Healthcare delivery firms are increasingly owned by private equity, venture capital, and public ... [+] markets. Ethical operations of these firms will require new guardrails.

In the last decade, there has been a remarkable shift in ownership of healthcare delivery.Previously independent, physician-owned medical practices have been acquired by private equity firms and publicly traded corporations.The rationale for these acquisitions istypically two-fold.First, the acquiring entity can streamline cost structures and implement management practices to lower the overall cost of delivering care.Second, these firms can use their consolidated position in the marketplace to extract more favorable rates from third-party payers. In addition to private equity and publicly traded companies, venture capital firms have invested heavily in healthcare hoping to reap rewards from new models of care delivery.

Contrary to others observers of these trends, I believe thischange in ownership of healthcare is not intrinsically good or bad.There are countless examples of not-for-profit healthcare organizations behaving in predatory ways, just as there are examples of for-profit healthcare organizations operating altruistically.In addition, private capital does create opportunities to transform care delivery at scalein meaningful ways that otherwise might not otherwise receive investment.

This change in ownership does, however, create a new operating reality where the previous central tenet of healthcare deliverydoing what is best for the patientnow has a competing imperative: doing what is best for shareholders and investors.The code of professionalism taught in medical schools butts up against the fiduciary responsibility taught in business schools.I believe that publicly traded healthcare firms and their private equity counterparts must must proactively build ethical frameworks that ensure that these two imperatives conflict do not conflict.

In the past several months, I have observed several cases where these competing priorities were handled poorly.A hiring freeze was implemented in a clinical care company because of potential earnings shortfalls by its publicly-traded parentdespite clear patient need for clinical services.In the midst of the COVID-19 pandemic, a private equity owned home-based assessments company continued to perform non-clinical coding visits to capture more Medicare Advantage revenue.Entering a new funding cycle, a venture-backed healthcare company pushed its physicians for schedule follow-up visits earlier than needed to improve revenue and enhance the companys valuation.In each of these cases, a business imperative trumped a clinical onein each case introducing potential harm to patients for the benefit of shareholders and investors.

I believe that shareholders and investors have a longer-term interest in preserving the clinical ethics of the healthcare organizations in which they invest.There is growing momentum to limit the influence of private capital in healthcare.In California, for example, lawmakers introduced legislation requiring the State to approve any transaction in which a healthcare provider organization is being acquired by private equity.To be sure, this is a reaction to to the belief that private enterprise can not be trusted to do what is in the public interestin the way the medical profession historically has been trusted. The need for investor-backed healthcare to adopt a clear and defensible ethical framework has never been greater.I believe this framework has four parts: 1) board obligations and composition; 2) organizational structure; 3) clinical decision-making governance; and 4) compensation design.

Boards of private equity and public traded firms owning healthcare delivery assets must commit to a dual obligation to investors and shareholders and patients; and commit to the idea that when these interests are in conflict, the obligation to patients trumps others interests.Many decisions are made in organizations without adequate consideration of clinical impact because boards are not expected or empowered to consider these impacts.The monocular focus on creating shareholder value or long-term returns frees them from considering deleterious clinical impact.Enlightened boards and board members will often implicitly consider patient impactbut this is by no means an industry standard.Companies operating in healthcare must visibly and meaningfully acknowledge at the highest level that when human interests and financial interests collide, human interests will supersede financial interest in decision-making.This is a controversial notion to some who believe corporations need a single organizing objective.However, the only way investor-back healthcare will sustainably earn and maintain the public trust is to embrace this dual obligation and hierarchy.

To enable this dual obligation, companies should adopt an organizational structure in which the the chief clinical executive (often the chief medical officer) has dual reporting to the chief executive and the board.I have observed a deleterious trend where chief clinical executives are not reporting directly to the chief executives, sometimes reporting to chief operating officers or chief financial officers.I believe the enhanced primacy of clinical decision-making in these organizations demands a seat at two tablesthe organizational executive committee, leveling the chief medical officer equivalent to other corporate officers, but also a direct line to the board of directors.This structure is similar to the dual reporting many publicly traded companies adopt with other high priority areas such as compliance.The board must have direct visibility into clinical care operations in order to take responsibility for its ethical administration.This structure is not to absolve chief executive officers of their responsibilitybut to create a necessary counterbalance to the profit motive.

To further enhance the clinical sophistication of boards, organizations should consider a dedicated board position of an independent clinical director, a full-time practicing clinician or patient whose job it is to enhance the clinical perspective and decision-making of the boardand constantly ask the question how will the affect the patient. Too often, the physician voices (if any) on boards are physicians whose days in full-time clinical practice are far in the past and whose perspectives are more dominated by business considerations than clinical ones.Boards must be vigilant and thoughtful about installing a thoughtful clinical conscience in the form of a practicing physician or patient.

Clinical organizations must further adopt a governance norm that any decision that is clearly clinical in nature will ultimately be made by clinicians.To be sure, operations and finance leaders can and should provide input into clinical decisions.However, I havetoo often observed non-clinicians providing input into clinical decisions without adequate consideration of the consequences.The staffing example provided earlier is emblematic.Clinical decisions should ultimately be made by people expert in clinical care who are ultimately most capable of balancing trade-offs between business and clinical imperatives..

