All Your Vitals At Home With One Device

Sathya Elumalai, Founder and CEO of Aidar Health, wants to make using his simple device part of your daily routine, like brushing your teeth, as a preventative measure in health, even if you don’t live with a chronic health condition.

For those that do, it can be a lifesaver. Even if you’re healthy it can be a lifesaver by detecting something early. We’ve all known otherwise healthy people who have a heart attack, stroke or even get diagnosed with cancer at a late stage.

Early detection still remains one of the best ways to prevent a fatal diagnosis.

The device called MouthLab is the first 30-second non-invasive, tricorder-style handheld device to record all your vitals.

You can use it within the comfort of your own home without the need of other devices.

“Although half of the US population have chronic conditions, the problem is, everyone is subject to multiple chronic conditions. Providing only what is essential for your one condition, is not going to really help you. Every year, patients develop other conditions.”

-Sathya Elumalai

Sathya learned this first-hand from his own experience with his Mom.

“My mom suffers from multiple chronic conditions. It started off with diabetes, and then moved on to heart condition, and then, all other complications associated with it. So, what MouthLab can do is help you predict complications early.” -SATHYA

MouthLab measure all these different parameters each day, so if you find something wrong, it can be detected early.

“Let’s say you’re diabetic, but if you see some problems within your heart condition, like blood pressure or or heart rate, that can be captured at a very early stage.” -SATHYA

It not only helps patients, but helps providers take care of patients at an early stage.

Specifically, the MouthLab device measures:

Your Temperature

Your Blood Pressure

Your ECG

Your Blood Oxygen Saturation

Your Pulse Rate

Your Breathing Rate and Pattern

Your Lung Function lung function (technically called FEV1. FEV1 or FVC)

And soon…Your Dehydration Level and Glucose

    Sathya Elumalai, MS, MBA, Founder and CEO of Adair Health, is a medical device executive with over 15 years of experience working with payers, providers, pharmaceutical companies, and patients. At Multisensor Diagnostics (MDx), Elumalai has developed a revolutionary tricorder-style rapid medical assessment device and artificial intelligence-enabled triaging system for efficient home management of chronic disease.

In addition to his efforts at MDx, Elumalai also serves as an advisory board member at Rutgers University, as a PCORI Ambassador, and PCORI merit reviewer. Elumalai holds a dual master’s degree in public health and healthcare management from Johns Hopkins University.

He is also a certified professional in healthcare quality and safety with over 10 years of diverse leadership experience at the Johns Hopkins Medical Institute. Elumalai is a proven leader recognized for building scalable processes, integrating analytics into decision making, improving customer satisfaction, and driving large-scale digital transformations in health care.

FOR MORE INFORMATION VISIT: http://www.aidar.com

 

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Face2Face Health: Concierge Care for Children

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Face2Face Health is a web & mobile-based holistic pediatric telehealth platform with a mission to help parents and caregivers accurately learn about, identify, and manage their children’s health and well-being challenges –all in one simple place.

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Dr. Ami Shah, MD, FACP, FAARM
, founder of Face2Face Health is not only a physician for over two decades, but she’s also a Mom, who was frustrated when her own children were diagnosed with physical delays and she couldn’t easily find access to care or evidence-based information.

Shah says, “I was shocked as both a doctor and parent. The top three health websites had such outdated information. I couldn’t believe it. So much traffic means millions of parents are misinformed. I couldn’t even find another parent going through the same thing.  I wanted everything in one place. That’s when I took a step back to create a solution.”

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She realized parents, caregivers, and educators face the following fragmented approach to health and wellness:

CARE: Services are disconnected and not coordinated. Just 30% of 90M U.S. children are screened for challenges or receive timely and comprehensive care. Average wait time for a physician specialist can be 19 days & rural areas are underserved. One third must travel 40+ miles for care.

LEARN: According to the U.S. Dept of Health & Human Services, almost 90% of the population is health illiterate. Health and well-being information on several top websites is inaccurate, hard to find, incomplete and not reviewed by experts.

SHARE: Parents and caregivers feel isolated. Communities are needed that provide advocacy and support.

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She’s not alone. 1 in 4 U.S. children have developmental, emotional, physical or learning issues and only 30% of all children are screened or have access to care, information and support.

AND the top 20 challenges in pediatrics cost our healthcare system $200B annually.

So she created Face2Face Health as a solution to offer people a complete digital wellness platform that allows access to multidisciplinary care via phone, video or concierge interactions; 200+ validated, evidence-based screening tools; 125+ peer-reviewed e-learning courses, and online support communities.

The Face2Face Health platform includes centralized Electronic Health Records (HIPAA, MU2, MU3, high tech). The EHR offers an integrative health approach covering over 70 traditional/alternative disciplines, SOAP forms, prescriptions, labs, remote monitoring, exercises, and other valuable resources.

This integrated hub streamlines clinical workflows and care coordination to expeditiously coordinate diagnoses, early intervention, comprehensive treatment, education, and optimized care.

It can be white-labeled, integrated, and adapted for different population segments & care conditions.

For many conditions, best patient outcomes can only be achieved through a coordinated, collaborative, comprehensive approach to care.

Surveys show parents & caretakers want expert-reviewed, trustworthy information in one place.

