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The world has long looked at the Nordics as an example fordriving much of the innovation that is happening nowadays, and the situation is no different in digital health, according to a new study from HIMSS, in cooperation with McKinsey,published today.

Supported by international management consulting firm McKinsey & Company, it reveals that the Netherlands and the Nordicscontinue to be seen as role models for the adoption and use of eHealth in Europe, based on the responses of over 500 professionals in the field.

But Estonia has swapped places with Denmark and is now perceived to be the leading eHealth country in Europe, following the launch of an initiative that allows EU citizens to retrieve medication prescribed electronically by doctors in Finland in Estonian pharmacies through the new eHealth Digital Service Infrastructure.

TOPLINE DATA

Despite progress being made, findings indicate that eHealth professionals in Europe continue to grapple with many of the challenges seen in other regions around the globe, from the lack of funding or political direction to poor interoperability.

The shortage of skilled workers is another concern for all the stakeholder groups surveyed. Jrg Studzinski, director of research and advisory services at HIMSS Analytics, said workforce development should be a priority for every organisation in a separate interview with Healthcare IT News published today.

Improving the competencies of the workforce can lead to significant efficiency gains, higher work satisfaction and improved safety for patients. Ideally this is a combination of process changes and staff trainings.

If we give healthcare staff members better digital tools and if we want them to be accountable for their work performance, we need to make sure that they are properly trained, but also that these tools are aligned with internal workflows, Studzinski said.

IT security, EMR implementation and improving patients access to information are seen as top priorities for the next 12 months, although the results vary according to each countrys level of digital maturity.

While the deployment of electronic records is the main concern for those in Germany and the UK, the Netherlands and the Nordics are focusing more on ensuring patients have access to their data, improving interoperability and leveraging the use of artificial intelligence.

IT security and EMR solutions are top of mind topics for German eHealth professionals. This is important to build a solid foundation for working in a digital health system, said Tobias Silberzahn, partner at McKinsey & Company.

However, we should already now think about tomorrow and ask ourselves: What is the goal of digitising the healthcare system? Or more specifically: How do we intend to link the more than 25 digital product categories that are currently being created with our existing healthcare system for the benefit of the patient? These are exciting questions that range from digitally integrated care delivery to personalised medicine,"Silberzahn added.

Looking a bit further ahead, over the next two to three years, eHealth professionals from most European countries expect a shift of priorities towards empowered and more active patients, the provision of telemedicine, and the enablement of continuity of care.

According to the study, anincrease inAI-based solutions and the provision of more personalised medical or preventative services is also expected.

But it is rather unlikely that we willseewidespread implementation and use of products and services featuring augmented reality capabilities or blockchain technology within the next three years. This will either take longer or work for special use cases, the researchers cautioned.

WHY IT MATTERS

Furthermore, across all the countries polled, a majority of healthcare staff believethat their organisations IT budget is too low.

Clinical staff members do more often perceive the IT budgets of their own organisations to be insufficient than their colleagues from IT departments. This can be a sign of frustration, i.e. digital solutions not delivering the expected benefits from an end user perspective. We recommend to investigate this further, the researchers noted.

But the findings show that the countries that are ahead are also the ones that are prioritising investment in digital.

While the reported spending numbers will have to be interpreted with some caution because they are based on estimations from professionals that do not always have insights into the exact accounting figures, it is still intriguing to see that the countries that are perceived to be more digitally mature in eHealth are also those who spend the most on technology, Studzinski said.

THE LARGER TREND

The study published today echoes many of the challenges and priorities identified in reports from previous years.

Only this month, management and technology consultancy Sopria Steria Consulting found in a survey that a majority of Germans were disappointed with the progress that their country was making in digitising healthcare, based on the responses of around 200 citizens.

On the provider side, in the UK, a recent study found that around 80% of GPs saw poor IT and tech support as key barriers to the widespread adoption of video consultations.

But with increasing pressures on health systems, including ageing populations and workforce shortages, it is clear that more stakeholders are turningto evidence-based innovations to provide services that are fit for the future.

ON THE RECORD

Commenting on the eHealth trends identified in the HIMSS report, Jochen Messemer, partner at McKinsey & Company, said: In Germany and many other countries, providers must speed up empowering patients through pan-organisational electronic patient records and the supplementary provision of telemedicine.

Healthcare IT News is a publication of HIMSS Media.

Originally posted here:
Estonia, the Netherlands & Nordics continue to drive eHealth adoption and use in Europe, study finds - Healthcare IT News

Introduction

Artificial intelligence (AI) refers to the capacity of machines to perform tasks that are typically associated with human decision-making. AI computer systems use a variety of datasets and sensory inputs to make decisions in real time and to modify future decisions with additional data and experience with minimal human intervention or additional programming. In conjunction with machine learning, AI touches on nearly all aspects of modern life. As digital technologies take the place of certain human activities, legal disputes surrounding AI are inevitable.

Already, such issues have reached both federal and state courts. Judges are tackling emerging AI issues and creating case law that will impact the future course of technological innovation. For example:

In these and other cases, judges must understand the role that AI and machine learning play in the legal system itself. Lawyers, as well as judges and their staff, use machine learning to improve case law searches for relevant legal authority to cite in briefs and decisions. Document production and technology-assisted reviews use AI to search for relevant documents to produce and to mine those documents for the information most important to a partys claims without attorneys having to review every document. Some scholars and practitioners are already using AI to predict the outcome of cases based on algorithms based on tens of thousands of prior cases. Recent research suggests that such outcome predictions may have around a 70% accuracy rate. AI is ushering in a new era of quantitative legal decision forecasting.2

AI is ushering in a new era of quantitative legal decision forecasting.

In short, courts face no small task in: identifying the legal and ethical issues at stake, including concerns about transparency, due process, and data privacy; understanding the AI technology at issue in order to make sound legal rulings; and appreciating the potential implications of legal rulings on future technological advances and individual rights.

With that in mind, it is vital to improve judges ability to understand the technical issues in AI-related litigation. There are several things court systems and professional organizations should do to enhance the technical capabilities of judges:

A variety of strategies are available to educate judges on the AI-related technology at issue in a litigation. These include the use of science or technology tutorials, court-appointed technical advisers or special masters, and court-appointed experts.

I have written previously on the use of technology tutorials to allow judges to ask the parties, experts, or technical advisers to identify and educate a judge about scientific and technological issues central to a litigation. The goal of a technology tutorial is to transform the courtroom into a classroom. Tutorials may include a demonstration of how a certain method, software, or product works, an overview of key technical terminology, or a presentation of how a certain innovation developed over time. Judges may request, or the parties may recommend, live presentations by one or more experts or by the parties, question and answer sessions, or videotaped tutorials or demonstrations. Tutorials provide a forum for judges to ask questions about AI technology outside the context of the parties advocating on behalf of a particular motion or at trial.

[S]afeguards should be added to ensure that there is limited opportunity for technical advisers to introduce bias into the judicial decision-making process.

In addition, federal judges have the authority to appoint technical advisers, use specially trained clerks, or request special masters to provide them with the technical expertise they need. These advisers usually do not testify at trial; their role is to educate the judge on technical issues involved in a case. To avoid any undue influence and to ensure that the parties views on science and technology are given proper weight, safeguards should be added to ensure that there is limited opportunity for technical advisers to introduce bias into the judicial decision-making process. These safeguards include limiting the scope of case-specific materials that a technical adviser reviews or analyzes and defining the content and nature of any scientific or technical help to be provided to the judge. Technical adviser appointments are mentioned in federal case law as early as 1950, and their use is becoming increasingly common.

Finally, judges may appoint experts for exceptional circumstances and particularly complex AI issues in a litigation. Judges may appoint such experts on a partys motion or on the judges own initiative. A court-appointed expert must advise all parties of any findings, may be deposed by any party, may be called to testify at trial, and can be subjected to cross examination by any party.3 While still fairly novel, court-appointed experts have been used in a number of litigations, and their use is becoming more common.

Regardless of the strategy used, it is crucial that the process provides technical information and expertise to judges in as neutral a fashion as possible. Sound, subsequent judicial decision-making is best served by an educational, neutral delivery of information on AI through a tutorial, technical adviser, or court-appointed expert. While it may seem counter to the underpinnings of our adversarial system, the judge should require that the parties work together to provide the court with mutually agreed-upon recommendations on the format, topics, and ideal presenters for tutorials, or a joint list of potential technical advisers, or court-appointed experts (should one be needed).

These methods, however, should not be read to preclude the parties from putting forth their own, separate expert witnesses at trial. Moreover, it is important that, regardless of the strategy used, these methods conform to the basic expectation underlying the adversary system that, with limited exceptions, judges should not receive advice and guidance without the parties to the dispute having an opportunity to contest that advice and guidance.

In addition to the practices outlined above, court systems and professional organizations should undertake research and pilot programs for the judiciary to explore other strategies that may be useful in assisting judges in developing the technical understanding needed for AI-related lawsuits. One example would be a pilot program to conduct technology tutorials at the appellate level. To date, trial court judges have been the primary users of tutorials. Scholars and judges alike have questioned the reliability of technical information obtained by judges informally outside the existing factual record, including information that has appeared in appellate and Supreme Court decisions. Providing tutorials on key AI-related issues to appellate judges may reduce reliance on non-validated resources, such as amicus briefs, that have not undergone third-party fact checking or materials that have not been subjected to cross examination by the parties at trial. Tutorials may help limit the perceived need for judges and clerks own independent research to supply additional facts in appellate decisions.