Finally, there must be vigilance around the design of incentives to ensure that clinical incentives payments of any kind are not tied to any potential source of harm to patientsoveruse, under-use, or misuse of clinical servicesor any imperative to enhance billing documentation (I.e. HCC coding).This may be the trickiest to implement, as companies typically use a combination of incentive payments and stock to reward performanceeach of which may be tied indirectly to decisions made by clinicians on a daily basis.Where possible,incentives must be tied most closely to clinical outcomes.

The incursion of private equity and publicly traded firms into healthcare delivery has grown increasingly controversialespecially as these firms grow in number and an increasing share of US healthcare is being delivered by entities whose stated primary obligation is to investors, not patients and communities.Private equity and public markets are not incompatible with ethical medical practice, but they do require enhanced ethical safeguards; the same might be said for large integrated delivery systems whose behaviors and business practices increasingly resemble for-profit companies more than community-based non-profits..The time is now for all types of organizations to proactively adopt frameworks to ensure that in the rush to create value our care and concern for the patient is not lostand that the ethical mores underlying the practice of medicine are not permanently compromised.

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Practicing Medicine In The Era Of Private Equity, Venture Capital, And Public Markets - Forbes

The Panthers Kawann Short, an E.C. Central grad, has played a key role on the defensive line.

The big, bold and colorful mural on the outside wall of Columbus Drive Gyros hits you like a storm surge while entering the building.

Its a life-size painting of hometown hero Kawann Short, defensive tackle for the Carolina Panthers, in his No. 99 uniform and holding the Super Bowl 50 trophy triumphantly in his right hand, an event that was not to be.

Throughout Northwest Indiana, there were banners, posters and pep rallies throughout the city in support of the E.C. Central grad. Social media kept him in touch daily with the Region, as if he were standing at the corner of Chicago Avenue and Indianapolis Boulevard, taking it all in.

One particular banner stretched across Columbus Drive at Alder Street, proclaimed: East Chicago is proud of our hometown Kawann Short. We are East Chicago Super Bowl 50. Go Panthers!

That 10-by-10-foot mural at Columbus Drive Gyros was painted Jan. 28 by the artist known as Fhat Cousins, who worked on his labor of love for eight hours.

Im 6-foot, and I still have to look up at it, said restaurant owner John Troupis. Its a win-win for the city because it went viral on social media. People are always pulling up, taking pictures of it.

Kawann loved it and ended up sharing it (on social media). It lit a fire under everybody to join the celebrating.

E.C. Central and middle school football players watched the 2016 Super Bowl in the high schools mini-theater, with a pre-game video message delivered by Kawann Short.

Ive seen so much of the love coming from home. Its sincere and coming from the heart, he said by phone prior to the game. East Chicago isnt very big. It has only about 30,000 but they respect people who get out and do things with their lives.

And when you do, they gladly jump on board and support you 100 percent.

The 44th overall pick in the 2013 draft, Short went from five sacks combined over his first two seasons to an eye-popping 11 in 2105-16 a team record for defensive tackles before the NFL championship game.

But what really jumps out to students of the game is 11 sacks, 55 tackles and three forced fumbles by a 4-3 interior lineman who also is a fierce pass rusher on the edge.

Short has transformed from a player who flashed across the screen once a game to a surefire Pro Bowler.

Im just out here doing what Im doing and trying to help this team win. Its the only thing I can ask or work for, said the 6-foot-3, 315-pound Short.

Short has partnered with Athletes for Charity, HealthLinc and the East Chicago Fire and Police Departments to create academic incentives to benefit youth. Hes launched a Youth Literacy Project to deliver books and academic incentives to children in need of encouragement when it comes to reading and academic achievement.

They always come back. Theyve never forgotten about their city and thats whats so great, said Steve Segura, multimedia director of East Chicago.

Getting involved, sending a positive message, can work wonders in any environment.

Some guys play this game 16-17 years and havent been to the Super Bowl. Ive played three years and Im here, said Short, who had a video message for the citys football players watching Super Bowl 50 game at the high school:

Ive been in your position and in the same seats many years ago. I had a vision and a dream to be where I am today, Short said. East Chicago ... you guys have been behind my back 100 percent. I appreciate you guys for being there, showing love and support. Youve been amazing. Have a blessed day.

As kids, ETwaun Moore and Short often stopped at Columbus Drive Gyros for a quick bite after school. It was a popular hangout with their basketball teammates.

ETwaun was the star point guard and Kawann a power forward on the Cardinals 2006-07 team. Owner John Troupis recalled how the players, prior to sectionals, had assured him they were going to win the 4A championship.

He made a deal. Win state and its all you can eat.

The Cardinals advanced through the tourney knocking off Lowell, Munster, South Bend Adams, Valparaiso and Marion for a shot at Indianapolis North Central, featuring high school phenom Eric Gordon.

E.C. Central prevailed, 87-83.

It wasnt long after when Moore and Short, holding the trophy, led the Cardinals into Columbus Drive Gyros and said: Were really hungry!

