Breakthrough: Mi-Eye2 Diagnoses Joint Injuries With Tiny Camera

TRICE MEDICAL closes $19.3M in Series C financing for their tiny needle-based camera to analyze joint injuries and expedite orthopedic diagnosis without the need for an MRI.

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Mi-Eye2 is a hand-held imaging scope which received FDA-clearance.  It enables doctors to diagnose a sports-related injury in the office, without an MRI.

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It consists of a hypodermic needle with a small camera tethered to a Microsoft surface tablet that shows high-definition pictures.

 

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Jeffrey O’Donnell, Sr. who is President and CEO of Trice Medical says this latest round of financing is a “significant milestone” and will help expand the company’s U.S. market.

Check out CBS2’s Dr. Max Gomez report:

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CBS 2’s DR. MAX GOMEZ: If you’ve ever injured your knee it can be hard to tell exactly what’s causing the pain, so the doctor usually sends you for an expensive MRI and maybe an arthroscopy in the O.R. to take a look inside. But what if you could do a scope in the doctor’s office cheaper and safer.

Lemouchi Soufinae injured his knee in a car accident two years ago. Since then he hasn’t been able to play his beloved soccer, because of the pain in his knee.

“I can’t walk more than three blocks, have to lay down, have trouble sleeping at night, lot of strong pain,” he said.

DR. MAX GOMEZ: Two MRIs later, it still wasn’t completely clear what was causing his knee pain.

Lemouchi, Liz Meris has been having severe knee pain. “I couldn’t kneel or straighten without pain, can’t get out of car, swelling in back of knee, hurts to walk, feels unstable,” she said.

DR. MAX GOMEZ: Worse yet, Liz is claustrophobic in an MRI.

“I hate em, I’m claustrophobic. I’m out, I’m in, I’m out again,” she said.

DR. MAX GOMEZ:  The next is usually a trip into the operation room to look around by sticking a scope in the knee. It’s expensive and requires anesthesia. Why not do that in the office, under a local anesthesia?

Thanks to a tiny scope with a hi-def camera on the tip, doctors can do in the office what once took a trip to the O.R.

“It’s a huge game changer, been trying to do for 10 to 15 years, clarity and resolution are now tremendous,” Dr. James Gladstone, Mt. Sinai Health System said.

DR. MAX GOMEZ:  Using only a local anesthesia, Dr. Gladstone inserts the MI-Eye-2™ into Liz’s knee. She was actually watching the same thing Dr. Gladstone was seeing.

It allows him to check and see what and where there’s damage inside the knee.

“Almost as good as O.R. scope, and in many ways better than MRI because it can give you direct visualization,” Dr. Gladstone said.

DR. MAX GOMEZ:  Better yet, if the damage is minimal it saves the patient a trip to the O.R. for a conventional scope, and here’s the best part; it costs under $500 to do this in the doctor’s office as opposed to the $1,500 or $2,000 for an MRI and thousands more for an O.R. scope.

Almost any joint that you can scope can be done with the MI-Eye™: shoulder, wrist, ankle, elbow.

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FOR MORE INFORMATION on THE INNOVATIVE MI-EYE2 VISIT:

http://www.tricemedical.com

 

Also, check out Dr. Max Gomez’s new book available for preorder on Amazon:

“Cells Are the New Cure”

by Robin Smith, MD + Max Gomez, Ph,D; Foreword by Sanjay Gupta, MD of CNN

https://www.amazon.com/Cells-Are-New-Drugs-Bre…/…/1944648801

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Maria Dorfner, a 33 year veteran of broadcast news is the founder of this blog.

Contact:  maria.dorfner@yahoo.com

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GAME CHANGER: NEW SMART HEART MONITOR

 

Super excited to tell you about a new smart heart monitor you can use at home. It will help 28 million heart disease patients in the U.S. keep track of their heart.

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Keep track from the comfort of their home at any time. And it’s just been FDA approved.

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Meet Eko DUO.  The first handheld mobile, wireless, EHR-connected stethoscope, which connects to your smart phone.

It allows you to amplify, visualize and record crystal clear heart and lung sounds.

Imagine not needing to wait for your next followup appointment to transmit a concern to your physician. It works under the supervision or prescription from a physician.

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Eko Duo is set to help millions of heart disease patients who are often discharged with little more than an info packet and instructions to monitor their weight.

