Plugging Cell Biology Into a Genomic World

| January 15, 2014

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Personalized oncology epitomizes the concept of interdisciplinary research where pathologists, bioinformaticians, oncologists, and biologists work together to identify and ultimately target drivers of cancer. We gather at tables to collaborate across disciplines and try to speak the same language with the goals of advancing knowledge and helping patients. As a cancer cell biologist at the Winship Cancer Institute, I have been privileged to be a part of these conversations and to contribute to our efforts to understand tumor biology.

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Ohio Living

Founded in 1922, Ohio Living is the largest and most experienced not-for-profit provider of life plan communities and services in Ohio. With headquarters in Columbus, Ohio Living serves more than 90,000 people annually through its wholly owned subsidiaries Ohio Living Communities, Ohio Living Home Health & Hospice and Ohio Living Foundation.

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COVID-19: How do we get out of this quagmire?

Article | July 17, 2020

The COVID-19 virus (C19) pandemic is turning out to be the event of the century. Even World War seems timid in comparison. We are in the 4th month of the virus (in non-China countries) and have gone past the lockdown in many places. Isn’t it time we re-think the approach? What if there is another wave of C19 coming soon? What if C19 is the first of many such events in the future? Before we get into analysis and solution design, summarizing the C19 quirks: While a large section of the affected population is asymptomatic, for some it can be lethal There isn’t clarity on all the ways C19 spreads It’s known to affect the lungs, heart, and kidneys in patients with weak immunity It has been hard to identify a definitive pattern of the virus. Some observations in managing the C19 situation are: With no vaccine in sight, the end of this epidemic looks months or years away Health care personnel in hospitals need additional protection to treat patients Lockdowns lead to severe economic hardship and its repeated application can be damaging Quarantining people has an economic cost, especially in the weaker sections of society If one takes a step back to re-think about this, we are primarily solving 2 problems: Minimise deaths: Minimise the death of C19 and non-C19 patients in this period Maximise economic growth: The GDP output/growth should equal or higher than pre-C19 levels One needs to achieve the 2 goals in an environment of rising number of C19 cases. Minimise deaths An approach that can be applied to achieve this is: Data driven health care capacity planning Build a health repository of all the citizens with details like pre-existing diseases, comorbidity, health status, etc. The repository needs to be updated quarterly to account for patient data changes This health repository data is combined with the C19 profile (disease susceptibility) and/or other seasonal diseases to determine the healthcare capacity (medicines, doctors, etc.) needed The healthcare capacity deficit/excess needs to be analysed in categories (beds, equipment, medicine, personnel, etc.) and regions (city, state, etc.) and actions taken accordingly Regular capacity management will ensure patients aren’t deprived of timely treatment. In addition, such planning helps in the equitable distribution of healthcare across regions and optimising health care costs. Healthcare sector is better prepared to scale-up/down their operations Based on the analysis citizens can be informed about their probability of needing hospitalisation on contracting C19. Citizens with a higher health risk on C19 infection should be personally trained on prevention and tips to manage the disease on occurrence The diagram below explains the process Mechanism to increase hospital capacity without cost escalation Due to the nature of C19, health personnel are prone to infection and their safety is a big issue. There is also a shortage of hospitable beds available. Even non-C19 patients aren’t getting the required treatment because health personnel seek it as a risk. This resulted in, healthcare costs going up and availability reducing. To mitigate such issues, hospital layouts may need to be altered (as shown in the diagram below). The altered layout improves hospital capacity and availability of health care personnel. It also reduces the need for the arduous C19 protection procedures. Such procedures reduce the patient treatment capacity and puts a toll on hospital management. Over a period, the number of recovered C19 persons are going to increase significantly. We need to start tapping into their services to reduce the burden on the system. The hospitals need to be divided into 3 zones. The hospital zoning illustration shown below explains how this could be done. In the diagram, patients are shown in green and health care personnel are in light red. **Assumption: Infected and recovered C19 patients are immune to the disease. This is not clearly established Better enforcement of social factors The other reason for high number of infections in countries like India is a glaring disregard in following C19 rules in public places and the laxity in enforcement. Enforcement covers 2 parts, tracking incidents of violation and penalising the behaviour. Government should use modern mechanisms like crowd sourcing to track incidents and ride on the growing public fear to ensure penalty enforcement succeeds. The C19 pandemic has exposed governance limitations in not just following C19 rules, but also in other areas of public safety like road travel, sanitation, dietary habits, etc. Maximise economic growth The earlier lockdown has strained the economy. Adequate measures need to be taken to get the economy back on track. Some of the areas that need to be addressed are: One needs to evaluate the development needs of the country in different categories like growth impetus factors (e.g. building roads, electricity capacity increase), social factors (e.g. waste water treatment plants, health care capacity), and environmental factors (e.g. solar energy generation, EV charging stations). Governments need to accelerate funding in such projects so that that large numbers of unemployed people are hired and trained. Besides giving an immediate boost to the ailing economy such projects have a future payback. The governments should not get bogged down by the huge fiscal deficit such measures can create. Such a mechanism to get money out in the economy is far than better measures like QE (Quantitative Easing) or free money transfer into people’s bank accounts Certain items like smartphone, internet, masks, etc. have become critical (for work, education, critical government announcements). It’s essential to subsidise or reduce taxes so that these items are affordable and accessible to everyone without a financial impact The government shouldn’t put too many C19 related controls on service offerings (e.g. shops, schools, restaurants, cabs). Putting many controls increases the cost of the service which neither the seller not buyer is willing or able to pay. Where controls are put, the Govt should bear the costs or reduce taxes or figure out a mechanism so that the cost can be absorbed. An event like the C19 pandemic is a great opportunity to rationalise development imbalances in the country. Government funding should be channelized more to under-developed regions. This drives growth in regions that need it most. It also prevents excess migration that has resulted in uncontrolled and bad urbanisation that has made C19 management hard (guidelines like social distance are impossible to follow) Post-C19 lockdown, the business environment (need for sanitizers, masks, home furniture) has changed. To make people employable in new flourishing businesses there could be a need to re-skill people. Such an initiative can be taken up by the public/private sector The number of C19 infected asymptomatic patients is going to keep increasing. Building an economy around them (existing, recovered C19 patients) may not be a far-fetched idea. E.g. jobs for C19 infected daily wage earners, C19 infected taxi drivers to transport C19 patients, etc. In the last 100 years, mankind has conquered the destructive aspects of many a disease and natural mishap (hurricanes, floods, etc.). Human lives lost in such events has dramatically dropped over the years and our preparedness has never been this good. Nature seems to have caught up with mankind’s big strides in science and technology. C19 has been hard to reign in with no breakthrough yet. The C19 pandemic is here to stay for the near future. The more we accept this reality and change ourselves to live with it amidst us, the faster we can return to a new normal. A quote from Edward Jenner (inventor of Small Pox) seems apt in the situation – “The deviation of man from the state in which he was originally placed by nature seems to have proved to him a prolific source of diseases”.

