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Statement from HHS Secretary Xavier Becerra on the Swearing-In of Rebecca Jones Gaston as Commissioner of the Administration on Children, Youth and Families
Swearing in of Rebecca Jones Gaston, ACF Commissioner
Members of the 2025 Dietary Guidelines Advisory Committee Announced
HHS Secretary Becerra and USDA Secretary Vilsack announced the appointment of 20 nationally recognized scientists.
HHS Releases Report Detailing Biden-Harris Administration Efforts to Protect Reproductive Health Care Since Dobbs
Sunday Marks 50th Anniversary of Supreme Court's Roe v. Wade Decision
A $30 Million Gift to Build an Addiction Treatment Center. Then Staffers Had to Run It.
DECATUR, Ill. — The question came out of the blue, or so it seemed to Crossing Healthcare CEO Tanya Andricks: If you had $30 million to design an addiction treatment facility, how would you do it?
The interim sheriff of Macon County, Illinois, posed the question in 2018 as he and Andricks discussed the community's needs. When she responded that she'd have to do some research, she was told not to take too long because the offer wouldn't be there forever.
"I thought: 'Oh, my God, he's serious,'" Andricks said.
That sheriff was Howard Buffett, the philanthropist son of billionaire investor Warren Buffett. The younger Buffett ended up giving Crossing about $30 million from his charitable foundation to build an addiction treatment center in Decatur, a city with a population of just over 69,000 in the heart of Macon County.
There was a caveat, though. The donation to Crossing was a one-time gift to pay only for the buildings. It was up to Andricks and her team to find money to run the programs. And that has proven difficult.
The covid-19 pandemic upended everything mere months after the facilities opened in October 2019. An audited financial statement said the inpatient recovery center had lost $2.5 million by June 2021, and management worried about its ability to continue operating. Even so, the center remained open while other addiction treatment facilities around the country shuttered.
Now communities nationwide are preparing for an unprecedented windfall of their own for addiction treatment from a nearly $26 billion national opioid settlement and a more than $300 million expansion of a federal pilot program for mental health. The experience at Crossing offers them a model but also a warning: It will take more than a single shot of money to build a treatment program that can last.
Drug addiction wasn't on Howard Buffett's radar, he told KHN, until he joined the Macon County sheriff's office as an auxiliary deputy in 2012. While the county has had some treatment resources, like a behavioral health center, it has one of the state's higher death rates from opioid overdoses.
Buffett moved to the area in 1992 to work for food-processing giant Archer Daniels Midland. He runs a farm nearby and his Decatur-based foundation donates hundreds of millions of dollars for initiatives ranging from helping people kidnapped by Joseph Kony's Lord's Resistance Army in central Africa to revitalizing the cacao industry in El Salvador.
Soon after Buffett was appointed interim sheriff in 2017, he toured Crossing to learn more about local social services. The health center offers primary care, including mental health, for all ages and sees roughly 17,500 patients a year. Most Crossing patients are on Medicaid, the public health insurance for people with low incomes.
"He was impressed with what we were able to provide patients," Andricks recalled. "I don't think he expected the scope and size of what we do."
Addiction treatment, though, is notoriously difficult. Evidence supports treating addiction like a chronic illness, meaning even after difficult short-term behavior changes, it requires a lifetime of management. Research suggests relapse rates can be more than 85% in the first year of recovery. So any new treatment program is likely to face headwinds.
Buffett didn't set Crossing up for failure. In fact, he has helped fund other aspects of the organization's work. Part of the idea behind paying for the addiction treatment buildings but not the operations, Buffett said, is to keep his foundation "creative." If it spends all its money on the same programming every year, that means less is available to fund other work around the globe. Buffett said it's also about sustainability.
"If Tanya can show 'with this investment I made this work,'" Buffett said, "then other people should be making that investment."
Crossing's inpatient recovery center holds eight beds for medication-assisted detox, 48 beds for rehabilitation, and a cafeteria where meals are cooked with input from dietitians working with patients. An outpatient treatment center also has classrooms for continuing education, a gym with a small bowling alley, and a movie theater. Buffett insisted on the last two amenities. ("People have to feel good about getting better," he said.)
A separate building holds 64 beds of transitional housing, and just across the street are 20 rent-controlled apartments. Buffett spent an additional $25 million on buildings at that campus for other organizations focused on housing, workforce development, and education, among other things.
"There's a lot to like in this program," said Dr. Bradley Stein, director of Rand Corp.'s Opioid Policy and Tools Information Center.
As positives, Stein pointed specifically to the spectrum of care offered to patients as they progress in their recovery, the use of medication-assisted treatment to help stave off physical cravings for opioids, the connection to the health center, and even the involvement of law enforcement.
Laura Cogan, a 36-year-old mother who has struggled with addiction since she was 14, is one of the patients working their way through the system.
Cogan said she was the first patient in the doors when the recovery center opened. Less than 24 hours later, she was also the first patient to walk out.
The biggest challenge with Cogan's previous attempts at recovery, she said, was never being sure about her next steps: What was she supposed to do after getting out of detox and residential treatment?
Crossing's approach was designed to address that by providing transitional housing, easy access to outpatient services, and educational programming.
On her third attempt, Cogan got a round of applause after completing the first three days in detox. After six days, she joined residential treatment. After a month, she moved over to transitional housing, began outpatient treatment, and started offering peer support at Crossing. She tutored other patients, taught a writing class, and helped them get on computers and fill out job applications.
Then the pandemic hit.
Like other health centers around the nation, Crossing turned its attention to providing covid testing and vaccines. Meanwhile, just about every aspect of addiction treatment became more expensive. Crossing halved the number of residential treatment beds so each room would have only one patient and converted the rooms into negative pressure chambers to reduce the risk of covid transmission.
Staffing grew harder amid a nationwide nursing shortage. The number of patients in residential treatment dropped, Andricks said, because few people wanted to live inside a facility and wear masks. It was common to have as few as 10 beds occupied on a given day. The women's unit was temporarily closed due to lack of demand and staffing constraints.
Cogan said several other transitional housing residents left once the $1,200 pandemic stimulus checks arrived, with some resuming treatment when that money dried up. But Cogan continued. Eventually she moved into Crossing's rent-controlled apartments, where she has been one of just a few tenants.
Without the federal Paycheck Protection Program's $1,375,200 forgivable loan in 2020, Andricks said, the outpatient treatment program might have had to close altogether.
But momentum at the recovery center started to change last spring as covid cases tapered off, Andricks said. Hiring became easier. More patients arrived. In October, the center received a grant to use the apartments for women with a history of substance misuse who are pregnant or who have given birth within the prior year. They've placed six women, in addition to Cogan, there already. The inpatient recovery center now averages about 27 occupied beds a day, within striking distance of the 30 that Andricks said the inpatient center needs to survive.
Rand's Stein suggested another measurement of a treatment program's success: whether people in the community get into treatment when they need it. National "secret shopper" reports have found significant barriers to service, such as long wait times.
Crossing's program quadrupled the number of residential treatment beds in Macon County, according to Andricks. In the three years since the inpatient recovery center opened, it has had over 1,300 admissions. While most patients haven't stayed in recovery, staffers have seen a pattern of success with those like Cogan who stay on campus and become involved with recovery offerings — although Andricks estimated that's fewer than 10% of the patients.
Cogan said she hopes Crossing doesn't get discouraged. People are going to mess up, she said, but she's living proof of the impact the recovery center can have.
"I'm one of the lucky ones and I don't know why," Cogan said, sitting on a couch in the apartment on Crossing's campus that she shares with her 12-year-old son since regaining custody of him. "I just know that today I am. And I hope that more people get the opportunity."
Biden-Harris Administration Takes Additional Steps to Strengthen Nursing Home Safety and Transparency
HHS to increase oversight of inappropriate antipsychotics use
Numbers Don't Lie. Biden Kept His Promise on Improving Obamacare.
Promise: "I'll not only restore Obamacare; I'll build on it."
In a speech on Nov. 2, 2020, then-presidential candidate Joe Biden promised, "I'll not only restore Obamacare; I'll build on it."
Two years and counting since then, how is he doing in meeting that promise?
KHN has teamed up with our partners at PolitiFact to monitor 100 key promises — including this one — made by Biden during the 2020 presidential campaign. The pledges touch on issues related to improving the economy, responding to calls for racial justice, and combating climate change. On health care, they range from getting covid-19 under control and improving veterans' health care to codifying Roe v. Wade. KHN has recently done progress checks on the administration's pledges to lower the costs of prescription drugs and to reduce the nation's maternal mortality rate.
Eight days into his tenure as president, Biden signed an executive order aimed at strengthening Medicaid and the Affordable Care Act, or Obamacare. A couple of months later, he signed his first major piece of legislation, the American Rescue Plan, which included provisions expanding eligibility for subsidies and increasing premium tax credits available to help low- and moderate-income Americans purchase ACA coverage.
That legislation also offered financial incentives to encourage the 12 states that had declined to expand Medicaid eligibility to do so.
The consumer subsidies were originally set to expire this year but were extended by the Inflation Reduction Act, which Biden signed into law Aug. 16, after much debate and without any Republican votes. The expanded eligibility for subsidies was also continued by this measure.
In October, the Biden administration addressed another issue in the ACA, the so-called family glitch, which prevented some people with job-based insurance from qualifying for subsidies.
Those items alone prompt "an unequivocal yes," to the question of whether Biden has met his campaign promise, said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University.
Joe Antos, a senior fellow at the American Enterprise Institute think tank, offered a different perspective — that the actions taken on the glitch can't count toward Biden's promise to "restore" the ACA. Antos said that's because it wasn't a glitch at all, but rather an intentional element of the original ACA put there to save the government money, and help win its passage in Congress.
"Biden was vice president when the bill was signed into law, and he supposedly supported it," Antos said.
Corlette touted other Biden administration changes, including increased funding for consumer assistance programs that help people sign up for ACA coverage and streamlined some of the paperwork required for enrollment.
The White House issued an official recap of other actions taken as a result of the executive order, including extending the annual open enrollment period to bring in more policyholders, and allowing low-income Americans to sign up anytime.
Last year, a record 14.5 million Americans selected an ACA plan. This year's sign-up period ended Jan. 15 in most states and, based on preliminary numbers, enrollment in 2023 will continue the upward trend.
The boost in enrollment is due, in part, to the enhanced subsidies, which lowered premiums to $10 or less a month for some low-income consumers, and eliminated a cutoff threshold, allowing some higher-income families to qualify for at least some subsidy, said Corlette.
Antos agreed that the administration has made changes that "clearly built on Obamacare and expanded spending and probably did cover more people."
What happened with the financial incentives meant to get states to expand their Medicaid programs to include more low-income adults, particularly those at or below the poverty level who have no children? Those incentives are still there for the taking, but, so far, no states have done so.
South Dakota expanded after the rescue plan's passage, but that was because voters approved a ballot measure, not because of the financial incentives.
"That was part of Biden's goal, to close the coverage gap," said Joan Alker, executive director of the Center for Children and Families at Georgetown. "We still have 11 states resisting Medicaid expansion, and that leaves a big, gaping hole in coverage in those states. But that's not for lack of trying by the Biden administration."
Because enrollment is up, subsidies are more available, more people are helping consumers enroll, and there are additional enticements to get states to expand Medicaid, we rate this as a Promise Kept.
Our sources:
Telephone interview with Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University, Dec. 20, 2022
Telephone interview with Joseph Antos, senior fellow at the American Enterprise Institute, Jan. 5, 2023
Telephone interview with Joan Alker, executive director of the Center for Children and Families at Georgetown University, Jan. 10, 2023
Archive Today, transcript of Joe Biden campaign speech in Pittsburgh, Nov. 2, 2022
KHN, "Inflation Reduction Act Contains Important Cost-Saving Changes for Many Patients — Maybe for You," Aug. 12, 2022
White House, Executive Order on Continuing to Strengthen Americans' Access to Affordable, Quality Health Coverage, April 5, 2022
KFF, "Marketplace Enrollment 2014-2022," accessed Jan. 5, 2023
KFF, "Five Things to Know About the Renewal of Extra Affordable Care Act Subsidies in the Inflation Reduction Act," Aug. 11, 2022
KFF, "Navigating the Family Glitch Fix: Hurdles for Consumers with Employer-Sponsored Coverage," Nov. 21, 2022
NPR, "Shopping for ACA Health Insurance? Here's What's New This Year," Oct. 31, 2022
After a Brief Pandemic Reprieve, Rural Workers Return to Life Without Paid Leave
ELKO, Nev. — When Ruby B. Sutton found out she was pregnant in late 2021, it was hard to envision how her full-time job would fit with having a newborn at home. She faced a three-hour round-trip commute to the mine site where she worked as an environmental engineer, 12-plus-hour workdays, expensive child care, and her desire to be present with her newborn.
Sutton, 32, said the minimal paid maternity leave that her employer offered didn't seem like enough time for her body to heal from giving birth or to bond with her firstborn. Those concerns were magnified when she needed an emergency cesarean section.
"I'm a very career-driven person," Sutton said. "It was really difficult to make that decision."
Sutton quit her job because she felt even additional unpaid time off wouldn't be enough. She also knew child care following maternity leave would cost a substantial portion of her salary if she returned to work.
Tens of millions of American workers face similar decisions when they need to care for themselves, a family member, or a baby. Wild variations in paid leave regulations from state to state and locally mean those choices are further complicated by financial factors. And workers in rural areas face even more challenges than those in cities, including greater distances to hospitals and fewer medical providers, exacerbating health and income disparities. Companies in rural areas may be less likely to voluntarily offer the benefit because they tend to be smaller and there are fewer employers for workers to choose from.
While a growing number of states, cities, and counties have passed paid sick leave or general paid time off laws in recent years, most states where more than 20% of the population is rural haven't, leaving workers vulnerable. Vermont and New Mexico are the only states with a sizable rural population that have passed laws requiring some form of paid sick leave.
Experts say the gaps in paid leave requirements mean workers in rural areas often struggle to care for themselves or loved ones while making ends meet.
"The problem is, because it's a small percentage of the population, it's often forgotten," said Anne Lofaso, a professor of law at West Virginia University.
The covid-19 pandemic steered attention toward paid leave policies as millions of people contracted the virus and needed to quarantine for five to 10 days to avoid infecting co-workers. The 2020 Families First Coronavirus Response Act temporarily required employers with fewer than 500 employees and all public employers to give workers a minimum of two weeks of paid sick leave, but that requirement expired at the end of 2020.
The expiration left workers to rely on the Family and Medical Leave Act of 1993, which requires companies with 50 or more employees to provide them with up to 12 weeks of unpaid time off to care for themselves or family members. But many workers can't afford to go that long without pay.
By March 2022, 77% of workers at private companies had paid sick leave through their employers, according to the Bureau of Labor Statistics — a small increase from 2019, when 73% of workers in private industry had it. But workers in certain industries — like construction, farming, forestry, and extraction — part-time workers, and lower-wage earners are less likely to have paid sick leave.
"Paid leave is presented as a high-cost item," said Kate Bronfenbrenner, director of labor education research at the School of Industrial and Labor Relations at Cornell University.
But it comes with a payoff: Without it, people who feel pressure to go to work let health conditions fester and deteriorate. And, of course, infectious workers who return too early unnecessarily expose others in the workplace.
Advocates say a stronger federal policy guaranteeing and protecting paid sick and family leave would mean workers wouldn't have to choose between pushing through illness at work or losing income or jobs.
A recent report by New America, a left-leaning think tank, argues that creating policy to ensure paid leave could boost employment numbers; reduce economic, gender, and racial disparities; and generally lift up local communities.
Support for paid sick and family leave is popular among rural Americans, according to the National Partnership for Women & Families, which found in 2020 polling that 80% of rural voters supported a permanent paid family and medical leave program, allowing people to take time off from work to care for children or other family members.
But lawmakers have been divided on creating a national policy, with opponents worrying that requiring paid leave would be too big a financial burden for small or struggling businesses.
In 2006, voters in San Francisco approved the Paid Sick Leave Ordinance, making it the first U.S. city to mandate paid sick leave. Since then, 14 states, the District of Columbia, and 20 other cities or counties have done so. Two other states, Nevada and Maine, have adopted general paid time off laws that provide time that can be used for illness.