So if you’re seeking that one place, look no further than:

Face2Face Health at http://www.f2fhealth.com

On Twitter: @f2fhealth

Progress to date:User interface/user experience/product market fit: Questionnaire and phone survey of 500 multi-disciplinary providers and potential customers received over 85% product market offering support and guided site design. Developmental: Alpha tests and user experience feedback, each stage for optimizing product offering. We will be conducting beta testing with 500 to 1,000 parents and providers in Q4 2017, which has already been paid for as part of our UI/UX development. Pilots: we have partnered with a privately held company offering a B2C subscription testing service for children with over 500,000 parent subscribers and another organization involving both educators and parents. Competitive market gap analysis: Companies in the market offer limited services in comparison; few focus exclusively on pediatrics. Partners: We have partnered with a leading screening company and testing company.

E-Learning Development Progress:

1.Topic Identification

The use of Google Analytics drove selection of nearly 130 topics to be included in the Learning Module Development Series within Face2Face Health’s 5 (F2F) Knowledge Integrative silos:

a. General Health

b. Emotional Health

c. Development

d. Mind/Body/Nutrition

e. Education and Advocacy

2. Source Selection

Several top analytically driven consumer and professional websites were selected as information sources for each of the various topics, including:

a. Top medical literature and professional references

b. Popular referenced sites such as WebMD, Wikipedia

c. Reference databases such as PubMed and Google Scholar

3. Collection

Professional consultant researchers collected, referenced and tracked all relevant data to prepare for analysis of all available topic information.

4. Compare and Curate

Several subject matter experts compared and curated information to identify content reflecting the highest relevance, credibility and educational value.

5. Gap Analysis

To ensure comprehensiveness and quality control of our Learning Management System (LMS), global subject matter experts such as physicians, alterative health practitioners, developmental and educational experts further researched any gaps in integrative knowledge within the silos to guide further content collection as needed.

Transformation

The information was then transformed to original health-literate and referenced

copy materials.

7. Expert Review

Subject matter experts, including Advisory Board members representing expertise

across the 5 silos reviewed all modules for comprehension and accuracy.

8. Production Design and Development

Modules were then given to our design team for customized E-learning design

and development in collaboration with LMS consultant and content experts.

9. Delivery and Management

E-learning modules integration into the online LMS platform for interactive E-learning delivery and  management in process, including learning performance analyses and revisions and new content development as needed.

Face2Face Health Team:

Creator: Ami Shah

Education: Wright State University School of Medicine

Bio: Ami Anand Shah, MD FACP, FAARM is an entrepreneur, pharmaceutical industry executive, active part- time integrative medicine practitioner, philanthropist and leader in several local, state and national medical non-profit organizational communities.

She has over 15 years of both clinical practice and global versatile pharmaceutical industry executive experience with demonstrated leadership, people management and global expertise in the arenas of pharmacovigilance and risk management, clinical development, strategic business development/due diligence, global labeling, OTC/nutritionals formulation, clinical trial development and medical marketing from small sized to big sized pharmaceutical companies.

She is a Board Certified Internal Medicine physician and fellow of the American College of Physicians.

Board Certified in Integrative Medicine and also fellowship trained in Anti-aging, Regenerative and Functional Medicine, as well as Aesthetics.

She currently practices part-time Integrative, Personalized Medicine which focuses on integrative evidence based, peer reviewed holistic health, e consulting, physician health coaching, and telemedicine services for over 15 years.

Dr. Shah has held several leadership positions at the local, state and national levels (see Affliations section).

To date, she has mentored several next generational leaders, performs various free health care services in clinics or lectures in the community.

She has travelled to over 20 countries on medical missions.

Dr. Shah is also a member of countless other non-profit organizations too numerous to name but have in common a focus on children and women’s global health and education issues.

She has been the recipient of the prestigious top 50 Outstanding Asian Americans in business 2012.

She is also featured as one of the top 101 Indian American Emerging and Global Leaders by Roshni Media published in 2015.

Hospital Affiliation: ACP Fellow, NY Country Medical Society, SAHI, AAPI, Clinical Associate Prof, Wright State University

Title: Founder & CEO

Advanced Degree(s): MD FACP, FAARM

WARNING: LONG BIOS AHEAD!  About Team Members

Raj Jhaveri
Co-founder and Chief Technology Officer, MS

Biography:
Raj Jhaveri is an innovator, entrepreneur, social media persona, philanthropist, hip-hop dancer, and a former TV Host for Sony Entertainment Television and UrbanAsian.com.

He is known for his unique ways of charitable fundraising through entertainment and has been featured in multiple media outlets such as Entrepreneur Magazine, MTV, Vice Magazine – Motherboard, Wall Street Journal, Motley Fool, MedCity News and MedCrunch.

By day, Raj is a visionary entrepreneur and strategist in the Digital Health, Medical and Biotechnology Industry, who has worked with Bio-Reference Laboratories, Sage Science, Bio-Genex, Pfizer, Abpro Labs, Ferring Pharmaceuticals, Genentech and the Department of Defense in the past.

He obtained his Bachelor’s at Ohio State University and continued his graduate studies at Harvard Medical School. Later, he co-founded Manethryn Technology, Inc. and assisted in launching Fermentöme, Inc.

Raj is a partner at The Catalan Group, a strategy consulting firm based in New York. It successfully founded and launched Canopy Apps, a company focused on medical translation services and education with over 200,000 medical provider users.

He is also an in-house mentor at Techstars and, an industry consultant for General Catalyst Partners in regards to their healthcare investments.

In his spare time, he partakes in the fashion, film, music, and dance industry, and enjoys being a true “Curious George” exploring anything that is new and intriguing, hence his former social media persona as “The Urban Nerd.”

This allowed him to become the brand ambassador for a rising fashion brand, Convey.

Raj is also known for hosting The Annual Aquarius Charity Affair, an annual free event held in January/February, which has attracted and raised thousands multiple charities since 2008.

