020, we filed an automatically effective shelf registration
statement on Form S-3 (File No. 333-251331) with the SEC as a "well-known
seasoned issuer." The registration statement allows us to issue an indeterminate
number or amount of common stock, preferred stock, debt securities and warrants
from time-to-time in one or more offerings. However, there can be no assurance
that we will complete any such offerings of securities. Any future offerings
under this registration statement will be dependent upon, among other factors,
market conditions, available pricing, our financial condition, investor
perception of our prospects, our capital needs and our ability to maintain
status as a well-known seasoned issuer.

Public offerings of ordinary shares


On June 29, 2020 and July 2, 2020, we issued and sold 2,000,000 and 300,000
shares of our common stock, respectively, of our common stock in a follow-on
public offering at a price of $37.00 per share. We received $79.5 million in
aggregate net proceeds, after deducting underwriting discounts and commissions
and offering costs. The shares issued and sold on July 2, 2020 reflect the
underwriters' exercise in full of their 30-day option to purchase additional
shares at the public offering price, less underwriting discounts and
commissions.

On December 18, 2020, we issued and sold 4,600,000 shares of our common stock
(including the exercise in full by the underwriters of their option to purchase
an additional 600,000 shares) in a follow-on public offering at a price of
$58.00 per share. We received $250.5 million in aggregate net proceeds, after
deducting underwriting discounts and commissions and offering costs (excluding
$0.4 million in offering costs that were incurred but not paid as of December
31, 2020). The shares issued and sold includes the underwriters' exercise in
full of their 30-day option to purchase additional shares at the public offering
price, less underwriting discounts and commissions. On December 21, 2020, we
used a portion of these proceeds to repay, in full, our outstanding term loan
credit facility. See "Long-Term Debt" below for additional information.

As mentioned above, we plan to use some of these products, as well as the few $65.9 million of the net proceeds of our IPO in July 2019to further support and accelerate our research and development activities, including the aforementioned clinical studies.

Prepayment of health insurance


On April 16, 2020, we received an advance payment of $8.3 million ("the Advance
Payment") from CMS under its Accelerated and Advance Payment Program, which was
expanded to provide increased cash flow to service providers during the COVID-19
pandemic. CMS began recoupment of the Advance Payment in April 2021 by applying
25% of the Medicare payments otherwise owed to us against the balance of the
Advance Payment. Recoupment of the full amount of the Advance Payment was
complete by December 31, 2021.

Material cash needs


Our primary uses of capital are, and we expect will continue to be, compensation
and related expenses, clinical research and development services, laboratory
operations, equipment and related supplies, legal and other regulatory expenses,
general administrative costs and, from time to time, expansion of our laboratory
and office facilities in support of our growth. We anticipate that a substantial
portion of our cash requirements in the foreseeable future will relate to the
further commercialization of our currently marketed products, the development of
our future product candidates in our pipeline and the potential
commercialization of these pipeline products, should their development be
successful.

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In the past 12 months we completed two strategic opportunities, which we funded
using our available cash on hand, and in the longer-term may evaluate and
consummate other strategic acquisitions of businesses, assets, products or
technologies, which we expect to be able to fund from our available cash and
cash equivalents. In May 2021 and December 2021, we completed the acquisitions
of the Myriad myPath Laboratory for $32.5 million and Cernostics, Inc. for $30.7
million, respectively. In both cases, the source of funding was from our
existing cash and cash equivalents. Under the definitive agreement with
Cernostics, we have also agreed to pay up to an additional $50 million in cash
or our common stock, at our sole discretion, based on the achievement of certain
commercial milestones relating to the year ending December 31, 2022. Our
liability with respect to the commercial milestone payments will depend on our
ability to successfully integrate Cernostics into our suite of commercial
product offerings, while future cash requirements arising from any additional
strategic acquisitions will depend on, among other things, our identification of
a target company with a product offering that we view as complementary to our
product offerings. See Note 5 to the consolidated financial statements for
additional information on recent acquisitions.

Since our inception, we have generally incurred significant losses and negative
cash flows. For the year ended December 31, 2021 we had a net loss of $31.3
million and an accumulated deficit of $93.8 million as of December 31, 2021. Our
ability to generate revenue sufficient to achieve profitability will depend
heavily on the successful commercialization of our currently marketed products
and the products we plan to launch in the future as well as our spending on
research and development activities. We expect to incur additional expenses and
losses in the future as we invest in the commercialization of our existing
products, the development of our future product candidates and the
commercialization of our product candidates. Further, we expect that any
acquisitions of businesses, products, assets or technologies will also increase
our expenses. We believe that our existing cash and cash equivalents and
anticipated cash generated from the sale of our commercial products will be
sufficient to fund our operations for the next twelve months. We believe we will
meet longer-term expected cash requirements and obligations through a
combination of existing cash and cash equivalents, anticipated cash generated
from sales of our products and issuances of equity securities or debt offerings,
including through our shelf registration statement on Form S-3 that became
automatically effective in December 2020. However, we have based these estimates
on assumptions that may prove to be wrong, and we could utilize our available
capital resources sooner than we expect. There are numerous risks and
uncertainties associated with developing genomic tests, including, among others,
the uncertainty of:

• successful initiation and completion of clinical study protocols;

•successful identification and acquisition of tissue samples;

•the development and validation of genomic classifiers; and

•the acceptance of new genomic tests by doctors, patients and third-party payers.


Because of the numerous risks and uncertainties associated with research,
development and commercialization of product candidates, we are unable to
estimate our exact working capital requirements. Our future funding requirements
will depend on, and could increase significantly as a result of, many factors,
including those listed above as well as those listed in the section titled "Risk
Factors."

We do not currently have any committed external source of funds. In the event
additional funding is required, we expect that we would use a combination of
equity and debt financings, which may not be available to us when needed, on
terms that we deem to be favorable or at all. To the extent that we raise
additional capital through the sale of equity or convertible debt securities,
the ownership interest of our stockholders will be diluted, and the terms of
these securities may include liquidation or other preferences that adversely
affect the rights of common stockholders. Debt financing and preferred equity
financing, if available, may involve agreements that include covenants limiting
or restricting our ability to take specific actions, such as incurring
additional debt, making acquisitions or capital expenditures or declaring
dividends. Any disruptions to, or volatility in, the credit and financial
markets or any deterioration in overall economic conditions may make any
necessary debt or equity financing more difficult to obtain, more costly and/or
more dilutive. If we are unable to raise additional funds through debt, or
equity financings or other arrangements when needed, we may be required to
delay, limit, reduce or terminate our product discovery and development
activities or future commercialization efforts.