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Now patients can be sent home from the hospital with a direct link back to their physician, helping reduce readmissions and false alarms.

“The goal is to bring hospital-quality care to the home.”
Connor Landgraf, CEO and co-founder, Eko DUO

The device wirelessly pairs with Eko’s secure, HIPAA-compliant app, enabling remote monitoring and diagnosis by a clinician or specialist.

It works with the Eko app on any iPhone, iPad, Windows PC or Android device.

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Eko DUO can also be used by clinicians as an enhanced stethoscope for in-clinic cardiac screenings, enabling physicians to quickly diagnose and monitor patients.

Clinicians can use it bedside or remotely to quickly spot heart abnormalities including arrhythmias, heart murmurs, and valvular heart diseases.

I interviewed Ami Bhatt, M.D., a Cardiologist at Massachusetts General Hospital and Director of Outpatient Cardiology and the Adult Congenital Heart Disease Program at Massachusetts General Hospital and she believes Eko DUO will improve outcomes through early intervention.

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Dr. Bhatt says, “Cardiology programs are looking for ways to deliver hospital-quality healthcare at home.  The ability to capture digital heart sounds and an ECG expands our portfolio of mechanisms to remotely monitor the heart – and brings diagnosis and opportunities for early intervention even further upstream.” 

Heart disease can strike people of all ages.

I spoke with Stacy Bingham, a registered nurse from Oregon with 5 children, who knows this firsthand. She and her husband have no prior history of heart disease in their family, yet 3 of her 5 children end up needing heart transplants.

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When Stacy noticed her oldest child, Sierra acting tired with a loss of appetite for a few weeks, she never suspected the cause was an underlying heart condition.

“I noticed her face and eyes were swollen. She complained her stomach hurt.”

That’s when Stacy and her husband took her to a family practitioner.

“The doctor told us it’s probably a flu bug and sent us home. When her condition worsened she had an x-ray.”

X-ray results revealed Sierra’s heart was enlarged.  Dilated cardio myopathy. She later learned two of her other children also had heart problems.

“If they had not finally found Sierra’s heart condition, she may not have survived. We live in a really rural part of Eastern Oregon and we now have three kids with heart transplants that need to be monitored for life.”

Today, Stacy’s family takes nothing for granted, especially innovations that help.

“If this device can be used at home and we can rule out scary things and know when it’s not something we need to rush to a hospital for that would be wonderful.” –Stacy Bingham

James Young also knows how life can change in a heartbeat.

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Young was just 40-years-old when he first experienced symptoms of heart failure. Symptoms he ignored until they were severe and his sister insisted on it.

“I was coughing in mornings and throughout the day. I thought it was simply allergies. I vomited phlegm some mornings and still didn’t see a doctor.”

But the coughing became more painful. While shoveling, it stopped him in his tracks.

“I was outside shoveling snow when I turn behind me and  see a trail of blood.”

His sister noticed he didn’t look well and insisted he go see a physician.

“That’s when I was diagnosed with congestive heart failure. I was shocked.”

James felt anxiety, depression and uncertainty about his future at this time. Young believes Eko DUO will not only help alleviate false alarms and unnecessary hospital readmissions, but needless worrying as well.

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“Eko DUO would have given me assurance the doctor knew where I stood daily. If there were any issues outstanding needing to be addressed immediately. It gives the doctor an opportunity to respond expeditiously to those concerns.”

Today, James is doing great and is a national spokesperson and heart failure Ambassador for the American Heart Association.

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“I went from a 25% functioning heart to being an avid runner and cycler. I’ve taken on a new lease in life. As a community advocate I can help inspire others and give them hope.”

Ami Bhatt, M.D says that hope also translates to much needed continuous care rather than outpatient care.

“Robust toolkits for caring for patients in the community will hopefully lead to more appropriate healthcare utilization through continuous rather than episodic outpatient care.”

HERE’S HOW EKO WAS DEVELOPED:

Eko’s co-founder & CEO, Connor Landgraf, is also a heart disease patient.

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Connor navigated countless cardiology visits, screenings and referrals.

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In 2013, during his senior year as at the University of California at Berkeley, Connor attended a panel discussion at UC San Francisco on technological shortcomings facing modern medical practices.

One technical gap cardiologists claimed stood out beyond the rest: the stethoscope.