He is currently working on forming his first non-profit, The Urban Nerd Effect, where global causes and charities are conveyed through entertainment and free networking events.

Title:
Co-founder and Chief Technology Officer
Advanced Degree(s): MS
LinkedIn: https://www.linkedin.com/in/rajpjhaveri/

Dale McManis
Head of Education and Advocacy, BS, MEd, PHD

Biography:
Lilla Dale McManis is President and CEO of Parent in the Know and Early Childhood Research Solutions, launched to focus on assessment of the parental role and child functioning, and a consultant for numerous start-ups to improve and position products and services.

She holds a PhD in educational psychology with a concentration in learning and cognition, a master’s in special education, and a bachelor’s in child development.

She has taught special needs K-12 students in the public-school setting, served as Academic Coordinator and instructor for court-ordered teens in a non-traditional educational setting and as an instructor of prospective teachers at the University of Florida.

She has held senior research positions at the Massachusetts Department of Education as lead evaluator for the state’s school health programs and the Massachusetts Department of Public Health in the Division of Maternal and Child Health as Project Manager for the state’s school and adolescent programs and Co-Director of the Office of Statistics and Evaluation.

She was on the faculty at the University of Texas-Houston in the School of Public Health and then the Medical School-Developmental Pediatrics in the Children’s Learning Institute and the State Center for Early Childhood Development as part of multi-disciplinary teams on CDC, USDOE, and NIMH research grants.

She is the former Research Director for Hatch Early Learning, a leading technology content development company, where she was on the product development team and conducted product efficacy studies.

She is a founding member of the Early Childhood Technology Collaborative, has served as research consultant on a number of large projects, presented frequently at national conferences, & has published a number of academic papers.

She has been inducted into several honor societies: Golden Key, Phi Kappa Phi, & Phi Lambda Theta graduated summa cum laude, on the National Dean’s List, and received the Gamma Sigma Delta Outstanding Senior Award.

Title:
Head of Education and Advocacy
Advanced Degree(s): BS, MEd, PHD
LinkedIn: https://www.linkedin.com/in/dalemcmanisecars/

Doron Wesly
Chief Marketing Officer, BS

Biography:
Doron Wesly is Senior Vice President and Chief Marketing Officer for Lotame, where he spearheads global marketing, communications, and research and insights for a global team of data management specialists, enabling marketers, agencies, and publishers to harness audience data across all digital devices.

Prior to Lotame, Doron spent more than three years at Tremor Video (NYSE: TRMR) as head of Market Strategy, where he helped brand marketers understand the advertising impact of online video relative to all screens.

As online video expanded to more viewers and devices, Doron played a critical role in helping advertisers understand the advanced analytics emerging from these campaign, enhanced by his deep knowledge of cross-media studies, marketing mix models, attribution modelling, and more than 20 years of experience spanning traditional media planning to the frontiers of digital.

Prior to joining Tremor Video, Doron served as Senior Managing Partner, Managing Director, Leader Business Science and Planning, North America, for Mindshare, based in New York, where he led a multi-disciplined team that included consumer insights, competitive intelligence, digital analytics, business planning, and advanced analytics.

Doron’s marketing and research career has also included time as Global Media Director at Cheil Worldwide, Samsung’s in-house ad agency, based in Seoul, South Korea, and Millward Brown’s Strategic Services.

He spent time at the Interactive Advertising Bureau (IAB) leading industry research efforts, and he has worked for Terra Lycos, Interevco, and Hotbar.com. Doron is a citizen of both the Netherlands and Israel and is fluent in Dutch, Hebrew, and English.

He is also proficient in German and French and enough Korean (to be dangerous).

Doron speaks regularly on marketing and media topics at industry events and universities in the U.S., Europe, and Asia.

Title:
Chief Marketing Officer
Advanced Degree(s): BS
LinkedIn: https://www.linkedin.com/in/doronwesly/

Richard Hamilton
Head of Learning Management Systems, BA, MA

Biography:
Richard Hamilton is a veteran Communications Services provider experienced in Instructional Design, Sales and Marketing Communications and Multi-Media Production in corporate, agency, private business and independent markets.

His credits include pioneering effort in the development and implementation of many industry innovations involving computer-based learning, blended learning, distance learning, online interactive learning, online accredited Continuing Medical Education, Intranet portals, learning management systems, sale force automation and integrated marketing strategies.

As a consultant, Richard provided communication services to Affymax, Allergan, Amgen, Baxter Bioscience, Centocor, Genentech, Medicis, Neutrogena, Pharmacia, Roxro Pharma and Scios in the pharmaceutical industry and to Medical Communication firms Chandos Communications, Churchill Communications, HLS, IntraMed West, Pacific Communications and Triage Health Communications.

Prior to consulting, Richard held corporate positions as Training Media Producer, Sr. Instructional Designer, Communications Analyst and Product Marketing Manager at Syntex Laboratories; Distance Learning Manager and Corporate Multimedia and Information Development Manager at Applied Materials; and World-Wide Sales and Marketing Programs Development Manager for Sun Microsystems.

During his early career, while pursuing an education in Behavioral Sciences, Communication and Education Technology, Richard worked as a Community Worker, Training Media Producer and Rehabilitation Counselor for the Santa Clara County Department of Health.

Title:
Head of Learning Management Systems
Advanced Degree(s): BA, MA
LinkedIn: https://www.linkedin.com/in/rwhamilton/

Florence Michelet
Head of Medical Communications, MS, MBA

Biography:
Florence Michelet founded EosMorae, LLC in 2011, after more than 20 years of senior global and domestic US medical communications experience in major global corporations.