[G]iven the need for technical expertise in AI-related litigations, specialized technical courts may provide a viable solution in some instances.

Another proposal that has re-emerged recently is the creation of expert panels or science courts with special jurisdiction to hear complex scientific or technological disputes.4 Some judges, legislators, and legal scholars have argued that technically trained judges or panels should decide scientific issues instead of generalist judges or layperson juries to ensure that the scientific or technological components of litigation are decided correctly by those with the relevant expertise. Though this concept remains controversial, the idea of science or technology courts has gained renewed interest in our increasingly complex world. Further research is warranted to explore whether these panels meet our societal expectations of judicial fairness and process. It is also unclear whether complex scientific issues can be separated from policy and legal issues that arise, as well as which court should decide these issues where they overlap. As AI makes its way into all aspects of our daily lives, it may be seen as unreasonable to take away general courts (and juries) role in legal decisions surrounding AI. Nonetheless, given the need for technical expertise in AI-related litigations, specialized technical courts may provide a viable solution in some instances.

Initiatives to provide judges with the technical understanding needed for AI-related litigation are unlikely to succeed without support from the parties involved in a dispute and their counsel. It is important for state bars and other legal professional organizations to familiarize attorneys with the broader implications of AI-related legal cases and the methods that they can suggest to judges to provide them with neutral information on AI.

Attorneys may be understandably hesitant to recommend to either their client or a judge the use of tutorials, technical advisers, or other strategies with which they are unfamiliar. However, education of not just the judiciary but other legal professionals can help ensure their necessary buy-in to implement existing strategies, to participate in pilot programs of new approaches, and to assist judges in receiving technological understanding needed for sound judicial decision-making.

AI professional organizations and their members should work together to provide additional educational opportunities and resources to both federal and state courts. There are a number of models that professional organizations can follow to provide valuable assistance and technical expertise to judges generally. The Federal Judicial Center, the research and education agency of the federal judiciary, provides information to and educates judges on areas of emerging science and technology through written pocket guides, online tutorials and modules, and in-person workshops. The legal community often relies on the centers Reference Manual on Scientific Evidence to better understand and evaluate the relevance and reliability of scientific and technical evidence being proffered by experts in litigation.5 The centers new Technology and the Bench initiative will help provide federal judges with critical information on areas where technology and legal issues overlap. In addition, the National Academies of Sciences provides valuable opportunities for members of the judiciary (and the technology community) to discuss areas of emerging technology that are likely to appear in lawsuits.

AIs pervasive nature will require coordination among a variety of technology professionals to educate the public about AI and machine learning.

It is essential that AI professional organizations and relevant stakeholders join in these efforts and work together to develop additional neutral, educational content to the courts. Providing judges with silos of subject matter-specific training is unlikely to be effective, as AI reaches into all aspects of lifedata privacy, financial transactions, transportation, human health and safety, and the delivery of goods and services. AIs pervasive nature will require coordination among a variety of technology professionals to educate the public about AI and machine learning.

AI professionals should also consider developing a universal glossary of key technical terms or a basic set of general reference materials designed specifically to provide the judiciary with general background on AI that would be broadly applicable, regardless of any particular case assignment. Reference manuals on other science and technology-related topics have proven highly effective in delivering useful content to judges.6

In addition, AI professional organizations should consider forming a technical adviser referral system or panel that is available to assist judges or arbitrators in cases with unique AI issues. Such a panel or referral system, when requested, could provide judges with the names of potential independent AI experts, including computer scientists, engineers, data analysts, and software programmers. The American Association for the Advancement of Science assists the legal profession by providing an independent expert referral system for issues related to science. This type of system could be adapted to address AI-related technical expertise needs of judges. However, additional research is needed to assess whether judges are aware of this resource, how frequently judges have used this resource, and any changes that could improve its usefulness to them.

Finally, skilled individuals with technical expertise must be able to convey effectively, to judges and juries, relevant key concepts in their respective fields. This means that data scientists, programmers, and software developers will need training in communicating with lay audiences about the key aspects of the technology likely to be at issue in AI-related lawsuits. This is especially true given recent findings of low public literacy on topics related to technology generally and AI concepts in particular.

Others have written extensively on the costs and benefits of judicial policymaking, and that is not the focus of this policy brief. Nonetheless, it bears repeating that when legislators, policymakers, and regulators fail to anticipate and act on issues of emerging technology, judges are left in the unfortunate position of being the first branch of government to evaluate new issues related to AI.

[W]hen legislators, policymakers, and regulators fail to anticipate and act on issues of emerging technology, judges are left in the unfortunate position of being the first branch of government to evaluate new issues related to AI.

Legislation guided by sound policy considerations would establish means to provide courts with the guidance they need to avoid setting legal precedent that unintentionally stifles technological advancement on the one hand, or improperly interferes with individuals freedoms, safety, privacy, or right to fair compensation for harm on the other. Because both state and federal law impact AI-related litigation, actors at the state and federal level must work together to try to ensure federal and state policies and legislation are aligned. That would help address AI issues while also elevating the level of expertise available to decision-makers.

The Brookings Institution is a nonprofit organization devoted to independent research and policy solutions. Its mission is to conduct high-quality, independent research and, based on that research, to provide innovative, practical recommendations for policymakers and the public. The conclusions and recommendations of any Brookings publication are solely those of its author(s), and do not reflect the views of the Institution, its management, or its other scholars.

Microsoft provides support to The Brookings InstitutionsArtificial Intelligence and Emerging Technology (AIET) Initiative, and Google provides general, unrestricted support to the Institution. The findings, interpretations, and conclusions in this report are not influenced by any donation. Brookings recognizes that the value it provides is in its absolute commitment to quality, independence, and impact. Activities supported by its donors reflect this commitment.

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How to improve technical expertise for judges in AI-related litigation - Brookings Institution

While aging equipment and bureaucracy continue to put a strain on the military's performance, training injuries are also taking a devastating toll.

Soldiers injured during training missed more than 4 million duty days in the first half of 2019 alone, medical researchers said during a panel at the Association of the US Army's conference in Washington, D.C.

"Injuries are the number-one medical threat to readiness," preventative medicine researcher Dr. Bruce Jones said Wednesday. "Musculoskeletal injuries, due mostly to training and vigorous operational activities, are the biggest portion of that problem."

More than three out of four of these kinds of injuries are from overuse. Running accounted for 43% of training injuries, according to Jones, making it the leading cause. Work-related tasks, equipment maintenance, and similar activities were also significant contributors.

The US Army

Research also showed that the slower the runner, the more they risked injury. And while the Army has strict body mass index requirements for its soldiers, Jones' research found those who had middle to high BMIs had less chance of injury compared with those with lower BMIs.

"So it appears being somewhat overweight, but physically fit, is protective against musculoskeletal issues," Jones said.

High rates of training injury given the requirements put on the modern soldier might not be surprising, but the Army has established a network of Army Wellness Center locations in an effort to promote a healthier force. The centers test a soldier's body fat composition, caloric needs, and aerobic capacity in order to help them meet their fitness goals.

"Instead of going [with] the traditional health education, health promotion, what we wanted to do was something a little bit more evidence-based," said Todd Hoover, the Army Wellness Center operations division chief. "So instead of just like lecturing people, holding classes, and stuff like that, what we wanted to do was assess where they're at."

The Army could see more soldiers injured in training as it begins to implement its new fitness test, which aims to mirror the physical requirements expected in the field. The new dead lift, for example, could increase back injuries for soldiers unfamiliar with proper weightlifting techniques.

Jones told the Washington Examiner he suspects there could be more injuries associated with the new test, but it's too soon to tell.

"The bottom line is we will have to wait and see," he said.

See the rest here:
The biggest threat to military readiness has nothing to do with combat - Business Insider

(All Peer News articles are submitted by readers of Citizen Truth and do not reflect the views of CT. Peer News is a mixture of opinion, commentary and news. Articles are reviewed and must meet basic guidelines but CT does not guarantee the accuracy of statements made or arguments presented. We are proud to share your stories, share yours here.)Changing from reactive based healthcare to proactive based healthcare could help Americans save millions.

Humana released a study on Monday, October 7 revealing that $265 billion is being wasted on healthcare in the U.S. annually. With medical costs already at staggering highs, many Americans cant afford to waste money on unneeded healthcare. After all, as CNBC reports, rising health-care costs are a reality and cause stress for many peopleIf we are to successfully confront the issues of cost and efficiency in care, we first need to fully understand the systemic problem of wasteful spending.

The last thing anyone wants to worry about during a medical emergency or when facing a chronic condition is the cost of healthcare. Unfortunately, for many Americans, worrying about healthcare costs is a reality. After all, the U.S. spends more on healthcare than any other country. In order to waste less money, the healthcare system must evolve to deliver more cost-efficient care to each and every patient.

The ultimate goal of the study conducted by Humana and the University of Pittsburgh School of Medicine was to estimate the levels of monetary waste on healthcare in the U.S. They focused on the top six aspects of healthcare that are attributed to wasting money, including:

The study found that the administrative complexity is the greatest source of monetary waste. Administrative complexity involves physician credentials, information systems, processing of medical claims, and administrative operating. Patients expect these responsibilities to be carried out seamlessly, however, clinicians and health plans typically work separately which can contribute to waste.

Each of these domains of healthcare will require different kinds of action to eliminate waste while improving patients experiences.

