Integrated health care a growing movement

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The 40-year-old man didnt want rehabilitation.

He knew he had a drinking problem, knew if he kept drinking nearly a case of beer a day it would kill him. But he wasnt ready to quit.

So psychologist Suzanne Bailey waited. And waited.

A typical doctor probably wouldnt have waited so long -- more than a year -- for the man to be ready for substance abuse treatment, but Bailey isnt a typical doctor.

As a member of an integrated health care team in Knoxville, Tennessee, she is charged with treating the bodies and the minds of some of her communitys most desperate and poverty-stricken residents.

She works for a Cherokee Health Systems clinic that combines the expertise of behavioral health specialists, accustomed to addressing mental health issues like depression and bipolar disorder, with primary care physicians.

With 57 clinical sites in 14 Tennessee counties, Cherokee Health is one of the largest integrated health care providers in America, and a health care initiative to be launched in January in Lincoln is expected to be built partially on Cherokee's integrated approach to health care.

Nonprofit health providers Lutheran Family Services of Nebraska and the Peoples Health Center plan to combine operations to form the Health 360 Clinic, which is expected to open in December 2015 in the former OfficeMax building at 23rd and O streets.

On Jan. 12, the two nonprofits will open a smaller integrated clinic in Lutheran Family Services offices at 2201 S. 17th St. That smaller clinic will be open until the larger one opens, when Lutheran Family Services plans to move into the space at 23rd and O as well.

By the end of 2015, the Health 360 Clinic will have one physician, one nurse practitioner and one nurse practitioner/physician assistant. Organizers are expecting 20,000 medical patient visits and 12,000 behavioral health visits within the first three years.

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Integrated health care a growing movement

Why changes in health care costs vary widely around the U.S.

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JUDY WOODRUFF: Lets turn to the latest on expanding health insurance coverage and the real costs for people.

The law is called the Affordable Care Act. And while theres been much attention on enrollment, theres been less discussion about a key question, affordability. The first month of the new enrollment season through has gone a lot more smoothly than last year. More than 2.5 million people have selected a plan through the federal exchange so far.

But what about premiums and out-of-pocket costs?

Mary Agnes Carey covers this for Kaiser Health News. I sat down with her the other day to discuss the latest.

Mary Agnes Carey, welcome back.

MARY AGNES CAREY, Kaiser Health News: Thanks for having me.

JUDY WOODRUFF: So lets talk first about enrollment. We understand there has been a surge in interest just in the first month. What are you seeing?

MARY AGNES CAREY: From November 15 to until December 10, which was the last set of reported figures, 2.5 million people have signed up for a health plan on healthcare.gov.

And, by comparison, this is what happened in the first three months of last year, when you had all those Web site problems. Were not seeing those this year. But there seems to be real interest.

JUDY WOODRUFF: Can you so is it just the fact that the Web site is up and working? Is there something else going on here?

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Why changes in health care costs vary widely around the U.S.

Health care leaders lobby state for improvements

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By - Associated Press - Tuesday, December 23, 2014

PROVIDENCE, R.I. (AP) - Health-care leaders have asked Rhode Islands top elected officials to back efforts improving health care delivery in Rhode Island.

The Providence Journal reports (http://bit.ly/1gE23RO ) that a group convened several months ago by U.S. Sen. Sheldon Whitehouse, D-R.I., and Neil Steinberg, president and chief executive of the Rhode Island Foundation, wrote to Gov.-elect Gina Raimondo, Senate President Teresa Paiva Weed and House Speaker Nicholas Mattiello.

The group says that among the goals for 2015 are developing a strategy to control costs, such as linking health-care inflation to the gross state product, a measurement of the economic output of a state.

Members of the group also call for health providers, insurers, employers and consumers to collaborate with the state. It also says baseline information on health-care spending should be collected to track progress.

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Information from: The Providence Journal, http://www.providencejournal.com

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Health care leaders lobby state for improvements

St Mary's Hospital to lead genetic revolution in fight against cancer and rare diseases

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Patients in Greater Manchester are set to spearhead a genetic revolution to help fight cancer and rare diseases.

The citys St Marys Hospital has been named as one of 11 Genomic Medicine Centres, which together will map the complete genetic codes of 100,000 patients.

The three-year project, unveiled by the Prime Minister earlier this year, is a bold bid to transform diagnosis and treatment.

It will allow doctors to learn more about cancer and rare conditions by decoding and exploring human genomes - complete sets of peoples genes.

University of Manchester scientists and doctors at St Marys will work closely with colleagues at Salford Royal, The Christie, Wythenshawe Hospital and the Pennine Acute Hospitals Trust on the project.