She has spent her entire career developing sound educational solutions for healthcare professionals (physicians, nurses, pharmacists, physician’s assistants, etc.) and patients in a variety of therapeutic areas.

A French native, Florence started her career in Paris as a statistician. After moving to the United States in 1989, she earned her MBA degree in international marketing and joined the field of strategic medical communications immediately thereafter.

In 1998, she joined Physicians World (a Thomson Reuters corporation), holding positions of increasing responsibility and ultimately being appointed as General Manager for GeoMed Global Communications, the company’s global division.

Florence moved to Oxford Clinical Communications (OCC) in 2004 as President of North American operations (including the global and US promotional medical education activities, and the Oxford Institute for Continuing Education, the CME-accredited division).

Prior to starting her own business, Florence was Senior Vice President, Director of Client Services, at Publicis Groupe Company for over 5 years, where she provided strategic leadership to a number of the company’s clients, both at the domestic and global level.

Title:
Head of Medical Communications
Advanced Degree(s): MS, MBA
LinkedIn: https://www.linkedin.com/in/florencemichelet/

Jennifer Kirschenbaum
General Counsel, BA, JD

Biography:
Jennifer Kirschenbaum is a managing partner of Kirschenbaum & Kirschenbaum, P.C.’s healthcare department.

She devotes her practice towards assisting practitioners in all aspects of private practice, Office-Based Surgery practice, Article 28 facility formation and operation, Independent Practice Association formation and operation and hospital based practice and hospital relationships/arrangements.

Jennifer began her career focusing on third party payor and government payor audit defense, OPMC and OPD licensure matters and general practice matters, including license agreements, during her time as an associate at Abrams Fensterman, et al.

Her practice expanded when she joined Rivkin Radler LLP, where she focused on regulatory compliance and transactional matters.

After bringing healthcare to Kirschenbaum and Kirschenbaum, P.C. in 2008, Jennifer has grown the firm’s healthcare department to representing over 800 practices, Article 28 facilities, IPAs and small to mega-group private practices.

K&K’s healthcare department represents MDs, DOs, DPMs, DDS, DMDs, DCs, PTs as well as other practitioners. Jennifer operates the healthcare department in conjunction with the other practice areas of law at the firm.

When necessary our litigation, real estate, trust and estates or bankruptcy attorneys are available to assist in matters related to healthcare, issues involving practice break-ups, trademark infringement, breach of contract, etc.

Practitioners contact Jennifer at all stages of practice, from their first employment agreement review and negotiation, their first lease, first partnership agreement, first patient issue, first lawsuit, first HIPAA complaint, first hospital contract, collection issues, audit through partnership structuring, mergers and acquisitions, practice sale, hospital employment or closure and everything in between.

We are here to assist in any and all issues that arise that cannot be easily addressed internally or require third party consultation.

Title:
General Counsel
Advanced Degree(s): BA, JD
LinkedIn: https://www.linkedin.com/in/jennifer-kirschenbaum-1a169a17/

 

 

 

For More Information Visit:  www.f2fhealth.com

 

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contact: maria.dorfner@yahoo.com

Female Founder Set To Disrupt Billion Dollar E-Learning Industry

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Busy Mom Frustrated with Finding STEM Classes for Daughter Starts Online Learning Platform 

Learning is always healthy, so today we’re excited to tell you about a new way to keep your brain cells sharp. Meet Amy Olivieri, President and CEO of TakeAClass. TakeAClass is an online resource to support academic, recreational, and professional class searches, payment processing, live stream technology, and Classalytics – an event management tool for instructors, schools, and organizations.

It seeks to revolutionize educational options for adults and children by providing access to local and online classes to anyone in the world.

Turns out, the Global E-Learning Market is expected to reach $325 Billion by 2025.

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Welcome Amy. Tell me more about what prompted you to start TakeAClass?

AMY OLIVIERI: “As a busy mom and professional the last thing I have time for is to spend hours online searching for swim or piano classes for my daughter or a salsa dancing computer class for me. I discovered that when needing to take a class there was no online platform that immediately came to mind. So, I would have to search the internet or ask my friends and family for recommendations. So, I created TakeAClass!

Name is easy for everyone to remember. That’s a major plus right there.

AMY OLIVIERI: “Yes! And TakeAClass takes the drama out of the class search process, making it easy for consumers to find exactly what they want – including fitness, cooking, dance, computer, skydiving classes and thousands of other classes. The idea behind TakeAClass is to organize all the information needed to make an informed decision in one place. We allow consumers to search class listings for free.”

Who can use it?

AMY OLIVIERI: “Instructors, schools, and organizations will have the convenience of listing their classes, which will help increase their visibility and get more students with stunning profiles, photos, class descriptions and schedules.”

What if someone wants to teach cooking or how to knit or play basketball on the site, how does it work? Do they get paid?

We charge a 18% booking fee for every class purchased through our website. There is no monthly subscription. We don’t get paid unless a class is paid for.

AMY OLIVIERI: “Teachers are our class vendors. They get to set their own price for teaching and get paid weekly for all completed classes.”

Let’s say there’s a local kid’s cooking class in town or yoga class for adults and they want to fill those classes locally — can they utilize the site to fill classes?

AMY OLIVIERI:  “Yes. Right now, we’re launching in Houston, Texas. But we will be available everywhere soon.”

Great. What about the person wanting to take the class? Do they pay?

“It’s free for consumers to search through our marketplace of classes. They simply search, find, and buy the class they wish to take.”

You also intend to utilize blockchain technology. Tell me about that.