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So Conner and his co-founders welcomed the stethoscope, a two-century old tool, into the 21st-century.

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Photo: Connor and his co-founders, Jason Bellet and Tyler Crouch

 

The newly FDA approved Eko DUO brings that to the next level.
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To learn more about this remarkable 21st Century technology we love visit:  http://www.ekodevices.com

 

 

Factoids:

  • According to the CDC, heart disease is the leading cause of death in the U.S.
    The American Heart Associations says the U.S. currently spends over $26 billion annually on heart failure hospitalization. 25% of heart failure patients are readmitted within 30 days — 50% are readmitted in 6 months with hospitals now being penalized for high readmission rates.
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  • Fact: 83% of parents experience anxiety surrounding their child’s referral to a pediatric cardiologist for an innocent murmur.
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  • Fact: Average cash price for an echocardiogram is $2,275 and even with insurance, patients can expect to pay 10 to 30% of this cost.
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  • Fact: For a pediatric subspecialist such as a pediatric cardiologist, patients must wait between 5 weeks and 3 months to get an appointment.
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  • Fact: Internal medicine residents misdiagnose more than 75% of cardiac events.
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  • Fact: 70% of all pediatric cardiac referrals for murmurs are unnecessary.
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  • Fact: Average PCP needs to coordinate care with 99 other physicians working across 53 practices.
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  • Fact: Only 50% of initial referrals are accompanied by information from the PCP.
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  • Fact: Patients in rural communities must travel an average of 56 miles to see a specialist.
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  • Fact: About 46.2 million people, or 15% of the U.S. population, reside in rural counties.

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Eko DUO.  A real game changer for heart patients worldwide.

http://www.ekodevices.com

 

 

Expert Newborn Screenings A Heartbeat Away!

jimmy-kimmel-baby-billy2-1This week, Jimmy Kimmel shared the emotional story of his beautiful newborn son’s heart surgery.  He and his wife Molly welcomed their second child, William “Billy” Kimmel.

At three days old, Billy had successful open heart surgery at Children’s Hospital Los Angeles and is now home with his family.  On his show, Jimmy opened up about his son’s birth and health complications. He also underscored the need for the accurate and timely screening of congenital heart disease (CHD).

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Essential to early CHD diagnosis is the detection of a murmur using a stethoscope during a newborn’s first physical exam.

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But routine neonatal examination without specialist consults fail to detect more than half of babies with heart disease.

Approximately 160 infants pass away from undetected Congenital Heart Defects each year in the United States.

William “Billy” Kimmel, who is absolutely adorable below is one of the lucky ones; looks like he’s already laughing at Dad’s jokes too.

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Billy thankfully had the condition detected early, but many children with CHD get discharged with undetected or misdiagnosed conditions.

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After the events of this week, expecting parents have every right to question if their child is being screened appropriately or if clinicians known to misinterpret heart sounds are interpreting their child’s heart sounds accurately.

Kimmel’s story is really a wake-up call that we need more nurses like the wonderful ones who treated his baby boy.

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Now, there’s a device that will make sure congenital heart screenings more effective for infants.

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And it’s not just infants. Over 1.3 million adults live with congenital heart disease in the U.S, which now surpasses the number of children with congenital heart disease.

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Three entrepreneurs are well on their way to making sure accurate screenings are a heartbeat away. Their innovation paves the way for a new era of cardiac screenings.

They want to do what Shazam did for music, only for heartbeats.

Their new device called Eko [pronounced like Echo, as in a heart echo] offers the potential to dramatically improve the efficacy of newborn screenings, especially for newborns far from a pediatric cardiology center.

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The San Francisco based digital medical device company, launched Eko, an FDA-cleared digital stethoscope that enables ANY clinician, regardless of their training level, to secure a virtual pediatric cardiology opinion on heart sounds recorded with their FDA-cleared digital stethoscope.

It was a pleasure interviewing one of the founders, Jason Bellet.

Bellet says, “The silver lining in Jimmy Kimmel’s story is that the congenital heart failure was detected early through a murmur using a stethoscope and could be treated, but very often these murmurs go undiagnosed and undetected and infants leave the hospital with potentially life threatening situations.” [:27]

“Eko Devices would enable nurses and clinicians to get Cardiologist’s second opinion to immediately decrease the number of missed cases.” [:12]

Bellet is the co-founder and a brilliant former student from the University of Berkley.  He graduated in 2014 and founded Eko Devices with two fellow students, Connor Landgraf and Tyler Crouch out of the Start-up accelerator at Berkley.