Bill Newman, professor of translational Genomic medicine at the Manchester Centre for Genomic Medicine at the University of Manchester and honorary consultant at Central Manchester University Hospitals Trust, said doctors, nurses and scientists at the Manchester Centre for Genomic Medicine, based at St Marys, were delighted to have been selected for the pioneering project.

He said: They plan to work with colleagues to use the new type of genetic testing called whole genome sequencing to find out why some people have certain types of rare health problems and to treat people with cancer more effectively.

The project is expected to revolutionise the future of healthcare. It could improve the prediction and prevention of disease, enable new diagnostic tests, and allow treatments to be personalised.

It could also allow patients with rare conditions to be diagnosed more quickly and unlock the secrets of genetic changes in cancer.

St Marys and The Christie have already been part of a pilot phase of the project.

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St Mary's Hospital to lead genetic revolution in fight against cancer and rare diseases

NHS DNA Scheme To Fight Cancer And Genetic Diseases

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A new genetics project could help "unlock a series of secrets about devastating diseases", the NHS says.

Under the scheme, 11 Genomics Medicine Centres are being set up in English hospitals to gather DNA samples to help devise targeted treatments for a wide range of diseases.

It is focusing on cancer and rare genetic diseases.

The aim is to sequence 100,000 genomes within three years in order to develop new tests and drugs.

Doctors will offer suitable patients the opportunity to take part in the scheme.

They will have to agree to have their genetic code and medical records - stripped of anything that could identify them - made available to drugs companies and researchers.

Up to 25,000 cancer patients will have the genetic code of their healthy tissue compared to the genetic code of their tumour.

A giant game of spot-the-difference will then take place to identify the precise mutations in DNA that are causing a patient's tumour.

This would allow targeted medicines to be developed.

Genetic code

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NHS DNA Scheme To Fight Cancer And Genetic Diseases

Liverpool to lead world in genetic cancer research

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A team of Liverpool scientists have been selected to take part in a genetic revolution.

The group will participate in a world-leading project to tackle the genetic causes of cancer and rare diseases.

The North West Coast NHS Genomic Medicine Centre is a partnership led by Liverpool Womens Hospital which will be helping deliver the 100,000 Genomes Project, a three year scheme launched by David Cameron.

Angela Douglas, scientific director for genetics at Liverpool Womens NHS Foundation Trust and chair of the British Society for Genetic Medicine (BSGM), said: The 100,000 Genome Project is welcomed by the BSGM as an exciting and unprecedented development that offers the UK the opportunity of being a leader in the field of genomic medicine.

The project has the potential to transform the future of healthcare.

It could improve the prediction and prevention of disease, enable new and more precise diagnostic tests, and allow personalisation of drugs and other treatments to specific genetic variants.

The initiative involves collecting and decoding 100,000 human genomes complete sets of peoples genes that will enable scientists and doctors to understand more about specific conditions.

Life Sciences Minister George Freeman said: We want to make the UK the best place in the world to design and discover 21st century medicines which is why we have invested in the 100,000 Genomes Project.

We also want to ensure NHS patients benefit which is why we have now selected NHS hospitals to help us sequence genomes on an unprecedented scale and bring better treatments to people with cancers and rare diseases for generations to come.

It is anticipated that around 75,000 people will be involved in this project which will also include some patients who have life threatening or debilitating diseases.

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Liverpool to lead world in genetic cancer research

How the genomes project could help you

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Eleven genomic medicine centres (GMC) are the heart of the project, a plan to map 100,000 complete genetic codes of patients. The human genome consists of more than three billion chemical units or "base pairs" that make up the letters of the genetic code - abbreviated to A, T, C, and G. The way the letters pair up on both sides of the double-helix DNA molecule shapes the genome sequence. Mistakes in the pairing can lead to disease.

The project is needed to treat illnesses such as cancer, which can take a variety of forms - breast cancer, for example, has at least 10 - each requiring a different treatment. In the case of breast cancers, more than 70 per cent respond to hormone therapies, but their reaction to the treatment is very varied. The new research centres will create personalised treatment that can be targeted more effectively at each variation of cancer.

The participants in the project will agree to share their genetic code and medical records with drugs companies and researchers. Their DNA will then be examined in order to compare the genetic code of their healthy tissue to the genetic code of their tumour.

It should then be easier to spot the mutations in DNA that are causing the tumour, and so create a more precisely targeted treatment.

Some 15,000 patients with rare diseases will have their genome compared with those of close relatives in order to spot the mutations.

Ultimately the aim is to secure the participation of more than 100 NHS trusts over the project's three-year lifespan. Scientists and doctors hope the 300m initiative will transform medicine by uncovering DNA data that can be used to develop personalised diagnostic procedures and drugs.