AMY OLIVIERI: “We seek to take advantage of the exciting blockchain technology by offering global access to education while removing the barriers to pay for it by introducing our own cryptocurrency, which we hope will change the way payments are accepted for academic institutions.”

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You were raised by a single mother who is now a retired nurse. Tell me what role your upbringing played in what you’re doing today.

AMY OLIVIERI: “My mother instilled in me at an early age that if I wanted to be successful I needed an education. So education was my first passion. She raised two children and worked multiple jobs. She was my first role model and gave me my work ethic. She taught me that I could pave my own path, which gave me the confidence to excel in my professions as an African-American woman in male dominated industries.”

What are some challenges you faced launching it and how did you overcome them?

AMY OLIVIERI: “My greatest challenge was finding trusted service providers who didn’t over promise and under deliver. It’s not easy to find the right team ofpeople who see your vision and are willing to move with that vision to make your idea a reality. And as a female founder of a tech company there are many obstacles you must overcome in this space. I have an amazing support infrastructure that helps me navigate around the challenges and stay focused.”


Part of that supportive infrastructure is from you forming a strategic partnership with KiwiTech, 
where we met.

AMY OLIVIERI: “Yes, we’re pleased to join hands with KiwiTech and view them as the ideal technology partner to help us launch our platform and take it to the next level.”

Explain to our readers what KiwiTech does.

AMY OLIVIERI: “KiwiTech, LLC, is a technology services provider that invests in tech startups. Most recently, they featured their first all Female Founders Demo Day in New York City. As part of the partnership, KiwiTech will provide exclusive technology development capabilities to TakeAClass.”

CEO of KiwiTech says:

“KiwiTech is excited to partner with TakeAClass,” says Rakesh Gupta, CEO of KiwiTech. “Their platform offers consumers fast access to academic and recreational local and online classes. Leveraging our deep domain expertise, we’re committed to helping TakeAClass achieve their mission.”

When do you launch?

AMY OLIVIERI: “We’re real excited to go live Monday, June 25, 2018.

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How can be people sign up for a class or offer one on the site?

AMY OLIVIERI:  Go to:  http://www.takeaclass.com

Thank you, Amy! Congratulations and continued success. You’re a great role model.

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More About KiwiTech 
KiwiTech provides end-to-end digital technology solutions across a wide range of industries, including publishing, healthcare, media & entertainment, education, financial services, energy and nonprofit & government.

KiwiTech has quickly gained recognition as an innovator by investing in numerous early-stage startups and partnering with large enterprises. Drawing on its deep expertise across mobile and web technologies, KiwiTech enables companies to create groundbreaking digital experiences. KiwiTech is based in Washington DC, with additional offices in New York and New Delhi.

RELATED:

Online Learning Industry Poised for $107 Billion In 2015
https://www.forbes.com/sites/tjmccue/2014/08/27/online-learning-industry-poised-for-107-billion-in-2015/#287eae667103

The $107 Billion dollar industry that nobody’s talking about
https://www.inc.com/john-nemo/the-107-billion-industry-that-nobodys-talking-about.html

Global E-Learning Market 2017 to Boom $275.10 Billion Value by 2022 at a CAGR of 7.5% – Orbis Research
https://www.reuters.com/brandfeatures/venture-capital/article?id=11353

Global E-Learning Market to Reach $325 Billion by 2025
https://globenewswire.com/news-release/2017/02/06/914187/0/en/Global-E-Learning-Market-to-Reach-325-billion-by-2025-Rapid-Growth-in-Online-Content-Digitization-Innovations-in-Wearable-Technologies-are-Flourishing-the-E-learning-Industry.html

Global Online Education Market (2018-2023) by Type, Technology, Vendor and End-User – Market to Reach $286.62 Billion Growing by 10.26% CAGR – ResearchAndMarkets.com
https://www.businesswire.com/news/home/20180226006458/en/Global-Online-Education-Market-2018-2023-Type-Technology

US E-Learning Statistics
https://www.statista.com/statistics/693280/the-self-paced-e-learning-industry-revenue-in-the-us/

 

MEDIA:

To book an interview with Amy or for more info call: (713) 298-6597

Available live in Boston July 1-7, New York City, July 26-27

 

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http://www.takeaclass.com

 

 

 

Coming Up Next…

Female Physician finds flaws in system when she needs to find help for own child. Instead of getting angry, she creates a solution.

Click FOLLOW below to be notified of story.

 

Real Deal: No More Needles for Blood Draws

v12Velano Vascular is on a mission to bring compassion to healthcare and make painful blood draws more pleasant for patients.  So far, they’re succeeding. They’ve received their 3rd FDA-clearance to help children and adults who cringe at the sight of needles.

Needlephobia affects 24% of adults and 63% of children.

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The Boy Who Cried Wolf may come to mind when we talk about no more needles for blood draws because of ill-fated Theranos.  They’re the overly-hyped biotech start-up currently under federal investigation by the S.E.C. and U.S. Attorney’s office. Patients initially thrilled about no more needles got hoodwinked by fake news.

Meet the Real Deal.

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Velano Vascular creates a single-use, disposable device called PIVO.

 

It attaches to a peripheral IV line, in hospital inpatients, allowing for lab quality blood samples to be drawn back through the IV –without requiring venipuncture (needle sticks or drawing blood from central lines) .

 

Many of the questions Therano’s CEO never answered, avoided or even got asked by reporters is welcomed by Velano Vascular’s CEO, Eric Stone, who I interviewed.

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WHAT IS PIVO AN ACRONYM FOR?