Leases


We have entered into various operating and finance leases, which are primarily
associated with our laboratory facilities and office space. Total undiscounted
future minimum payment obligations under our operating leases and finance leases
as of December 31, 2021 totaled approximately $10.6 million, of which $1.4
million is payable in 2022 and $9.2 million is payable through the end of 2033.
The leases expire on various dates through 2033 and provide certain options to
renew for additional periods. We expect our lease obligations will increase in
the near term as we expand our facilities, operations and headcount in support
of the anticipated growth in our portfolio of commercial products and pipeline
tests. Refer to Note 9 to the consolidated financial statements for additional
information on our leasing arrangements.

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Cash flow

The following table summarizes our sources and uses of cash and cash equivalents for each of the periods presented (in thousands):

                                                                          Years Ended December
                                                                                   31,
                                                                                       2021               2020
Net cash (used in) provided by operating activities                                $ (18,983)         $   9,865
Net cash used in investing activities                                                (66,657)            (4,748)
Net cash provided by financing activities                                              5,421            305,890
Net change in cash and cash equivalents                                              (80,219)           311,007
Cash and cash equivalents, beginning of year                                         409,852             98,845
Cash and cash equivalents, end of year                                             $ 329,633          $ 409,852


Operating Activities

Net cash used in operating activities of $19.0 million for the year ended
December 31, 2021 was primarily attributable to the net loss of $31.3 million,
deferred income taxes of $8.7 million, recoupment of the Advance Payment of $8.3
million and increases in accounts receivable of $4.6 million, partially offset
by stock compensation expense of $21.7 million, increases in accrued
compensation of $6.2 million, depreciation and amortization of $3.4 million and
increases in other accrued liabilities of $2.3 million.

Net cash provided by operating activities was $9.9 million for the year ended
December 31, 2020 and was primarily attributable to net non-cash charges of
$10.5 million (consisting of $8.3 million in stock-based compensation expense,
$1.4 million of loss on extinguishment of debt, and $0.8 million in amortization
of debt discount and issuance costs), the receipt of the Advance Payment of $8.3
million, increases in accrued compensation of $3.3 million and decreases in
accounts receivable of $1.7 million, partially offset by the net loss of $10.3
million and increases in prepaid expenses and other current assets of $2.8
million, other assets of $1.4 million and inventory of $1.0 million.

Investing activities


Net cash used in investing activities for the year ended December 31, 2021 was
primarily attributable to our asset acquisitions of Myriad myPath LLC and
Cernostics (which collectively totaled $63.2 million) and purchases of property
and equipment of $3.5 million.

Net cash used in investing activities for the year ended December 31, 2020
entirely made up of purchases of property, plant and equipment.

Fundraising activities


Net cash provided by financing activities for the year ended December 31, 2021
consisted primarily of $4.2 million of proceeds from exercise of common stock
options and $2.3 million of proceeds from contributions to the employee stock
purchase plan, partially offset by payment of employees' taxes on vested
restricted stock units of $0.8 million and payment of common stock offering
costs of $0.3 million. We did not complete any public offerings of common stock
during the year ended December 31, 2021.

Net cash provided by financing activities for the year ended December 31, 2020
consisted primarily of $330.0 million of proceeds from two public offerings of
our common stock (net of underwriting discounts, commissions and issuance
costs), $1.6 million of proceeds from contributions to the employee stock
purchase plan and $1.6 million of proceeds from exercise of common stock
options, partially offset by repayments of term debt, including extinguishment
costs, of $27.4 million.

Inflation

We do not believe that inflation has had a material impact on our results of
operations during the periods presented. However, recently, the rate of
inflation in the U.S. has risen to levels not experienced in decades. We have
begun to see some inflationary pressures, primarily in personnel and related
costs. The extent of any future impacts from inflation on our business and our
results of operations will be dependent upon how long the elevated inflation
levels persist and if the rate of inflation were to further increase, neither of
which we are able to predict.

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Critical accounting estimates


Our consolidated financial statements are prepared in accordance with accounting
principles generally accepted in the United States of America. The preparation
of our consolidated financial statements and related disclosures requires us to
make estimates and judgments that affect the reported amounts of assets,
liabilities, costs and expenses, and the disclosure of contingent assets and
liabilities in our consolidated financial statements. We base our estimates on
historical experience, known trends and events and various other factors that we
believe are reasonable under the circumstances, the results of which form the
basis for making judgments about the carrying values of assets and liabilities
that are not readily apparent from other sources. We evaluate our estimates and
assumptions on an ongoing basis. Our actual results may differ from these
estimates under different assumptions or conditions.

While our significant accounting policies are described in more detail in Note 2
to our audited consolidated financial statements, we believe that the following
accounting policies are those most critical to the judgments and estimates used
in the preparation of our consolidated financial statements.

Revenue recognition


We recognize revenue is recognized in accordance with ASC 606. In accordance
with ASC 606, we follow a five-step process to recognize revenues: (1) identify
the contract with the customer, (2) identify the performance obligations, (3)
determine the transaction price, (4) allocate the transaction price to the
performance obligations and (5) recognize revenues when the performance
obligations are satisfied. We have determined that we have a contract with the
patient when the treating clinician orders the test. Our contracts generally
contain a single performance obligation, which is the delivery of the test
report, and we satisfy our performance obligation at a point-in-time upon the
delivery of the test report to the treating physician, at which point we can
bill for the report. The amount of revenue recognized reflects the amount of
consideration to which we expect to be entitled, or the transaction price, and
considers the effects of variable consideration.

All of our revenues from contracts with customers are associated with the
provision of diagnostic and prognostic testing services. Most of our revenues
are attributable to DecisionDx-Melanoma for cutaneous melanoma. We also provide
a test for UM, DecisionDx-UM. We launched a test for patients with cutaneous
SCC, DecisionDx-SCC in August 2020 and launched a test for use in patients with
suspicious pigmented lesions, DecisionDx DiffDx-Melanoma in November 2020. We
began offering a test for difficult-to-diagnose melanocytic lesions, myPath
Melanoma, following an asset acquisition completed in May 2021 and began
offering the TissueCypher® Barrett's Esophagus Assay for patients with BE
following an asset acquisition completed in December 2021. Information on the
disaggregation of revenues is included below.

Once we satisfy our performance obligations and bill for the service, the timing
of the collection of payments may vary based on the payment practices of the
third-party payor and the existence of contractually established reimbursement
rates. Most of the payments for our services are made by third-party payors,
including Medicare and commercial health insurance carriers. Certain contracts
contain a contractual commitment of a reimbursement rate that differs from our
list prices. However, absent a contractually committed reimbursement rate with a
commercial carrier or governmental program, our diagnostic tests may or may not
be covered by these entities' existing reimbursement policies. In addition,
patients do not enter into direct agreements with us that commit them to pay any
portion of the cost of the tests in the event that their insurance provider
declines to reimburse us. We may pursue, on a case-by-case basis, reimbursement
from such patients in the form of co-payments and co-insurance, in accordance
with the contractual obligations that we have with the insurance carrier or
health plan. These situations may result in a delay in the collection of
payments.