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SPORTS MEDICINE:Routine needed in times that are anything but - The Times of Northwest Indiana

(WJCL) - Nonprofits everywhere depend on donations to stay up and running, but unfortunately, the coronavirus has caused many to cancel major fundraising events.Now, one Hilton Head Island fundraiser is going virtual, and organizers are asking for your help to make it a success. Volunteers in Medicine Hilton Head Island works to provide health and wellness needs to the medically under-served on Hilton Head and Daufuskie Islands.The clinic is able to provide everything from internal medicine to radiology to dental care and so much more thanks to volunteers and donors.Unfortunately, one of VIMs biggest fundraisers of the year had to be canceled because of COVID-19, its Circle of Caring Gala.The gala accounts for about a quarter of a million dollars in our annual revenue budget each year. So thats just a huge gaping hole in our budget that were having to make up somehow," says SOT Ginger Allen, Director of Development for Volunteers in Medicine Hilton Head Island.That gala is now going virtual.It will include a presentation by the clinics executive director, patient testimonials and a virtual concert by island favorite Deas Guyz.Allen says now more than ever because of the coronavirus, VIMs services are a critical need.Our patients were among some of the hardest hit by this pandemic. They are already economically disadvantaged. Many of them are facing unemployment, lost wages. And they were already in a bad situation thats been made even tougher," Allen says.You can make the gala a success by becoming a donor or sponsor of the event.VIM neither seeks nor accepts any kind of government funding, so we are strictly reliant on donations from individuals and foundations. So its absolutely huge," Allen adds.Allen says VIM's services are not only beneficial to its patients; they keep the islands tourism industry going and the local economy thriving.I try to remind businesses that we really affect their bottom line because we keep employees at work, we keep them healthy, we keep them productive. We keep kids at school. And were really keeping this community strong," says Allen. If youd like to donate or sponsor the Circle of Caring Gala, click here.Right now the VIM clinic on Hilton Head is open, but by appointment only.

(WJCL) - Nonprofits everywhere depend on donations to stay up and running, but unfortunately, the coronavirus has caused many to cancel major fundraising events.

Now, one Hilton Head Island fundraiser is going virtual, and organizers are asking for your help to make it a success.

Volunteers in Medicine Hilton Head Island works to provide health and wellness needs to the medically under-served on Hilton Head and Daufuskie Islands.

The clinic is able to provide everything from internal medicine to radiology to dental care and so much more thanks to volunteers and donors.

Unfortunately, one of VIMs biggest fundraisers of the year had to be canceled because of COVID-19, its Circle of Caring Gala.

The gala accounts for about a quarter of a million dollars in our annual revenue budget each year. So thats just a huge gaping hole in our budget that were having to make up somehow," says SOT Ginger Allen, Director of Development for Volunteers in Medicine Hilton Head Island.

That gala is now going virtual.

It will include a presentation by the clinics executive director, patient testimonials and a virtual concert by island favorite Deas Guyz.

Allen says now more than ever because of the coronavirus, VIMs services are a critical need.

Our patients were among some of the hardest hit by this pandemic. They are already economically disadvantaged. Many of them are facing unemployment, lost wages. And they were already in a bad situation thats been made even tougher," Allen says.

You can make the gala a success by becoming a donor or sponsor of the event.

VIM neither seeks nor accepts any kind of government funding, so we are strictly reliant on donations from individuals and foundations. So its absolutely huge," Allen adds.

Allen says VIM's services are not only beneficial to its patients; they keep the islands tourism industry going and the local economy thriving.

I try to remind businesses that we really affect their bottom line because we keep employees at work, we keep them healthy, we keep them productive. We keep kids at school. And were really keeping this community strong," says Allen.

If youd like to donate or sponsor the Circle of Caring Gala, click here.

Right now the VIM clinic on Hilton Head is open, but by appointment only.

Read this article:

Volunteers in Medicine Hilton Head Island is counting on you to make its virtual gala a success - WJCL News

All residents of Shivamogga city will get Ayurvedic kits that will help avoid contracting COVID-19 infection, Minister for Rural Development and Panchayat Raj K.S. Eshwarappa said in Shivamogga on Monday.

As many as four lakh individuals would get free medicine, approved by the Ministry of AYUSH, worth 4 crore, he told a press conference.

Mr. Eshwarappa, who is also in-charge of Shivamogga district, said that the COVID-Surkasha team would distribute the kits. In the first phase, 85,000 families would get the kits, each one consisting of three types of medicine.

The public would be advised how to use the medicine. Beneficiaries have to produce their Aadhaar cards to obtain the kits. Representatives of local non-government organisations would be taking part in the distribution of the kits, he added.

The distribution programme would be held at Kuvempu Rangamandir in Shivamogga on Wednesday. The medicine would be first given to beneficiaries on C.L. Ramanna Road in the city the same day. Thereafter, all residents would get the kits in 10 days, he added.

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Free Ayurvedic medicine to fight COVID-19 - The Hindu

In all honesty, I hesitated a lot before writing this article. Part of my hesitation is because of my personality. I am traditionally an upbeat guy. I dont like negativity it drains productivity and efficiency.

My hesitation also comes from being a man of faith. I was taught to always call on God in my time of need and not succumb to the evil chatter of the beast in my ear.

But sometimes in life, we have to go to unpleasant places and discuss unfortunate things.

Part of my hesitation also involves the current state of our world; were going through bigger challenges right now with this pandemic. But maybe I can thank this pandemic for taking me to this unpleasant place of discussing the prevalence of suicide in the veterinary field.

I believe a lot of veterinarians and veterinary staff would like to shed a light on this topic but are hesitant because there is this idea that everything we do revolves around puppies and kittens. And how can that be unpleasant?

But in fact, veterinary medicine is among the highest at-risk occupations for suicide.