Federal workers are offered 12 weeks of paid parental leave in the Federal Employee Paid Leave Act, adopted in October 2020. It covers more than 2 million civilian workers employed by the U.S. government, though the law must be reapproved each fiscal year and employees are not eligible until they've completed one year of service.
The patchwork of laws nationwide leaves workers in several mostly rural states — places like Montana, South Dakota, and West Virginia where more than 40% of residents live outside cities — without mandated paid sick and family leave.
Sutton said she "would have definitely loved" to stay at her job if she could've taken a longer paid maternity leave. She said she wants to return to work, but the future is unclear. She has more things to consider, like whether she and her husband want more children and when she might feel healthy enough to try for a second baby after last summer's C-section.
Sutton recalled a friend she worked with at a gold mine years ago who left the job a few months after having a baby. "And I understand now all the things she was telling me at that time. … She was like, 'I can't do this,' you know?"
THÔNG CÁO: Chính Quyền Biden-Harris Công Bố Chiến Lược Quốc Gia nhằm Tăng Cường Tính Bình Đẳng, Công Lý và Cơ Hội cho các Cộng Đồng Người Mỹ Gốc Á, Người Hawaii Bản Địa và Người Dân Đảo Thái Bình Dương
Các quan chức chính chủ cấp cao, các nhà lãnh đạo cộng đồng và các quan chức được bầu chọn tổ chức lễ kỷ niệm công bố hơn 30 kế hoạch hành động của cơ quan liên
PAHAYAG: Inihayag ng Administrasyong Biden-Harris ang Pambansang Estratehiya para Umunlad ang Pagkakapantay-pantay, Hustisya, at Oportunidad para sa mga Komunidad ng Asian American, Native Hawaiian, at Pacific Islander
Inihayag ng Administrasyong Biden-Harris ang Pambansang Estratehiya para Umunlad ang Pagkakapantay-pantay, Hustisya, at Oportunidad para sa mga Komunidad ng
เผยแพร่: ผู้บริหาร Biden-Harris เปิดตัวยุทธศาสตร์ระดับชาติเพื่อพัฒนาความเท่าเทียม ความยุติธรรม และโอกาสสำหรับชุมชนชาวอเมริกันเชื้อสายเอเชีย ชาวฮาวายพื้นเมือง และชาวหมู่เกาะแปซิฟิก
เจ้าหน้าที่บริหารอาวุโส ผู้นำชุมชน และเจ้าหน้าที่ที่ได้รับการเลือกตั้งได้ฉลองการเปิดตัวแผนปฏิบัติการของหน่วยงานรัฐบาลกลางกว่า 30 แผน เพื่อส่งเสริมความปลอดภัยและ
발표: 바이든-해리스 행정부, 아시아계 미국인, 하와이 원주민 및 태평양 섬 주민 지역사회를 위한 형평성과 공정성, 기회 발전을 위한 국가 전략 공개
바이든-해리스 행정부, 아시아계 미국인, 하와이 원주민 및 태평양 섬 주민 지역사회를 위한 형평성과 공정성, 기회 발전을 위한 국가 전략 공개
發佈:拜登—賀錦麗政府發佈促進在美亞裔、夏威夷原住民及太平洋島民社區 公平、正義和機會的國家戰略
高級政府官員、社區領袖與當選官員共同慶祝新發佈的 30 多項聯邦政府機構行動計劃,全力促進在美亞裔 (AA)、夏威夷原住民和太平洋島民 (NHPI) 的安全和公平。
发布:拜登—哈里斯政府发布促进在美亚裔、夏威夷原住民和太平洋岛民社区 公平、正义和机会的国家战略
政府官员、社区领袖和当选官员共同庆祝新发布的 30 多项联邦政府行动计划,全力促进在美亚裔(AA) 、夏威夷原住民和太平洋岛民(NHPI)的安全和公平。
Biden-Harris Administration Unveils National Strategy to Advance Equity, Justice, and Opportunity for Asian American, Native Hawaiian, and Pacific Islander Communities
National Strategy to Advance Equity, Justice, and Opportunity for Asian American, Native Hawaiian, and Pacific Islander (AA and NHPI) Communities.
¿Será tu celular tu próximo consultorio médico?
Los mismos dispositivos que se utilizan para tomar selfies y escribir tweets se están reutilizando y comercializando para acceder rápidamente a la información necesaria para monitorear la salud de un paciente.
La yema del dedo presionada contra la lente de la cámara de un celular puede medir la frecuencia cardíaca. El micrófono, colocado junto a la cama, puede detectar apnea del sueño. Incluso el altavoz está siendo modificado para monitorear la respiración usando tecnología de sondas.
En lo mejor de este nuevo mundo, los datos se transmiten de forma remota a un profesional médico para comodidad del paciente o, en algunos casos, para ayudar a un médico sin necesidad de usar un hardware costoso.
Pero el uso de teléfonos inteligentes como herramientas de diagnóstico es un trabajo que está en proceso, dicen expertos. Aunque los médicos y sus pacientes han tenido cierto éxito en el mundo real al implementar el teléfono como dispositivo médico, el potencial real todavia es incierto.
Los teléfonos inteligentes contienen sensores capaces de monitorear los signos vitales de un paciente. Pueden ayudar a evaluar a las personas buscando conmociones cerebrales, observando la fibrilación auricular y realizando controles de bienestar de salud mental, por nombrar algunas aplicaciones incipientes.
Las empresas y los investigadores ansiosos por encontrar aplicaciones médicas están aprovechando las cámaras y los sensores de luz incorporados en los teléfonos modernos; los micrófonos que detectan los movimientos del cuerpo; e incluso los altavoces.
Las aplicaciones usan software de inteligencia artificial (IA) para analizar las imágenes y los sonidos recopilados para crear una conexión fácil entre pacientes y médicos. El potencial de ingresos y la comercialización se evidencian en los más de 350,000 productos de salud digitales disponibles en las tiendas de aplicaciones, según un informe de Grand View Research.
"Es muy difícil colocar dispositivos en el hogar del paciente o en el hospital, pero todo el mundo camina con un teléfono celular con conexión", dijo el doctor Andrew Gostine, director ejecutivo de la empresa de redes de sensores Artisight.
La mayoría de los estadounidenses tiene un teléfono inteligente, incluido más del 60% de las personas mayores de 65 años, un aumento con respecto a solo el 13% hace una década, según el Pew Research Center.
La pandemia de covid-19 también ha impulsado a las personas a sentirse más cómodas con la atención virtual.
Algunos de estos productos han buscado la aprobación de la Administración de Drogas y Alimentos (FDA) para ser comercializados como dispositivos médicos. De esa forma, si los pacientes deben pagar para usar el software, es más probable que las aseguradoras de salud cubran al menos parte del costo.
Otros productos están designados como exentos de este proceso regulatorio, ubicados en la misma clasificación clínica que una curita. Pero la forma en que la agencia maneja la IA y los dispositivos médicos basados en el aprendizaje automático aún se están ajustando para reflejar la naturaleza adaptativa del software.
Garantizar la precisión y la validación clínica es crucial para asegurar la aceptación de los proveedores de atención médica. Y muchas herramientas aún necesitan ajustes, dijo el doctor Eugene Yang, profesor de medicina en la Universidad de Washington. Actualmente, Yang está probando la medición sin contacto de la presión arterial, la frecuencia cardíaca y la saturación de oxígeno obtenida de forma remota a través de imágenes de la cara de un paciente desde la cámara de Zoom.
Juzgar estas nuevas tecnologías es difícil porque se basan en algoritmos creados por aprendizaje automático e inteligencia artificial para recopilar datos, en lugar de las herramientas físicas que se usan normalmente en los hospitales.
Por eso, los investigadores no pueden compararlas con los estándares de la industria médica, explicó Yang. El hecho de no incorporar tales garantías socava los objetivos finales de esta tecnología de mejorar el acceso y los costos porque un médico aún debe verificar los resultados.
"Los falsos positivos y los falsos negativos conducen a más pruebas y más costos para el sistema de atención médica", dijo.
Las grandes empresas de tecnología como Google han invertido mucho en la investigación de este tipo de tecnología, atendiendo a los médicos y cuidadores en el hogar, así como a los consumidores. Actualmente, en la aplicación Google Fit, los usuarios pueden verificar su frecuencia cardíaca colocando el dedo en la lente de la cámara trasera, o rastrear su frecuencia respiratoria con la cámara frontal.
"Si sacas el sensor del teléfono y de un dispositivo clínico, probablemente son la misma cosa", dijo Shwetak Patel, director de tecnologías de salud en Google y profesor de ingeniería eléctrica e informática en la Universidad de Washington.
La investigación de Google utiliza el aprendizaje automático y la visión por computadora, un campo dentro de la IA basado en información de entradas visuales como videos o imágenes. Entonces, por ejemplo, en lugar de usar un manguito de presión arterial, el algoritmo puede interpretar cambios visuales leves en el cuerpo que sirven como representantes y bioseñales para la presión arterial de un paciente, explicó Patel.
Google también está investigando la efectividad del micrófono incorporado para detectar latidos y soplos cardíacos, y el uso de la cámara para preservar la vista mediante la detección de la enfermedad ocular diabética, según información que la compañía publicó el año pasado.
El gigante tecnológico compró recientemente Sound Life Sciences, una startup de Seattle con una aplicación de tecnología de sondas aprobada por la FDA. Utiliza el altavoz de un dispositivo inteligente para hacer rebotar pulsos inaudibles en el cuerpo de un paciente para identificar el movimiento y controlar la respiración.
Binah.ai, con sede en Israel, es otra empresa que utiliza la cámara del teléfono inteligente para calcular los signos vitales. Su software observa la zona alrededor de los ojos, donde la piel es un poco más delgada, y analiza la luz que se refleja en los vasos sanguíneos y regresa a la lente.
La compañía está finalizando un ensayo clínico en Estados Unidos, y comercializando su aplicación de bienestar directamente a las aseguradoras y otras compañías de salud, dijo su vocera Mona Popilian-Yona.
Las aplicaciones llegan incluso a disciplinas como la optometría y la salud mental:
Con el micrófono, Canary Speech utiliza la misma tecnología subyacente que Alexa de Amazon para analizar las voces de los pacientes en busca de problemas de salud mental. El software puede integrarse con las citas de telemedicina y permitir que los médicos evalúen la ansiedad y la depresión utilizando una biblioteca de biomarcadores vocales y análisis predictivos, dijo Henry O'Connell, su director ejecutivo.
ResApp Health, con sede en Australia, obtuvo la aprobación de la FDA el año pasado para su aplicación para iPhone que detecta la apnea obstructiva del sueño de moderada a grave al escuchar la respiración y los ronquidos. SleepCheckRx, que requiere receta médica, es mínimamente invasivo en comparación con los estudios del sueño que se utilizan actualmente para diagnosticar la apnea, que pueden costar miles de dólares y requieren una variedad de pruebas.
La aplicación Reflex de Brightlamp es una herramienta de apoyo a la toma de decisiones clínicas para ayudar a controlar las conmociones cerebrales y la rehabilitación de la visión, entre otras cosas. Usando la cámara de un iPad o iPhone, la aplicación móvil mide cómo reaccionan las pupilas a los cambios de luz. A través del análisis de aprendizaje automático, las imágenes brindan a los profesionales datos identificables para evaluar a los pacientes. Brightlamp vende directamente a proveedores de atención médica y se utiliza en más de 230 clínicas. Los médicos pagan una tarifa anual estándar de $400 por cuenta, que actualmente no está cubierta por el seguro. El Departamento de Defensa tiene un ensayo clínico en curso usando Reflex.
En algunos casos, como con la aplicación Reflex, los datos se procesan directamente en el teléfono, en lugar de el cloud, dijo Kurtis Sluss, CEO de Brightlamp. Al procesar todo en el dispositivo, la aplicación evita problemas de privacidad, ya que la transmisión de datos a otro lugar requiere el consentimiento del paciente.
Pero los algoritmos deben entrenarse y probarse mediante la recopilación de grandes cantidades de datos, y ese es un proceso continuo.
Los investigadores, por ejemplo, han descubierto que algunas aplicaciones de visión artificial, como el control de la frecuencia cardíaca o la presión arterial, pueden ser menos precisas para pieles más oscuras. Se están realizando estudios para encontrar mejores soluciones.
Los pequeños fallos en los algoritmos también pueden producir falsas alarmas y asustar a los pacientes lo suficiente como alejar la posibilidad de adoptarlos masivamente. Por ejemplo, la nueva función de detección de accidentes automovilísticos de Apple, disponible tanto en el último iPhone como en el Apple Watch, se activaba cuando las personas estaban en montañas rusas y marcaban automáticamente al 911.
"Todavía no hemos llegado", dijo Yang. "Ese será el resultado final".
The Biggest, Buzziest Conference for Health Care Investors Convenes Amid Fears the Bubble Will Burst
SAN FRANCISCO — Health care's business class returned to its San Francisco sanctuary last week for JPMorgan's annual health care confab, at the gilded Westin St. Francis hotel on Union Square. After a two-year pandemic pause, the mood among the executives, bankers, and startup founders in attendance had the aura of a reunion — as they gossiped about promotions, work-from-home routines, who's getting what investments. Dressed in their capitalist best — ranging from brilliant-blue or pastel-purple blazers to puffy-coat chic — they thronged to big parties, housed in art galleries or restaurants.
But the party was tinged with new anxiety: Would the big money invested in health care due to covid-19 continue to flow? Would investors ask to see results — meaning profits — rather than just cool ideas?
The buzzy conference had just as many words about profits as about patients. The mostly maskless crowd spoke English, French, Japanese — and, of course, money.
Besides the corporate and investment types, attendees routinely saw surprising characters — like celebrity doctor Mehmet Oz, fresh off a Senate run, holding court in the lobby on Jan. 10.
If the vibe in the hotel's congested halls was upbeat — or, at least, cheery — underneath there was a frisson of anxiety as all were aware that the health care business bonanza looked to be slowing down.
The conference started with a sidewalk protest of pharmaceutical company Gilead Sciences, whose drugs combating HIV and hepatitis C are fabulously effective — and fabulously expensive. During the pandemic, Congress for the first time has set up a plan to allow Medicare to negotiate U.S. drug prices, which are by far the highest in the world. In a statement, company spokesperson Catherine Cantone said Gilead is the largest private funder of HIV programs in the U.S., adding, "Gilead's role in ending the HIV and hepatitis epidemics is to discover, develop, and ensure access to our life-saving medicines."
Then there's the economic environment, which is turning treacherous. Journalists at financial publication Bloomberg diagnosed a lack of exciting deals. Startup executives — who previously found millions of dollars in investments easy to come by — seemed obligated to show results in their impromptu pitches in bars and coffee shops. Business executives of all stripes promised they either currently made profits or were about to, soon.
"I think this is a tricky year," said Hemant Taneja, CEO of the venture capital firm General Catalyst, during one panel. He suggested that large swaths of health tech startups were overvalued and that their clients will be more interested in whether they're actually providing useful services.
The new message from potential investors was clear. "The idea you could grow and not be profitable is dead, gone," said Dr. Jon Cohen, CEO of the mental health startup Talkspace, in an interview.
There was some cognitive dissonance at the conference. Take, for example, BioNTech, the vaccine developer whose mRNA vaccine, created with Pfizer, provides powerful protection for covid. Company co-founder Uğur Şahin was interrupted by applause during a presentation recounting its role in fighting the pandemic — and that's before he touted his company's role in reducing infectious disease, saving lives, and meeting global health needs for tuberculosis and malaria.
The conversation later turned to the pricing of his company's flagship vaccine — which it's jockeying to set at more than $100 a dose, up from an average government purchase price of $20.69. It was a fair price considering the "health economics," BioNTech's chief strategy officer, Ryan Richardson, explained: the hospitalizations and serious outcomes averted.
Or take drugstore giant CVS — which is steadily expanding beyond its retail roots into health insurance and primary care. CVS Health CEO Karen Lynch said that as part of its health business the company is looking at all the factors that underlie being well. "Health isn't just about the engagement with the provider; it's about all the other factors — including housing and nutrition," she said. Left unaddressed was the sight often greeting CVS customers upon entering a store: candy, chips, and other processed foods.
For critics, it was a mind-bending comment. "The last I heard, CVS was a for-profit company, not a social welfare agency," said Marion Nestle, a researcher who is a longtime critic of the food industry. "It sells junk foods that make people sick and drugs to treat those illnesses. How's that for a nifty business model!"
CVS spokesperson Ethan Slavin offered a very different vision, one in which CVS is seeking to be a premier health and wellness destination. "We're always evolving our food and beverage assortment to provide healthier, on-trend products." It is also supporting programs to bolster food availability in underserved areas, he added.
Some techies encountered new skepticism about "artificial intelligence." Ginkgo Bioworks co-founder Jason Kelly noted during his presentation that people at the conference heard so much about artificial intelligence during the meetings, "they want to stop hearing it." (Ginkgo's AI, used to support pharmaceutical and biotech research, he said, was different than the rest.)
One surgeon, Dr. Rajesh Aggarwal, found conversations with financiers about the stealth startup he founded, which focuses on metabolic health, were focused on silver bullets. "Tell me if I invest in this, I'll 10x" the outlay, he said, paraphrasing the bankers. Many, he said, wanted to "do some good as well" for patients.
Aggarwal felt the investors were looking for simple solutions to health problems. And one item fit that bill: a new class of drugs — GLP-1 agonists, a type of medication that aids in weight loss but will likely have to be taken for long periods. Some analysts are projecting these drugs will be worth $50 billion. The bankers, Aggarwal felt, aren't "thinking about health care," they're "thinking about the dollars attached to the pill."
Rural Seniors Benefit From Pandemic-Driven Remote Fitness Boom
[UPDATED at 11 a.m. ET]
MALMO, Minn. — Eight women, all 73 or older, paced the fellowship hall at Malmo Evangelical Free Church to a rendition of Daniel O'Donnell's "Rivers of Babylon" as they warmed up for an hourlong fitness class.
The women, who live near or on the eastern shore of Mille Lacs Lake, had a variety of reasons for showing up despite fresh snow and slippery roads. One came to reduce the effects of osteoporosis; another, to maintain mobility after a stroke.
Most brought hand and ankle weights, which they would use in a later portion of the program focused on preventing falls, known as Stay Active and Independent for Life, or SAIL. The class meets twice a week in Malmo, a township of about 300 residents. It is run by Juniper, a statewide network of providers of health promotion classes.
A few years ago, older adults who were interested in taking an evidence-based class like SAIL — meaning a class proved by research to promote health — had only one option: attend in person, if one was offered nearby.
But then the covid-19 pandemic and physical distancing happened. Along with social isolation came the rapid introduction of remote access to everything from work to workouts.
After widespread lockdowns began in March 2020, agencies serving seniors across the U.S. reworked health classes to include virtual options. Isolation has long since ended, but virtual classes remain. For older adults in rural communities who have difficulty getting to exercise facilities, those virtual classes offer opportunities for supervised physical activity that were rare before the pandemic.
And advocates say online classes are here to stay.
"Virtually the whole field knows that offering in-person and remote programming — a full range of programming — is a great way to reach more older adults, to increase access and equity," said Jennifer Tripken, associate director of the Center of Healthy Aging at the National Council on Aging. "This is where we need to move together."
Since April 2020, the National Council on Aging has organized monthly conference calls for service providers to discuss how to improve virtual programs or begin offering them.
"We found that remote programming, particularly for rural areas, expanded the reach of programs, offering opportunities for those who have traditionally not participated in in-person programs to now have the ability to tune in, to leverage technology to participate and receive the benefits," Tripken said.