More than 100 patients with cancer and rare inherited diseases have already had their genomes sequenced during the project's pilot phase.The first wave of GMCs will be linked to NHS trusts in 11 locations covering London, Manchester, Oxford, Birmingham, Cambridge, Southampton, Exeter and Newcastle.

Professor Mark Caulfield, chief scientist at Genomics England, the Department of Health company set up to deliver the project, strongly defended the decision to let drug companies have access to the data.

"It is absolutely vital if you want to develop maximum benefit from this project that we encourage industry to join us in this," he said. "There's no university in the land that can develop a medicine on its own."

But he pointed out that drug companies would be restricted to using the facility like a reading library. They would be able to work with data, but not take it away.

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How the genomes project could help you

Genomics: the revolution that's transforming medicine

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During a conversation I had with a doctor a couple of years ago, the subject of cancer diagnoses came up, in a tangential way. She said that not all that many decades ago, a physician who had established that a patient had cancer often wouldnt bother investigating further: since there werent any effective treatments for any kind of cancer, there wasnt much point in finding out what kind of cancer it was. You could try to cut it out, or you could leave it in and see what happened, and that was about it.

Now, of course, that has changed. It matters what cancer you have, because different cancers respond differently to different treatments. As we get better at treating the disease, it pushes us to get better at differentiating them; as we establish the various kinds, it allows us to target drugs more precisely at the ones they work on, so that the drugs themselves become more effective. There is a virtuous circle between diagnostics and treatment that improves both. Thats why the news that the NHS is to open 11 major genomics centres with more to follow around the country is so hugely positive.

Over the past few years, genomics the study of our genetic code has taken off in spectacular style: while it took decades and billions of pounds to sequence the first human genome, now the information in a human cell can be catalogued in a few days for about a grand. This, obviously, opens up huge possibilities for medicine. It renders it practical to record and analyse the genetic code of thousands of people, and to see how small differences in our DNA change our vulnerability to different diseases.

And thats exactly what the NHS plan, with Genomics England, involves. The centres will take the genetic data of 100,000 people, all suitably anonymised, and analyse and record them, making them available to researchers at universities and drug firms. They will also sequence the DNA of 25,000 cancer sufferers, and the DNA of the cancers themselves. Cancer is a disease of the genes the product of mutations which send the cell into uncontrolled reproduction and establishing which genes are vulnerable to which mutations will be vital in defeating its various incarnations.

This has possibilities far beyond cancer, though. To a startling degree, we are freed from the crippling burden of infectious disease. Thats not the case in developing countries, where more than half of all deaths are caused by infection, according to the World Health Organisation; but in the rich West, nearly nine out of 10 of us will die of a non-communicable disease, when something simply goes wrong with our bodies. Sometimes that something goes wrong because of environmental factors smoking, drinking, obesity and sometimes were just unlucky, but our risk of suffering pretty much any non-communicable disease, from heart disease to diabetes to stroke, is influenced by our genes. If we can see which genes tend to be associated with which diseases, doctors can help those at the greatest risk to take steps to avoid it.

An obvious example is breast cancer, which oncologists now think of as at least 10 different diseases. While the average lifetime risk for a woman in the UK is about 12.5 per cent, according to Cancer Research UK, if they have a particular mutation in a gene called BRCA1, that risk goes up to between 60 and 90 per cent. Angelina Jolie was tested and found to have this mutation, and chose to have a double mastectomy as a preventive measure. Less dramatically, statins could be prescribed specifically to those people who are found to be more susceptible to high blood pressure or heart disease, instead of as now giving them to a huge swath of the population in order to help the minority who actually need them. It is the difference between a sniper rifle and a shotgun.

The trick with the genomics revolution will be tying it in to the everyday business of health care in England, and that is where these centres will become vital. When doctors are able to look at a patients genetic information as easily as they can their height and weight, they will be able to target those patients with the interventions that will work best on them true individualised medicine. But that involves making genome sequencing routine, calming understandable fears about privacy, and convincing people to take that first scary step and look at what their genes hold in store for them.

A year or so after my conversation with the doctor about cancer, a close relative was diagnosed with malignant melanoma. It was a horrible, terrifying time. Skin cancer comes in various forms, many of them relatively benign, but melanoma is a killer. And until recently there were no drugs that were effective against it. If caught early, it could be cut off, and you were usually all right; later, once it had got into your system, you were in real trouble. Like the cancers a century ago, there was little point knowing more about what kind of melanoma it was, because you couldnt do much about it.