The Medicare claims that are covered by policy under an LCD are generally paid
at the established rate by our Medicare contractor within 30 days from receipt.
Medicare claims that were either submitted to Medicare prior to the LCD's
effective date or are not covered by the terms of the LCD, but meet the
definition of being medically reasonable and necessary pursuant to the
controlling Section 1862(a)(1)(A) of the Social Security Act are generally
appealed and may ultimately be paid at the first (termed "redetermination"),
second (termed "reconsideration") or third level of appeal (de novo hearing with
an ALJ). A successful appeal at any of these levels results in payment.

In the absence of LCD coverage or contractually established reimbursement rates,
we have concluded that our contracts include variable consideration because the
amounts paid by Medicare or commercial health insurance carriers may be paid at
less than our standard rates or not paid at all, with such differences
considered implicit price concessions. Variable consideration attributable to
these price concessions is measured at the expected value using the "most likely
amount" method under ASC 606. The amounts are determined by historical average
collection rates by test type and payor category taking into consideration the
range of possible outcomes, the predictive value of our past experiences, the
time period of when uncertainties expect to be resolved and the amount of
consideration that is susceptible to factors outside of our influence, such as
the judgment and actions of third parties. Such variable consideration is
included in the transaction price only to the extent it is probable that a
significant reversal in the amount of cumulative revenue recognized will not
occur when the uncertainties with respect to the amount are resolved. Variable
consideration may be constrained and excluded from the transaction price in
situations where

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there is no contractually agreed upon reimbursement coverage or in the absence
of a predictable pattern and history of collectability with a payor. Variable
consideration for Medicare claims that are not covered by an LCD, including
those claims subject to approval by an ALJ at an appeal hearing, is deemed to be
fully constrained due to factors outside our influence (i.e., judgment or
actions of third parties) and the uncertainty of the amount to be received is
not expected to be resolved for a long period of time. Variable consideration is
evaluated each reporting period and adjustments are recorded as increases or
decreases in revenues. Included in revenues for the years ended December 31,
2021 and 2020 were $3,324,000 and $176,000, respectively, of revenue increases
associated with changes in estimated variable consideration related to
performance obligations satisfied in previous periods. These amounts include (i)
adjustments for actual collections versus estimated amounts and (ii) cash
collections and the related recognition of revenue in current period for tests
delivered in prior periods due to the release of the constraint on variable
consideration.

Consolidation of DecisionDx-Melanoma Claims


In June 2017, we submitted to OMHA a formal request to participate in a program
that OMHA developed with the intent of providing appellants a means to have
large volumes of claim disputes adjudicated at an accelerated rate. The program
consolidates outstanding claims at the ALJ level and uses a statistical-sampling
approach where five ALJs will determine reimbursement results for a sample of
claims which are then extrapolated to the universe of claims. Our consolidation
includes 2,698 DecisionDx-Melanoma claims dating from 2013 through spring 2017.
Hearings were held in April 2019 with a supplemental hearing in May 2019. On
March 12, 2020, OMHA issued a decision denying payment on all claims in the
consolidation. We have filed an appeal to the decision, although no ruling on
such appeal has been issued to date. In accordance with ASC 606 and consistent
with prior periods, we have not recognized (fully constrained the variable
consideration) any revenues attributable to these claims in our consolidated
financial statements pending the outcome of this matter.

Stock-based compensation


Stock-based compensation expense for equity instruments issued to employees and
non-employees, including stock options, restricted stock units ("RSUs") and
purchase rights issued under our 2019 Employee Stock Purchase Plan ("ESPP") is
measured based on the grant date fair value of the awards. For stock options and
purchase rights granted under the ESPP, we estimate the grant date fair value
using the Black-Scholes option-pricing valuation model. For RSUs, we use the
closing price of our common stock on the date of grant to determine the fair
value. We recognize compensation costs on a straight-line basis for all
stock-based compensation awards over the requisite service period of the awards,
which is generally the awards' vesting period, typically four years for options
and RSUs and the two-year offering period for the ESPP. Forfeitures are
accounted for as they occur.

Below is a description of the key assumptions used in the option pricing model:


•Expected term. The expected term is the period of time that granted options are
expected to be outstanding. For stock options, we have set the expected term
using the simplified method based on the weighted average of both the period to
vesting and the period to maturity for each option, as we have concluded that
our stock option exercise history does not provide a reasonable basis upon which
to estimate the expected term. For the ESPP, the expected term is the period of
time from the offering date to the purchase date.

•Expected volatility. Previously, because of the limited period of time our
stock had been traded in an active market, we calculated expected volatility by
using the historical stock prices of a group of similar companies looking back
over the estimated life of the option or the purchase rights under our ESPP and
averaging the volatilities of these companies. In the third quarter of 2021, we
adjusted this calculation to include our own stock price on a relative basis to
the peer group in the calculation of expected volatility, as our common stock
has now been traded in an active market for more than two years.

•Risk-free interest rate. We base the risk-free interest rate used in the Black-Scholes pricing model on the prevailing market yield at the time the option is granted and on the offer date for the ESPP provided by the Federal Reserve Board Statistical releases and historical publications of the Treasury
constant maturity rates for equivalent residual terms.


•Dividend yield. We have not paid, and do not have plans to pay, cash dividends.
Therefore, we use an expected dividend yield of zero in the Black-Scholes option
valuation model.

The fair value of our common stock is also an assumption used to determine the
fair value of stock options. Prior to our IPO, the estimated fair value of our
common stock had been determined by our board of directors as of the date of
each award, with input from management, considering our most recently available
third-party valuations of common stock and our board of directors' assessment of
additional objective and subjective factors that it believed were relevant and
which may have changed from the date of the most recent valuation through the
date of the grant, which intended all options granted to be exercisable at price
per share not less than the per share fair value of our common stock underlying
those options on the grant date.

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Subsequent to our IPO, the fair value of our common stock is the closing selling
price per share of our common stock as reported on the Nasdaq Global Market on
the date of grant or other relevant determination date.