In 2022, at least 1,547 seniors participated in an online fitness program through Juniper, part of a Minnesota Area Agency on Aging initiative. More than half were from rural areas.
Because of grant funding, participants pay little or nothing.
Juniper's virtual classes have become a regular activity both for people who live far from class locations and others who because of medical needs can't attend. Carmen Nomann, 73, frequented in-person exercise classes near her home in Rochester before the pandemic. After suffering a rare allergic reaction to a covid vaccine, she's had to forgo boosters and limit in-person socializing.
Virtual classes have been "really a great lifeline for keeping me in condition and having interaction," she said.
Since 2020, Nomann has participated in online tai chi and SAIL, at one point logging on four days a week.
"Now, we would never go away from our online classes," said Julie Roles, Juniper's vice president of communications. "We've learned from so many people, particularly rural people, that that allows them to participate on a regular basis — and they don't have to drive 50 miles to get to a class."
When seniors drive a long way to attend a class with people from outside their communities, "it's harder to build that sense of 'I'm supported right here at home,'" she said.
Roles said both virtual and in-person exercise programs address social isolation, which older adults in rural areas are prone to.
Dr. Yvonne Hanley has been teaching an online SAIL class for Juniper since 2021 from her home near Fergus Falls. She had recently retired from dentistry and was looking for a way to help people build strength and maintain their health.
At first, Hanley was skeptical that students in her class would bond, but over time, they did. "I say 'Good morning' to each person as they check in," she said. "And then during class, I try to make it fun."
AgeOptions, an Illinois agency serving seniors, has seen similar benefits since introducing virtual fitness programs. Officials at the agency said last year that their operations "may have changed forever" in favor of a hybrid model of virtual and in-person classes.
That model allows AgeOptions to maintain exercise programs through Illinois' brutal winters. Organizers previously limited winter activities to keep older adults from traveling in snow and ice, but now AgeOptions leans on remote classes instead.
"If the pandemic didn't happen, and we didn't pivot these programs to virtual, we wouldn't be able to do that," said Kathryn Zahm, a manager at AgeOptions. "We would just potentially spend months limiting our programming or limiting the types of programming that we offered. So now we can still continue to offer fall-prevention programs throughout the year because we can offer it in a safe way."
But the new approach has challenges.
AgeOptions has identified increasing access to technology as a funding priority for the next few years, to ensure seniors can sign on.
The agency found that for many "folks in rural communities it was a challenge not only for them to have the device but to have the bandwidth to be able to do video conference calls," Zahm said.
Tripken said providers and participants need guidance and support to facilitate access to virtual classes.
"For older adults in particular, that includes ensuring those with vision loss, those with hearing loss, those with low English proficiency" can participate in virtual classes, she said.
Some programs have created accommodations to ease the technology barrier.
Participants in Bingocize — a fall-prevention program licensed by Western Kentucky University that combines exercise and health education with bingo — can use a printed copy of the game card mailed to them by AgeOptions if they lack the proficiency to play on the game's app. Either way, they're required to participate on video.
The mail option emerged after Bingocize fielded requests from many senior service organizations trying to figure out how to offer it remotely, said Jason Crandall, the creator and international director of Bingocize.
Crandall designed Bingocize as a face-to-face program and later added the online application to use during in-person classes. Then covid hit.
"All of a sudden, all of these Area Agencies on Aging are scrambling, and they were scrambling trying to figure out, 'How do we do these evidence-based programs remotely?'" Crandall said.
He said Bingocize was one of the few programs at the time that could quickly pivot to strictly remote programming, though it had never done so before.
"From when the pandemic began to now, we've come light-years on how that is done," he said, "and everybody's getting more comfortable with it."
Will Your Smartphone Be the Next Doctor's Office?
The same devices used to take selfies and type out tweets are being repurposed and commercialized for quick access to information needed for monitoring a patient's health. A fingertip pressed against a phone's camera lens can measure a heart rate. The microphone, kept by the bedside, can screen for sleep apnea. Even the speaker is being tapped, to monitor breathing using sonar technology.
In the best of this new world, the data is conveyed remotely to a medical professional for the convenience and comfort of the patient or, in some cases, to support a clinician without the need for costly hardware.
But using smartphones as diagnostic tools is a work in progress, experts say. Although doctors and their patients have found some real-world success in deploying the phone as a medical device, the overall potential remains unfulfilled and uncertain.
Smartphones come packed with sensors capable of monitoring a patient's vital signs. They can help assess people for concussions, watch for atrial fibrillation, and conduct mental health wellness checks, to name the uses of a few nascent applications.
Companies and researchers eager to find medical applications for smartphone technology are tapping into modern phones' built-in cameras and light sensors; microphones; accelerometers, which detect body movements; gyroscopes; and even speakers. The apps then use artificial intelligence software to analyze the collected sights and sounds to create an easy connection between patients and physicians. Earning potential and marketability are evidenced by the more than 350,000 digital health products available in app stores, according to a Grand View Research report.
"It's very hard to put devices into the patient home or in the hospital, but everybody is just walking around with a cellphone that has a network connection," said Dr. Andrew Gostine, CEO of the sensor network company Artisight. Most Americans own a smartphone, including more than 60% of people 65 and over, an increase from just 13% a decade ago, according the Pew Research Center. The covid-19 pandemic has also pushed people to become more comfortable with virtual care.
Some of these products have sought FDA clearance to be marketed as a medical device. That way, if patients must pay to use the software, health insurers are more likely to cover at least part of the cost. Other products are designated as exempt from this regulatory process, placed in the same clinical classification as a Band-Aid. But how the agency handles AI and machine learning-based medical devices is still being adjusted to reflect software's adaptive nature.
Ensuring accuracy and clinical validation is crucial to securing buy-in from health care providers. And many tools still need fine-tuning, said Dr. Eugene Yang, a professor of medicine at the University of Washington. Currently, Yang is testing contactless measurement of blood pressure, heart rate, and oxygen saturation gleaned remotely via Zoom camera footage of a patient's face.
Judging these new technologies is difficult because they rely on algorithms built by machine learning and artificial intelligence to collect data, rather than the physical tools typically used in hospitals. So researchers cannot "compare apples to apples" with medical industry standards, Yang said. Failure to build in such assurances undermines the technology's ultimate goals of easing costs and access because a doctor still must verify results.
"False positives and false negatives lead to more testing and more cost to the health care system," he said.
Big tech companies like Google have heavily invested in researching this kind of technology, catering to clinicians and in-home caregivers, as well as consumers. Currently, in the Google Fit app, users can check their heart rate by placing their finger on the rear-facing camera lens or track their breathing rate using the front-facing camera.
"If you took the sensor out of the phone and out of a clinical device, they are probably the same thing," said Shwetak Patel, director of health technologies at Google and a professor of electrical and computer engineering at the University of Washington.
Google's research uses machine learning and computer vision, a field within AI based on information from visual inputs like videos or images. So instead of using a blood pressure cuff, for example, the algorithm can interpret slight visual changes to the body that serve as proxies and biosignals for a patient's blood pressure, Patel said.
Google is also investigating the effectiveness of the built-in microphone for detecting heartbeats and murmurs and using the camera to preserve eyesight by screening for diabetic eye disease, according to information the company published last year.
The tech giant recently purchased Sound Life Sciences, a Seattle startup with an FDA-cleared sonar technology app. It uses a smart device's speaker to bounce inaudible pulses off a patient's body to identify movement and monitor breathing.
Binah.ai, based in Israel, is another company using the smartphone camera to calculate vital signs. Its software looks at the region around the eyes, where the skin is a bit thinner, and analyzes the light reflecting off blood vessels back to the lens. The company is wrapping up a U.S. clinical trial and marketing its wellness app directly to insurers and other health companies, said company spokesperson Mona Popilian-Yona.
The applications even reach into disciplines such as optometry and mental health:
With the microphone, Canary Speech uses the same underlying technology as Amazon's Alexa to analyze patients' voices for mental health conditions. The software can integrate with telemedicine appointments and allow clinicians to screen for anxiety and depression using a library of vocal biomarkers and predictive analytics, said Henry O'Connell, the company's CEO.
Australia-based ResApp Health got FDA clearance last year for its iPhone app that screens for moderate to severe obstructive sleep apnea by listening to breathing and snoring. SleepCheckRx, which will require a prescription, is minimally invasive compared with sleep studies currently used to diagnose sleep apnea. Those can cost thousands of dollars and require an array of tests.
Brightlamp's Reflex app is a clinical decision support tool for helping manage concussions and vision rehabilitation, among other things. Using an iPad's or iPhone's camera, the mobile app measures how a person's pupils react to changes in light. Through machine learning analysis, the imagery gives practitioners data points for evaluating patients. Brightlamp sells directly to health care providers and is being used in more than 230 clinics. Clinicians pay a $400 standard annual fee per account, which is currently not covered by insurance. The Department of Defense has an ongoing clinical trial using Reflex.
In some cases, such as with the Reflex app, the data is processed directly on the phone — rather than in the cloud, Brightlamp CEO Kurtis Sluss said. By processing everything on the device, the app avoids running into privacy issues, as streaming data elsewhere requires patient consent.
But algorithms need to be trained and tested by collecting reams of data, and that is an ongoing process.
Researchers, for example, have found that some computer vision applications, like heart rate or blood pressure monitoring, can be less accurate for darker skin. Studies are underway to find better solutions.
Small algorithm glitches can also produce false alarms and frighten patients enough to keep widespread adoption out of reach. For example, Apple's new car-crash detection feature, available on both the latest iPhone and Apple Watch, was set off when people were riding roller coasters and automatically dialed 911.
"We're not there yet," Yang said. "That's the bottom line."
New HHS Report Shows Gains in Health Coverage Under Biden-Harris Administration from 2019 to 2021
Administration policies helped increase coverage among younger adults, Latino individuals, American Indian/Alaska Native, and non-English speaking adults
Why People Who Experience Severe Nausea During Pregnancy Often Go Untreated
Mineka Furtch wasn't bothered by the idea of morning sickness after going through a miscarriage and the roller coaster of fertility medication before she finally became pregnant with her son.
But when the 29-year-old from suburban Atlanta was five weeks pregnant in 2020, she started throwing up and couldn't stop. Some days she kept down an orange; other days, nothing. Furtch used up her paid time off at work with sick days, eventually having to rely on unpaid medical leave. She remembered her doctor telling her it was just morning sickness and things would get better.
By the time Furtch was 13 weeks pregnant, she had lost more than 20 pounds.
"I fought so hard to have this baby, and I was fighting so hard to keep this baby," Furtch said. "I was like 'OK, something is not right here.'"
Now, Furtch's son is 18 months old, and she is suffering again from severe nausea and vomiting well into the second trimester of a new, unplanned pregnancy.
The nausea that comes with morning sickness is common in the first trimester of pregnancy, but some women, like Furtch, experience symptoms that linger much longer and require medical attention. However, those often go untreated or undertreated because the condition is misunderstood or downplayed by their doctors or the patients themselves.
Mothers have said they went without care for fear that medicine would hurt their fetus, because they couldn't afford it, or because their doctor didn't take them seriously. Left alone, symptoms get more difficult to control, and such delays can become medical emergencies. Extreme cases are called hyperemesis gravidarum and may last throughout a pregnancy, even with treatment.
"For most women, it's not until they end up in the ER and go, 'Well, most of my friends haven't been to an ER,' they realize this isn't normal," said Kimber MacGibbon, executive director of the Her Foundation, which researches and raises awareness of hyperemesis gravidarum.
There are a lot of unknowns around the cause of nausea and vomiting in pregnancy. Research has indicated genetics plays a role in its severity, and hyperemesis is estimated to occur in up to 3% of pregnancies. But there's no clear line differentiating morning sickness from hyperemesis or consistent criteria to diagnose the condition, which MacGibbon said results in underestimating its impact.
Wide-ranging estimates suggest at least 60,000 people — possibly 300,000 or more — go to a hospital in the U.S. each year with pregnancy-related dehydration or malnourishment. An untold number go to walk-in clinics or don't seek medical care.
The effects ripple into every aspect of a person's life and the economy. One study estimated the total annual economic burden of severe morning sickness and hyperemesis in the U.S. in 2012 amounted to more than $1.7 billion in lost work, caregiver time, and the cost of treatment.
Research for this article was personal. I'm pregnant, and by the fifth week I was vomiting five to seven times a day. My primary care doctor in Missoula, Montana, directed pregnancy-related questions to my obstetrician's medical team, whom I wouldn't see until my first prenatal appointment, more than a month later. Taking advice from an on-call nurse, I tried over-the-counter supplements and medication to ease the nausea.
It didn't stop the vomiting. Nearly a month after my symptoms began, all I could keep down was brown rice. My husband and I had hoped for this pregnancy, but at that point, part of me thought a miscarriage would at least end the retching.
The next week, a remote on-call doctor prescribed anti-nausea medication after I went 24 hours without food. Now, well into my second trimester, the nausea remains but my symptoms are manageable and continue to improve.
For this story, I spoke with women who went weeks without being able to keep solids down and could no longer take in water before they received IVs for hydration. For many, it can be difficult to know when to seek medical attention.
"There's not a number, like, 'OK, you vomited five times, so now you meet the criteria,'" said Dr. Manisha Gandhi, an American College of Obstetricians and Gynecologists vice chair who helps determine clinical practice guidelines for obstetrics. "The key is, 'Are you keeping liquids down? Are you tolerating anything by mouth?'"
Gandhi said, in her experience, a small segment of patients experience severe symptoms, which for the majority peak around the eighth or 10th week of pregnancy. She said it's standard for doctors to ask during a first prenatal visit whether a patient has felt nauseated, and patients should call if issues arise before then. Treatment is gradual — changing the diet or taking a natural supplement like vitamin B6 — before considering an anti-nausea prescription medication.
First prenatal visits vary but can happen as late as 10 to 12 weeks into the pregnancy, once it's possible to confirm the fetus's heartbeat. JaNeen Cross, a perinatal social worker and assistant professor at Howard University in Washington, D.C., said that leaves a gap in care for women early in pregnancy.
"That's a lot of time for nausea, sickness, bleeding to go on as they think 'Is this normal?'" Cross said. "And we're assuming people have access to providers."
Barriers to care include whether someone has insurance or can afford their copays, or if they have child care and paid time off work to go to the doctor.
About two-thirds of Black patients in the U.S. saw a doctor in their first trimester in 2016, compared with 82% of white patients, according to a report released by the Centers for Disease Control and Prevention. Overall, roughly half of people who have to pay out-of-pocket went without that first-trimester checkup.
Cross said she'd like to see more services and resources built into communities, so that as soon as someone finds out they're pregnant, they're linked to support groups, community health workers, or programs that make home visits. That could help with another hurdle for care: trust that treatment is safe.
Some of that mistrust may be rooted in the 1950s and '60s, when the morning sickness drug thalidomide led to thousands of babies being born with severe birth defects. Research has found today's anti-nausea medications used in pregnancy pose little if any risk to the fetus.
By her sixth week of pregnancy with her first child, Helena Schwartz, 33, of Brooklyn, New York, was on at-home IVs because she couldn't keep food down. That helped for about two days; then her body began rejecting food again. Schwartz said her doctor, who had been quick to help her, prescribed anti-nausea medication. She left the medicine untouched for three weeks as her symptoms got worse.
"I was scared it would hurt the baby," Schwartz said. "I waited until it was impossible."
Even with a diagnosis and supportive medical team, people like Schwartz have experienced extreme symptoms throughout their pregnancies, and healing is slow.
As for Furtch, the prescription medication she used in her first pregnancy didn't do enough this time around to ease her symptoms.
Her new obstetrician takes her symptoms seriously, but at times she has still faced roadblocks to care. At first, she couldn't afford thousands of dollars out-of-pocket for a medical device that would constantly pump anti-nausea medication through her system. When her doctor prescribed a series of drugs as a backup plan, her insurance initially refused to cover the cost. She went days without medicine, which meant throwing up about eight times a day.
Since she started the prescription medicines, she typically can keep some food down. But she still has her bad days, and had to go to the hospital again in late December to get IVs.
Her baby girl is due this spring. After that, she plans to see her doctor again to have her tubes tied.
"Giving birth is nothing compared to 10 months of hell," Furtch said.


