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The Club PUBlication 11/26/2018

11/26/2018

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A birthing simulation for students in the Clemson University School of Nursing, at the Greenville Memorial Medical Campus in South Carolina, Oct. 1, 2018.
​​SCIENCE
Med school 2.0: Training the next generation of doctors and nurses.  Technology is helping to close the gap between classroom and hospital room. 

By Laura Pappano New York Times
 
NOVEMBER 16, 2018 — 12:15AM
As technology explodes into patient care, the gap between medical education and ​For decades, medical education has followed a timeworn path — heaps of books and lectures, then clinical rotations exposing students to patients.

But as technology explodes into patient care (surgeons can preview operations using virtual 3-D images built from a patient’s scans), the gap between medical education and real-world care has “become a chasm,” said Marc Triola, director of New York University Langone’s Institute for Innovations in Medical Education, created in 2013 to address the issue.

“The health care delivery system is changing every day,” he said, “and our medical education system has been lagging.”

In what looks like an urgent game of catch-up, medical and nursing schools are retooling how and what they teach. This is also getting a boost from concern about the looming shortage of primary caregivers.

While “the national narrative is that we need more” doctors and nurses, said Erin Fraher, director of the Carolina Health Workforce Research Center, “that is precisely the wrong way to frame this. The question has to be: Where are the places in the U.S. where patients cannot get access to diabetes care, access to prenatal care?”
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Those questions are redesigning health care education, with more community-based clinic rotations, special programs (and scholarships) for rural and underserved students, and a greater role for nurses and nurse practitioners. As schools seek to make learning more efficient, technology — including virtual reality — is a big part of that.
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Nidhiben Patel, standing at left, and Caroline Brewer, leaning over bed in blue shirt, prepare to attach a blood-pressure cuff to another student playing the role of the patient during a simulation for a class in the Clemson University School of Nursing, at the Greenville Memorial Medical Campus in South Carolina, Oct. 1, 2018.
And it must be, given that students have to learn more information, faster. Much of medicine is slow; you can’t shortcut taking a medical history. But visiting the pathology lab to study a colon sample?
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This is where Greg Dorsainville, a multimedia developer and one of 28 full-time staff members in the NYU institute, steps in, using a 360-degree camera to film a 45-minute session with a pathologist. He cut the lesson to 5:46, time that a medical student can spare to don goggles, zoom in and see what a polyp actually looks like.


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The availability of such tools is changing how students acquire science content. But the bigger deal may be what technology is doing to skill learning.

Marlene Alfaro, a second-year student at the University of California Riverside School of Medicine, can slip on goggles and — in virtual reality — call up a beating heart and, with a controller, probe its structures. In the textbook, she said, “it was hard for me to visualize.” Virtual reality “lets me see real quick how everything goes together.”

No one wants to be the first human a student intubates (navigating a breathing tube down a patient’s throat), yet students have often trained on real patients. Now, lifelike simulations are giving students more chances to practice before plunging in for real.

In replica hospital rooms fitted with mannequins programmed to mimic conditions like strokes and seizures, and that can bleed, blink and give birth, students get “deliberate practice,” said Robert Morgan, director of the Greenville Health Care Simulation Center in South Carolina.

Rather than hope to encounter a teaching opportunity in the hospital, he said, “you come here and start your first 10, 15, 100 IVs before you actually have to place one in a patient.”

Instructors have used mannequins for decades to teach CPR. But recently, he said, technology has advanced, giving students the realistic experience of caring for a patient.

Which is what was happening at Clemson’s newly opened $31.5-million nursing school on the Greenville campus. From behind two-way mirrors, instructors used consoles to adjust “patient” heart rates and responses to treatments.

For students, simulations let them rehearse treatment choices, as well as the best ways to talk with patients. Instructors can create dire circumstances like uncontrolled bleeding (though “nobody dies until senior year” said Jean Ellen Zavertnik, the lab director), or a scenario letting students puzzle over when (and when not) to give a patient insulin.