The following table sets forth the assumptions used to determine the fair value
of stock options:

                                                     Years Ended December 31,
                                                2021                          2020
     Average expected term (years)               6.1                           6
     Expected stock price volatility       66.50% - 68.83%              
59.57%- 67.02%
     Risk-free interest rate                0.51% - 1.48%                0.28% - 1.76%
     Dividend yield                              -%                            -%

The following table presents the assumptions used to determine the fair value of the call rights issued under the ESPP:


                                                     Years Ended December 

31,

                                               2021                           2020
    Average expected term (years)               1.2                           1.2
    Expected stock price volatility       61.13% - 86.50%              
56.80% - 100.49%
    Risk-free interest rate                0.06% - 0.20%                 0.12% - 0.95%
    Dividend yield                              -%                             -%


Intangible Assets

Our intangible assets, which are comprised primarily of acquired developed
technology, are considered to be finite-lived and are amortized on a
straight-line basis over their estimated useful lives. Estimating the useful
lives of our intangible assets requires considerable judgment. In determining
the estimated useful lives, management considers factors such as historical
experience, industry and regulatory factors, competition, patent expirations and
commercial plans. If new information becomes available in future periods, we may
be required to revise our estimated useful lives. If the revised useful lives
are shorter than originally estimated, our future amortization expense will
increase.

Conditional consideration


Under the terms of business combinations or asset acquisitions, we may be
required to pay additional consideration if specified future events occur or if
certain conditions are met. With respect to the additional consideration that
may be payable in connection with our acquisition of Cernostics, which was
treated as an asset acquisition for accounting purposes, we account for the
contingent consideration as liability in accordance with ASC 480, Distinguishing
Liabilities from Equity ("ASC 480"), under the guidance for obligations that
must or may be settled by issuance of a variable number of shares. In accordance
with ASC 480, we record the contingent consideration initially and subsequently
at fair value with changes in fair value recorded in the statements of
operations and comprehensive loss each period. This liability is classified as a
"Level 3" fair value measurement (as defined in Note 11 to our consolidated
financial statements) due to the use of significant unobservable inputs and a
Monte Carlo simulation to determine its fair value. The Monte Carlo simulation
uses projections of the commercial milestones for the applicable period as well
as the corresponding targets and approximate timing of payment based on the
terms of the arrangement. The analysis also uses assumptions for expected
volatility of the financial metrics and a risk-adjusted discount rate. The
assumptions and estimates we use in the Monte Carlo simulation require
considerable judgment and may change in future periods as a result of new
information.

Recent accounting pronouncements

See Note 2, “Summary of Significant Accounting Policies,” in the Notes to our Consolidated Financial Statements included with this Annual Report on Form 10-K for a discussion of recent accounting pronouncements.

Accounting election of the JOBS law


Previously, we were an emerging growth company within the meaning of the JOBS
Act. Section 107(b) of the JOBS Act provides that an emerging growth company can
leverage the extended transition period, provided in Section 102(b) of the JOBS
Act, for complying with new or revised accounting standards. However, because
the market value of our common stock held by non-affiliates exceeded $700.0
million as of June 30, 2021, we are no longer an emerging growth company
effective December 31, 2021. As a result, we now apply public company adoption
dates for new or revised accounting standards. Further, we were required to
comply with the auditor attestation requirements of Section 404(b) of
Sarbanes-Oxley regarding our internal control over financial reporting as of
December 31, 2021.

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Te wiki o te tāke: Are these costs related to COVID-19 deductible? https://www.sociologyesoscience.com/te-wiki-o-te-take-are-these-costs-related-to-covid-19-deductible/ Sat, 19 Feb 2022 23:45:00 +0000 https://www.sociologyesoscience.com/te-wiki-o-te-take-are-these-costs-related-to-covid-19-deductible/ The Week In Tax Deductibility of Covid-19 expenses, future of tax administration, tax perils of migration We are now in the third year of the pandemic which, for two and a half years, has brought enormous upheaval, both socially and for businesses. Many unusual situations result and the tax treatment of these situations needs to […]]]>

The Week In Tax Deductibility of Covid-19 expenses, future of tax administration, tax perils of migration

We are now in the third year of the pandemic which, for two and a half years, has brought enormous upheaval, both socially and for businesses. Many unusual situations result and the tax treatment of these situations needs to be clarified.

The taxman has therefore released draft guidelines for consultation on the tax deductibility of costs specifically generated by COVID-19. What the document notes is that businesses have experienced significant disruption as a result of the pandemic, and many have had to incur additional costs that would normally be considered unusual or abnormal and which have only arisen due to of the pandemic. Additionally, businesses continue to incur holding costs such as interest and amortization of assets that they cannot use at this time, either due to COVID-19 restrictions or they temporarily reduced the size of the company.

This document is designed to provide guidance on the tax deductibility of expenses in these circumstances. It examines a number of specific situations that the tax authorities have obviously seen or on which they have been asked to give their opinion. For example, what about the costs of bringing employees to New Zealand or retaining teams unable to work? What about providing accommodation to keep teams housed together in a bubble during a particular set of COVID-19 restrictions?

Other scenarios include what is the tax deductibility of granting vouchers or incentive payments to employees? And then what about severance pay – is it deductible if it resulted from COVID 19? What about contract termination costs and related legal fees?

Repairs, maintenance and depreciation of assets and equipment that are not in use due to the pandemic – are they deductible? And then premises costs such as lease-breaking fees and other costs such as maintaining an appropriate distance between people in a workplace. As you can see, many scenarios are considered in the document.

The general deductibility rule is found in Section DA 1 of the Income Tax Act. For a cost to be deductible, there must be a connection between the cost and the person’s income-generating process. Now, it’s always a matter of fact and degree and what you have to keep in mind is that the deductible cost doesn’t need to be tied to any particular item of income and the income need not be generated in the same year as the cost was incurred. The cost must be incurred in general terms as part of the business’s revenue-generating activities. This means you can set longer term goals for why you incur expenses.

The document then combines these basic principles with the scenarios that I laid out before with a series of good examples. These scenarios involve a hotel chain, a cafe, a construction company, a tourist company and an office. I recommend that you read the document if you have encountered some of these unusual situations. The consultation, as I said, is open now and continues until March 31.

Incidentally, speaking of consultation, submissions end at the end of this month on a tax consultation regarding charities and donee organizations. I covered this consultation in early December and the question of the charitable status of a few organizations was in the news recently. So here is your opportunity to make submissions to Inland Revenue.

Tax in a digital world

Moving on, in my first podcast of the year, I suggested that Inland Revenue will seek to move the tax administration process forward now that it has completed its business transformation. And I recommended watching a document prepared by Business New Zealand on the future of tax administration.

The taxman now has published an official document on tax administration in a digital world. And that, I think, is a very important development for tax administration and for tax agents and intermediaries, or anyone involved in the tax system. As the paper points out, businesses are moving online, which is shaping the Inland Revenue’s thinking about the future world in which the tax system will operate.

The document is 25 pages long and there are a lot of things to consider so I can go on for a while. It takes many of the principles or ideas from the Business New Zealand paper, but probably at a higher level. The Inland Revenue believes that there are four pillars which set the basic framework for the proper functioning of tax administration and social policy administration. That is, fairness and integrity, efficiency and effectiveness. And the document discusses the impact of technology on all of this.