Please send me your snail mail addresses and I'll have QN send a copy of Quilter's Newsletter Special Interest Publication on Fat Quarter Quilts your way!
Tomorrow I'll be back with Bejeweled - I promise yo-yo craziness.
Ditto! Congrats and enjoy to the lucky recipients.


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Linkin Park Promises Tour Surprises
Linkin Park has plenty of surprises in store for fans when it hits the road next month for a North American tour with P.O.D., Hoobastank and Story Of The Year, singer Mike Shinoda says. "We're playing an all-new set and we've added some songs that people haven't heard us play live before and some songs we haven't played live in a long time," Shinoda told Billboard.com. "So, even though I know a lot of our fans are going to check out 'Live in Texas,' the set that we will be playing in January and February is longer, has more songs and it has a lot of stuff that people haven't heard."
December 9, 2003 rockdirt Uncategorized No Comments Linkin Park
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Home Blogs Behind the Page Local photojournalist presents Project Hands: For the Stories We Hold
Farewell Frank. And Thank You.
Day Trip to C-Ville
Local photojournalist presents Project Hands: For the Stories We Hold
by Samantha Hoback
Laura Weeks
An unexpected illness left Vanessa unable to work and provide for her young family. After many failed housing situations, including stays with friends and family, she moved into the Rescue Mission with her four young children.
Jasim
Jasim is a refugee from Iraq. He moved to the US to build a better life for himself and his family, who remained behind in the Middle East. He hopes to bring them here to join him.
Joy and Shirlene
Joy suffered from ovarian cancer and became a resident of hospice care at the Rescue Mission. Her friend, Shirlene, became her caretaker until Joy lost her battle to cancer in October. "Project Hands" is dedicated to Joy.
After attempting to take his own life, Rick was in in intensive care for 3 months, a coma for 18 days and a wheelchair for half a year. Today he is grateful for a second chance at life and says his greatest accomplishment is being himself.
Dustin suffers from an anxiety disorder and has been in and out of psychiatric facilities for years. His stepfather was mentally abusive, but he found strength and support in his mother. One day, he'd like to to work in the psychiatric field, perhaps as a counselor.
Tyler Richards
Laura Weeks, Artist
A Cave Spring graduate, Laura Weeks studied journalism at JMU, where she discovered her passion for photography working for the university newspaper. She currently works in the marketing department at Magnets USA.
Laura Weeks loves to photograph people: her nephew, couples and families at strolling the fairgrounds of Salem, portraits of babies and ballerinas. Her pictures vary in theme and composition, but one thing they all have in common: her photos tell a story.
After a tour at the Rescue Mission, Weeks was inspired to learn more about the people there and their stories. She met with more than 50 people and took images of their hands, capturing so much emotion in the curves of fingers and the lines of skin. Those photos are now a part of her collection, "Project Hands: For the Stories We Hold," which will show at the Alexander/Heath Contemporary in downtown Roanoke. The exhibit opens Friday, December 4. The collection was previously on display at 2nd Helpings.
While all of the photos tell incredible stories, a few stand out for Weeks. "Jasim's story is one of my favorites," she says. "He is a refugee from Iraq. He came to the US and left his wife and children behind. He wanted to build a life for himself and have his family join him."
And then there are Joy and Shirlene. Joy, a hospice-care resident, suffered stage-four ovarian cancer. Her friend, Shirlene, became her caretaker. Unfortunately, Joy recently lost her battle to cancer, but not before she encouraged Weeks to share her collection with the community. Her exhibit at the Alexander/Heath is dedicated to Joy.
For more information about the collection and the artist, visit her websites, LauraAWeeks.com and StoriesWeHold.com.