The three founders successfully pitched their idea and raised $5M to bring it to market quickly and bring it to as many clinicians as they can.  It received FDA approval in September of 2015.

QUESTION: WHAT IS EKO?

ANSWER:  It’s basically a Smart Stethoscope that can bring the sounds to a trained ear immediately.

The vision is to bring machine learning and physician support tools to every clinicians stethoscope to make their screening process as easy as Shazaming a song.

QUESTION:  HOW DID YOU COME UP WITH THE IDEA FOR EKO?

ANSWER:  The idea stemmed from the fact that we realized the stethoscope is used as the primary screening tool for cardiac health, including for newborn babies.

But, it’s extremely outdated and ultimately leading to misdiagnosis and lack of cardiac conditions because you hear the heart sounds, but don’t understand what you’re hearing.

Cardiologists are the ones who can differentiate what is normal and what is not.

So, what we wanted to do was make it easy for clinicians to modernize their own stethoscopes to bring it into the modern era and send concerning or confusing heart sounds immediately to cardiologists in real time using this platform or capture it to send it to a specialist.

QUESTION:  There are other digital stethoscopes out there. Why is this one unique?

Bellet says, “Our digital stethoscope is the first to allow clinicians to stream sounds wirelessly from the stethoscope to a smartphone and to a cardiologist anywhere in the world.”  [:15]

QUESTION: Is it HIPPA compliant?

ANSWER:  It’s the ONLY digital stethoscope on the market that has built a HIPPA compliant software platform to stream heart sounds from any clinician to any specialist anywhere in the world.

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QUESTION: THAT’S GROUNDBREAKING. WHERE IS IT CURRENTLY BEING USED?

ANSWER:  Eko is now used at over 700 institutions across the country and has been adopted by pediatric cardiology programs.

QUESTION: WHO NEEDS EKO?

The technology is applicable in many aspects of patient care, but especially in newborns.

QUESTION:  WHAT IS YOUR ULTIMATE GOAL WITH EKO?

ANSWER: The ultimate goal is bringing it even one step further.  Our idea is have machine learning tied directly into the stethoscope itself, so one day clinicians can be as accurate as cardiologists in their initial interpretation of what they hear.

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Next, I spoke with renown adult congenital heart disease specialist Ami Bhatt, M.D. F.A.C.C. who says identifying congenital heart disease in the community can be challenging at any age whether we are trying to identify a high risk newborn like Jimmy Kimmel’s or catching congenital heart disease in a school age student or adulthood.

Ami Bhatt, M.D. F.A.C.C.  is director of outpatient cardiology at the Massachusetts General Hospital in Boston as well as a renown adult congenital heart disease specialist.  She innovates with the Healthcare Transformation Lab, serves as a scientific advisor for Eko Devises and runs a telemedicine practice.  She can be reached at mghachd@partners.org

Bhatt says,  “Because congenital heart disease is relatively rare it’s difficult for clinicians to identify it. The use of digital stethoscopes and other telemedicine technology which can connect the patient and caregiver in the community with experts at academic centers can improve initial diagnosis AND longterm followup.”

QUESTION:  WHAT HAPPENS WHEN KIDS WITH CONGENITAL HEART DISEASE AGE?

ANSWER:   Two things. One, as kids with congenital heart disease age, we know there are complications that may arise. Technologies like digital stethoscopes and the use of algorithms can help monitor their progression and track changes in disease BEFORE they progress too far.

And two, lack of follow-up is a persistent problem with children with congenital heart disease become adults. One of the main drivers is the challenge of access to subspecialty care.

Additionally, distance from medical centers, along with the time it takes and sometimes the cost of being away from work and family drives young adults to ignore their own healthcare needs.

The advent of digital health in congenital heart disease care empowers the patient to engage in a partnership to their health without taking away from their ability to live a full and active life.

QUESTION:  DO YOU THINK TECHNOLOGY HELPS OR HINDERS DOCTOR-PATIENT RELATIONS?

ANSWER: As the delivery of healthcare changes, caregivers are desperate to return to the ideal  doctor patient relationship, which is based on a human connection. As we build digital technology, and use machine learning to support our physicians at at time when there are so many diagnosis to be made, it allows us to concentrate on a shared patient and provider centered experience.