According to Inland Revenue, the main features of the digital world are likely to be businesses operating in a digital ecosystem. That is, digitally connected to their suppliers and customers. The administration of tax and social payments will be integrated into broader economic systems. This means, for example, that individuals or companies can use a common digital identity for a whole range of services. I think that’s something that happened with COVID-19. The pandemic will accelerate this trend because it makes life so much easier for everyone. You don’t have to worry about providing repeated information to different agencies.

Tax administration processes are going to be integrated into the business systems that businesses use. In other words, they will use systems adapted to their activity rather than tax obligations. And then, this is a key element, digital processes will allow data to flow in real time.

This is a point I keep coming back to – the amount of data that is circulating and the Inland Revenue’s access to that data is ever increasing. And the speed at which this data is received and processed is also accelerating. Which means, as I’ve said many times, there are fewer and fewer places to hide from the taxman.

And so this paper looks at what that future might look like and it sets some frameworks and sets the scene for the digital shift. There is a very important chapter for tax agents, intermediaries and others who work with the Inland Revenue on how it sees these relationships developing. The document examines the issue of data, how it is collected, how it is shared and what statistical data should be made available on an anonymous basis.

You know that at the moment there is a lot of controversy concerning a rich project where Inland Revenue asks a group of about 400 New Zealanders for detailed information about their wealth. In my opinion, one of the weaknesses of the New Zealand system for some time is that we don’t collect a lot of data when we file tax returns. And so, compared to other jurisdictions, we don’t really have good data on many aspects of economic wealth. This project, as controversial as it is, addresses this question. In the future, because data can be found and provided more easily, I expect requests for data from agencies and in particular the Inland Revenue will increase.

There is also talk of publishing debt data. In other words, if someone’s been a bad boy – and by the way, it’s invariably been boys in my experience – the IRS can share that data and can develop a number of tools of execution.

Then, the last chapter talks about the process of general simplification, how tax laws are drafted, simplification of the tax year-end position and payments around the tax system.

Data sharing and data protection issues are very, very important. In my opinion, Inland Revenue has a good reputation and processes for not disclosing data, and its data is secure. But as he changes roles to interact more with intermediaries such as tax agents, there is a clear risk of leakage.

The document therefore suggests that the current process by which a person can become a tax agent needs to change. In fact, within the tax agent industry, I think there is a recognition that needs to change even if it reflects a certain amount of, you might say, self-interest by professional bodies. It is quite true and not an apocryphal story that a prisoner registered as a tax agent with the IRS while in prison. He was able to do this because he had 10 clients who had to file tax returns.

While data is now going to be shared more freely, and the Inland Revenue does not directly control much of the process, it needs to be confident that the people it grants access to its systems or data are trustworthy. So that’s a big question to consider. As I said, the document is fascinating. It’s a big topic, but it’s only 25 pages, and an easy read. Submissions are now open and continue until March 31.

The tax consequences of emigration

And finally, this week, according to the latest statistics from New Zealand figures, more and more people continue to leave New Zealand permanently and on a long-term basis than those that arrive in the long term. In 2021, there was a net annual loss of three 3,915 people. Now, at the risk of sounding like a broken record, one thing I regularly encounter is this problem of people migrating overseas, usually to Australia, sometimes to Britain or America, and migrants from overseas from other countries coming to New Zealand.

It is quite amazing how many people move abroad without looking through it and without considering all the tax implications of their move. In particular, if he is a trustee of a trust. As I have recounted many times, especially in relation to Australia, the consequences of becoming resident in Australia can be quite disastrous. But I keep having this problem. In fact, at the moment, I have three cases in progress involving variations on this theme.

So, just a reminder to anyone thinking of moving to Australia or moving overseas. Remember to get tax advice before you go. You may be missing an opportunity. You can also give yourself a major tax headache, which no one wants.

Well that’s all for this week. I’m Terry Baucher and you can find this podcast on my website www.baucher.tax or wherever you get your podcasts. Thanks for listening and please send me your feedback and tell your friends and customers.

Until next time kia pai te wiki, have a great week!


Terry Baucher is an Auckland-based tax practitioner with 25 years of experience. He works with individuals and entities that have complex tax issues. Before starting his own business, he spent six years with one of the ‘big four’ accounting firms, including a period advising Australian businesses on how to do business in New Zealand. You can contact him here.

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Chiquita Brooks-LaSure Makes History Among White House’s Most Diverse Administrations https://www.sociologyesoscience.com/chiquita-brooks-lasure-makes-history-among-white-houses-most-diverse-administrations/ Wed, 16 Feb 2022 14:58:48 +0000 https://www.sociologyesoscience.com/chiquita-brooks-lasure-makes-history-among-white-houses-most-diverse-administrations/ Chiquita Brooks-LaSure A White House photo featuring dozens of African-American members of the Biden-Harris administration circulated the internet during the early days of Black History Month, and it would be hard to find anyone. as proud as Chiquita Brooks-LaSure. The first black woman to lead the Centers for Medicare and Medicaid Services (CMS), Brooks-LaSure offered […]]]>
Chiquita Brooks-LaSure

A White House photo featuring dozens of African-American members of the Biden-Harris administration circulated the internet during the early days of Black History Month, and it would be hard to find anyone. as proud as Chiquita Brooks-LaSure.

The first black woman to lead the Centers for Medicare and Medicaid Services (CMS), Brooks-LaSure offered the brightest smile as she mentioned the historic photo featuring Vice President Kamala Harris and a host of black staff members helping to advance the work of the administration.

“I’m so proud and really moved,” said Philadelphia-born Brooks-LaSure.

“When I was nominated, I heard from women across the country, and I hadn’t realized how meaningful it would be to so many people for me to sit in that chair,” he said. she continued. “I have older women and younger women coming to tell me how proud they are. It really inspires me to want to use this role in a way that changes people’s lives, and I’m so grateful for the opportunity.

“The National Newspaper Publishers Association (NNPA) wholeheartedly salutes and congratulates Chiquita Brooks-LaSure for her outstanding leadership at CMS Health and Human Services (HHS).

We look forward to expanding the partnership between CMS and NNPA. Medicare and Medicaid are vital to the present and future of African Americans and other communities of color,” said Dr. Benjamin F. Chavis, Jr, President and CEO of NNPA.

A former politician who played a crucial role in guiding the Affordable Care Act — or Obamacare — through passage and implementation, Brooks-LaSure benefits from decades of experience working in government. and the private sector. As deputy director of policy at the Center for Consumer Information and Insurance Oversight, and earlier at the Department of Health & Human Services as director of coverage policy, Brooks-LaSure led the agency’s implementation policy provisions and Obamacare coverage. She helped House of Representatives leaders pass several health care laws, including the Medicare Improvements for Patients and Providers Act of 2008, on the Democratic staff of the Committee on ways and means of the House.