According toa study published by the American Veterinary Medical Association, 24.5% of men and 36.7% ofwomen in veterinary medicine have experienced depressive episodes, accounting for 11/2 times the prevalence of U.S. adults. In addition, 14.4% of men and 19.1% ofwomen in the veterinary field have considered suicide.

More shocking, from 1979 to 2015, the rate of veterinarian death by suicide wasup to 31/2 timesas high asforthe general U.S. population.

Just as human doctors, veterinarians also spend at leastfouryears in doctoral programs.

Most veterinarians I know went to veterinary school and chose this career because of their passion for working with animals (all kinds) regardless of the monetary gain. They could have easily chosen to treat humans and make more money.

So how can performing such a pleasant job become stressful to this tragic end?

How can treating puppies and kittens bring anyone depression?

Perhaps one of the reasons is student debt. Honestly, this is a factor that deters a lot of students from entering this field, and I know several. The average student loan debt for veterinarians typically exceeds $200,000 with monthly payments of more than $2,000 on a standard 10-year repayment term. This massive debt load along with the lack of debit to income ratio makes veterinarians feel that they may never be able to achieve financial security.

Another reason that may contribute to depression among veterinarians is the long work hours. The majority of veterinarians that I personally know are general practitioners. This means that they not only treat clinical cases but also perform surgeries. Sometimes, both tasks are done in the same day with seeing appointments in the morning and then scrubbing in for surgeries in the afternoon or vice versa.

As GPs, we encounter a lot of different client personalities. The majority of our clients are appreciative of what we do and respect our time. However, I would be lying if I didnt also mention that we do come across people who do not respect our time.

This is most obvious when they do not commit to coming in for their scheduled appointments or demand that their pet be squeezed in to an already tight schedule. Because of these long hours (sometimes 12-hour days), veterinarians suffer from burnout, neglect self-care and undergo compassion fatigue.

Another reason for veterinary depression that can contribute to suicide is that fact that most veterinarians wear at the very least two hats: one of a medical professional and one of a business professional. They are on ground between veterinary medicine as a service to help injured animals and relieve their pain and sufferings and one of operating a small business that has employees, bills and operating expenses.

Talk of money in the veterinary setting is considered a deadly sin. There is an unfortunate understanding that if you ever talk about money, you will be labeled as heartless, money-hungry and other various names that I cant share here.

Exposure to euthanasia on a daily basis is another contributing factor to veterinary depression. This is by far the hardest part of the job.

Undoubtedly, our job as veterinarians is to prolong a animals lives by healing their illnesses and making them feel better. We never knew that we would also become educators and counselors by participating in end-of-life discussions.

Pet parents expect us to be strong sometimes to the point of burying our own emotions. I cant tell you how many times I have heard, I dont think I could do what you do. During those dark days, its hard to understand if that sentiment is a compliment or a criticism of our profession. In the end, we know that euthanasia is the most humane thing to do to stop the pain and suffering of an animal.

I also cannot ignore the role of social media. We are living in the age of anonymous online reviews and individuals saying whatever it is they want to say. Veterinary teams are expected to be perfect all the time. And unfortunately, like everyone else, we sometimes have bad days. If by chance we dont meet the clients expectations on that particular day, they resort to aggressive and antagonistic words sometimes even defamatory. Their words hurt more than they will ever realize.

Finally, I love what I do. If I did not, I do not think that I could spend the amount of hours I do in the office. I dont think I would be willing to tackle difficult clinical cases or perform surgeries that may have risky outcomes.

I do not think I would be willing to forgo a lot of social and family events.

With all this being said, I cannot ignore the fact that I have fellow colleagues who may be struggling and deserve a little more compassion and understanding from our communities.

We are making critical coverage of the coronavirus available for free. Please consider subscribing so we can continue to bring you the latest news and information on this developing story.

Fayez Assad, DVM, medical director at Johnstown Veterinary Associates, was born and raised in Cairo, Egypt. In 1994, he graduated from the Cairo University School of Veterinary Medicine. In 1999, Assad moved to Johnstown and attended Tufts University School of Veterinary Medicine in North Grafton, Massachusetts, where he obtained his degree. Assad is an active member of AVMA, PAVMA, AAFP and AAHA. He is also a USDA-accredited veterinarian.

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Fayez Assad | Veterinary medicine among the highest at-risk occupations for depression, suicide - TribDem.com

CBD-infused coffee almost sounds like the premise for a bad sitcom episode. But seriously...isnt it almost comical to consider what happens when the go-go kick of high-octane caffeine slams headlong into the calming, tranquil effects of CBD?

The reality is, it actually can be the best of both worlds situation for many CBD coffee fans. A morning cup not only kickstarts the day and propels you along like traditional coffee, but thanks to CBD, without any of the jitters or headaches that some encounter. Plus, you still get all the pain relief, anti-anxiety, and other medicinal advantages that CBD provides.

Since its definitely worth trying for yourself, you can start with some quality by sampling this Bean and Bud by Allo Rise blend.

Made from 100 percent Arabica coffee beans, this combination of elite beans with CBD is an exquisite balancing act. In order to maintain responsible and sustainable practices, Bean and Bud coffees are sourced directly from farmers, who actually use their own unique natural processes to infuse the coffee with industrial CBD without losing the grains genuine properties.

This African Essential Blend Coffee is rich, yet bold, with notable hints of raspberry and dark chocolate with no artificial flavors or additives. Meanwhile, the 8-ounce bag contains 320 mg of CBD, which many users swear serves as a near miracle elixir, providing relief for anxiety, depression, post-traumatic stress, body pain, and even a better nights sleep.