ERIC STONE, CEO, VELANO VASCULAR:  PIVO derives from “peripheral intravenous catheter,” or PIV, which is a medical term for the standard IV most hospital patients are hooked up to in order to receive intravenous fluids..

WHAT IS PIVO?

STONE: PIVO is a single-use, disposable device that attaches temporarily to an IV line, allowing for needle-free blood draws from this existing line.

HOW DOES IT WORK?

STONE: It enables blood draws to be taken by clinicians from the same intravenous (IV) catheter most hospital patients already have inserted in their arms, instead of poking them again each time they need their blood drawn and instead of accessing larger catheters (Central Venous Catheters) which raise different challenges associated with each time they are accessed.

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WHO DOES THIS DEVICE HELP PEOPLE?

STONE:  The device works for any patient with an IV catheter. Of course, children tend to more commonly have an acute fear of needles, so it can make pediatric care less invasive and painful.

There are also an estimated 30% of our hospital inpatients that are classified as DVA (Difficult Venous Access) because of aging, obesity, disease and more.

PIVO helps practitioners capture critical labs from these growing populations of patients who otherwise may take significant time and expense.

STONE: Also, those in hospitals or other inpatient settings, where the average length of stay is almost 5 days in the U.S. require daily or more frequent blood draws. Many of these patients have problematic veins or skin, which requires a lot of poking and prodding to draw blood. PIVO tackles these issues head on.

According to the CDC, an estimated 35M inpatient stays occur in the U.S. alone each year.  So, PIVO is set to  help many millions of Americans, not to mention those inpatients around the world.

HOW IS PIVO MORE COMFORTABLE & LESS DANGEROUS FOR PATIENT?

STONE:  For patients who have their blood drawn for a check-up once a year in an outpatient setting, blood draws are not that disruptive.  For a “frequent flyer” in the hospital, or a DVA (difficult venous access) patient –noted as such upon admission or who has become DVA after 10 or 20 days in the hospital feeling like a pin cushion –removing the needle from the procedure can have a lifelong impact.

Enabling practitioners to avoid accessing central lines (large, surgically-placed catheters) for blood draws aims to reduce the risks of Central Line Associated Blood Stream Infection.

Further, removing the needle from blood draws helps avoid risk of injury and infection for our phlebotomists, nurses and physicians. Hospital leadership is recognizing that an important alternative to a prevalent practice is now available.

IF I GET BLOOD WORK FROM AN ANNUAL PHYSICAL WILL THEY USE PIVO?

STONE:  PIVO requires a Peripheral IV catheter in order to access the vein. The IV line serves as a temporary conduit to the vein, so without the IV line PIVO cannot access the vein.

The IV line serves as a temporary conduit to the vein, so without the IV line, PIVO cannot access a patient’s blood.  As such, this procedure is most appropriate for the hospital inpatient setting.

I do envision PIVO will adopted in other care settings, where patients possess an IV line and require frequent blood draws, but the annual physical unfortunately is not one of these.

WHY AREN’T IV’S GOOD FOR DRAWING BLOOD WITHOUT PIVO?

STONE:  IV’s are essentially plastic  tubes which overtime become soft, like a noodle. While a noodle is fine for injecting fluids and medications into a patient, its soft walls collapse under the negative pressure of suction when you try to take fluids out.

There are other reasons why IV’s are less-than-optimal for drawing blood back, but these are quite complex in nature and we’re only just now uncovering some of the novel reasons through our research with leading clinical collaborators.

PIVO simply inserts a small, stiffer tube inside the existing IV tube for the purpose of drawing blood.

It works by propping open and unkinking the IV tube temporarily while enabling lab quality blood be collected.

HOW WAS THE IDEA FOR PIVO ORIGINALLY DEVELOPED?

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STONE:   Velano’s co-founder and physician, Pitamber Devgon had an elderly patient with bruises up and down her arms from repeated needle sticks.  That patient asked him why he was continually sticking her with needles when she already had an IV catheter in her vein. He didn’t know, but began exploring if it was possible to draw lab quality samples out of the IV line using a separate device.

Stone, a Wharton MBA shares, “Most of my career has been in healthcare, plus I am a needle phobic following my childhood diagnosis with Crohn’s disease as a teenager. So, when I was looking for a company start and a product to bring to market and my former graduate school classmates introduced us, I was instantly engaged following years as a serial healthcare entrepreneur and patient advocate.  From that connection,  Velano was born. “

Velano first won FDA approval for PIVO in 2015, and has also obtained multiple U.S. and international patents for it, with additional applications outstanding in the U.S. & abroad.

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STONE: “Five years from now,” asserts Stone, “I believe, without a doubt that PIVO will be the standard of care for inpatient blood draws and vascular access.”

Thanks for a great interview and innovation for healthcare consumers! -Maria Dorfner

http://velanovascular.com

 

MEDIA:   Contact: Michael Azzano at 415-596-1978 to set up telephone or on-camera interviews with patients or Eric Stone, CEO, Velano Vascular.

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RELATED NEWS:

 

A year ago, Forbes contributor Robert Reiss called Eric Stone “The Steve Jobs of Drawing Blood” and tested PIVO himself.  Reprint of article below courtesy of Reiss.

The Steve Jobs Of Drawing Blood

by Robert Reiss , FORBES CONTRIBUTOR (specializing in writing about CEOs)

Opinions expressed by Forbes Contributors are their own.

I was recently at a board meeting at Griffin Hospital and our CEO was telling us about a new product that could transform perhaps the most ubiquitous healthcare practice – drawing blood.

The concept from a company called Velano Vascular repurposes the IV most hospital patients already have in their arms so blood can be drawn without having their veins repeatedly stuck by needles.