Traditional health care has been slow to respond to patients’ varying circumstances, but medical training has been stuck, focused on acute hospital-based care, said Paul Lyons, chairman of the department of family medicine at the UC Riverside School of Medicine.
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Yet, he said, bigger issues for much of the population are chronic diseases like hypertension and diabetes. Those may call for strategies around smoking cessation, obesity and other lifestyle issues, which Lyons said, are skills different from what students are usually taught. “It is as if I trained you to drive in rural Iowa,” he said, “but then set you up to drive in Manhattan.”
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The Club PUBlication  11/18/2018

11/19/2018

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SLASH CLAWS
The "worst toys" for the holidays, according to safety group
By PHILIP MARCELO Associated Press
NOVEMBER 13, 2018 — 5:20PM

BOSTON — A Black Panther "slash claw" and a plastic Power Rangers sword are among the items topping a consumer safety group's annual list of worst toys for the holiday season.
Massachusetts-based World Against Toys Causing Harm, or W.A.T.C.H., unveiled its 46th annual list of the 10 "worst toys" Tuesday at Franciscan Children's Hospital in Boston.

Joan Siff, the nonprofit organization's president, said many of the toys on the list represent choking, eye and other safety hazards that surface year after year, despite the group's efforts.

Siff advised parents to shop "defensively" and not be lulled into a false sense of security because a toy is made by a familiar brand or sold at an established retailer. One child is treated in a U.S. emergency room every three minutes for a toy-related injury, according to the Center for Injury and Research at Nationwide Children's Hospital.

A Cabbage Patch Kids ballerina doll that made this year's list, for example, is marketed to children ages two and above, but includes a removable tutu and headband that can be choking hazards, said James Swartz, a trial lawyer who serves as W.A.T.C.H.'s director.

A slender mallet that comes with VTech's caterpillar-shaped electronic xylophone — a toy made for children as young as 18 months old — is another similar choking threat, he said.

Other toys on the list included a Nerf gun that fires soft discs, a "stomp rocket" that launches foam-tipped projectiles up to 200 feet in the air and a plastic "cutting fruit" set. The cutting set, which includes a toy knife made out of rigid plastic, is made for children who are older than 2.

But the Toy Association, an industry trade group that represents most of the toy companies named this year, complained the list is biased, inaccurate and "needlessly frightening" to parents.The association said many of the hazards highlighted by W.A.T.C.H. are clearly spelled out in the products' packaging and instructions. It also said only two products listed on the nonprofit's "worst toy" lists from the five years prior were recalled, and those two had already been pulled before W.A.T.C.H. released its list.

Swartz responded by pointing to a list of dozens of toys that have been recalled or pulled from retailers' shelves from the early 2000s all the way back to the 1970s, in part by the group's efforts.

And he said providing detailed warning labels "doesn't absolve" toy makers from needing to simply design safer items. "They're trying to shift the responsibility to parents and consumers," Swartz said. "They're really shirking their responsibility."

Swartz highlighted Hasbro's retractable plastic claws for Marvel's Black Panther, an item featured on this year's list. The toy gloves come with a warning they should not be used to hit or swing at people.

"When you call it a slash claw," he said, "there's likely one thing a child is going to do with that claw."
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The Club Publication  11/12/2018

11/12/2018

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Jennie-O will let consumers know where their turkeys were raised with new packaging info. File photo of a turkey farm near Willmar that supplies Hormel-owned Jennie-O.
It's now possible to know down to the farm where your turkey comes from

By Kristen Leigh Painter Star Tribune   
NOVEMBER 8, 2018 — 9:35PM
Foodies used to pay more for turkeys with a back story. Now, more birds are getting one.

Jennie-O Turkey Store, a subsidiary of Hormel Foods Corp. and the nation's second-largest turkey brand, said Thursday it will start using labels that let consumers trace its whole-bird turkeys to their home farm.
​
With its size and influence, Jennie-O's new label is helping turn what had been an attribute of premium foods into something mainstream as more consumers seek information about food.

The news came a few days after Minnetonka-based Cargill Inc. announced expanded traceability for a limited number of its Honeysuckle White turkeys during the holiday season. Willmar-based Jennie-O is going further by making all of its fresh and frozen whole birds traceable year-round.

"Jennie-O's announcement is proof that this is not a niche trend but something with legs," said Laurie Demeritt, chief executive of consumer foods research firm the Hartman Group.
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Jennie-O has been working for a year to make its turkey supply traceable and around 52 farms are currently included in the program. Minnesota raises more turkeys than any other state, around 45 million annually, according to the U.S. Agriculture Department. The majority of Jennie-O's turkey are raised in the state and neighboring Wisconsin.
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Last year, Jennie-O processed more than 1.2 billion pounds of turkey meat, leading Cargill's 1 billion pounds and trailing only Butterball LLC, which processed nearly 1.4 billion pounds, according to Watt PoultryUSA, a trade publication.