If youre already someone who makes daily Starbucks runs or appreciates the soothing properties of CBD, this Bean and Bud blend might be the perfect way to see how those two worlds work together to help you navigate through your day.

Right now, you can get an 8-ounce bag of Bean and Bud by Allo Rise, good for about 40 cups of coffee, for $2 off the regular price, available now for just $29.99.

In this footage, a supercomputers CPU cores nearly 900 of them are neatly lined up in the Task Manager. The Doom logo appears, generated by code that targets each core. Then Doom itself plays, each pixel generated by thrashing a core with just the right amount of busy work. Max Holt: Finally got []

The UK government today ordered domestic companies to stop buying equipment from Chinese vendor Huawei and to stop using its kit entirely by 2027. Huawei is suspected to be an arm of the Chinese government, breaking into western markets (and maybe its networks) by selling impossibly cheap equipment. The UK only recently approved more Huawei []

Amazons new Chinese thermal spycam vendor was blacklisted by U.S. over allegations it helped China detain and monitor Uighurs and other Muslim minorities

You sort out your recycling. You dont use plastic bottles anymore. And youve even gone paperless, right down to using the canvas shopping bag at the grocery store. But even if youre trying to be ultra-vigilant to the environmental impact you make on our planet, there are bound to be some blind spots in that []

When you used to walk through any office you would likely spot a few bobbleheads. These wobbly figurines are great fun to have around, although most celebrate people we will never meet. For something a little more personal, tryHandmade Custom Bobbleheads. These mini caricatures are sculpted and painted by skilled artisans, based on any photo []

Most people enjoy having items on their desks that convey a taste of who they are and what theyre about to visitors. Under those circumstances, could there possibly be a greater flex to show off all of your galactic ambitions than having the entire solar system on exhibit right on your desktop? Even if you []

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CBD-infused coffee just might be the medicine you need to start your day - Boing Boing

This article is part of our continuing Fast Forward series, which examines technological, economic, social and cultural shifts that happen as businesses evolve.

As shortages of personal protective equipment persist during the coronavirus pandemic, 3-D printing has helped to alleviate some of the gaps. But Anthony Atala, the director of the Wake Forest Institute for Regenerative Medicine, and his team are using the process in a more innovative way: creating tiny replicas of human organs some as small as a pinhead to test drugs to fight Covid-19.

The team is constructing miniature lungs and colons two organs particularly affected by the coronavirus then sending them overnight by courier for testing at a biosafety lab at George Mason University in Fairfax, Va. While they initially created some of the so-called organoids by hand using a pipette, they are beginning to print these at scale for research as the pandemic continues to surge.

In the past few years, Dr. Atalas institute had already printed these tiny clusters of cells to test drug efficacy against bacteria and infectious diseases like the Zika virus, but we never thought wed be considering this for a pandemic, he said. His team has the ability to print thousands an hour, he said from his lab in Winston-Salem, N.C.

The process of constructing human tissue this way is a form of bioprinting. While its use in humans is still years away, researchers are honing the methods to test drugs and, eventually, to create skin and full-size organs for transplanting. Researchers are making strides in printing skin, critical for burn victims; managing diseases like diabetes where wound healing is difficult; and for the testing of cosmetics without harming animals, or, of course, humans.

Even to us it sometimes seems like science fiction, said Akhilesh Gaharwar, who directs a cross-disciplinary lab in the biomedical engineering department at Texas A&M University that focuses on bioprinting and other approaches to regenerative medicine.

Bioprintings importance for pharmaceutical analysis is paramount now, not only for potential Covid-19 treatments, but also for testing treatments for cancer and other diseases. Dr. Atala says that the organoids allow researchers to analyze a drugs impact on an organ without the noise of an individuals metabolism.

He cited Rezulin, a popular diabetes drug recalled in 2000 after there was evidence of liver failure. His lab tested an archived version of the drug, and Dr. Atala said that within two weeks, the liver toxicity became apparent. What accounts for the difference? An organoid replicates an organ in its purest form and offers data points that might not occur in clinical trials, he said, adding that the testing is additive to, rather than in lieu of, clinical trials.

Testing on bioprinted skin or other miniature organs also can more readily determine which drugs that work in animals like rats might not perform well in people.

The 3-D models can circumvent animal testing and make the pathway stronger from the lab to the clinic, Dr. Gaharwar said. That has importance for consumer goods as well as pharmaceuticals; since 2013, the European Union, for example, has prohibited cosmetics companies from testing products on animals.

The foundation for a printed organ is known as a scaffold, made of biodegradable materials. To provide nutrition for the organoid, microscopic channels only 50 microns in diameter roughly half the size of a human hair are included in the scaffold. Once completed, the bioink, a liquid combination of cells and hydrogel that turns into gelatin, is then printed onto the scaffold like a layer cake, Dr. Atala said.

Another important part of the process is constructing blood vessels as part of the printing. Pankaj Karande, an assistant professor of chemical and biological engineering at Rensselaer Polytechnic Institute, has been experimenting with skin printing since 2014 and recently had success in this step.

Using a cell known as a fibroblast, which helps with growth, along with collagen, as a scaffold, researchers at the institute printed the epidermis and dermis, the first two layers of skin. (The hypodermis is the third layer.) It turns out the skin cells dont mind being sheared, Dr. Karande said, and they could ultimately survive.