It aims to eliminate the associated negatives of traditional blood drawing: the pain and anxiety, injuries, excessive time and cost.

It seemed like such a revolutionary solution to a broad issue – sort of like in 1892 when Keds invented sneakers – and I was curious to understand if this was truly an historic moment where the age old process of drawing blood could once and for all be revolutionized.

It reminded me of one of my first CEO interviews back in 2007 with Jay Walker, the founder of Priceline when he described the driving force behind one of his over 700 patents, “The key to successful innovation is having a better solution for something that’s used everywhere and every day.”

So I decided to experience this innovation firsthand and a few weeks later I intentionally became a patient and experienced this new needleless way to draw numerous samples of blood.

I was amazed, the nurses were able to draw blood easily, and to do so as many times as they wanted without ever having to stick a needle in me again.

I was next introduced to the founder of Velano Vascular, Eric Stone, who I now admiringly call the Steve Jobs of drawing blood, and below are a few insights from our conversation:

Robert Reiss: How much blood is currently being drawn and what are the problems with the current system?

Eric Stone: Blood draws are not fun – and they are overlooked and underappreciated…except by patients. They are likely the most common invasive medical procedure, with an estimated half a billion in U.S. hospitals alone conducted every year, and two to three times this number across all hospitals worldwide annually.

Recognizing that the U.S. represents nearly 40 million inpatient admissions annually, with an average length of stay of five days, and a conservative estimate of two blood draws per patient per day, we are easily conducting hundreds of millions of inpatient draws each year quite readily.

This does not even take into account other non-hospital settings where patients require regular blood draws, such as long-term care facilities, skilled nursing homes and more – all locations where patients may have a peripheral IV (PIV) catheter indwelling (a requirement for our innovation to be relevant).

For a procedure that informs nearly 70% of all clinical decisions, it is remarkable that the last major innovation was the abandonment of bloodletting centuries ago.

Whether you’re the parent of a sick child or the son or daughter of an elderly parent, repeat hospitalizations and frequent blood draws hit home for just about everyone. It’s scary, it hurts, and it’s critical that we begin to pay attention and stop taking the steely reserve of our patients for granted.

Herein lies the rub. People scared of needles (trypanophobia) avoid necessary tests and treatment, needles injure healthcare workers more than 2 million times a year in accidents that can lead to serious infection, and the list of dysfunction goes on.

The way we draw blood today has real emotional, clinical and financial consequences. We can, and we must, do better. We can start by paying attention.

Reiss: What specifically is different about the Velano Vascular product?

Stone: Velano’s FDA-approved PIVO™ is a disposable, needle free device that connects to a patient’s existing IV catheter, enabling blood draws during their entire hospital stay without requiring subsequent needle sticks.

It turns out that IVs are great at putting fluids into the body but unreliable at pulling them out – that’s why patients receive so many needle sticks while in the hospital.

PIVO turns the routine IV into a reliable conduit for drawing high quality blood samples. This is an elegant solution to a centuries-old problem.

Now, patients no longer need to feel like a “pin cushions” or experience abrupt awakenings between 2:00 am and 6:00 am for the nighttime needle stick – when 40% of blood draws occur.

The company was founded based on a simple idea back in 2012, and subsequently PIVO has been used in clinical pilots and trials at a number of leading U.S. hospitals since receiving regulatory clearance in early 2015.

It has won a number of awards, including the Frost & Sullivan New Product Innovation Award for Vascular Access in 2016 and the Sheikh Zayed Institute for Pediatric Surgical Innovation competition at Children’s National Health in Washington, DC.

Reiss: What are the strengths and weaknesses of your methodology on quality outcomes?

Stone: Velano is most often measured by the clinical quality of blood samples drawn and its impact on both practitioner and patient experience.

In thousands of patients, the quality of our blood samples has been definitive and easy to measure, both through clinical studies and “real world,” commercial use.

Blood drawn from PIVO has similarly low hemolysis rates (blood cell shearing or tearing that can relegate a patient to a re-draw and delays in essential care) to needle draws.

Clinical study efforts and pilots with some of the country’s leading healthcare institutions such as University Hospitals Cleveland, Intermountain Healthcare, The University of Pennsylvania Hospital and Harvard’s Brigham and Women’s Hospital reflect clinically appropriate laboratory results – confirming that blood drawn with our compassionate technology can become a standard of care for clinical decision-making.

Practitioner and patient experience is harder to quantify, but our surveys and testimonials to-date are resoundingly positive. In fact, patients who receive PIVO draws are requesting PIVO when transferred to floors in the hospital that are not participating in our pilots or upon readmission to the hospital. They are actually asking for the product – it is remarkable.

The onus is on Velano to continue improving our quality measurements to undeniably prove this innovation is truly a win-win-win, as we seek to elevate the quality of care and outcomes for patients, practitioners and hospitals alike.

Reiss: What is the financial model for a user and what is the economic impact nationally?

Stone: The cost of a blood draw is not just the $1 or less spent for a needle. Instead, it is the many billions of dollars a year spent on wasted materials, rejected blood samples, patient and practitioner risks, delayed results, labor costs, central line escalations, and more resulting from this less-than-desirable and madly inefficient procedure.

Some of the financial downsides of traditional blood draw standards are somewhat obscure, however we’ve helped our hospital partners understand the current impact by simply asking sincere questions, seeking to learn, and paying a modicum of attention to the topic.

Think about the blood draw on an elderly or obese or diabetic patient that can take as long as an hour of a nurse’s time and 2-3 needles to find a vein and collect an adequate sample.