Today, I present to you the King of all cheat meals (why does this keep happening?). Bikini season is just days away and I am doing this to myself. If you're wanting to treat your body as a temple this summer, then stop reading now. Especially if you're hungry. Don't say I didn't warn you.
We had our first meal together as a full family in a long time since everyone is usually in different corners of the globe doing god knows what, and where better to go for such a special occasion than to Bob Bob Ricard?
Bob Bob Ricard is stunning. Everything about it is beautiful – the interior, the food, the drinks, even the waiter's outfits.
I was planning on pressing it and spending the rest of the night sipping on champagne… Until I saw the cocktail list. Hello, Champagne Mojito! It was a perfect mix of sweet and tangy, and was washed down far quicker than an Asian should drink alcohol. Mum did the same with her Strawberry Sauvignon Twinkle and ended up a little happy for the rest of the night, which I'm not going to pretend I didn't enjoy.
Daddy Bridges was kept happy with his organic beer, which he said was very nice. I had a sip but as hard as I've tried to be a beer girl, it's just not happening.
As always, we ordered a range of starters to share so we get to try a bit of everything. We ordered the 'BBR Signature Venison Tartare Imperial' which was made with 12G Petrossian Alverta Sturgeon caviar, the seabass ceviche with avocado and oysters baked with parmesan and black truffle.
Everything was amazing, particularly the oysters. This is mainly because I love oysters, parmesan and black truffle, so it was destiny.
For mains, Mama Bridges went for the chateaubriand, which was 28 day aged fillet of Aberdeenshire scotch beef. It was a little disappointing as the outsides were very dry, although the centre was fine.
Ming ordered the grilled fillets of seabass, which was the best dish out of all of the ones we ordered. It tasted so fresh that the juice of the lemon that came with it was all it needed as a dressing.
Daddy Bridges got the 'Mariner's Fish Pie', which he enjoyed. I absolutely loved the branded patterns on top of the pies.
My chicken, mushroom and champagne pie had a different pattern which excited me far more than it probably should have. I'll admit that I ordered the pie purely because it had champagne as one of the ingredients, and came with truffle gravy. I couldn't really taste the champagne but still enjoyed it. It looked a lot bigger than it was, which was essentially as a good thing as they looked massive and I'm only one tiny person.
As always, we ordered a range of healthy sides. We resisted the truffled mashed potato and lobster mashed potato and went with sautéed spinach, tomato salad and the crushed minted peas. The first two were the average sides you'd expect, but the crushed minted peas were exceptionally good as the two flavours worked perfectly together.
I tried to convince someone to share the beef wellington for two with me, but there were no takers. I got major food envy when I saw the table next to us had ordered it.
Although my mood was lifted when I glanced at the dessert list (just kidding, the dessert list was clearly the first thing I looked at).
Again, we got two to share so we didn't feel like little fatties. I highly recommend everybody should try both of them. The first was the 'Strawberries & Cream' Soufflé which was outstanding. I had to fight spoons away to get some for myself. Things very nearly got ugly.
Mum was unimpressed with the amount of cream he poured in and decided to use up the rest.
And this. The 'BBR Signature Chocolate Glory'. Watching this transform was (sadly?) the highlight of the evening. Until we tasted it.