When a consumer enters the code listed on a whole turkey's package at the Jennie-O website, they will be taken to a page giving them the region of the farm — such as "west central Minnesota" — pictures of the family and a quote from the farmer. The company's tracking program doesn't include ground turkey, "Oven-Ready" birds or other Jennie-O branded turkey items bought in the meat aisle.

There are some other differences between the Jennie-O and Cargill traceability efforts. While Jennie-O's program applies to all its whole birds, all year long, Cargill's gives greater detail about the families — like names and a more precise location.

Cargill's harnesses the power of blockchain technology to give consumers the power to verify their bird's home farm. Blockchain is a cloud-based technology that allows multiple users to add information to a "digital ledger" shared across a network of computers. The data is constantly updated and stored in countless places making it harder to hack and easier to verify.

Jennie-O's program is accessed on a website that the company regularly updates. The traceability doesn't add any additional costs to the consumers, said Brent Koosmann, director of marketing at Jennie-O.

Food labels were unregulated and fairly vague until the late 1960s. But it took until 2002 for rules to emerge in the U.S. for country-of-origin labels for various meats, fish, shellfish, nuts, fruits and vegetables.

Since then, some farmers and smaller producers have used origin labels and stories to distinguish their products. Meanwhile, food activists and conscientious consumers have pressed to know more about the origins of food they eat.

In some places, such passions are so strong they have become ripe for satire. The TV show "Portlandia," which spoofs life in Portland, Ore., produced a popular episode in 2011 depicting a couple questioning the restaurant staff about the name, social life and farm location of the chicken being served.

And while the traceability programs of mass producers like Jennie-O and Cargill may not satisfy the most information-hungry eaters, it's a step that reflects the nation's evolving food values, Demeritt said.

"It is a formerly premium attribute that is starting to go mainstream," she said, "but is still evolving and I wouldn't say is firmly entrenched in the consumer landscape yet."

Kristen Leigh Painter covers the food industry for the Star Tribune. She previously covered growth and development for the paper. Prior to that, Painter was a business reporter at the Denver Post, covering airlines and aerospace. She frequently writes about sustainable food production, consumer food trends and airlines.
[email protected] 612.673.4767 KristenPainter
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The Club PUBlication  11/05/2018

11/5/2018

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Thousands Of Swedes Are Inserting Microchips Under Their Skin

​October 22, 2018  PBS
All Things Considered


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Jowan Osterlund holds a microchip implant in Stockholm in 2017. His company, Biohax International, is a leading provider of the devices in Sweden. James Brooks/AP
Technology continues to get closer and closer to our bodies, from the phones in our pockets to the smartwatches on our wrists. Now, for some people, it's getting under their skin.
In Sweden, a country rich with technological advancement, thousands have had microchips inserted into their hands.

The chips are designed to speed up users' daily routines and make their lives more convenient — accessing their homes, offices and gyms is as easy as swiping their hands against digital readers.

They also can be used to store emergency contact details, social media profiles or e-tickets for events and rail journeys within Sweden.

Proponents of the tiny chips say they're safe and largely protected from hacking, but one scientist is raising privacy concerns around the kind of personal health data that might be stored on the devices.

Around the size of a grain of rice, the chips typically are inserted into the skin just above each user's thumb, using a syringe similar to that used for giving vaccinations. The procedure costs about $180.
​
So many Swedes are lining up to get the microchips that the country's main chipping company says it can't keep up with the number of requests.

More than 4,000 Swedes have adopted the technology, with one company, Biohax International, dominating the market. The chipping firm was started five years ago by Jowan Osterlund, a former professional body piercer.

After spending the past two years working full time on the project, he is currently developing training materials so he can hire Swedish doctors and nurses to help take on some of his heavy workload.

"Having different cards and tokens verifying your identity to a bunch of different systems just doesn't make sense," he says. "Using a chip means that the hyper-connected surroundings that you live in every day can be streamlined."