QUESTION:  HOW DOES AN ADULT KNOW WHEN TO GET THEIR HEART CHECKED?

ANSWER: If they had heart disease or heart surgery as a child, they should check in with their cardiologist to find out if they need any longterm care.

QUESTION: HOW DO THEY FIND A SPECIALIST?

There are advocacy websites, such http://www.ACHAheart.org which report self-identified Specialists in congenital heart disease or they can call a major center like Massachusetts General who can find a local center that can partner in their care.

QUESTION: HOW CAN THEY FIND OUT WHO USES THE EKO DEVICE?

ANSWER: If they want to find a specialist using the Eko Device people can contact Massachusetts General http://www.massgeneral.org\adultcongenitalheart for more information and ask about centers near them. They can also contact any hospital and ask for their telemedicine department and inquire if they use Eko.

QUESTION: HOW DO CLINICANS FIND EKO IF THEY’RE INTERESTED IN USING IT?

ANSWER:  Clinicians are able to access the device by going to the Eko Devices website at http://www.ekodevices.com and then if they’re interested in testing it they can purchase a unit directly from the website and send it back if they don’t like it. But that’s a rarity as the success rate has been high with over 5,000 clinicians across the country using it.

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This truly is a hot technology that will save kids like Jimmy’s, as well as those who aren’t at top hospitals in the country.

Billy will have another open-heart surgery within six months to repair the hole, and Our thoughts, well wishes and prayers are with him and his family.

“As a cardiologist, we sometimes worry about technology interfering with the doctor patient relationship. However, in these cases, it is technology that brings us to meet the patient where they live. Technology is finally bringing us home.” 

-Ami Bhatt, M.D. F.A.C.C.

If you haven’t seen Jimmy Kimmel’s story see it on Emmy-award-winning @GMA:

WATCH: @jimmykimmel shares emotional news about newborn son’s emergency heart surgery; son now at home recovering. http://abcn.ws/2pSPakE

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QUICK FACTS:

According to the CDC, 40,000 babies in the U.S. are born each year with congenital heart disease.

Recent studies estimate approximately 160 infants or 1 in 25,000 live births die per year from unrecognized CHD.

The reported sensitivity for detection of a pathologic heart murmur in newborns ranges from 80.5 to 94.9 percent among pediatric cardiologists, with specificity ranging from 25 to 92 percent.

A study in the American Journal of Medicine discovered internal medicine residents misdiagnose as many as 75% of murmurs with a stethoscope.

Routine neonatal examination fails to detect more than half of babies with heart disease; examination at 6 weeks misses one third.

A normal examination does not exclude heart disease.

Babies with murmurs at neonatal or 6 week examinations should be referred for early pediatric cardiological evaluation which will result either in a definitive diagnosis of congenital heart disease or in authoritative reassurance of normal cardiac anatomy and function.

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Take care of your heart everyone!

 

For more on Eko visit: http://www.ekodevices.com

UPDATES:

Good Morning America
ABC NEWS
May 9, 2017
Jimmy Kimmel returns to TV with update on his son’s health, defends his call for children’s health care coverage

One week after Jimmy Kimmel revealed that his son, Billy, had been born with a heart defect, the comedian returned to host his late night show with an emotional update on his son’s health and a defense of his foray into the country’s heated debate on health care.

The “Jimmy Kimmel Live!” also thanked his fans for their “humbling outpouring of support” and said that he and his wire “very grateful” for the multitude of donations made to the Children’s Hospital of Los Angeles, where his son was treated.

“First I want to tell you because so many people have asked: Our son Billy is doing very well,” Kimmel said. “He’s eating. He is getting bigger. He is sleeping well. He can read now — which they say is unusual [for a child his age].”

Kimmel, 49, revealed last Monday that his son underwent surgery on his heart three days after he was born, and will require another procedure when he’s a little bigger in three to six months.

During his monologue, Kimmel asked all politicians to come together to ensure healthcare for all Americans, especially those who have pre-existing health conditions.

Though there were many who supported Kimmel’s point of view, he noted that there were many others who called him an “out of touch Hollywood elitist.” To those critics, the late night host offered a sarcastic apology.

“I’d like to apologize for saying that children in America should have health care,” he joked. “It was insensitive – it was offensive – and I hope you can find it in your heart to forgive me.”