As a CMS administrator, Brooks-LaSure oversees programs such as Medicare, Medicaid, the Children’s Health Insurance Program and the HealthCare.gov health insurance marketplace.

“I was born in Philadelphia, raised in New Jersey and lived in Virginia for much of my life,” said LaSure, who is married and has a young daughter. “I’ve always been interested in politics from an early age,” she explained. “When I was in graduate school, I had a friend who I took classes with in health policy and social policy, and she really put me on the path to health policy. J I’ve always said, “Once you start health, you never look back, because no policy area has the capacity to touch so many lives, especially in the federal government.”

The COVID-19 pandemic has increased pressure on CMS and other agencies, but Brooks-La-Sure recalled similarities to the coming into force of the ACA. “The ACA was born out of a difficult time,” she recalls. “Before we passed the law, not everyone thought we should focus on health policy. We had the Great Recession, and one of the elements of people’s financial security was health care, because one in three bankruptcies resulted from medical expenses. So it became imperative to pass the ACA, and I think we are at the same time today. The pandemic has made it harder to do so much with health policy. »

Brooks-LaSure said Americans now have a better understanding of why health care is vital and why the uninsured and those without access to vaccines and drug treatments affect everyone. “I think people saw health disparities on a different level,” she said. “I think we now have the opportunity to address these [disparities] if we seize this moment.

To that end, Brooks-LaSure noted the six strategic pillars by which CMS would achieve its mission and measure success:

• Advance health equity by
tackling the health disparities that underpin America
health system
• Build on the affordable
Care and Expanding Access Act
affordable and quality health
coverage and care
• Engage partners and the
communities served by CMS
throughout the process of policy development and implementation • Stimulate innovation to tackle
health system challenges
and promote the value,
person-centred care
• Protect CMS’ programs
sustainability for future generations by acting as a responsible steward to the public
funds
• Foster a positive and inclusive work environment and
workforce and promote
excellence in all aspects of
CMS operations

Brooks-LaSure said CMS has already made significant progress on these pillars, focusing its efforts on improving health equity and access to coverage by working across federal agencies. She told NNPA Newswire that a record 14.5 million people signed up for 2022 health care coverage during the enrollment period. “Investing in financial assistance and awareness helps more people access the care they need,” Brooks-LaSure said.

As part of Vice President Kamala Harris’ call to action to reduce maternal mortality and morbidity, HHS, through CMS, has taken steps to improve maternal health and support the delivery equitable and high-quality care for pregnancy and postpartum care. CMS has proposed a “Birthing-Friendly” designation to support perinatal health outcomes and improved maternal health equity. According to a statement, the designation would initially identify hospitals that provide perinatal care, participate in a maternity care quality improvement collaboration and implement recommended patient safety practices.

CMS also encouraged states to take advantage of the American Rescue Plan’s option to provide 12 months of postpartum coverage to pregnant women enrolled in Medicaid or CHIP.

Brooks-LaSure said history would eventually smile on the unprecedented diversity. “I think representation is so important, and we will have changed this country because so many of us are in these roles with our diverse perspectives that strengthen policy-making,” Brooks-La-Sure said. “The more people you have who come from different backgrounds, you build stronger and better policies and make sure the next generation sees they can fill those roles.”

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Carlisle mayor says ‘enough is enough’ after yet more reports of anti-social behavior https://www.sociologyesoscience.com/carlisle-mayor-says-enough-is-enough-after-yet-more-reports-of-anti-social-behavior/ Wed, 16 Feb 2022 05:00:00 +0000 https://www.sociologyesoscience.com/carlisle-mayor-says-enough-is-enough-after-yet-more-reports-of-anti-social-behavior/ CARLISLE Mayor Pam Birks said “enough is enough” when it comes to anti-social behavior in the city. His comments come after Cumbria Police attended an incident on Monday night in Scotch Street following yet more reports of anti-social behavior and criminal damage. Police were also seen patrolling The Lanes and Globe Street following anti-social behavior […]]]>

CARLISLE Mayor Pam Birks said “enough is enough” when it comes to anti-social behavior in the city.

His comments come after Cumbria Police attended an incident on Monday night in Scotch Street following yet more reports of anti-social behavior and criminal damage.

Police were also seen patrolling The Lanes and Globe Street following anti-social behavior in the area.

Carlisle Mayor Pam Birks believes a ‘zero tolerance’ approach must now be taken to tackle the behavior within the city.

She said: ‘There seems to be an increase in anti-social behavior at the moment and it’s almost as if the police can’t be there all the time.

“In the city center we feel like there are gangs of young people who think they can do whatever they want, so maybe we should have zero tolerance and instead of giving just warnings.

“Maybe we should go further and say enough is enough.

“We’ve been handing out these dispersal orders and all these remedial actions have happened, but maybe with these young people parents should know where they are at night and if they’re not, and that’s going to affect parents pocket so maybe it will make parents more aware of where their kids are or maybe they will have those conversations with their teenager saying ‘look it’s not on “.

“The police are doing their best, but if things don’t work out, maybe we need to be less lenient.

“I would absolutely hate to think there’s going to be a generation of young people with criminal convictions, but maybe that’s where we’ve come to.”

The mayor said she believed many of the problems could be the result of the Covid pandemic, with children not attending school to participate in essential program activities that aim to end anti-social behavior in cities around the world. country.

She said: “I wonder if it’s because the young people who come here have had to deal with Covid and they haven’t been to school to take the citizenship classes on understanding respect and the consequences of their actions.

READ MORE: Police work to tackle anti-social behavior in Carlisle town center

READ MORE: Carlisle Police continue to crack down on anti-social behavior

READ MORE: Carlisle has anti-social behavior problem as youngsters throw bricks at buses

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American child care providers are still struggling to survive | News https://www.sociologyesoscience.com/american-child-care-providers-are-still-struggling-to-survive-news/ Sun, 13 Feb 2022 05:15:00 +0000 https://www.sociologyesoscience.com/american-child-care-providers-are-still-struggling-to-survive-news/ The American child care industry has been crushed by the COVID-19 pandemic. Since the virus arrived in earnest in early 2020, around a third of centers have closed and some 111,000 workers have left the sector. To stem the bleeding, Congress has allocated tens of billions of dollars, including $39 billion last March under the […]]]>

The American child care industry has been crushed by the COVID-19 pandemic.

Since the virus arrived in earnest in early 2020, around a third of centers have closed and some 111,000 workers have left the sector. To stem the bleeding, Congress has allocated tens of billions of dollars, including $39 billion last March under the auspices of the American Rescue Plan Act signed into law by President Joe Biden. That package included $24 billion in grants to states meant to quickly help providers who were struggling to stay open.