Prior to this newly released study, various initiatives have been implemented to help mitigate healthcare spending. Some of these initiatives include payment reform (bundled payments, value-based arrangements/reimbursements) and delivery reform (enhanced care coordination, Partnership for Patients initiative). However, these initiatives have only made a minor dent in healthcare spending waste and substantial waste still remains.

Sadly, the authors of the study found no reputable studies that have effectively found ways to reduce administrative complexity. Very few value-based payment options have been able to produce sufficient savings.

Don Berwick, a renowned physician and author of an editorial examining the Humana study, suggests that moving to a single-payer system, simplifying administrative costs, and lowering branded drug prices could help reduce waste.

Additionally, the Affordable Care Act implemented an effective preventative care plan that providers can follow to lower costs and prevent wasted money by treating diseases such as mental illness, diabetes, multiple sclerosis, and many other chronic diseases.

Too often, people wait until symptoms become severe to seek medical care. This can contribute to higher healthcare costs and chronic conditions. This is known as the reactive care model. Focusing more on proactive and preventative care, however, can help drive down long term healthcare costs. Proactive healthcare involves targeted communication and improved engagement allowing patients to take control of their own health outcomes. In addition, proactive healthcare focuses on more collaboration among patients and physicians in small-scale practices to help lower administrative costs, therefore, preventing administrative complexity waste.

Reactive healthcare is responsible for more than 75% of healthcare spending. Proactive and preventative healthcare, on the other hand, focuses on preventing chronic disease and improving healthcare outcomes. As a result, conditions can be tackled at the root causes and treated before they become a dangerous problem that requires costly medical care.

Innovative types of healthcare that are focusing on proactive and preventative health include workplace wellness initiatives, age management programs, and concierge medicine. Advocates for changing healthcare using preventative and proactive medicine suggest that proactive medicine treats diseases before they become a bigger problem saving patients time and money in the long run.

Aside from preventing disease, proactive healthcare is also proven to increase retention rates and extend patients lifetime value. Retention is vital to keeping healthcare costs low, as it costs 5 to 25 times more to treat new patients than it does to retain old ones.

While preventative medicine may not be the end-all-be-all solution to wasted healthcare costs, it can certainly play a role in preventing disease in order to keep costs down. It is evident that further research and initiatives need to be done to improve the efficiency of administrative complexity and healthcare spending. Its safe to say that healthcare reform is critical to lowering costs and expanding healthcare access to all Americans in need without the excessive worry of wasted money.

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New Humana Study Suggests $1 out of $4 Spent on Healthcare Is Wasted Each Year - Citizen Truth

U.S.-based economists Abhijit Banerjee, Esther Duflo and Michael Kremer won the 2019 Nobel Economics Prize on Monday for work fighting poverty that has helped millions of children by favoring practical steps over theory.

French-American Duflo becomes only the second woman to win the economics prize in its 50-year history, as well as the youngest at 46. She shared the award equally with Indian-born American Banerjee and Kremer, also of the United States.

The Royal Swedish Academy of Sciences said their work had shown how poverty could be addressed by breaking it down into smaller and more precise questions in areas such as education and healthcare, and then testing solutions in the field.

It said the results of their studies and field experiments had ranged from helping millions of Indian schoolchildren with remedial tutoring to encouraging governments around the world to increase funding for preventative medicine.

"It starts from the idea that the poor are often reduced to caricatures and even the people that try to help them do not actually understand what are the deep roots of (their) problems," Duflo told reporters in Stockholm by telephone.

"What we try to do in our approach is to say, 'Look, let's try to unpack the problems one-by-one and address them as rigorously and scientifically as possible'," she added.

The team pioneered "randomized controlled trials," or RCTs, in economics. Long used in fields such as medicine, an RCT could for example take two groups of people and study what difference a treatment makes on one group while the other group is only given a placebo.

Applied to development economics, such field experiments found for example that providing more textbooks and free school meals had only small effects, while targeting help for weak students made a big difference to overall educational levels.

"It's a prize not just for us but for the whole movement," Banerjee later told a joint news conference at the Massachusetts Institute of Technology (MIT), where they both work. Kremer is a researcher at Harvard University.

Citing Banerjee's methods as having transformed classroom teaching in state schools in New Delhi, the Indian capital's chief minister Arvind Kejriwal said on Twitter that it was a "big day for every Indian."

Story continues

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Nobel Econ winners 'excited' about their work - Yahoo News

The Smart MedTech Forum atSemicon Europa will focus on innovation and the future of medtechat Messe Mnchen from 12-15 November.

The SMART MedTech Forum fosterscollaboration across the semiconductor and medtech value chains, and gathers industry experts for insights into the latest developments and trends in medtech innovations driven by semiconductors.

The Forum will be located at theInspiration Hub, an pavilion where attendees can connect with companies behind medtech innovations, experience leading products, and discover startups.

It features the following sessions focused on the critical role of semiconductors and medtech in enabling technology innovation and solutions to the worlds most pressing healthcare challenges.

Global healthcare solutions

Janssen Pharmaceutical Companies of Johnson & Johnson will hold a presentation on global healthcare challenges and opportunities, followed by MedTech Europe, which will discuss trends in healthcare, the medtech industry and digital. imec and GE Research will focus on bridging the gap between semiconductors and medical technologies to solve global healthcare challenges.

Digitisation of preventive healthcare

The focus of more Smart medtech device companies on preventive medicine sets the stage for a presentation by OnePlanet Connected Health Solutions on opportunities in digital health for tracking mental stress using wearable data and machine learning. Maxim Integrated will explore the potential of sleep monitoring to prevent health problems and reduce healthcare costs, and how wearables can help prevent high blood pressure. ams AG will examine how sensors can enable consumer health applications for preventative healthcare.

Revolutionising healthcare with personalised medicine

Personalised medicine is on the rise in its aim to increase the efficiency and quality of care through customised patient management. Yole Developpement and Fraunhofer EMFT will introduce innovative solutions in precision medicine and drug delivery for personalised healthcare, while X-FAB will discuss how MEMS manufacturing is enabling breakthroughs in personalised medicine.

The digital patient: The future of artificial organs and human avatars

Digital patients promise to prevent and cure disease and transform healthcare through personalised treatment. Key figures from EPFL Lausanne, Philips, Robert Bosch, and Bart's Heart Centre will discuss quantum leaps in personalised treatment including the use of artificial organs, Organ-on-Chip, and human avatars as the next paradigm in healthcare.

Pioneering research in medical technologies

With fundamental research key to healthcare innovation, research and innovation centres imec and the KU Leuven will explore how CMOS-compatible technologies and systems can be applied to life sciences to enable platforms for personalised medicine.

Other SMART MedTech Forum highlights

The Medtech Startup Session will host startups including Sensome and its remote monitoring technology that can turn invasive vascular medical devices into connected healthcare devices. Onera Health and ChronoLife will introduce their diagnostic solutions, while PKvitality will present its health-monitoring smartwatches. ICAlps will present its products and services for the design and supply of ASIC/SOC integrated circuits for medtech applications.

Also, figures from ChronoLife, the European Commission and Siemens Healthineers will gather for the panel Key Drivers Transforming Healthcare: AI, Big Data and Cybersecurity, three areas central to medtech advances.

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Semicon Europa to host Smart MedTech Forum in Munich - Med-Tech Innovation

The Vandal Health Clinic formerly known as the Student Health Clinic will move back to its Moscow campus location this fall.

The clinic was moved off campus last year to the downtown location of Moscow Family Medicine. It was moved again and is now located next to the QuickCare clinic behind WalMart.

We dont have a definitive date of being open, but itll be soon, Dean of Students Blaine Eckles said. Likely before Thanksgiving, if not sooner than that.

The on-campus clinic, located in the same building as the Student Health Insurance Office and Vandal Health Education, is in the final stages of being remodeled, Eckles said.

ICYMI: CTC fills psychiatry void

The clinic will house six exam rooms, a procedure room, office space for physicians and an x-ray room. It is unclear at this time if the clinic will have the capacity to do other types of lab work on site, but those resources will remain available through other healthcare facilities in Moscow.

There is room within the current space to expand.

The move (back to campus) was ultimately my decision, Eckles said. I dothat in consultation with campus leadership, the president. This conversation started last spring as an opportunity for us to engage. President Staben and Provost Wiencek were in support of that, President Green is in support of it as well.

The clinic was moved to the Gritman Medical Center location behind WalMart during the remodeling process because that location had the capacity to meet student needs better than the downtown Moscow Family Medicine location, Eckles said.

Moscow Family Medicine integrated with Gritman Medical Center last year, Eckles said, which allowed this move to happen.

Eckles said the team behind the move wanted to open the clinic sooner, but the remodel took time. It was originally predicted to open in January, but Eckles said the clinic is likely to open much sooner.

The physician who will be based out of the clinic, Dr. Jacob Christensen, completed a Primary Care Sports Medicine Fellowship at the University of New Mexico last summer and began seeing patients at the current clinic location recently.

Christensen will provide general healthcare in addition to mental, preventative and womens health services. He will also work with University of Idaho athletic teams as an athletic physician.

Eckles and Christiansen said there should not be any changes in services when the location of the clinic changes.

ICYMI: UI employees to expect higher rates for healthcare coverage

Some types of lab work may be unavailable on site, Christianson said, but finding alternatives and other local resources should not be a problem.

The Vandal Health Clinic will be open five days per week including over academic breaks and will be open to students, staff, faculty and other members of the campus community. Eckles said this will provide another line of healthcare service for students and ease access to services throughout Moscow, cutting down line sizes and wait times.