text:
It was fall 2015, and massive wildfires had devastated parts of eastern Washington. Yet as James Schroeder, Conservation Director for the Conservancy in Washington, toured the damage, he saw very different impacts.
Some areas were totally scorched. But where forests had been managed with thinning and controlled burns, the landscape was still green and vibrant. There, the impact of wildfire was beneficial, not destructive, says Schroeder. "I was amazed to see how well the thinning and controlled burn had worked to make the forest more resilient to the wildfire."
Now, a scientific study has put real numbers on the power of such tactics to combat not only forest fires, but climate change itself. The report, called Natural Climate Solutions for the United States, analyzed the potential for various natural land management strategies to reduce or offset carbon emissions, slowing the alarming pace of climate change.
Their conclusion: forests matter. A lot.
a forest that has been thinned and treated with prescribed fire comes back green and better able to withstand wildfire. Photo (c) John Marshall
Carbon Control
The report by Nature Conservancy scientist Joseph Fargione and more than a dozen research institutions outlined 21 natural strategies which, added together, could counter as much as 21 percent of United States carbon emissions. It was published in the November 14, 2018 issue of Science Advances.
By far, the two most potent natural solutions identified were forest management and reforestation According to the report, if the United States maximized the potential of these alone, it would be like taking 145 million cars off the road every year. "The Natural Climate Solutions report is very newsworthy. It puts solid and practical scientific evidence behind our approach to harness nature to combat climate change," says Schroeder.
Forests play a key role largely because of their ability to sequester, or store, carbon—just one mature tree can sequester as much as 48 pounds of carbon per year. That keeps carbon out of the atmosphere, so naturally, the more forests the better. And fire-resilience is key. "By not burning up, that forest is still storing carbon," says Schroeder.
Leading the way in the Evergreen state
In Washington, our trees stand especially tall in the fight against climate change. Half of Washington's total land area is forested. We at the Conservancy are a leader in strategies noted in the report, such as increasing fire-resilience and lengthening the time between harvests so that we can grow bigger trees and bolster carbon sequestration. What's more, says Schroeder, we also lead the way in developing partnerships with local, state, federal and tribal organizations that allow restoration on a landscape-scale, coming together around shared goals while respecting diverse concerns. It's a big-view approach, and it works, as Schroeder has seen firsthand.
Half of Washington's land mass is covered in forest.
Meanwhile, scientists like Michael Case focus on the details. Case, the forest ecologist for the Conservancy in Washington, analyzes how climate change is altering our forests, and how we can help those forests play the biggest role possible in fighting climate change globally. He considers carbon-related impacts as well as ecological ones.
"One of the best things we can do is to recognize the differences between forests on the drier eastern side of the state and the more lush forests on the western side," Case explains. "On the east side, reducing the potential for big forest fires is critical. But on the western side, forest fires are much less frequent. There, it's important that we speed up the process of succession to old growth, because old growth characteristics are what makes those forests more resilient." For example, Case points to our work at Ellsworth Preserve, the Hoh River, and other areas, which are teaching us—and other states— how to effectively restore the unique, ecological complexity of old growth forests.
Plenty of Potential
Now, with the Natural Climate Solutions Report, we have even more validation that well-managed forests can slow climate change. "The Nature Conservancy's work here in Washington directly supports the report's recommendations," says Schroeder. "We're on the right track with our forests."
Yet, the report also brings to light a serious gap in how much is being done to maximize the power of our forests and other natural solutions, versus how much could potentially be done. "Globally, current natural climate solution efforts receive only 0.8% of public and private climate financing," write the authors, even though by 2030 such solutions could account for 37% of possible mitigation. Thanks to the report, that right track is clearer than ever.
Learn More About our Work in Washington's Forests
drought, science, Climate Change, forests
Drought Returns to Washington. Now What?
Summer 2019 kicked off on an upbeat note for Washington hikers: our favorite mountain trails were snow-free weeks sooner than in previous years. But like schoolkids let loose unexpectedly early, we are wary of a catch. And there is a catch: it's a drought.
Climate Change, floodplains, estuaries, Port Susan Bay, science, natural climate solutions
Tapping the Power of Estuaries for Blue Carbon Capture
Coastal habitats mangroves, sea grasses and estuaries can capture and store carbon, and are a key natural climate solution. In Washington, our estuaries hold great promise.
science, cascades, Climate Change, snowpack
Seeking climate clues in Washington's snowpack
We're tracking snow accumulation and melt-out in the Cascade forests, collecting key data that will help ensure water security for valleys and communities below.
sea level rise, coastal resilience, coast, science, Climate Change
King Tides reveal the future of sea-level rise
The highest tides of the year offer a glimpse into a future of rising sea levels along Washington's coast.
Header photo by John Marshall
Tagged: climate change, forest, science, Michael Case, James Schroeder, Climate Change
Newer PostMeet Alfonso Orozco, Volunteer and Field Experiences Manager
Older PostMoses Coulee Inspires Artists