But it’s taken many states a good chunk of a year to even start the application process, let alone get money to those who need it. And now that money has become more important than ever: With the promise of a structural fix for the struggling industry following the demise of Biden’s “Build Back Better” plan, these ARPA funds are all that stands between many suppliers and closing for good.

Some states like Connecticut did what they were supposed to do, which was to secure funding for providers as early as last June. But others — like Florida, Missouri and Texas — had yet to make the apps available even as of earlier this month. Colorado, Iowa and New Jersey only recently opened their portals, while some states that have already accepted applications have yet to distribute funds. As of mid-January, nine of those states had yet to pay child care providers, according to Stephanie Schmit, director of child care and early education at the Center for Law and Social Policy. .

After the pandemic hit and lockdowns ensued, Congress included $3.5 billion for child care in its initial bailout package in April 2020 and another $10 billion in a second bailout bill. law in December. But at $39 billion, “the scale of ARPA funding is very different,” said Anne Hedgepeth, senior director of federal and state government affairs at Child Care Aware of America, a network of resource and benchmark for child care. According to early childhood education advocates, one of the biggest challenges states faced was the lack of existing infrastructure to obtain subsidies for child care providers. Prior to ARPA, public funding for child care (and therefore the staffing of the agencies that distribute it) was generally limited and reached only a “small number of providers,” Schmit said.

Most states simply didn’t have the capacity in place to quickly distribute so much money to so many businesses, she said. American child care providers have been dragged from pillar to pillar during the pandemic. Many were forced to close during the initial lockdowns. When they reopened, they were crippled by a lack of staff willing to return, and parents feared sending their children amidst the drumbeat of waves of infection. As the industry contracted, the lack of childcare services forced working parents to stay home, further exacerbating the labor shortage.

Suppliers faced additional challenges. Keeping employees and children uninfected is a costly undertaking. Social distancing and other precautions necessarily limit the number of children who can be safely accommodated, which limits potential income. While much of the US economy has been badly hit by the crisis, the child care industry has been in the eye of the storm.

And the storm has not passed yet. “There is a desperate and continuing need for a lifeline,” Hedgepeth said.

Tim Kaminski owns Gingerbread Kids Academy in Richmond, Texas, which before the pandemic served 230 children along with another 350 children in after-school programs. He said he was still unable to request money from ARPA.

Last year, he received $221,000 under the second bailout, money that allowed him to retain his employees by increasing his wages by $2 an hour. But in March, that money will run out, Kaminski said, and he will be forced to cut workers and programs. Meanwhile, its enrollment is around 75% of pre-pandemic levels at its two main child care centers and around 50% at its five after-school locations, he said.

His ARPA grant, which Kaminski said is expected to exceed $600,000, would cover payroll through the end of the year, he said. But even though Texas officials said the application process would begin this month, Kaminski expressed doubts that the money would arrive on time. “Not knowing how quickly we’ll get that other round of funding is stressful because I don’t have any additional income,” he said. “All things are up in the air right now.”

Francisco Gamez, a spokesperson for the Texas Workforce Commission, said the agency is currently modifying its systems in preparation for managing ARPA grants. Gamez said 13,386 licensed child care providers (out of 15,606 total operations statewide) will be “invited to apply this month.”

“It’s not the will that’s the problem,” said Kim Kofron, director of early childhood education at Children At Risk, a nonprofit focused on child poverty. It’s that Texas has billions of dollars to reach thousands of suppliers, all routed through a complex government network. The state Health and Human Services Commission (HHSC) oversees child care licensing; the TWC distributes grants. “One of the biggest hurdles was getting these two systems talking in agencies,” Kofron said.

But the damage is already done. The number of HHSC-supervised child care businesses has dropped about 9% since February 2020, according to the agency. Suppliers that haven’t disappeared, Kofron said, are “hanging by a thread.”

“We needed help then. But we need it even more now. But even in states where ARPA money has started flowing, child care is still struggling. Tiffany Skaggs runs a small program in Waverly, Iowa, which serves only eight children. For micro-providers like her, the cost of protective equipment and food has become prohibitive. Skaggs said she and her husband took second jobs to pay their bills, including working weekends at a library and entering data online.

Skaggs said the state gave her $500 a month in early 2021 and up to $1,500 a month later in the year — just “a band aid,” she said. Now, the way Iowa distributes ARPA funds could mean that those past grants bar it from receiving additional federal funds.

“We needed help then. But we need it even more now.

“I had to make a lot of tough decisions while waiting for funding,” she said, including capping enrollment. “But I refuse to give up because more family child care programs are closing every week in Iowa.”

Babysitter Kay Strahorn, who runs the Bidwell Riverside Center in Des Moines, Iowa, said she didn’t even know ARPA grants existed until recently. It lost two teachers, which limited its ability to enroll more children. She said she applied for money from ARPA two weeks ago and expected to receive $80,000 this month, but “it sure would have been nice to have those funds. a month ago,” she said. “Iowa kind of dropped the ball on that,” she said. State officials did not respond to multiple requests for comment. In their defense, Hedgepeth said most states had to build systems for ARPA from scratch while spending months building awareness. Family and home providers were particularly difficult to contact, she said. “It’s not as simple as filling out a form and hoping people will submit their information.”

Yet state governments were often victims of their own bureaucracy. Missouri’s Department of Elementary and Secondary Education is awaiting approval for credit from the state legislature, according to an agency spokesperson. Hedgepeth said Alaska’s decision to partner with the US Department of Health and Human Services triggered a lengthy contracting process. And the Colorado program was delayed because it sent out an RFP outside of its normal network of contractors, according to Schmit.

Conversely, in states that were able to withdraw ARPA money quickly, the funds made a huge difference.

In Connecticut, one of the main goals was to get ARPA grants “quickly and efficiently,” said Elena Trueworthy, director of the state’s Head Start Collaboration Office. Administrators prioritized making the app as easy as possible and worked with existing partners like United Way of Connecticut, which already had relationships with all child care providers in the state, to start the process, she said.

The state said it has already disbursed $108 million in ARPA funds to 2,564 programs. The Bristol Child Development Center is one of them. Maegan Adams, the executive director, asked for the money last May. In June, a first installment of $307,737 arrived, she said. Adams used the money to give staff bonuses (to encourage them to stay) and to fix a leaky roof, among other things. A class of toddlers had to be moved to a teachers’ lounge at the start of the pandemic to allow for social distancing, but ARPA funds enabled him to renovate the old classroom so those children could return safely.