Eckles said he will send out a campus-wide email once a final opening date has been set for the clinic. The team plans to host a ribbon-cutting ceremony when the clinic opens.

Alexis Van Horn can be reached at arg-news@uidaho.edu or on Twitter @AlexisRVanHorn

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Health clinic to return to University of Idaho campus - Argonaut

Kiran Mathur Mohammed

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The bodies and minds of half the country and more than $6.8 billion a year are being lost because we arent stopping heart disease, diabetes or mental illness before they kill us or lock us away.

How many of the men and women trapped in cages and defecating in buckets; that filled our screens last week, had treatable issues that might have been prevented much earlier?

You may not realise it, but we have more in common with those poor souls than we think.

You might not end up in a cage. But as dramatic will be the heart attack that suddenly robs you of life or health; or the innocuous doctors visit that turns into a gut wrenching revelation: Im sorry maam your eyesight is going, and possibly for good; Im sorry but your sons mania requires institutional confinement.

It is a natural human bias to discount early care and preventative treatment. Psychologists and economists alike fret about the reasons why we (and it is most all of us) dont spend enough time looking after our minds and our bodies.

Still, one in two people that die in this country die of heart disease, a stroke or diabetes, says the Health Ministry. And, says the World Health Organisation, in Latin America and the Caribbean up to 24.2 per cent of our populations suffer from some mental disorder ranging from anxiety to depression.

The equally wondrous and frustrating thing is that human knowledge and modern medicine make all these things largely preventable. We could literally glow with health.

How? Weve all been lectured about cutting out the refined starch, sugar, salt, and unhealthy fats. We all know we need to go for a walk or a hit the gym. We know we need to pop our pills. We all know we need to steer clear of smoking, cut down the booze and go see a shrink.

But its tough. The reality is that many unhealthy things like booze or ice-cream lubricate social interactions and enable experiences that bind us together with family, friends and strangers. And our culture still views soft feelings as a sign of weakness.

The concept that we must simply buckle down with self-discipline is old hat. We can only make the right choices if our whole lives are redesigned to help us do so.

We now know that a choice as simple as taking a heart pill is guided by a huge number of factors: from cost, to time, to physical access to education. Thats why more than 46 per cent of people dont even bother to fill their prescription, says Dr Mandreker Bahall.

The same goes for the decision to reach for broccoli instead of fried chicken. The Health Ministry reckons that 90 per cent of the population have less than five servings of fruit and vegetables daily, while 74.6 per cent of students still drink more than one sweet soft drink every day.

But changing these behaviours is not impossible.

First, we can throw more resources at capturing the crucial data that should inform our policymakers every decision, as UWI lecturer Dr Robin Seemongal-Dass and others have advocated.

Then we can quickly tack up a few whiteboards and map peoples decision processes from start to finish; from the decision to eat poorly, to the decision to not exercise or the decision to not take lifesaving medication. Once we find those pain points, we can surgically remove them.

Can technology make taking drugs less difficult or confusing? Can the State use school lunches to bombard children with vegetables? Can employers be convinced that physically active employees make them more money?

If spun right, a national preventative medicine programme, dull as it sounds could make as many headlines as announcing a new hospital. Look at the global attention New Zealands PM got with her mental health budget.

The opportunity is tremendous: dont forget the $6.8 billion that diabetes and heart disease extract through healthcare costs and lost productivity, as think-tank RTI International has measured.

The private health sector has just as much an incentive to get involved as the public. It is an opportunity for the health industry to enter the rapidly growing markets for wellness, and outpatient and continual care. GPs are the unsung heroes in this battle: people like Dr Maria Clapperton of the Caribbean Collection of Family Practitioners.

We must escape those dark places of last resort: the emergency room and the psychiatric ward. We still have the chance to cheat death.

Kiran Mathur Mohammed is a social entrepreneur, economist and businessman. He is a former banker, and a graduate of the University of Edinburgh

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How to cheat death and save billions - TT Newsday

Hippocrates conceived one of the most revolutionary health concepts, Let food be thy medicine and medicine be thy food, around 400 BC, yet modern society has yet to capitalize on this concept. The worlds pharmaceutical market, worth $934.8 billion in 2017, is projected to reach a staggering $1170 billion by 2021, while the average American lifespan has decreased over the past few years. This is due, in large part, to a dramatic increase in the early onset and acceleration of chronic diseases that are perpetuated by poor nutrition and lack of exercise, such as heart disease, cancer, Alzheimers and diabetes.

Nutrition businesses, under soft food regulations, are vested in exploiting our palates with high-carb, high-protein and cheap, unhealthy high-fat products.The consequent surge of chronic diseases has furthered the sick care model of medicine to create a multi-pill-a-day standard of care that has prolonged the sick part of our lives rather than our healthspan, i.e. the healthy part of our lives.

The U.S. healthcare system is at risk of bankruptcy unless we invest in the economic potential of lifestyle improvements, with food as medicine as a top priority. Food is the only product we ingest every day, multiple times a day, so it has the potential to be the most powerful medicine or poison. A nutrition-tech company can use the same research and scientific standards when developing its nutrition programs and/or products that the biotech industry uses.

As a physician and the CEO of a leading nutrition-tech company developing products based on clinical research from the USC Longevity Institute, I believe evidence-based nutrition formulations have the potential to greatly increase our healthspan. Realizing the potential of this emerging industry will require several paradigm shifts for patients, healthcare providers, consumers, corporations, regulatory systems and payers policies. Here a few key considerations.

Food As Powerful Medicine

Recent scientific evidence shows that, at the cornerstone of all major chronic diseases, lie common metabolic factors driven by unhealthy lifestyle factors, specifically nutrition. It is along these lines that some are calling Alzheimers Type 3 Diabetes. One strategy for maintaining optimal health is to eat less, less frequently. Various recent pre-clinical trials are showing how the stress induced to the body by fasting activates the bodys own defense mechanisms against multiple cancers, diabetes and autoimmune diseases.

According to the International Food Information Council Foundations annual survey, intermittent fasting (IF) was the U.S.s most popular diet in 2018 and a close runner-up to clean eating in 2019. While intermittent fasting helps improve weight loss and certain metabolic markers, prolonged fasting for several consecutive days is showing additional rejuvenating effects by enhancing the bodys own protective capabilities. Intermittent fasting and diets that can mimic prolonged fasting are becoming new interventions besides pharmaceuticals for doctors and health practitioners to effectively recommend.

Health Care Before Sick Care

Another paradigm shift that supports the proliferation of nutrition-tech is a growing emphasis on true health care instead of sick care. Preventative medicine is cheaper and more effective, while empowering people to assume more responsibility for their own health outcomes. Insurance companies are increasingly incentivizing patient-driven preventative medicine efforts, offering gym membership reimbursement, for example. The U.S. health coach market, worth $6.14 billion in 2017, is projected to reach $7.85 billion by 2022, while a reported 60% of Americans say they want health coaching. A certified health coach could be the nurse of the new healthcare model.

Similarly, the demand for increased nutrition education for medical practitioners reflects a growing consensus that health practitioners should prescribe food as medicine. Indeed, first line therapy for the reversal of prediabetes and early diabetes lies in better nutrition and lifestyle drug therapy could be used thereafter. According to David Eisenberg, an adjunct associate professor of nutrition at Harvard T.H. Chan School of Public Health, most U.S. medical students currently receive fewer than 25 hours of nutrition education and less than 20% of American medical schools mandate a course in basic nutrition.

Todays physicians have little faith in food as medicine, because the standard food industry has cut corners to sell diets based on taste and profits rather than health value and evidence-based protocols. However, the tide is turning with the burgeoning nutrition-tech industry.

Food Regulation And Payer Policy Reform

A large part of reshaping the way we think about food as medicine lies with the FDA. Currently, the FDA classifies medical foods as intended for people who have a disease or condition that results in a distinctive nutritional need which cannot be met by a diet of regular food, but is met by the medical food. Put simply, a medical food supplements a nutritional lack or deficiency, e.g. a potassium deficiency. The FDA has a great chance to expand this definition to include foods that impact the progression or the treatment of common diseases such as diabetes, cancer and Alzheimers.

However, there is currently no clear pathway for classification of foods to treat or better manage mainstream chronic diseases, such as cancer, Alzheimers and autoimmune diseases. The FDA could relax the interpretation of this definition to include foods that have strong scientific evidence and a degree of novelty with respect to alleviating or reversing mainstream chronic diseases.

Finally, insurance companies, driven by financial pressure, are slowly shifting to embrace reimbursement of certain nutrition plans. This year, Secretary of Health and Human Services, Alex Azar, announced that Medicare Advantage will begin reimbursing some social determinants for health, such as home-delivered meals a milestone step in the right direction for increasing access to nutrition-tech products and creating a predictable, therefore investable, nutrition-tech market. Similar Medicaid policies could encourage the poor to use food stamps for nutritious or fasting-mimicking food products instead of cheap fast food. If this true healthcare model were realized, the benefits to individuals and society could be enormous.

Read the rest here:
How Nutrition-Tech Could Save Our Healthcare System And Billions Of Lives Around The World - Forbes

NEW YORK (CBSNewYork) Do you have back pains and headaches and cant figure out why? The cause could be as simple as your posture.

CBS2s Dr. Max Gomez says our bodies were meant to be used a certain way to support our weight, but modern devices and workplaces tend to sabotage that design.

In a few weeks, when its time for finals, students at the New York Institute of Technology will get to work. Theyre members of the schools posture patrol.