To further the conversation, he interviewed Bill Cassidy, a Republican senator from Louisiana who last week tweeted that there should be a “Kimmel Test” for any healthcare bill passed.

The Jimmy Kimmel Test, he noted, would be in place to ensure that any healthcare plan would adequately cover pre-existing conditions “but in a fiscally conservative way that lowers cost.”

“I happen to like [it] a lot,” Kimmel said. “He is a doctor – a gastroenterologist. He is married to a retired doctor — his wife Laura, was a surgeon. And he co-founded the Greater Baton Rouge Community Clinic, which provides free dental care and health care to the working uninsured. So obviously – this is someone who cares about people’s health.”

 

 

Digital Strategy & Value-Based Care

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Digital Strategy and the Shift to Value-Based Care
by Guest Author, Terence Maytin

The U.S. healthcare system is rapidly transitioning from fee-for-service to value- based care as part of massive and ongoing industry-wide transformation. Digital strategy is evolving to meet new challenges, help drive disruptive innovation, and better engage a large, growing audience of connected health consumers.

Already complex and fragmented, the healthcare sector will look very different over the coming years. The Affordable Care Act (ACA) has spurred rapid innovation and disruptive change across the entire ecosystem in the quest for better quality care across the entire population at lower per capita cost. Payers are accelerating rollout of value- based payment models with providers, and the shift to pay for performance arrangements with Pharma companies is increasing as well.

Moving an entire industry from volume-oriented reimbursement requires aggressive, innovative approaches to move from traditional siloed care to collaborative models, with system-wide provider coordination, patient engagement and proactive interventions. Technology will continue to act as a critical change agent, enabling large- scale improvements in process efficiency, automation, connectivity, collaboration, interoperability and advanced analytics.

With the convergence of healthcare and digital technology, industry stakeholders are reassessing their digital strategies to help tackle new business opportunities and challenges. Just a few years ago, digital health efforts largely focused either on acquisition marketing, community aggregation, or customer service portals designed to redirect volume from higher cost channels. However amid the current environment, digital offers much greater and far-reaching impact potential than ever before.

Digital investments are ramping up to support the shift from volume to value, particularly in the areas of care coordination, patient engagement, post-discharge monitoring, measurement, and behavior change. Since 2014, venture capital has provided $10B in new funding for clinical tools, analytics, consumer engagement, mHealth, telemedicine, wearables, and business services. In 2016, firms have raised a record $1.8B.

Two important trends drive home the relevance and importance of having a comprehensive, well articulated digital strategy: the rise of consumerism and nearly ubiquitous web/mobile adoption. Across all age groups, large audiences not only already consume digital services but also expect high quality, omni-channel experiences. In order to deliver on this promise, companies must design optimized, journey-based experiences that balance customer needs, preferences, and behaviors against desired business objectives and outcomes. Companies must embrace the concept of “putting the customer first” throughout the organization and across functions (e.g. strategy, product development, marketing, operations and technology). This also must be accompanied by an insights-driven, decision-making approach.

Essentially, digital strategy will be most effective if viewed as an organizational imperative. Armed with a holistic vision and comprehensive strategy, stakeholders will be better able to leverage and capitalize on digital’s full disruptive potential to help solve some of the most pressing challenges facing healthcare today.

Healthcare Industry Transformation

The transformation of healthcare is multidimensional and complicated. Disruptive innovation, technology and consumer trends are upending traditional business models. The competitive landscape is getting ever more crowded with new entrants while at the same time, insurer and provider consolidation is accelerating.

Consumers are motivated with more skin in the game and greater information access than ever before. Payment models are shifting from volume to value, and payers, providers, pharma, and medtech will need to collaborate and coordinate to a much larger degree within a more integrated care delivery system. These factors along with intense focus on quality improvement and evidence-based outcomes have big implications for the entire care delivery continuum…

Click here to read full article

TerenceMartin  Guest Author, Terence Maytin is VP/Director | Head of Digital Strategy and Delivery | Digital Health Business Analytics and Technology  and  Strategic Advisor for First Growth VC.

Stay healthy!

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Maria Dorfner is the founder of NewsMD and Healthy  Within Network. This is her blog.
She can be reached at maria.dorfner@yahoo.com
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On Twitter:  Maria_Dorfner