Luckily (touch wood) my relatives cancer was caught early, and the prognosis is good. But if, heaven forfend, it comes back, there are now drugs that can be used, with some success and the choice of which drug depends on your genes. The genomic revolution is already transforming medicine, and saving the lives of people right now. This is an extraordinary time for medicine.

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Genomics: the revolution that's transforming medicine

New era of cheaper energy … and it's not just oil prices

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Published: Monday, December 22, 2014 at 1:00 a.m. Last Modified: Saturday, December 20, 2014 at 4:38 p.m.

We may well have entered a new era of lower energy costs.

This coincides with having entered the second stage of the global economy I wrote about in my October column.

Ever since I started writing and speaking about the future back in 2006, I have focused a lot on energy. The reason is simple and obvious: The energy sources, models, structures and infrastructures of the 19th and 20th century will have to change in the 21st century. So I have paid a good bit of attention to new forms of energy, new ways to distribute energy and emerging technologies, and also looked deeply into the landscape of global energy.

In fact, one of the things that put me on the map as a credible futurist was that in 2006, when oil was around $50 a barrel, I suggested that oil might well cross $125 a barrel in 2008. I fondly remember going on a syndicated business TV program in the second half of 2007 to talk about the price of oil. There was me, the futurist, and some oil analyst. The reporter asked me what I thought the price of oil might be in a year (at the time it was around $55 a barrel), I answered that it would very likely be above $100 in 2008. With ridicule dripping from her voice, the reporter then said something like "Well, we have heard from a futurist, now let's get the facts from an oil analyst" who then said oil would range between $50 and $60 a barrel for the next few years. You may remember that the price of oil topped out in 2008 at $147 a barrel. Ah, sweet victory!

In the last two to three years, I have been correct in forecasting that the price of oil would largely stay in the $90-$120 per barrel range. Coming into 2014, I thought there might be some softness due to several dynamics and suggested that it might well drop into the low $80s. Well, I was right that the price would soften this year, but was I wrong on how soft! As of this writing, West Texas Intermediate oil is around $56 and Brent crude is $61.

The dynamics for this price collapse have been widely reported: the technological revolution of fracking in the U.S., the softening demand in China and the commitment of Saudi Arabia to keep market share within the group of oil exporting nations and to put stress on the U.S. oil industry, which has moved the U.S. the closest it has ever been to energy independence.

The price will go up over the next year. In the meantime, low prices will cause geo-political havoc, because many of the oil-exporting countries, such as Russia, Iran and Venezuela, have break-even production levels well above $80.

That is for another column. This column is about more than oil; it is about the real possibility that we have entered into a decade-long era of generally lower energy costs. Several simultaneous developments point to this. So, in addition to lower oil prices, here are some dynamics that should lower energy costs in the years ahead:

Incredible efficiencies in the internal combustion engine, dramatically increasing the miles that cars can travel per gallon. In 2000, it would have been almost unimaginable that one could choose from dozens of cars that average more than 30 mpg.

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New era of cheaper energy ... and it's not just oil prices

Muse unveil live video of Futurism as gift for fans

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PanARMENIAN.Net - As a Christmas gift to their fans, Muse have unveiled a live video of 'Futurism', filmed at Tokyo's Zepp back in summer 2013, Gigwise reports.

The song was a bonus track from the classic Origin Of Symmetry, and as such has become a cult favourite among fans. The performance in Toyko was the first time they'd aired it live in 10 years.

The video was sent out as a gift to Muse fans and can be downloaded here or watched below. The gig in question was packed with obscurities and rarities, and was dubbed by the band as 'their most amazing yet'. They later revealed that the show was filmed and it will be released in the future. Taking to Twitter prior to the gig, the band's long-time friend, collaborator and video director Tom Kirk promised that the gig at The Zepp would have a few surprises in store .

Meanwhile, the band have also been working on their 'heavier' seventh album with AC/DC producer 'Mutt' Lange - due for release in Summer 2015.

Muse are currently confirmed to headline many festivals across Europe in 2015 - including Download Festival.

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Muse unveil live video of Futurism as gift for fans

Let’s Play – Assassin’s Creed II – Episode 23 – "Mercenary Freedom" [HD] – Video

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Let #39;s Play - Assassin #39;s Creed II - Episode 23 - "Mercenary Freedom" [HD]
Episode 23 of Let #39;s Play Assassin #39;s Creed II La verit scritta nel sangue... Ezio needs to save Bartolomeo in order to free some mercenaries. Once freed they look for Dante and Silvio...

By: ThePlayground

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Let's Play - Assassin's Creed II - Episode 23 - "Mercenary Freedom" [HD] - Video