But their work hit a snag: Without incorporating blood vessels, the skin eventually sloughs off. Collaborating with Jordan Pober and W. Mark Saltzman of Yale University, they eventually succeeded in constructing all three layers of human skin as well as vasculature, or blood vessels, which Dr. Karande said was essential to the skins surviving after it had been grafted.

The three began experimenting with integrating human endothelial cells, which line blood vessels, and human pericyte cells, which surround the endothelial cells, into the skin as it was printed. Eventually, after much trial and error, they were able to integrate the blood vessels with the skin and found that connections were formed between new and existing blood vessels.

Updated July 27, 2020

While the work is preliminary tested in mice Dr. Karande said he was hopeful that the success in printing integrated skin and vasculature would set the stage for successful grafting in humans eventually.

The research, according to Dr. Karande, is painstaking and involves a lot of trial and error. We have Plan A, which we often know wont work and then we go down the list. We can often write about what works in five pages but have 5,000 pages of what didnt work, he added.

Dr. Gaharwars lab also is investigating whether human bone tissue can be printed for eventual transplantation. His hope, he says, is that in the future, patient radiographic scans can be translated into the exact shape needed for implantation, especially important in repairing craniofacial defects where the curvature needed can be difficult to recreate.

Like Dr. Gaharwar, Dr. Karande says that personalization is important. He says that his work has already shown that skin can be fabricated to match an individuals color. And, because the skin is also critical in regulating body temperature, he is also working to engineer sweat glands into the skin, along with hair follicles.

When we graft, we want to be able to recreate the full functionality of the skin, Dr. Karande said. And by using the cells from a patient, rather than a donor, the risk of rejection is minimized or eliminated altogether.

Not surprisingly, researchers are also exploring the collection of data from testing. The team at Wake Forest is partnering with the technology company Oracle to capture the data from the organoids and analyze it with artificial intelligence. The project, known generally as the body-on-a-chip system, involves printing living tissue on a microchip to allow drugs to be studied for toxicity and efficacy even before clinical trials begin. The chips can be the size of a nickel or quarter, which is big enough to hold 10 to 12 miniature organs.

We work a lot with researchers, pharmaceutical companies and biotech companies, and we are trying to seed advances as quickly as possible, analyze data and develop new drugs, said Rebecca Laborde, the master principal scientist in Oracles health sciences division. This is the most exciting project Ive worked on in a long time.

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A Possible Weapon Against the Pandemic: Printing Human Tissue - The New York Times

MORGANTOWN, W.Va. A new project has been launched by the WVU School of Medicine in a partnership with the DTE Energy Foundation. This will allow physicians to now take to the road for the first Emergency Medical Services (EMS) Physicians Response Program.

The DTE Energy Foundation has awarded a $300,000 grant to the Department of Emergency Medicine Division of Prehospital Medicine at WVU to help establish this program. The program will allow certified physicians to respond to emergency calls and provide all the same services that the hospital has out in the field.

The development of EMS, in the past, its often focused on putting resources where there are larger communities. In doing so, they put the bulk of the resources within five minutes of a hospital, said Medical Director P.S. Martin. What were trying to do is reverse that. Were trying to take those resources actually out to the rural areas, where there may be fewer incidents, but where those resources can make the biggest difference.

Through this program, a physician-led team will work collaboratively with existing EMS resources to provide emergency medical treatment that was previously unavailable prior to arriving at hospitals. These treatments include diagnostic ultrasounds, medication/video-assisted intubations to secure patients airways, administration of blood products, procedural sedations, life-saving field amputations and more.

The vehicles will be able to provide all the same resources, and identical technology that the emergency helicopters have. This will allow easy transition if the there is a need for that. This program is already partially launched in Marion and Tucker counties. By this time next year, the goal is to have four certified physicians able to respond to calls and spread to more of the rural counties.

P.S. Martin is the Medical Director of both counties, and grew up in Thomas around the EMS station. He says now that he can help bring emergency services to the furthest point of the region, and possibly save several more lives, means everything to him.

The ability to take what Ive learned in my specialty emergency medicine, and subspecialty of EMS, to take that back to the rural communities, means the world to me. The office of EMS has clearly said if things if things continue to work well with the program, things will move quickly, said P.S. Martin. As the fellowships start up, and we get more physicians trained, I hope this spreads throughout the state of West Virginia.

In addition to enhancing patient care and research, the program will also provide important learning opportunities for health sciences students, emergency medicine residents and physicians participating in an intensive one year EMS fellowship tentatively slated to welcome its first class in 2021.

The fellowship will accept two per year, and will prepare physicians who have completed their emergency medicine residency for EMS subspecialty certification. For the full story, visit West Virginia Universitys website.

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New project launched by the WVU School of Medicine in a partnership with the DTE Energy Foundation - WBOY.com

The number of active cases province-wide is now 1,430, up 89 from Friday, and the number of recovered cases is 8,774, up 207. The province now has 10,390 total cases.

As we see in the case numbers, the curve is no longer flat in Alberta, said Dr. Deena Hinshaw. We all need to assess our own lives for where we are at risk of spreading or contracting the virus. All of us can make changes to our daily routines to prevent the spread of COVID.

Referencing an earlier description of hers that described the virus is like a wall of water, she said Alberta can tolerate some gradual streams of cases, as long as they stay gradual.