Its basically something people dont pay attention to a lot of the times, said physical therapy student Philip Hennings.

(Credit: CBS2)

Thats why theyll be handing out brochures to students and faculty.

Just correcting them with their posture and helping them become aware, I realize that it makes such a huge difference and is what we consider preventative medicine, Hennings said.

RELATED STORY: Is Sitting The New Smoking? Doctors Say Long Days And Poor Posture Can Cause Widespread Harm

Whether were sitting at our desks, staring at our devices or just walking around, posture is a big part of our day.

Dr. Mark Gugliotti is an associate professor of physical therapy. He says poor posture can lead to different types of pain.

The neck, the head, the shoulders, the elbow, hips, low back, knees, feet and ankles, the whole body is subject to any sort of postural dysfunctions, he said.

(Credit: CBS2)

Gugliotti and his students demonstrated the right way to sit at a desk. To start, your feet should be flat on the floor.

Im going to lower the chair to a position that helps accentuate a 90-degree angle between the trunk and the hip, as well as a 90-degree angle between the upper leg and the lower leg, he said.

Shoulders and elbows should also be at 90 degrees. Your computer screen should be an arms length away and positioned so your eyes are looking at the top third of the screen without moving your neck up or down.

Then theres what may be the biggest offenders; phones and other mobile devices can impact the back and especially neck.

Having your phone more towards the front of your face would be the best scenario, Gugliotti said.

Dont forget about your posture when youre walking. Keep your back straight, not slumped, and try to pull your belly button in towards the spine.

If left untreated, poor posture can lead to nerve compression in the back of the neck, which can lead to headaches. Poor posture can even impact the lungs of patients with asthma, COPD and emphysema.

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Bad Posture Could Be The Cause Of Your Back Pain & Headaches - CBS New York

RENSSELAER For the second year, the Jasper and Newton County Extension offices have joined to bring information and wellness testing to the Jasper County Fairgrounds for the elderly population of both counties. The senior expo, on Oct. 9, brought a variety of senior living residences, medicine and other agencies together for seniors to browse, gather some freebies and learn about the choices they have as they grow into their golden years, and all of it was free.

Franciscan Health Rensselaer brought nurses offering free screenings in bone density, cholesterol and glucose testing as well as Medicare information. Tim Ventrello, an RN who runs the Heartland Vascular Screening program for Franciscan Health was there to tell seniors about the new testing program and to discuss the hospitals new 3D mammography machine, making it easier for radiologists to see more clearly what is inside a breast and the ability to find something unusual that may not have been seen by regular mammography.

The machine gauges the persons body type and adjusts itself to each individuals body, making it more comfortable for the patient.

The new screening programs offer different heart, lung and vascular screenings for a flat fee without going through insurance or the need to have a doctors referral. A heart risk assessment is included in each screening. The screenings are by appointment and the office is open Monday and Thursday, 7 a.m. to noon, but appointments can be made outside of those hours for patients convenience.

Ventrello said the screenings are meant for young healthy people to find where they are in their health and to follow up each year as a wellness check rather than waiting for something to happen as they age. It is preventative medicine, he said.

Sherri Van Buren discusses information and Medicare options for seniors on Medicare health insurance in Rensselaer, Lafayette and Crawfordsville. She was on-hand Wednesday morning to help any seniors who stopped to talk about their healthcare coverage.

Josephine Mikuly, of DeMotte, said she came to the expo last year and enjoyed the information she received and was happy to return again this year. Ive gotten good information, she said.

The new senior living facility in Rensselaer, Autumn Trace, had representatives available to talk about their facility. It is three/quarters full and they receive inquiries daily regarding availability, Kristi Ritter said.

There was also a table for Parkview Haven in Francesville, the Rensselaer Care Center, Oak Grove Christian Retirement Village in DeMotte and George Ade Memorial Health Care in Brook. Ashland Place Senior Apartments in Goodland was also there to discuss its independent living apartments with the visitors.

Birthright of Rensselaer was there looking for senior volunteers to help answer the phone and do other volunteer work. Brook Library and the Jasper County Library had large print books to give away as well as information on services the libraries have to offer. Both community services from the two counties gave seniors information on the services they offer seniors as well.

Walgreens was offering free flu shots and pneumonia shots to the seniors as well.

Although attendance was down from last year, the expo went well, and those who went were glad they did.

Northwest Indiana Community Action promoted a free Living Healthy workshop that began on Thursday, Oct. 10 and continues each Thursday through Nov. 14, at 3:30 p.m. at the Community Church in Roselawn. The address is 10498 N 450 E, DeMotte/Roselawn. Seniors will need to register for the program by calling 800-826-7871, ext. 2203.

Read more from the original source:
Senior Expo provides information and wellness testing for Newton and Jasper - Newsbug.info

UNC School of Medicine researcher Rob Tarran, PhD, led a review of all published scientific literature on the effects of e-cigarette use on the respiratory system. The team of four authors strongly recommend tighter regulation of e-cigarette products.

Rob Tarran, PhD

Four scientists from four leading universities in the United States conducted a comprehensive review of all e-cigarette/vaping peer-reviewed scientific papers that pertain to the lungs and published their findings Sept. 30, 2019, in the British Medical Journal.

Corresponding author Rob Tarran, PhD, professor of cell biology and physiology and member of the UNC Marsico Lung Institute, said, Studies show measurable adverse biologic effects on lung health and cells in humans, in animals, and in tissue samples studied in the lab. The effects of e-cigarettes have similarities to those seen in traditional cigarettes and important differences.

Doctors know that the development of chronic, life-threatening diseases related to cigarette smoking, such as lung cancer and emphysema, take decades to develop. Also, it took decades to scientifically prove that smoking cigarettes caused cancer. Vaping has been popular for about 10 years. Scientists have been studying the effects of e-cigarettes for about five years. What theyve found suggests that vaping is not without effects. It is not safe.

The scientific communitys current knowledge is insufficient to determine whether the respiratory health effects of e-cigarettes are less than the now obvious health effects of combustible tobacco products, said Tarran, who is also a member of the UNC Lineberger Comprehensive Cancer Center.

The other authors of the BMJ paper are Jeffrey Gotts, MD, PhD, assistant professor of medicine at the University of California-San Francisco, Sven-Eric Jordt, PhD, associate professor of anesthesiology at Duke University with an adjunct appointment at Yale University, and Rob McConnell, MD, professor of preventative medicine at the Keck School of Medicine at the University of Southern California.

Gotts is a pulmonologist/intensive care clinician, Jordt is a toxicologist, McConnell is an epidemiologist, and Tarran is a cell biologist and physiologist.

The paper can be read in full. Below are a number of their key findings:

A number of epidemiological studies showed increased respiratory symptoms in adolescent vapers, such as increased bronchitis-like symptoms, increased asthma, shortness of breath, etc.

The researchers found a number of studies that showed effects of vaping on the whole lung, including possible lung damage (such as damage to the lungs blood supply), and identified case reports from around the world indicating lipoid pneumonia that is similar to what is seen with the current epidemic in the United States.

The researchers reported on a number of animal studies which typically found increased risk of lung damage and immunosuppression, such as increased susceptibility to bacterial or viral infections.

We also evaluated the effects of vaping on cells in the laboratory (in vitro studies), Tarran said. Most studies found that e-liquid exposure to pulmonary cells had effects including general cytotoxicity and impaired specialized functions, such as secretion and phagocytosis, which are important for proper lung function.

The researchers reviewed the possible health effects of e-liquid constituents including nicotine, propylene glycol/vegetable glycerin, and flavors. All have been shown to have adverse effects in animal and lab based studies at some concentrations. However, given the range of vaping behaviors in the real world, it is impossible to know the exact concentrations vapers are exposed to over any given timeframe.

Interestingly, when we looked at all the published papers on primary pulmonary cells straight from the lungs of people to the lab the only reports that did not see an effect of vaping on these cells were studies funded by the tobacco industry, Tarran said.

The researchers also provided recommendations for clinicians and for future regulation of e-cigarettes. For heavy smokers, e-cigarettes should be prescribed cautiously as a smoking alternative, and should only be recommended as a cessation devise along with counseling and other therapies to help quit nicotine-product use permanently.

We recommend that vape products be regulated more stringently along the lines of pharmaceutical products that go through a well-defined series of pre-clinical and human studies before they are released on the market, Tarran said.

The researchers also highlighted the challenges facing researchers in the field and provided recommendations for future research, such as the need to research the potential detrimental effects of vaping on adolescent lung development.

Source: University of North Carolina at Chapel Hill School of Medicine

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Researchers publish comprehensive review on respiratory effects of vaping - Taylorsville Times

On Friday afternoon, multiple Rowan clubs, departments, sports teams and others in the Rowan community convened at the Intramural Field to hold the inaugural Fitness Festival in support of ALS awareness, as well as to promote fitness as part of a healthy life.

The event was also held to commemorate the life of Dr. Theresa Cone, a former Rowan Health and Exercise Science professor, who was battling ALS.

Cone passed away Sept. 27 but had planned on attending the event. Her family, including her husband (Dr. Stephen Cone, who is also a former Rowan professor), her mother and a few more of her relatives attended the event.

The Fitness Festival consisted of stations for participants to do various exercises, such as throwing medicine balls, pushing sleds and doing push-ups.

All equipment was provided by Appenzeller Training Systems, a gym located in West Berlin and owned by Rowan alumnus CJ Appenzeller. Appenzeller facilitated the opening warm-up for participants.