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HIMSS Canceled Amid Coronavirus – What Can Healthcare IT Take Away?

Article | July 17, 2020

With the announcement of the HIMSS conference cancellation the healthcare IT industry is hit hard. Healthcare Information and Management Systems Society (HIMSS) is the super bowl of healthcare tech. 45,000 attendees from 50 countries were scheduled to fly into Orlando and spend 5 days immersed in innovative healthcare tech – and of course, shop around on the Expo floor. For many companies, the HIMSS event is the lifeline of their sales pipeline for the entire year – we’re talking tons of leads. Not having HIMSS means major threats to healthcare technology company revenue. We need to be more prepared to deal with pandemics no matter what. And as an industry, we need to be focused on developing technology solutions for disease detection, tracking, and prevention. And we need greater emphasis on data interoperability. Every time a crisis happens, the world is reminded of why it’s so important for systems and entities to share information. We learned this lesson when 9/11 happened. Data interoperability can help us identify problems earlier and get a handle on mitigation before issues get out of control.

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Can EHRs Stand Up Marketplaces for Innovation?

Article | July 17, 2020

The Office of the National Coordinator for Health IT (ONC) continues to advocate for improved data exchange, with the interoperability and information blocking rules being the latest federal push. One of the ONC’s goals with its latest guidance is to establish an ecosystem of innovation, with electronic health records (EHRs) serving as the foundation — i.e., the platform enabling application development and user access. But when it comes developing an EHR-based marketplace for innovation and mandating open APIs, there are many challenges for all players involved — including EHR vendors, tasked with standing up these sustainable marketplaces for innovation, and third-party developers, forced to bet big on which EHR platform(s) to innovate for and hope they chose right. How could the latest interoperability and information blocking guidelines impact the likelihood EHRs will be successful in developing sustainable innovation marketplaces?There are four key factors that stand to impact the success of EHR-based marketplace development, including:

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FUTURE OF HEALTHCARE

Hangover Alcohol Syndrome

Article | July 17, 2020

Ha, ha, ha, it’s me, alcohol hangover syndrome. Oh no, it feels like I have a fire burning through my head, that cannot be put out. What a pain, the hang-over. I can't get up. My eyes are red and blurred. I feel sick and body is tired. My body aches like French fries sizzling in scalding hot oil. Ouch, what a pain it is. Ouch is not a strong enough expression. So I Scream! Damn is the toe nail fungus vomiting too, I am sick. Screaming; oh no my head cannot handle it, it spinning and blazing like fire. My eyes are red, like a red eyed dragon. Well you are feeling the side effects of drinking excessive amounts of alcohol, referred to as intoxication - hang-over. Alcohol is labeled as the gateway to addiction and may lead to other drugs. The Lancet Medical Journal advises alcohol increases the risk of hypertension, stroke and heart attack. Alcohol intoxication is the result of high consumption of alcohol increase in the blood stream. The higher the amount of alcohol within blood stream the more impaired you become. According to statistics of 2015 an average of 6 people die each day due to alcohol poisoning or drinking so much that the body become overwhelmed. The body resistance to alcohol intoxication poison aligns in the critical or essential areas of the brain that control heart rate and breathing causing the heart rate and breathing to shut down and can lead to death. Frequent intoxication can inhibit ones' ability to think, focus, health, work, communicate, behavior and relationships. Frequent intoxication also influences one to become isolated, trying not to disclose habits by lying about drinking to family, friends or associates and even hiding alcohol in some cases whether it be at home or work. Hazardous harm of alcohol poison to the body begin as a craving for alcohol. This chain reaction is similar to the body becoming tired and fatigue and demands sleep which you cannot control, you must get sleep or pass out. Groans are similar to a choking frog that cannot control it voice. The craving or urge to drink may be triggered by internal or external factors. Attention and insight or consciousness to what triggers urge to drink is an advantage to assist in controlling the (ABV) alcohol beverage volume consumed. Mentioned in the beginning intoxication poison is not pleasurable and intoxication is unhealthy, so has this habit of excessive drinking become an uncontrollable addiction? My rap song is you are hooked and chorus is: Unforgettable, Unforgettable, Unforgettable You have made me your number one love You take me with you like a shadow You hold me with such a grasping hold of touch I am yours and you live just to be with me! Risk Factors of Alcohol Toxic obstacle of future damage Reality is a hard hitter and a definite strike out Consequences and penalties exist! Many times with a toast, alcohol is the toaster to recognize an individual are group of individuals. Toast with alcohol can lead the way to consumption of more alcohol. There is a chicle that friends don’t let friends drink drunk. Well when the friend is seeing through eyes of alcohol themselves who become the helper? Drinking and drinking is a serious violation of the law. Risk factors are costly, expensive and devastating. Risk factors include but are not limited to: DUI- (Driving under the influence) Driving under the influence of alcohol is prohibited by law and punishable by law. Consequences for illegally operating a vehicle while under the influence of alcohol can range from imprisonment, fines, community service and limited operating driving privileges. These factors are enforced under Misdemeanor Offense based on the merits, history of the first time offense. If the BAC (Blood Alcohol Concentration) is above .08 consumption while driving a vehicle one can be arrested. DWI- (Driving while intoxicated) Driving while intoxicated is also prohibited by law and is punishable by law. DUI and DWI are related and both are violations that have penalties. Multiple DUI’s are DWI’s fines can range from $2000 0r more, are or imprisonment depending on state which the violation occurred. The violation is governed under Gross Misdemeanor or felony. Factors include subject pass history, accidents and drug use. Related obligations imposed are rate of operating a vehicle insurance increase, storage and towing fees, attorney fees, DUI classes, restitution, possible criminal and court fees, scarred background record, possible driver license suspension or driver license being revoked. Accidents- According to National Institution on Drug Abuse report “Drinking and driving can add up to tragic ending. In the U.S. about 4300 people under the age 21 die each year from injuries caused by underage drinking, more than 35 percent in car crashes.” Relationships- Relationships are a valued connection, resource, positive interaction, communication and socially are viewed as binding or a bond. When a relationship becomes troubled an uncomfortable strain effects the stability of comfort and sometimes trust. Drugs for instance can cause damage to a good relationship with family, friends and acquaintances. Relationships should be positive, supported and loving. Jail- A sentence for punishment of an unlawful crime. Risk Factors of Alcohol Divorce – Divorce can carry the burden of a setback. Change is transition and sometimes stressful. An individual can feel pressure and seek relief that may eventually lead to depression anxiety or harmful opioids without medical advice. License Suspension- A period of time which a valid driver license privilege is suspend temporary. Financial Burden- Fines, fees, loss of driver privilege and other costly expenses create financial burden or loss of income that may be saved or distribute differently. Health Issues- Quote your health is wealth has merit and valuable. Your health matters and chemical dependency addiction impairs the body system with side effects such as strokes, hypertension, seizers, respiratory problems and heart failure. Employment- EAP (Employment Assistance Program) EAP is an employment assistance agency providing services to assist in personal, financial and work related occurrences. Court Ordered Rehabilitation – The risk factors associated with alcohol related court can be positive. The individual who takes advantage of this opportunity could overcome alcohol addiction and improve his or her behavior to become a more productive citizen. This also helps one to rebuild their lives. Alcohol rehabilitation also allows people to heal from addiction and dependence issues. Most people prefer alcohol rehabilitation programs to avoid a Criminal sentencing and to get their lives back on track. Risk factors can work out very well for one and help one redeem his or her positive life back. Children Neglect- Family and especially children struggle and suffer as they learn to live without your guidance. Being absent in your children life signal a lack of love and trust for them. They begin to doubt themselves despite your habit of addiction. Grief – Regret and self-emotional punishment for the injury, harm or death inflicted upon another while impaired by the use of alcohol (Drinking and driving) Don’t drive and drink is a safety factor that should not be ignored!

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Spotlight

Ohio Living

Founded in 1922, Ohio Living is the largest and most experienced not-for-profit provider of life plan communities and services in Ohio. With headquarters in Columbus, Ohio Living serves more than 90,000 people annually through its wholly owned subsidiaries Ohio Living Communities, Ohio Living Home Health & Hospice and Ohio Living Foundation.

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