What we need to prevent is a scenario where the breaches get so large that we become swamped with cases that overwhelm our system. This can happen quickly if we let our guard down, Hinshaw said.

COVID is out there waiting for us to become too tired to wash our hands, too distracted to notice whether we are within two metres of someone else, too busy to stay home if we are sick or too polite to suggest we all bring our own food to a gathering.

She said not taking simple everyday precautions lets everyone down and that its in everyones control to get case numbers moving in a positive direction and that we can get back to where we were a month ago when the province moved forward with Stage 2 of relaunch when the active case numbers were low.

Every step we take as individuals to stop the spread is a step in the direction of health and safety of everyone, the chief medical officer of health said.

She encouraged the wearing of masks, especially when unable to maintain proper physical distance and in public spaces.

Asked whether the economy is being weighted more heavily than public health, Hinshaw said that health is about more than just avoidance of the virus and that a more assertive approach is being developed for businesses to remain open and keep everyone safe.

A new online assessment tool has been created by Alberta Health for those who are at higher risk of severe outcomes. The tool will help people identify their level of risk for severe outcomes and guide protection decisions.

The chief medical officer of health also announced My Health Records, a secure online portal for Albertans to see their health records and get quicker test results.

She said Alberta health is working hard to shorten the time between testing and results and connect those who have the virus or are contacts of cases to the public health teams.

The 294 cases reported today is down from the 368 reported in the three-day period last weekend.

There are 88 Albertans currently in hospital due to COVID-19, 17 of which are in ICU. Hinshaw announced eight more deaths, bringing the total to 186.

The province conducted 27,893 tests in the past 72 hours.

The South Zone has a total of 1,599 cases 1,442 recovered, an increase of 28, and 142 active, an increase of one.

There are 13 people in the zone in hospital, three of which are in ICU and there have been 16 deaths, an increase of two.

Cypress County has totalled 31 cases one new active case and 30 recovered.

The County of Forty Mile has 10 total cases, three active cases and seven recovered.

The MD of Taber has 33 total cases 17 active and 16 recovered.

Special Areas No. 2 has 10 active cases and two recovered.

Brooks has two new cases, the first in more than a week. The city now has 1,123 total cases 1,111 are recovered and three are active. Brooks has recorded nine deaths. The County of Newell is showing a total of 23 cases three active and 20 recovered.

The County of Warner has 53 total cases. There are now six active cases and 46 recovered. There has been one death in the county.

The City of Lethbridge has a total of 102 cases. Of those, 37 are listed as active and 63 recovered. The city recorded its first two COVID-19 deaths over the weekend. Lethbridge County has 25 cases, 10 active cases and 15 recovered.

The figures on alberta.ca are up-to-date as of end of day July 26, 2020.

Saskatchewan reported 31 new cases of COVID-19 today. Of those, just nine are in the South Zone. Late last week the majority of cases 24 out of 27 on Friday were in the South Zone.

According to the government, 21 of the cases reported Friday were on colonies in the southwest and west central regions. Todays update from the Saskatchewan government indicates a slowing number of cases on colonies in the south and west central regions, but also a spread around the province. The update reports that 22 of the 31 cases are from colonies in the south, central, Saskatoon and north regions.

Saskatchewan has a total of 1,209 cases, 307 considered active. There are 886 recovered cases and there have 16 COVID-19 deaths in the province.

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Over 300 cases in Alberta over the weekend, no change in Medicine Hat - CHAT News Today

A $600 per week lifeline is about to run out of rope, threatening to leave millions of American families at the end of theirs.

The pandemic unemployment assistance payments, which were approved in March as part of the government's fiscal stimulus package, known as the CARES Act, are set to expire July 31. For administrative reasons, states have said the last payments will go out this weekend if the program isn't extended. Lawmakers are currently debating whether to extend the benefit, with some arguing that the size of the payments eliminates the incentive to work. Others say the benefit has been an economic lifeline for millions who lost their jobs because of the pandemic.

Sarah is a single mother from rural Texas, who asked for her last name to be withheld so her children arent embarrassed by others knowing they rely on government assistance. Earlier this year, she left her job in a densely packed call center when the employer and coworkers refused to follow standard guidelines from the Centers for Disease Control and Prevention on masks and social distancing, she told NBC News.

When it became evident that it would be business as usual at the call center and many of the management team were convinced it was all a hoax or being exaggerated, I left, Sarah said. Since then, one of her former colleagues has tested positive.

As badly as I need to go back to work after the extra $600 stops, I won't risk my family, Sarah told NBC News.

Now shes struggling to put food on the table and make rent, and doesnt know how shell manage when the funds for the emergency federal program extra assistance runs out. The local food bank only gives out small bags of bakery items, not enough to feed four children ranging in age from elementary to high school.

This month the Texas Health and Human Services Commission revoked her SNAP food benefits after she made $3 above the income limit, because her ex-husband had suddenly paid backdated alimony.

When Sarah contacted the agency, she got conflicting advice and was told it could take over two months to resolve her issue. After being contacted by NBC News, an agency spokesperson said they reviewed her case and found she had exceeded federally established income limits for SNAP but they've now reached out to her to let her know she will be eligible again in August.

The government benefits programs have failed the most vulnerable of us all, the working class American family, Sarah said.