The festival had a high turnout of Rowan sports teams, faculty, alumni and others in the Rowan community.

The goal of the fitness part of the event was to show people that exercising is essential to being healthy, as well as something that can be fun instead of doing boring timeworn exercises like going on a treadmill or lifting weights.

William Samalonis, a sophomore human performance in clinical settings major and the president of Exercise is Medicine, spearheaded the planning of the event and emphasized the role of exercise in our lives.

The overall goal of this event, for Exercise is Medicine, is to get people excited to get active and healthy, Samalonis said. Exercise is the best preventative medicine out there; it prevents pretty much everything you can think of on the chronic spectrum of disease.

On the other hand, the event sought to raise awareness for ALS.

Also known as Lou Gehrigs disease, ALS is a disease that attacks motor neurons. Neurons control muscle movement, and as the disease progresses, those who suffer from it are unable to move their bodies.

As of now, there isnt a cure for ALS. However, the event helped to fund research to find a cure by donating 50% of the proceeds to the ALS Association, as well as helped raise awareness for the disease.

One of the participants, Claire McKissick, attended as part of a bonding activity for the swimming and diving team. Though she had become aware of the disease originally through the Ice Bucket Challenge that overtook the internet five years ago, McKissick heightened her awareness by attending the festival.

I think this definitely helps [bring awareness] because I think a lot of the attention has kind of died down a little bit with the challenge, but I think this is a really great way of reminding people that its still an issue, its still out there and its still something that we can come together and help fix, said McKissick, a senior Radio, Television and Film major.

Dr. Theresa Cone dedicated most of her life to teaching health and physical education, both in public schools and at Rowan. She focused much of her attention on promoting funding for those with disabilities.

Cone had an immense impact on those with whom she came into contact.

Dr. Gregory Biren, a health and exercise science professor and coordinator of exercise science at Rowan, was one of those people.

[She was] energetic beyond belief, compassionate beyond beliefshes the greatest teacher Ive ever met in my life, Biren said. She looks at you, she talks to you, shes patient with you, and she just has nothing but goodness to give to people to help them overcome their issues.

In light of his wifes passing, Dr. Stephen Cone had a few words to say as a reminder to everyone at the event.

Its a little sappy, he said, but Im going to say it: Love those who are close to you, bring those who are further away from you close to you. Dont waste a day; dont waste a moment.

For comments/questions about this story, emailfeatures@thewhitonline.com or tweet @TheWhitOnline.

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Rowan community hosts first annual Fitness Festival to promote fitness and ALS awareness - The Whit Online

California's largest inland lake, the Salton Sea, lies in the Imperial and Coachella valleys. The lake, which is more than 50 percent saltier than the Pacific Ocean, is becoming more salt than water because it's essentially evaporating. The lake and the area that surrounds it once hotspots for tourism and wildlife have essentially become ghost towns.

But while people no longer visit, the lake's evaporation still has consequences for both humans and animals. Rates of asthma there are disproportionately high and are thought to be caused by dust blown up from the dry lakebed. Meanwhile fish populations are plummeting as are populations of migratory birds. So, what is happening at the Salton Sea and is anything being done about it?

First, a little backstory. The Salton Sea has existed in many forms over millennia, depending on changing flows of water from the nearby Colorado River. It's located in the Salton Basin near the Mexican border, and geologic evidence shows it has alternated between mostly freshwater, mostly saltwater and nearly dry.

The sea was in a dry phase when in 1905, the Colorado River overflowed, and, due to human error, breached its levees, flooding the desert valley for two years. This created the 400-square-mile (1,036-square-kilometer) inland lake, which was larger than Lake Tahoe.

In the 1920s, locals decided to divert agricultural irrigation runoff to the lake, which kept it alive longer than it probably would have on its own, given it's located in a desert where temperatures frequently soar above 100 degrees Fahrenheit (37 degrees Celsius).

This accidental lake turned out to be a boon for wildlife, though. Birds flocked to the area and fish seemed to thrive there, as well. In 1930, the U.S. Fish and Wildlife Service created the Salton Sea Wildlife Refuge to protect the ducks, geese and shore birds attracted to the lake. Since its establishment, millions of birds, including 400 different species, have been spotted along the shores.

The area continued to thrive in the 1940s and '50s. Tourism grew, and developers branded it the "Salton Riviera," building hotels, homes and yacht clubs. Salton Sea State Park opened in 1955, then the second largest state park in California. The California Department of Fish and Game bred saltwater fish in the lake and they flourished and fed large populations of migratory birds.

But this desert paradise's days were numbered and by the 1970s, the "Salton Riviera" was headed for trouble.

Because of the lake's desert location, it has never gotten much precipitation. Plus, most of the surrounding activity was agricultural, so the lake experienced high levels of pesticide and fertilizer runoff. And because the lake has no outlet, the poisoned water had nowhere to go.

This caused a process called eutrophication, which results in increased algae and bacteria known as dead zones. This perfect storm of conditions caused the lake to become saltier. The high salinity, along with the eutrophication, caused massive fish die-offs.

By the 1990s, the shores of lake were littered with dead fish. And 150,000 eared grebes (small waterbirds) died on the Salton Sea between December 1991 and April 1992. Another 20,000 died in 1994. By 1996, type C avian botulism killed more than 10,000 white and brown pelicans and nearly 10,000 other fish-eating birds. More than 1,000 endangered brown pelicans died in the largest reported die-off of an endangered species. Eight million tilapia died in one day in the summer of 1999.

But back at the Salton Sea, tourism dropped off. The lake level dropped, too, due in part to evaporation and in part, ironically, to a reduction in the same agricultural runoff that had caused so many problems in the first place.

Then in 2003, things became even more dire. Southern California's water districts finally sign off on the Quantification Settlement Agreement (QSA) that had been in negotiation for years. It called for a large portion of the Colorado River water that had gone to the Imperial Valley for farming irrigation to be redirected to urban areas in the Coachella Valley and San Diego for residential use.

To make up for that water loss, the agreement designated a water restoration plan for the Salton Sea for 15 years. It also paid farmers in the Imperial Valley to leave some of their land fallow and so the water they would have used for agriculture would go the Salton Sea instead. But that deal ran out in Dec. 31, 2017, so the lake continued to dry up.

But even before the QSA deal expired, the Salton Sea ran into problems. In 2012, a sulfurous smell wafted across hundreds of miles of Southern California. The odor turned out to be from the lake's rotting fish carcasses. In addition, the dried-up lake bed left large swaths of dirt that was once covered by water exposed like a massive beach.

"That [exposed dirt] has the potential to be moved by wind and increase the amount of dust that's in the air," says Jill Johnston, Ph.D., an assistant professor of preventative medicine at the University of Southern California. "This dust can get in your lungs and adversely affect respiratory health, cardiovascular health and cause learning issues."

Johnston is currently working on a long-term research project, "The Salton Sea and Children's Health: Assessing Imperial Valley Respiratory Health and the Environment," with partner Shohreh Farzan, Ph.D. The project follows elementary school children near the Salton Sea to look at changes in their respiratory health because of exposure to particulate matter.

There has already been evidence of high rates of asthma is the area. Still, correlation is not causation, which is why Johnston's study is so important. "The aim is trying to answer the question if Salton Sea dust is impacting the health of the community," she says.

Over the years, there have been several remediation proposals that promised to deal with the problems at the Salton Sea. An editorial in the Los Angeles Times from March 2019 blames the government's lack of urgency, at least in part, on the lake's location: It's far away from the urban centers that policymakers in the state tend to focus on. In addition, it is close to the Mexican border and smack dab on the southern tip of the San Andreas Fault.

But there have been even more promises made and promises broken. Congress passed the Salton Sea Reclamation Act directing the Secretary of Interior to prepare a feasibility study and submit it to Congress by Jan. 1, 2000. It never did. In 2003, then-governor Gray Davis signed the Salton Sea Restoration Act and Salton Sea Restoration Fund. But neither was funded.

Later in 2007, Sen. Barbara Boxer authorized the Army Corps of Engineers to spend up to $30 million on Salton Sea projects. But money was never appropriated until 2015, when the Obama administration included a measly $200,000 for yet another study.

By 2008, California's Legislative Analyst's Office refused to endorse the $8.9-billion Salton Sea plan prepared and released by the state in 2007. Later in 2008, Gov. Arnold Schwarzenegger signed a bill meant to accelerate the distribution of money for Salton Sea restoration. But ultimately the $8.9-billion plan failed, too.

It wasn't until January 2016 that the California legislature approved $80 million for the Salton Sea the state's largest-ever allocation. And in February the U.S. Bureau of Reclamation said it would increase its annual spending from $300,000 to $3 million. These announcements both came on the heels of California's Little Hoover Commission report, which urged state officials to "take immediate action on the Salton Sea" because of it was a "public health catastrophe."

But this money is just a drop in the bucket. California has since released another 10-year Salton Sea plan, which it expects will cost at least $383 million. The state is no longer focused on restoring the Salton Sea. It's too late for that. The plan now is to mitigate damage to the habitat and the people, birds and other animals living near and around it. But that will only happen if the plan is fully funded. And if the past is any indicator of the future, what's to become of the Salton Sea doesn't look so bright.