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Erik Frisk, a Web developer and designer, uses his implanted chip to unlock his office door in Stockholm. Maddy Savage for NPR
Many early adopters come from Stockholm's thriving startup scene. Erik Frisk, a 30-year-old Web developer and designer, says he was really curious about the technology as soon as he heard about it and decided to get his own chip in 2014.

"It's just completely passive, it has no energy source or anything. So when you tap it against a reader, the chip sends back an ID that tells the reader which chip it is," he explains.

"Swedes are very pragmatic and the chip is useful ... and since a lot of people know each other in the tech community — it's very tight — [the trend has] been spreading and people have seen the benefits," Frisk says.

When Frisk moved into a shared house earlier this year, he organized a chipping party for his new housemates. Now they can access the 16th century building they share in Stockholm's Old Town by tapping their hands on a digital reader by the door.

"The chip basically solves my problems," says Szilvia Varszegi, 28, who also uses it to get into her coworking space.

And she uses it to share her LinkedIn details at networking events, avoiding the need to spell out her name. She simply touches another attendee's smartphone and the information is transferred. "When another phone reads the chip, they see the [link] and they can open it in the phone browser," Varszegi explains.

Sweden's largest train company has started allowing commuters to use chips instead of tickets, and there's talk that the chips could soon be used to make payments in shops and restaurants.

"I see no problem for [it] becoming mainstream. I think it's something that can seriously make people's lives better," Varszegi says.

Osterlund believes there are two key reasons microchips have taken off in Sweden. First, the country has a long history of embracing new technologies before many others and is quickly moving toward becoming a cashless society.

In the 1990s, the Swedish government invested in providing fast Internet services for its citizens and gave tax breaks to companies that provided their workers with home computers. And well-known tech names such as Skype and Spotify have Swedish roots.

"The more you hear about technology, the more you learn about technology, the less apprehensive you get about technology," Osterlund says.

Only 1 in 4 people living in Sweden uses cash at least once a week. And, according to the country's central bank, the Riksbank, the proportion of retail cash transactions has dropped from around 40 percent in 2010 to about 15 percent today.

Osterlund's second theory is that Swedes are less concerned about data privacy than people in other countries, thanks to a high level of trust for Swedish companies, banks, large organizations and government institutions.
​
Swedes are used to sharing personal information, with many online purchases and administrative bodies requiring their social security numbers. Mobile phone numbers are widely available in online search databases, and people can easily look up each other's salaries by calling the tax authority.


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Osterlund implants a chip into a man in Stockholm. More than 4,000 Swedes have adopted the technology. Jonathan Nackstrand/AFP/Getty Images
Osterlund says personal microchips are actually more difficult to hack than many other data sources because they are stored beneath the skin.

"Everything is hackable. But the reason to hack them will never be bigger because it's a microchip. It's harder for someone to get to, since you put it in you," he says.

There are few vocal critics of Sweden's microchip trend, and there is currently no national legislation regulating the growing industry.

However, Ben Libberton, a British scientist based in southern Sweden, is among those starting to campaign for lawmakers to keep a closer eye on developments.

"What is happening now is relatively safe. But if it's used everywhere, if every time you want to do something and instead of using a card you use your chip, it could be very, very easy to let go of [personal] information," he says.

Libberton, a trained microbiologist now working in science communication, says one of his main concerns is how the chips could be used to share data about our physical health and bodily functions.

"Because it's implanted in your body, when more health-related information starts being used and incorporated into the chip and being transmitted — that could create an extra layer of privacy that we really need to look at and take care of before it's widely used," he says.

Despite these concerns, there seems to be no letup in the trend. One coworking space and innovation hub in Stockholm is holding a large implant party this month where a tech startup, DSruptive, is promising to reveal "the next generation consumer-level implant." The device will include 2KB of memory — double that of earlier implants — a range of new functions and an LED light designed to improve privacy by blinking if someone tries to read or access an implant.

Osterlund says the tougher data-privacy rules that came into effect across the European Union earlier this year, as part of the General Data Protection Regulation, could also help the microchip trend spread more rapidly.

​"It's the heaviest set of laws protecting individual integrity ever," he says of the rules, which affect any organization handling personal information linked to EU residents.
But Osterlund says the fact that this kind of regulation does not exist on a global level could delay the microchip trend elsewhere.
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"I have a hard time seeing the rest of the world following GDPR anytime soon. But at least all of Europe — I mean one continent — it's a good beginning," he says.
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