Details of the company Goondir Health Services in Saint George.
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Ooops! Missed my daily habit for the past few days.
I usually post my #healthIsHappening Challenge before I retire to bed at night but lately DS has had trouble sleeping because of his colds, which meant my hands were extra extra full.
When the kids get sick, my sleep tank goes into negative as well. If the kids can't sleep, mommies can't sleep too, you know. Now that DS is a bit better, I'm trying to slowly recover from my zombie mode.
Alarm set for 8 hours and 6 minutes from now!!! Sounds heavenly, right?!
Ok, ciao for now! I have about 6 minutes to read and reread and reread my post. I'm so OC that way!


text:
'Litmus test' begins in Maguindanao prosecution
By Bob Dietz/CPJ Asia Program Coordinator on August 17, 2010 2:31 PM ET
A judge's decision today to set a September 1 trial date for several defendants in the Maguindanao massacre highlights a positive development in what has been a very ugly story. The judge appeared determined to move the case forward and, for now, seemed able to keep the large legal teams in line.
Quezon City Regional Trial Court Justice Jocelyn Solis-Reyes needed only 45 minutes to set a no-nonsense tone for a case that is going to be closely watched in the Philippines and around the world. Recently elected President Benigno Aquino and his justice secretary, Leila de Lima, have made it clear that they grasp the importance of building a dynamic legal system to match their aspirations for national growth. De Lima has been calling the Maguindanao trial a "litmus test" for a Philippines judicial system that has been known for extended delays and pervasive conflict of interest.
In 66 journalist murders since 1992, prosecutors have won only five convictions, CPJ research shows. And most of those convicted were the hit men--guns for hire who didn't know their victims beyond recognizing their faces, skilled at carrying off drive-by killings, often while mounted on motorcycles. None of the plotters--the powerful people with the money to pay someone to do their dirty work--has been brought to justice. The most glaring example is the March 2005 murder of Marlene Garcia-Esperat, in which two prominent public officials accused of masterminding the crime have remained free. Only the gunmen have been tried and convicted in the Garcia-Esperat killing, which also occurred in Mindanao.
CPJ's Impunity Index, an annual assessment that calculates unsolved journalist murders as a percentage of each country's population, ranks the Philippines as the third worst country in the world in bringing the killers of journalists to justice. Only Iraq and Somalia, two war-riven nations, are worse. The problem in the Philippines is not unique to journalist killings; the country's judicial system has an abysmal overall conviction rate in murder cases. Detlev Mehlis, who heads the European Union's Philippine Justice Support Program, puts the Philippines murder conviction rate at 10 percent.
The prosecution in the Maguindanao killings could provide a turning point for this faltering system. Thirty-two media journalists and workers were slain in the Maguindanao massacre, which took 57 lives in all. The politically motivated killings were the deadliest event for the press ever recorded by CPJ.
Relatives of the victims occupied much of the Quezon City courtroom at today's hearing. The families had been brought on commercial flights from their homes in Mindanao with support from the national press freedom community and international backing. The families have been divided into three groups of about 20 each. They will rotate through the trial sessions, each group flying up and back from Mindanao to Manila. Continued support, both national and international, will be needed to help the families, most of whom lost their primary bread-winners in the massacre.
"I'm not sure if what we're doing will make a difference, but what can we do?" one family member told me. "We're working to bring these men to justice. Even if we don't, it will have been better to have tried than to have just sat silently." It was a bleak statement, struggling to be positive against a backdrop of women dressed in black, handkerchiefs to their faces. Some men wore t-shirts, their backs carrying the lines "Heirs of 11/23 Heroes Incorporated."
As the courtroom cleared out, a reporter from the Philippine Daily Inquirer asked me for some thoughts. His first question: "People are saying this trial could take a decade. Do you think that's true?"
That's for the government and the judge to determine, I answered, although the record makes it seem all too possible. Today's hearing and the setting of a trial date from a no-nonsense judge seemed to be a break from the past. But we're still at the start of a long process.
(Reporting from Manila)
Bob Dietz, coordinator of CPJ's Asia Program, has reported across the continent for news outlets such as CNN and Asiaweek. He has led numerous CPJ missions, including ones to Afghanistan, Pakistan, the Philippines, and Sri Lanka. Follow him on Twitter @cpjasia and Facebook @ CPJ Asia Desk.
Impunity
Short URL: https://cpj.org/x/3e0d
Mission Journal: Duterte leads tri-pronged attack on press amid condemnation of controversial policies
July 5, 2018 2:10 PM ET
Pia Randa is in Philippine leader Rodrigo Duterte's crosshairs. At presidential press conferences, Duterte has repeatedly singled out the reporter by name and referred to Rappler, the news site where she works, as "fake news" and her reporting as "corrupt" and "biased" against his administration....
Rappler fights to survive amid rising threats to journalists in the Philippines
April 3, 2018 12:42 PM ET
On January 15, the Philippines' Securities and Exchange Commission ruled that online news group Rappler had violated laws barring foreign ownership and control of local media, and moved to revoke its registration....
Philippine leader blows hot and cold on press freedom
August 4, 2016 11:51 AM ET
Newly installed Philippine President Rodrigo Duterte has sent mixed messages on his commitment to upholding press freedom and combating impunity in media murders, a mix of hope and fear that has broadly defined the first months of his leadership. Uncertainty about Duterte's stance on the media's watchdog role comes...
Justice delayed is justice denied in Philippines' Maguindanao massacre
July 31, 2015 10:19 AM ET
During his final State of the Nation Address this week, President Benigno Aquino III made only a passing mention of the 2009 Maguindanao massacre that killed 57 people, including 32 journalists and media workers. He did not detail any plans for action on the case, despite his vow to...


Ah.. the day I have been waiting for ! Windows Vista SP1 has been finally released via windows update today !
I upgraded to Vista last year and there were a few issues bugging me including the file copy to external drives, WiFi connectivity, Printer Connectivity etc.
Few of the issues were addressed by patches and few of them were also fixed when I upgraded to the beta release of Vista SP1. With today's final release of SP1 I am hoping that MS has addressed all the reported issues in Vista.
You can download the SP1 via Windows update; Note that if you are downloading via Windows Update, you might have to install all the pending updates before the SP1 shows up in the update list. Also as per the official release note, download via Windows update checks for specific driver issues and hence might not show up in the update list.
Did you install SP1, I have not tried, my internet connection is not fast enuf to download 440MB.


text:
Justin Showell Speaks at Bomaderry Rotary
Proof Read Edit Interviews Justin
Our Office In Nowra
Recently Justin Showell was requested to share at Bomaderry Rotary on how technology has changed our culture.
Justin shared how technology has changed the way that we interact with each other on, how it has changed the way that we educate our children and how it has changed the way we operate our businesses. Including how reliable computer support is a non-negotiable for today's business owners.
The message was well received. See the excerpt from the Bomaderry Rotary Bulletin below:
Guest Speaker: Justin Showell
"How Technology has Changed our Culture"
Justin was born in Wollongong and in 1998 their family moved down to the Shoalhaven. Justin attended Nowra Christian Scholl and got into IT after leaving school. He completed a Tafe course while working with a local IT company and leant a lot of his craft on the job. After buying into a local business in a partnership he left last year to form his own business, Shoaltec. Apart from his business Justin and his wife run the Youth ministry of the Nowra City Church.
Justin then when on to explain several areas of technology that are now part of our lives. iPhones have become a large part of shaping our lives even effecting how we date and cook. Justin started his working life repairing computers which have changed the way we communicate where children are now bringing their own device to school. Hand writing has almost become a thing of the past. NBN is going to make a big difference in schools for learning. Young people instead of watching TV now go on Facebook and U Tube. Facebook is a very useful for targeted marketing of products/services where you can target certain demographics thereby narrowing down your customer base. Business is now driven by consumers within a global market. Facebook is now the largest database in the world. Technology is changing the way we communicate and our leisure activities. Justin's talk was appreciated by an older audience
We're growing! Welcome Jacob for tech support
Happy News from Justin & Corey
What's A Website Worth?


text:
@class CCPBVActionPath;
@class CCPBVClinicalValue;
@class CCPBVDocument_DocumentItem;
@class CCPBVDocument_DocumentItemTypeEnum;
@class IOSObjectArray;
@class JavaLangStringBuilder;
@class JavaUtilDate;
@class JavaUtilEventObject;
@class JavaUtilHashMap;
@class JavaUtilLinkedHashMap;
@class RAREActionEvent;
@class RAREActionLink;
@class RARERenderableDataItem;
@class RARETableViewer;
@class RAREUIColor;
@class RAREUIFormsLayoutRenderer;
@class RAREUTJSONObject;
@class RAREWindowViewer;
@protocol JavaUtilList;
@protocol JavaUtilMap;
@protocol RAREUTiStringConverter;
@protocol RAREiPlatformIcon;
@protocol RAREiWidget;

#import "JreEmulation.h"
#include "com/appnativa/rare/aWorkerTask.h"
#include "com/appnativa/rare/iFunctionCallback.h"
#include "com/appnativa/rare/ui/event/iActionListener.h"
#include "com/appnativa/util/iFilter.h"
#include "com/sparseware/bellavista/Document.h"
#include "com/sparseware/bellavista/aChartHandler.h"
#include "com/sparseware/bellavista/aResultsManager.h"
#include "com/sparseware/bellavista/iValueChecker.h"
#include "java/lang/Runnable.h"

@interface CCPBVLabs : CCPBVaResultsManager < RAREiActionListener, CCPBViValueChecker > {
 @public
  BOOL bunFound_;
  BOOL creatFound_;
  NSString *bunID_;
  NSString *creatineID_;
  CCPBVClinicalValue *bunValue_;
  CCPBVClinicalValue *creatinineValue_;
  BOOL isSummary_;
  IOSObjectArray *trendPanels_;
  BOOL overViewLoaded_;
  id<JavaUtilMap> trendsLayout_;
  BOOL uniqueSummaryEntries_;
  BOOL documentsInlined_;
  BOOL sortCategoriesOnLinkedData_;
  id<RAREiPlatformIcon> pageIcon_;
  id<RAREiPlatformIcon> noteIcon_;
  NSString *seeReport_;
  CCPBVDocument *loadedDocument_;
  RAREUIColor *unknowResultColor_;
  NSString *collectionInfoKey_;
  JavaUtilHashMap *collectionInfoMap_;
  BOOL showUnits_;
  JavaLangStringBuilder *temp_;
}