See more here:
How the Salton Sea Became an Eco Wasteland - HowStuffWorks

Medical device manufacturers can now supply patients with devices that are tailored specifically to their physiology. As the nature of patient care evolves, so do global regulations governing the manufacture and supply chain for these personalized medical devices. These devices require more consistent monitoring and service and thus demand greater traceability. In the current complex environment, medical device organizations are turning to cloud Enterprise Resource Planning (ERP) solutions to enable them to better manage their devices. The ability to maintain visibility at a global scale requires a solution that has the capacity to reach across oceans and borders while maintaining compliance. Medical device manufacturers require ERP solutions that can analyze vast volumes of data that can be used to enhance the patient experience and the quality of treatment. Cloud-based ERP gives medical device manufacturers the software and the tools they need to effectively manage personalized patient devices.

ERP solutions have evolved from being installed on-premise at a manufacturers facility to living in the cloud in order to adapt and solve the challenges posed by distance. Organizations operate on a global scale, and as their footprint expands throughout the world, so do the regulatory and compliance complexities governing their operations in various regions. Cloud-based ERP has enabled medical device manufacturers to develop more agile and responsive solutions that allow their organization to keep up with the changing nature of the industry. Regional governing bodies, like FDA, Health Canada, and European Medicines Agency, modify regional regulations and compliance expectations regularly. Recent regulation changes, such as the transition from the Medical Device Directives (MDD) and Active Implantable Medical Device Directive (AIMDD) to the Medical Device Regulation (MDR), have a direct impact on medical device management. The introduction of Unique Device Identification (UDI) allows for increased traceability of medical devices. In order for medical device manufacturers to continue operations globally, they must comply with regional requirements in each of the countries in which they operate. The cloud has allowed medtech companies to shed the one-size-fits-all approach that previously hindered the effectiveness of their ERP solutions.

Medical device manufacturers are finding that one of the most beneficial aspects of cloud-based ERP comes from the ease of gathering and sharing data and the improved decision making enabled through better analysis. Organizations can eliminate constraints posed by traditional on-premise solutions enabling businesses to operate in a more real-time capacity.

ERP solutions are feature-rich now more than ever and continue to evolve to meet the changing needs of the industry. The use of advanced technology in conjunction with an organizations ERP solution critically impacts the relationship between the manufacturing organization and its customers. ERP companies are investigating how they can utilize IoT, machine learning and Artificial Intelligence (AI), robotic process automation (RPA), data lakes, and blockchain to enhance how their cloud software can improve patient outcomes.

Of these, Internet of Things (IoT) has been a primary focus for medical device manufacturers. Many medical devices are now paired with sensor technology to deliver real-time monitoring and transmission of patient information. This has allowed healthcare providers and medical device manufacturers to partner closely in providing thorough treatment to their patients across the globe. Traceability of the device gives the healthcare provider and manufacturer the opportunity to continuously and strategically monitor their devices. Manufacturers can trace a device to a particular customer and in turn analyze this patient information throughout the life span of the device to develop a comprehensive picture of the patients care. These sensors can signal when the device is malfunctioning and give the care provider an opportunity to respond quickly to preserve patient care. An ERP solution can record these malfunctions, adjustments, and repair as part of the complaint, non-conformance, and Corrective and Preventative Action (CAPA) process allowing the manufacturer to retain a comprehensive real-time Device History Record (DHR). The medical device manufacturer can gather significant data from a substantial sample of patients and analyze this data to advance R&D and develop more reliable products and treatments.

For instance, medical devices like the pacemaker can be uniquely configured to the patient and their physiology to help control the rate at which the patients heartbeats. These pacemakers have become so sophisticated that healthcare providers can now monitor and make real-time adjustments to a device inside a patients body. They monitor the patients heartbeat and relay the information, which allows the healthcare provider to develop a comprehensive healthcare plan. Patient mobility is no longer constrained, and cloud-based ERP allows real-time data to be gathered and analyzed regardless of the devices location.

Medical device management has moved beyond the confines of the walls of the hospital or doctors office. The search for improved patient outcomes has led to the emergence of personalized medicine. The strict tracking of critical device and patient information has become integral to achieving more efficient and effective care. The maturity of cloud-based ERP, through the integration of advanced technology and improved data gathering and analysis, has helped to facilitate a boom in patient-centric care.

See more here:
Medical Device Management in the World of Personalized Medicine - Medical Device and Diagnostics Industry

If your doctor told you she was going to give you a pill camera to swallow so she could see inside your intestines, would you be afraid? Already by 2008 pill cameras had been used in more than two million procedures since they were approved by the FDA in 2001, and they are becoming more common every day. When faced with the choice between a scope and swallowing a tiny pill, which sounds like a more pleasant experience? Nanotechnology in medicine is making procedures that once required anesthesia and hospital stays as simple as swallowing a pill. So whats next for nanotechnology in medicine?

Wound care is probably one of the most interesting advancements in the world of nanotechnology. There are bandages that can detect infection and dispense antibiotics right to the point of infection, both preventing the overuse of antibiotics as a preventative measure and also ensuring patients dont need constant monitoring during the healing process.

Nanotechnology can also be used to track the dosing and compliance of medications, ensuring patients who are already feeling poorly can get their medications at the right doses at the right times without forgetting whether they took it or not. Treatment non-adherence costs $290 billion in the United States from subsequent medical issues, and smart pills can help to curb those costs.

There are a wide variety of smart pills that solve a multitude of problems in a minimally invasive way, from clearing blockages to testing the gut microbiome. The question now is when will these technologies become affordable enough to be used en masse? There are also ethical concerns with certain types of technology being able to track patients or leading to vulnerabilities from hackers. Whats more, some tracking devices can enhance and confirm feelings of persecution from patients with certain types of mental health disorders.

Are you ready for the world of minimally invasive nanotechnology in medicine? Learn more about the future of nanotechnology in medicine below!

Last Updated on October 11, 2019

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Infographic: Is nanotechnology the future of medicine? - Techaeris

While trauma, divorce and bereavement can send anyone into a downward spiral of depression, there are some surprising, everyday, factors that also heighten our risk for mental illness.

A leading pharmaceutical firm concerned about SAs high use of antidepressant medication has launched an education campaign to shed light on the ordinary, often unsuspecting things that could have an impact on the publics mental well-being.

Abdurahman Kenny, Central Nervous System Portfolio Manager at Pharma Dynamics says the growing incidence of depression and anxiety worldwide implies that there are other factors too that make modern-day society more vulnerable to mental illness.

Research shows that spending too much time indoors, being stuck in traffic, heavy social media use, lack of movement and even slouching could all be triggers, he says.

According to research done by Harvards Medical School, staying cooped up indoors is not only bad for our physical health, but mental health too. These days most of us spend the majority of our days inside denying our bodies of much-needed vitamin D, which may provide some protection against depression.

Kenny says exposure to sunlight increases the brains production of serotonin a hormone associated with an elevated mood. By just spending 10 to 15 minutes outside with our arms and legs exposed to the sun (without sunscreen), is enough for our bodies to produce the required amount of vitamin D.

READ:SADAG urges men to seek mental health treatment

Our indoor lifestyle has led to more than a billion people across the glove being Vitamin D deficient even in the sunnier parts of the world, such as Australia, more than a third are deficient. Evidence shows that a lack of vitamin D increases the likelihood of depression by up to 14% and suicide by 50%, so be sure to make safe sun exposure either in the morning or late afternoons a habit, he remarks.

Life satisfaction and happiness also takes a dip among those who have to suffer through long commutes to work and back. A report by the UKs National Office of Statistics showed that people who commute for longer than half an hour to work each way (regardless of the mode of transport) have greater levels of stress and anxiety.

Kenny says the average South African spends almost three hours a day in traffic, which doesnt do our mood any good. He suggests speaking to employers about working flexi-hours or from home if the type of job you do allows for this arrangement. Alternatively, put on your favourite tunes or listen to motivational or interesting podcasts to keep you positive.

Heavy social media use equal to two or more hours a day has also been associated with poor mental health. Researchers from Ottawa Public Health found that those who spend more than two hours a day on social networking sites are more likely to suffer from psychological distress and suicidal thoughts than those who spend less time online.

READ:4 ways walking can boost your mental health

Based on the latest Global Digital Yearbook published by 'We Are Social' and 'Hootsuite', South Africans already spend almost three hours a day trawling Twitter, Facebook and other social platforms about half an hour more than the average global user which can take a toll on our mental well-being.

While social media isnt all bad, its important to set boundaries, as too much time on networking sites can have damaging consequences. Commit to not checking social media at meal times and when spending time with family and friends. Also, schedule regular breaks from social media. Studies have shown that week-long breaks from Facebook can lower your stress levels and lead to higher life satisfaction. Review your social media habits and instead of spending an exhaustive 30 to 45 minutes at a time on social media, rather limit it to five minutes in the morning, afternoon and early evening.

Sitting too long also makes us anxious! According to a study published in the American Journal of Preventative Medicine which tracked almost 9 000 women over a ten-year period. Researchers grouped them based on how much time they spent sitting each day (four or less hours a day or four to seven hours a day, or more than seven hours a day). Researchers found that those who were sedentary for more than seven hours a day were 47% more at risk of developing depression than those who sat for four or fewer hours a day. Women who didnt exercise at all, were 99% at risk of depressive symptoms, compared with those who exercised regularly.

Kenny says its no wonder that depression rates are on the increase when one considers that almost 40% of SA adults (men and women) are inactive based on the latest WHO statistics. Make a point of including exercise into your daily routine. Find something that you enjoy and stick to it. Exercise has shown to improve mood and forms part of a holistic treatment regime to help prevent the onset of depression.