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According to an analysis by The Century Foundation, an estimated 25 million Americans have benefited from the Federal Pandemic Unemployment Compensation. The program provides additional emergency income on top of an employees regular unemployment benefits which states set at around 50 percent of a person's previous income.

The program has been criticized for being overly generous to some workers for giving them more money than they made before the pandemic. But technical restrictions in the historically underfunded state unemployment infrastructure mandated a one-size-fits-all approach in order to deliver assistance as quickly and as widely as possible.

Many of the states antiquated unemployment systems, some programmed in the obsolete programming language of COBOL, couldnt handle fine-tuning payments based on a percentage replacement for lost wages, said Chad Stone, chief economist for the Center on Budget and Policy Priorities, a left-leaning research and advocacy institute.

That necessitated a flat rate that would work as income replacement to meet the needs for the greatest number of workers, and their ability to keep paying their bills and purchasing.

A compensation of $600 was designed to make up the difference between the $980 average weekly earnings of employees on private payrolls in March and the $380 average amount of weekly unemployment insurance benefits.

There is consensus in Washington that federal unemployment assistance needs to be continued, but there are differences over how it should be structured.

Pandemic Unemployment Assistance is expiring and we need to respond to that, Treasury Secretary Steven Mnuchin told CNBC in an interview on Thursday morning. We wont pay people more to stay at home than to work, but people who cant find jobs will get approximately 70 percent wage replacement.

There are no details on how that would be achieved through the current system. Either way, it may be weeks before any payments resume, as state unemployment offices especially those with the oldest systems will require time to reprogram their computers.

The need for continuation of the $600 was further highlighted on Thursday, after the Labor Department reported that more than 1.4 million workers filed new claims for state unemployment benefits last week. It's the first time in almost four months that weekly unemployment claims have risen, and marks the 18th-straight week that more than 1 million Americans have sought unemployment aid.

Tabitha Griffin, a single mother in Florida, had to shut down the cleaning business she owned when the pandemic hit. For now, she lives in a reduced-rate hotel room along with her 7-year-old daughter. If she can't afford that, they will have to sleep in her car, she told NBC News.

She has applied for federal pandemic unemployment assistance benefits, but accidentally entered one of her bank account digits wrong. She fixed it and has pleaded with the Department of Economic Opportunity, the state unemployment agency, to reissue her pay, to no avail.

When her backpay comes through, she says she will have enough to find a long-term rental.

Her attempts to contact the agency went nowhere. After being contacted by NBC News, the Florida Department of Economic Opportunity said it would look into the matter. But days later, she still hadn't heard from the agency.

To have a child and feel like you're failing them is the worst thing Ive ever felt, Griffin said.

The situation is especially critical for some unemployed workers who have been relying on the federal assistance to cover their ongoing out-of-pocket medical expenses.

Amy Leyendecker is a 46-year-old with Type 1 diabetes living in New Mexico. She needs daily doses of insulin to avoid going into a life-threatening coma. In 2018, she lost a foot to amputation after trying to ration her insulin to stretch it out. With a note from her doctor, she went on unemployment in March from her part-time cashier job after her employers encouraged anyone to do so who didnt feel safe working through the pandemic. Since then, the $600 per week has enabled her to cover her monthly medical costs.

We don't know how long this will go on, so I don't know month to month if I will be able to afford to live. This month, I am good unlike many many others. Next month? I guess we will see, Leyendecker said.

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Millions rely on emergency pandemic benefits for rent, food, and medicine. Now, that lifeline could disappear. - NBC News

Experts from around the world will discuss the impact of the internet and medicine on modern masculinity at a major conference.

Researchers will debate the changing ways people are able to act on their desires and socialise, and the complex ways in which politics and biology interact.

The online event, held from August 31 to September 11, will include keynote lectures and panels on topics including the sexual politics of science, porn, hook-up apps, and how the AIDS epidemic has affected the way gay communities meet.

The free conference, open to all, will feature presentations by art historians, geographers, anthropologists, public health researchers, sociologists, media experts and cultural theorists.

Dr Joo Florncio, from the University of Exeter, who is organising the event, said: Were living in a viral world in many ways the age of memes, fake news, hacking, epidemics, ecological crisis, global migration flows, online dating, and antiretroviral drugs. This can bring both new forms of control through medication, cyber security, monitoring and surveillance systems, but it can also open up to new ways of feeling and spend time with one another other socially and intimately.

Im delighted we have such a prestigious group of researchers and experts from around the world who will come together to discuss these complex issues and I hope as many people will be able to join us virtually.

Topics discussed at the event include Viagra spam, masculinity in YouTube videos, online porn, masculinity in the Philippines, the politics behind the use of PrEP and the role of drugs on how people socially construct their masculinity, the impact of PrEP on the cultural memory of AIDS, teenage fiction and fantasies of bodily contagion.

The conference will also include the virtual launch of Dr Florncios new book Bareback Porn, Porous Masculinities, Queer Futures: The Ethics of Becoming-Pig, published by Routledge.

Keynote speakers Professor Tim Dean from the University of Illinois, Professor Susanna Paasonen from the University of Turku, and Professor John Mercer from Birmingham City University will be joined by other expert speakers based at institutions in the UK, USA, Canada, Denmark, Switzerland, the Philippines, Germany, Brazil, India, Australia, and New Zealand.

Originally posted here:

Experts to discuss impact of internet and medicine on modern masculinity at major conference - Mirage News