+ (int)CATEGORY_NAME_POSITION;
+ (int *)CATEGORY_NAME_POSITIONRef;
+ (int)IS_DOCUMENT_POSITION;
+ (int *)IS_DOCUMENT_POSITIONRef;
+ (int)SORT_ORDER_POSITION;
+ (int *)SORT_ORDER_POSITIONRef;
+ (int)UNIT_POSITION;
+ (int *)UNIT_POSITIONRef;
+ (int)RESULT_ID_POSITION;
+ (int *)RESULT_ID_POSITIONRef;
+ (int)COMMENT_POSITION;
+ (int *)COMMENT_POSITIONRef;
+ (JavaUtilLinkedHashMap *)trendMap;
+ (void)setTrendMap:(JavaUtilLinkedHashMap *)trendMap;
- (id)init;
- (void)actionPerformedWithRAREActionEvent:(RAREActionEvent *)e;
- (void)changeViewWithNSString:(NSString *)eventName
               withRAREiWidget:(id<RAREiWidget>)widget
       withJavaUtilEventObject:(JavaUtilEventObject *)event;
- (void)onSummaryDisposeWithNSString:(NSString *)eventName
                     withRAREiWidget:(id<RAREiWidget>)widget
             withJavaUtilEventObject:(JavaUtilEventObject *)event;
- (CCPBVActionPath *)getDisplayedActionPath;
- (void)filterTableWithRARERenderableDataItem:(RARERenderableDataItem *)filterItem;
- (BOOL)checkRowWithRARERenderableDataItem:(RARERenderableDataItem *)row
                                   withInt:(int)index
                                   withInt:(int)expandableColumn
                                   withInt:(int)rowRount;
- (void)addCurrentPathIDWithCCPBVActionPath:(CCPBVActionPath *)path;
- (void)onFinishedLoadingWithNSString:(NSString *)eventName
                      withRAREiWidget:(id<RAREiWidget>)widget
              withJavaUtilEventObject:(JavaUtilEventObject *)event;
- (void)onLabReportLoadWithNSString:(NSString *)eventName
                    withRAREiWidget:(id<RAREiWidget>)widget
            withJavaUtilEventObject:(JavaUtilEventObject *)event;
- (void)onReportNavigatorChangeWithNSString:(NSString *)eventName
                            withRAREiWidget:(id<RAREiWidget>)widget
                    withJavaUtilEventObject:(JavaUtilEventObject *)event;
- (void)onSummaryTableActionWithNSString:(NSString *)eventName
                         withRAREiWidget:(id<RAREiWidget>)widget
                 withJavaUtilEventObject:(JavaUtilEventObject *)event;
- (void)onCreatedWithNSString:(NSString *)eventName
              withRAREiWidget:(id<RAREiWidget>)widget
      withJavaUtilEventObject:(JavaUtilEventObject *)event;
- (void)onDisposeWithNSString:(NSString *)eventName
              withRAREiWidget:(id<RAREiWidget>)widget
      withJavaUtilEventObject:(JavaUtilEventObject *)event;
- (void)onTrendsTableConfigureWithNSString:(NSString *)eventName
                           withRAREiWidget:(id<RAREiWidget>)widget
                   withJavaUtilEventObject:(JavaUtilEventObject *)event;
- (void)onTrendsTableCreatedWithNSString:(NSString *)eventName
                         withRAREiWidget:(id<RAREiWidget>)widget
                 withJavaUtilEventObject:(JavaUtilEventObject *)event;
- (void)selectLabsWithNSString:(NSString *)eventName
               withRAREiWidget:(id<RAREiWidget>)widget
       withJavaUtilEventObject:(JavaUtilEventObject *)event;
- (void)showChartForSelectedItemWithRARETableViewer:(RARETableViewer *)table;
- (void)disposeOfLoadedDocument;
- (void)showCollectionInfoWithRARETableViewer:(RARETableViewer *)table
                   withRARERenderableDataItem:(RARERenderableDataItem *)row;
- (void)configureTrendFormsRendererWithRAREUIFormsLayoutRenderer:(RAREUIFormsLayoutRenderer *)renderer;
- (void)dataParsedWithRAREiWidget:(id<RAREiWidget>)widget
                 withJavaUtilList:(id<JavaUtilList>)rows
               withRAREActionLink:(RAREActionLink *)link;
- (NSString *)getCategoryWithRARERenderableDataItem:(RARERenderableDataItem *)row;
- (NSString *)getSpeeedSheetColumnTitle;
- (void)handleSummaryLabsWithRARETableViewer:(RARETableViewer *)table
                            withJavaUtilList:(id<JavaUtilList>)rows;
- (BOOL)hasCategories;
- (void)loadStainsWithRAREWindowViewer:(RAREWindowViewer *)w
                     withCCPBVDocument:(CCPBVDocument *)doc
                       withRAREiWidget:(id<RAREiWidget>)browser;
- (void)loadSusceptibilitiesWithRAREWindowViewer:(RAREWindowViewer *)w
                               withCCPBVDocument:(CCPBVDocument *)doc
                             withRARETableViewer:(RARETableViewer *)table;
- (void)processDataWithRARETableViewer:(RARETableViewer *)table
                      withJavaUtilList:(id<JavaUtilList>)rows;
- (BOOL)reportHasStainsWithCCPBVDocument:(CCPBVDocument *)doc;
- (BOOL)reportHasSusceptibilitiesWithCCPBVDocument:(CCPBVDocument *)doc;
- (void)reset;
- (void)copyAllFieldsTo:(CCPBVLabs *)other;
@end

J2OBJC_FIELD_SETTER(CCPBVLabs, bunID_, NSString *)
J2OBJC_FIELD_SETTER(CCPBVLabs, creatineID_, NSString *)
J2OBJC_FIELD_SETTER(CCPBVLabs, bunValue_, CCPBVClinicalValue *)
J2OBJC_FIELD_SETTER(CCPBVLabs, creatinineValue_, CCPBVClinicalValue *)
J2OBJC_FIELD_SETTER(CCPBVLabs, trendPanels_, IOSObjectArray *)
J2OBJC_FIELD_SETTER(CCPBVLabs, trendsLayout_, id<JavaUtilMap>)
J2OBJC_FIELD_SETTER(CCPBVLabs, pageIcon_, id<RAREiPlatformIcon>)
J2OBJC_FIELD_SETTER(CCPBVLabs, noteIcon_, id<RAREiPlatformIcon>)
J2OBJC_FIELD_SETTER(CCPBVLabs, seeReport_, NSString *)
J2OBJC_FIELD_SETTER(CCPBVLabs, loadedDocument_, CCPBVDocument *)
J2OBJC_FIELD_SETTER(CCPBVLabs, unknowResultColor_, RAREUIColor *)
J2OBJC_FIELD_SETTER(CCPBVLabs, collectionInfoKey_, NSString *)
J2OBJC_FIELD_SETTER(CCPBVLabs, collectionInfoMap_, JavaUtilHashMap *)
J2OBJC_FIELD_SETTER(CCPBVLabs, temp_, JavaLangStringBuilder *)

typedef CCPBVLabs ComSparsewareBellavistaLabs;

@interface CCPBVLabs_LabDocument : CCPBVDocument {
 @public
  CCPBVDocument_DocumentItem *susceptibilities_;
  CCPBVDocument_DocumentItem *stains_;
}

- (id)initWithRAREiWidget:(id<RAREiWidget>)widget
       withRAREActionLink:(RAREActionLink *)link
             withNSString:(NSString *)id_;
- (CCPBVDocument_DocumentItem *)addAttachmentWithCCPBVDocument_DocumentItemTypeEnum:(CCPBVDocument_DocumentItemTypeEnum *)type
                                                                   withJavaUtilDate:(JavaUtilDate *)date
                                                                       withNSString:(NSString *)title
                                                                       withNSString:(NSString *)mimeType
                                                                       withNSString:(NSString *)body
                                                                       withNSString:(NSString *)href;
- (CCPBVDocument_DocumentItem *)processDocumentRowWithCCPBVDocument_DocumentItem:(CCPBVDocument_DocumentItem *)doc
                                                      withRARERenderableDataItem:(RARERenderableDataItem *)row;
- (void)copyAllFieldsTo:(CCPBVLabs_LabDocument *)other;
@end

J2OBJC_FIELD_SETTER(CCPBVLabs_LabDocument, susceptibilities_, CCPBVDocument_DocumentItem *)
J2OBJC_FIELD_SETTER(CCPBVLabs_LabDocument, stains_, CCPBVDocument_DocumentItem *)

@interface CCPBVLabs_ChartHandler : CCPBVaChartHandler {
}

- (id)initWithCCPBVLabs:(CCPBVLabs *)outer$
   withRAREUTJSONObject:(RAREUTJSONObject *)chartsInfo;
@end

@interface CCPBVLabs_$1 : NSObject < RAREUTiFilter > {
 @public
  CCPBVLabs *this$0_;
  NSString *val$cat_;
  id<JavaUtilList> val$fkeys_;
}

- (BOOL)passesWithId:(id)value
withRAREUTiStringConverter:(id<RAREUTiStringConverter>)converter;
- (id)initWithCCPBVLabs:(CCPBVLabs *)outer$
           withNSString:(NSString *)capture$0
       withJavaUtilList:(id<JavaUtilList>)capture$1;
@end

J2OBJC_FIELD_SETTER(CCPBVLabs_$1, this$0_, CCPBVLabs *)
J2OBJC_FIELD_SETTER(CCPBVLabs_$1, val$cat_, NSString *)
J2OBJC_FIELD_SETTER(CCPBVLabs_$1, val$fkeys_, id<JavaUtilList>)

@interface CCPBVLabs_$2 : NSObject < RAREiFunctionCallback > {
 @public
  RAREWindowViewer *val$win_;
  RARETableViewer *val$table_;
  RAREUTJSONObject *val$json_;
  RARERenderableDataItem *val$row_;
}

- (void)finishedWithBoolean:(BOOL)canceled
                     withId:(id)returnValue;
- (id)initWithRAREWindowViewer:(RAREWindowViewer *)capture$0
           withRARETableViewer:(RARETableViewer *)capture$1
          withRAREUTJSONObject:(RAREUTJSONObject *)capture$2
    withRARERenderableDataItem:(RARERenderableDataItem *)capture$3;
@end

J2OBJC_FIELD_SETTER(CCPBVLabs_$2, val$win_, RAREWindowViewer *)
J2OBJC_FIELD_SETTER(CCPBVLabs_$2, val$table_, RARETableViewer *)
J2OBJC_FIELD_SETTER(CCPBVLabs_$2, val$json_, RAREUTJSONObject *)
J2OBJC_FIELD_SETTER(CCPBVLabs_$2, val$row_, RARERenderableDataItem *)

@interface CCPBVLabs_$3 : RAREaWorkerTask {
 @public
  CCPBVLabs *this$0_;
  RARETableViewer *val$table_;
  id<JavaUtilList> val$rows_;
}

- (id)compute;
- (void)finishWithId:(id)result;
- (id)initWithCCPBVLabs:(CCPBVLabs *)outer$
    withRARETableViewer:(RARETableViewer *)capture$0
       withJavaUtilList:(id<JavaUtilList>)capture$1;
@end

J2OBJC_FIELD_SETTER(CCPBVLabs_$3, this$0_, CCPBVLabs *)
J2OBJC_FIELD_SETTER(CCPBVLabs_$3, val$table_, RARETableViewer *)
J2OBJC_FIELD_SETTER(CCPBVLabs_$3, val$rows_, id<JavaUtilList>)

@interface CCPBVLabs_$4 : NSObject < JavaLangRunnable > {
 @public
  id<RAREiWidget> val$label_;
  NSString *val$value_;
}

- (void)run;
- (id)initWithRAREiWidget:(id<RAREiWidget>)capture$0
             withNSString:(NSString *)capture$1;
@end

J2OBJC_FIELD_SETTER(CCPBVLabs_$4, val$label_, id<RAREiWidget>)
J2OBJC_FIELD_SETTER(CCPBVLabs_$4, val$value_, NSString *)

#endif // _CCPBVLabs_H_

redpajama_set_name: RedPajamaGithub


I've just released a new version of Overseer Network Monitor, 5.0.73. This is only a tiny bug fix release that fixes a bug involving upgrading from 4.x to 5.0 with HTTP resources that have URLs defined without a starting http:// or https://. Generally URLs start with http:// or https:// to define which they are, but Overseer supports an implied http:// when it's not there, and when implementing another feature, I didn't realize this was possible.