Surprisingly, a bad posture and slouching in ones chair have also been linked to an increase in depressive symptoms.

San Francisco State University found that those who slouched felt more negative about themselves and had lower energy levels. Kenny points out that the way we sit or stand not only has an emotional effect on ourselves, but also on the way others view and treat us. So next time, pay special attention to how you sit and take notice of how you feel and how others treat you.

He also encourages the public to follow a healthy, balanced diet, getting enough sleep, limiting alcohol intake, spending quality time with friends and family, and making time for hobbies and interests, which all contribute to a healthy mental outlook.

In the past decade, depression rates have risen by nearly 20%, making it the leading cause of disability worldwide. More than 300 million people are affected and at its worst, could lead to suicide. In South Africa, an estimated 20% will experience a depressive disorder at least once in their lifetime.

This message comes in the wake of Mental Health Awareness Month this October and aims to curb climbing depression rates in the country.

If you have felt unusually down and depressed for a prolonged period and dont know who to turn to, contact Pharma Dynamics toll-free helpline on 0800 205 026, which is manned by trained counsellors who are on call from 8am to 8pm, seven days a week. For additional support, visit http://www.letstalkmh.co.za.

READ:Dont ignore mental health problem warning signs

Article source:Meropa Communications on behalf of Pharma Dynamics

Image courtesy of iStock/Srdjanns74

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Shocking every day factors that can cause mental illness - East Coast Radio

Riverton athletic trainer Ross Anderson met with the Worland coaches before their game on Sept. 27 to see which Warrior players had any special interests or medical histories. Thats part of his job since Worland is currently without a dedicated athletic trainer. Both sidelines have their own policies, some overlapping, when dealing with potential injuries. So they discussed those policies, knowing theyre not often implemented.

Both teams discovered policy importance and the importance of medical professionals that night.

When a Worland player was unresponsive after going to the turf, his sideline quickly signaled to the official and the referees signaled to Anderson, who came onto the field. He helped stabilize the Worland player and performed CPR on the field. The ambulance came on and the player was transported for further medical attention.

That was just one instance of a high school athlete in Wyoming undergoing a frightening medical episode. As possible head injuries across sports but especially in football continue to occur, Wyoming high schools have faced the reality of seeing those policies put into practice.

Riverton knew the value in having a dedicated medical professional, thats why they brought in Anderson. Anderson instructs CPR classes. He says regardless of that, his response came from his time at the University of Wyoming being taught by Bill Lyons, the universitys former head athletic trainer.

Its a standard of care. Any medical professional would have reacted in the same exact way and the more that we can, in our state, get athletic trainers and physicians on sidelines, the more that will help, Anderson said. When you get there you evaluate the situation as much as possible and keep a clear head as much as you can. You wonder how youll handle the situation each time but you kind of just react on training.

Anderson enacts policy set forth by Fremont County School District No. 25. They looked at the national recommendations made by the National Federation of High Schools and enacted policies adopted by the Wyoming High School Activities Association.

Communication has proven to be the key, for them, because coaches and parents alike stress the importance of athletes being forthright with possible symptoms. Riverton uses a 1-10 grade system and has literature available that instructs parents on what symptoms to watch for at each level.

With the evaluation all the way through, it helps everybody being on the same page, Anderson said. Everyone understands what we need to do.

***

Communication also proved critical in Rock Springs back in August. While Sweetwater County School District No. 1 refused to share results of its investigation into the injury that led to sophomore Jaciel Granados being life flighted to Salt Lake City, a district spokesperson did say that their results would not result in any changes to district policy when dealing with potential head injuries.

Rock Springs activities director Tom Jassman couldnt share many details with the Star-Tribune, but did stress his confidence in how the injury was handled. He was absolutely satisfied by the proactive measures taken by coaches, who pulled Granados out of a scrimmage before summoning emergency medical treatment.

Jassman stressed the key of communication when addressing potential player injury. Not only is their policy set forth by district personnel, but the communication loop keeps district officials involved. That adds the potential for more resources than limiting response between player, coach, parent and medical professional.

All Class 4A teams, like Rock Springs, and most Class 3A teams at this point, like Riverton, have designated medical professionals on-hand. Rock Springs goes through a priority checklist to ensure its athletic trainer, Jami Wiseman, is at the event where shes the most irreplaceable.

Schools below that 3A level can also attest to the importance of medical professionals, while also representing communities that dont necessarily have them readily available.

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Moorcroft, for instances, contracts a designated professional through Gillette Physical Therapy. Activities director Dusty Petz has already found benefits of that agreement, now in its fifth year. Together theyve implemented a Return to Play protocol. That starts with the universal impact testing done on each athlete in the preseason, which has become the baseline for nearly every program nationally. Then, when a possible concussion occurs, Moorcroft conducts another impact test within 24 hours of that impact, taking the player out of action if a concussion is diagnosed. All of that is essentially ordinary among programs state-wide, but its importance cannot be overstated.

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How Wyoming high schools have enacted on head injury policy - Casper Star-Tribune Online

Photo by Alec Douglas on Unsplash.

While trauma, divorce and bereavement can send anyone into a downward spiral of depression, there are some surprising everyday factors that also heighten the risk for mental illness.

A pharmaceutical firm, concerned about SAs high use of antidepressant medication, has launched an education campaign to shed light on the ordinary, often unsuspecting things that could have an impact on the publics mental well-being.

Abdurahman Kenny, central nervous system portfolio manager at Pharma Dynamics, stated that the growing incidence of depression and anxiety worldwide implies that there are other factors too that make modern-day society more vulnerable to mental illness.

Research shows that spending too much time indoors, being stuck in traffic, heavy social media use, lack of movement and even slouching could all be triggers, he explained.

According to research done by Harvards Medical School, staying cooped up indoors is not only bad for our physical health, but mental health too.

These days most of us spend the majority of our days inside denying our bodies of much-needed vitamin D, which may provide some protection against depression. Exposure to sunlight increases the brains production of serotonin- a hormone associated with an elevated mood. By just spending 10 to 15 minutes outside with our arms and legs exposed to the sun (without sunscreen), is enough for our bodies to produce the required amount of vitamin D, he shared.

An indoor lifestyle has led to more than a billion people across the glove being vitamin D deficient- even in the sunnier parts of the world, such as Australia, more than a third are deficient.

Evidence shows that a lack of vitamin D increases the likelihood of depression by up to 14 percent and suicide by 50 percent, so be sure to make safe sun exposure either in the morning or late afternoons a habit.

Life satisfaction and happiness also takes a dip among those who have to suffer through long commutes to work and back.

A report by the UKs National Office of Statistics showed that people, who commute for longer than half an hour to work each day(regardless of the mode of transport), have greater levels of stress and anxiety.

Kenny said the average South African spends almost three hours a day in traffic, which doesnt do moods any good.

He suggested speaking to employers about working flexi-hours or from home if the type of job you do allows for this arrangement.

Alternatively, put on your favourite tunes or listen to motivational or interesting podcasts to keep you positive, he advised.

Heavy social media use, equal to two or more hours a day, has also been associated with poor mental health.

While social media isnt all bad, its important to set boundaries, as too much time on networking sites can have damaging consequences. Commit to not checking social media at meal times and when spending time with family and friends. Also schedule regular breaks from social media, he added.

Sitting too long also makes you anxious! According to a study published in the American Journal of Preventative Medicine which tracked almost 9, 000 women over a 10-year period.

Researchers grouped them based on how much time they spent sitting each day (four or less hours a day or four to seven hours a day, or more than seven hours a day). Researchers found that those, who were sedentary for more than seven hours a day, were 47 percent more at risk of developing depression than those who sat for four or fewer hours a day.

Women, who didnt exercise at all, were 99 percent at risk of depressive symptoms, compared with those, who exercised regularly.

Kenny explained that its no wonder that depression rates are on the increase when one considers that almost 40 percent of SA adults (men and women) are inactive based on the latest WHO statistics.

Make a point of including exercise into your daily routine. Find something that you enjoy and stick to it. Exercise has shown to improve mood and forms part of a holistic treatment regime to help prevent the onset of depression, he suggested.

Surprisingly, a bad posture and slouching in ones chair have also been linked to an increase in depressive symptoms.

So next time, pay special attention to how you sit and take notice of how you feel and how others treat you, he stated.

He also encouraged the public to follow a healthy, balanced diet, getting enough sleep, limiting alcohol intake, spending quality time with friends and family, and making time for hobbies and interests, which all contribute to a healthy mental outlook.

In the past decade, depression rates have risen by nearly 20 percent, making it the leading cause of disability worldwide. More than 300 million people are affected and at its worst, could lead to suicide. In South Africa, an estimated 20 percent will experience a depressive disorder at least once in their lifetime.

This message comes in the wake of Mental Health Awareness Month this October and aims to curb climbing depression rates in the country.

Read the original here:
Surprising 'everyday' factors that affect mental health - Rising Sun Chatsworth

The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health.

Of particular emphasis are papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and substance use disorders. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. Papers on health services research pertinent to prevention and public health are also published. The journal also publishes official policy statements from the two co-sponsoring organizations, review articles, media reviews, and editorials. Finally, the journal periodically publishes supplements and special theme issues devoted to areas of current interest to the prevention community.

For information on the American College of Preventive Medicine (ACPM) and the Association for Prevention Teaching and Research (APTR), visit their web sites at the following URLs:http://www.acpm.org/ andhttp://www.aptrweb.org

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American Journal of Preventive Medicine - Elsevier