The money enabled the Bristol center to “continue to have a safe environment for children”, Adams said. “It helped us stay afloat.” ARPA funding has helped Connecticut retain “the supply of child care services,” said Beth Bye, commissioner of the state Office of Early Childhood. Connecticut saw 130 fewer daycare center closures last year — at the height of the pandemic — than in 2019, before it even started.

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Study shows link between child poverty and me https://www.sociologyesoscience.com/study-shows-link-between-child-poverty-and-me/ Thu, 10 Feb 2022 02:02:26 +0000 https://www.sociologyesoscience.com/study-shows-link-between-child-poverty-and-me/ A study reported in December in an article by European child and adolescent psychiatry shows an association between child poverty and an increased propensity to develop externalizing disorders in adolescence and early adulthood, particularly in girls. According to psychiatrists, externalizing disorders are characterized by poor impulse control, breaking rules, aggression, impulsiveness, attention deficit, and hyperactivity, […]]]>

A study reported in December in an article by European child and adolescent psychiatry shows an association between child poverty and an increased propensity to develop externalizing disorders in adolescence and early adulthood, particularly in girls. According to psychiatrists, externalizing disorders are characterized by poor impulse control, breaking rules, aggression, impulsiveness, attention deficit, and hyperactivity, among other forms of behavior.

The researchers who conducted the study concluded that multidimensional poverty and exposure to stressful life events, including frequent deaths and family conflict, were preventable risk factors that should be addressed in childhood. to reduce the impact of mental health problems in adulthood. The analysis took into account parental education, access to basic services, housing conditions and family infrastructure, among other variables.

For about seven years, 1,590 students enrolled in public schools in Porto Alegre and São Paulo (Brazil) were evaluated in three stages, the last in 2018-19. The students participate in the Brazilian High-Risk Childhood Psychiatric Disorders Cohort Study (BHRC), a large community-based survey involving 2,511 families with children aged 6 to 10 when it began in 2010.

Considered one of the most ambitious child mental health surveys ever conducted in Brazil, the BHRC, also known as the Project Connection – Minds of the Futureis run by the National Institute of Developmental Psychiatry (INPD), Which one is supported by FAPESP and the National Council for Scientific and Technological Development (CNPq). Its principal investigator is Euripede Constantino Miguel Filho, professor in the Department of Psychiatry of the Faculty of Medicine of the University of São Paulo (FM-USP). More than 80 university professors and researchers affiliated with 22 institutions in Brazil and elsewhere participate in its activities.

“It seems logical to say that poverty is correlated with the future development of mental health problems, but this is the first survey ever conducted in Brazil to analyze the mental health of children and young adults based on psychiatric assessments done multiple times. . We designed our study so that we could collect data on mental health in adolescence and early adulthood,” said Caroline Ziebold, first author of the article. Ziebold is a researcher at the Department of Psychiatry of the Federal University of São Paulo (UNIFESP).

Researchers used the Developmental Well-Being Assessment (DAWBA), a combination of interviews, questionnaires, and assessment techniques, to obtain psychiatric diagnoses in childhood (9-10), the adolescence (13-14) and early adulthood (18-19). They sought to detect internalizing disorders, such as depression and anxiety, as well as externalizing disorders, although the former did not account for a significant proportion of the overall results.

They used a specific questionnaire to assess the socio-economic status of families, concluding that 11.4% of the sample lived in conditions of poverty.

“The three-step psychiatric assessment produced consistent results by tracking changes over time. Children from poor families had lower levels of externalizing disorder than non-poor children at the first stage, but after a few years the curve reversed and the disorder steadily increased in poor children, with a likelihood of 63% develop disorders, while they decreased in poor children. the non-poor,” Ziebold said.

Gender inequality

The stratification by sex shows that child poverty has particularly harmful consequences for women. “This finding was particularly striking and can be considered one of the most significant,” Ziebold said. “Externalizing disorders are generally more common in men. Our hypothesis is that mental health problems are less likely to be diagnosed early in poor girls, whether in the family or at school. Also, they tend to take on more responsibility for household chores from an early age, such as caring for younger siblings and sick family members. This added burden exposes them to more stressful life events, increasing the likelihood that they will develop mental health disorders in adulthood.

Externalizing disorders were particularly detrimental to women in terms of impact on educational attainment, leading to repeaters, dropouts and age distortions, as shown in a study by the group recently published in the journal Epidemiology. and Psychiatric Sciences.

Also using data from the BHRC, the study concluded that at least ten out of 100 girls older than the appropriate age for their grade level could have accompanied their age group if mental health problems, particularly disorders externalization, had been prevented or treated. If repeated, 5 girls out of 100 would not have failed (More than: agencia.fapesp.br/37741).

“Children and young adults with externalizing disorders may be more likely to fall behind in learning, social development, and the labor market, which increases the likelihood of poverty later in adult life,” Ziebold said.

In Brazil, the likelihood of children replicating their parents’ low level of education is twice the likelihood in the United States, for example, and well above the average of the 38 countries of the Organization for Cooperation and Development Economics (OECD). Nearly six in ten Brazilians (58.3%) whose parents did not complete high school also dropped out of school. In the United States and the OECD, the proportion is 29.2% and 33.4% respectively, according to the analysis of intergenerational mobility by the Institute for Mobility and Social Development (IMDS).

In the labor market, the likelihood of children finding skilled, well-paid jobs increases with the level of education of their parents. In the case of parents with a university degree, their children are 3.3 times more likely than average to hold high-skilled jobs and almost 9 times more likely than children of parents with little education (more in Portuguese on: imdsbrasil.org/doc/Imds_Sinopse%20de%20Indicadores01_Ago2021.pdf).

Pandemic

Because of the long-term impact of externalizing disorders on health and social outcomes in adult life, the researchers’ findings reinforce the importance of anti-poverty interventions in early childhood, according to Ziebold.

“When we highlight the need to reduce poverty in order to reduce the prevalence of mental health disorders, we are thinking about the issue in a multidimensional way,” she said. “There are no quick fixes. Immediate actions, such as abolishing school fees and providing cash transfers and income support for poor families, are important, but there is also a need to think about broader measures involving the promotion of social skills. -emotional, stress reduction, access to education and access to mental health services.

The proportion of the population living in poverty has increased alarmingly during the COVID-19 pandemic, she added. According to a report published by UNICEF, an additional 100 million children have fallen into multidimensional poverty worldwide, an increase of 10% since 2019.

The report also states that as of October 2020, the pandemic had interrupted or interrupted essential mental health services in 93% of countries and that more than 13% of girls and boys aged 10-19 live with a diagnosed mental disorder. . Even in the best-case scenario, he adds, it will take seven to eight years to recover and return to pre-pandemic levels of child poverty (More than: www.unicef.org/media/112841/file/UNICEF%2075%20report.pdf).

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