Consider that even one single case of an employee blood borne pathogen transmission from a needle stick can cost millions of dollars in exposure for a hospital.

For PIVO, we understand that in an environment of increasing health industry price transparency and pressures, when our entire healthcare system is experiencing economic upheaval, and cost neutrality is required for rolling out true innovation in hospitals.

 

Reiss: Why did you start Velano Vascular and what’s your vision?

Stone: The reason why is very simple – because I am first and foremost a patient, and I am a parent.   25 years ago I was diagnosed with Crohn’s disease, launching me on a lifelong journey as a healthcare entrepreneur, patient advocate, and National Trustee of the Crohn’s and Colitis Foundation of America. Since a young age, I’ve been motivated by IMPACT.

I started Velano in partnership with an intellectually curious physician inventor intrigued by a seemingly simple question posed by his patient – “why are you repeatedly sticking me with needles [when I already have an IV line in my arm]?”

This simple, yet elegant idea resonated strongly with me, for I am needle-phobic myself, and I have been that “tough stick” patient during my hospital stays. Today, this brilliant idea has become reality.

My vision for Velano is to touch every human being on the planet; for we will all spend time in a hospital at some point in life, and we will certainly need our blood drawn when we do.

 

http://velanovascular.com

 

MEDIA:   Contact: Michael Azzano at 415-596-1978 to set up telephone or on-camera interviews with patients or Eric Stone, CEO of Velano Vascular

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Maria Dorfner founder of NewsMD: What’s Hot in Health

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NewsMD Communications was founded in 1998 to educate healthcare consumers by connecting medical + media to inspire and empower millions to want to live healthy.

In 1993, Maria created Healthcare Consumers, Healthy Living, Lifestyles & Longevity and Healthcare Practitioners. The shows aired on CNBC, which she helped launch in 1989.  She is the founder of Cleveland Clinic News Service, helped launch MedPage Today (sold to CNN) and wrote & produced 21st Century Medicine for Discovery Health.  Her awards include Freddie for Excellence in Medical Reporting, Outstanding Leadership Abilities, Media Recognition, Who’s Who, Medical Reporting Scholarship. She produced for Journal of the American Medical Association (JAMA) Report, talk shows & reality programming.

She began as an intern at NBC todaylogo SHOW in NYC in 1983.

This is her blog.

Have an innovative solution healthcare consumers|media should know about?

Contact: maria.dorfner@yahoo.com  

Response only if it’s a story of interest. Thank you.

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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

Re-sharing my pick for what’s hot in AI from 2017, since Heart Health is in the news.

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. Eko’s Artifical Intelligence (AI) and TeleHealth Technology improves early detection of heart and lung disease at any point of care.  There’s also a digital Stethoscope for physicians, which helps them hear heart murmurs more clearly for early detection of problems to prevent future ones.

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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

Maria Dorfner is the founder of NewsMD. She has worked in Media for 38 years, beginning as an intern at NBC during college. She covered health for her college newspaper and covered The Ivy League Roundup. She has specialized in Medical/Health for 28 of those years. Her series on obesity won a Freddie Award for Excellence in Medical Reporting and she won a Media Recognition Award, Outstanding Leadership Award and Commitment to the Advancement of Women in Media Award. Her medical stories have aired on NBC, ABC, CBS, CNN, FOX, cable stations and O&O’s and affiliates.

She co-founded The Cleveland Clinic News Service, helped launch CNBC in 1989, helped launch MedPageToday and produced the weekly Journal of the American Medical Association (JAMA Report) airing weekly on every network. She also served as Director of Research for Ailes Communications, a political and media consulting company, which served as advisory to Presidents. She is the recipient of a Medical Reporting Scholarship from the American Medical Association and an Advanced Writing Scholarship from Columbia University. In 1998, she produced “21st Century Medicine” on tissue regeneration and regenerating life for Discovery, developed original medical/health programming which aired nationally on CNBC.

She’s travelled extensively interviewing a Who’s Who in pioneering medicine.

The series she created in 1993 include Lifestyles & Longevity, Healthcare Consumers, Healthcare Practitioners and Healthy Living with Dr. Joyce Brothers. She went on to replace Brothers as Host of the series.

Most recently, for a year, starting in 2019, she was the creator, producer and host of BoldHealth on BoldTV. In her spare time she enjoys nature, fitness, volunteering, reading a lot and helping people.

She began her career as an intern on the Today Show in 1983. She is the author of Healthy Within, Health Heart & Humor in an Italian-American Kitchen and PRESSure: Break Into Broadcasting.

This is her blog

Email: maria.dorfner@yahoo.com | @Maria_Dorfner on Twitter

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.”

 

 

Startup Reduces Needles for Blood Draws

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FDA-cleared to improve patient and practitioner experience in healthcare settings.

Full Story:  http://fortune.com/2016/05/20/startup-blood-draws/

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Or visit:  http://velanovascular.com/in-the-news/velano-vascular-needleless-blood-draw-technology-relieves-anxiety-for-patients-practitioners-and-hospitals/

 

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
Be sure to click red FOLLOW on upper right of this blog to be notified of new posts.
On Twitter:  Maria_Dorfner

 

 

 

 

Future Health: Lung Cancer Vaccine 5 to 10 Years Away

 

 

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A lung cancer vaccine some say could be a breakthrough in oncology, has CimaVax has reportedly been in development in Cuba for 25 years by a company called CimaVax, partly because lung cancer is one of the leading causes of death in the Caribbean nation.

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Health reporter, Maria Dorfner spoke with Dr. Kelvin Lee from Roswell Park Cancer Institute, located in Buffalo, New York.  He says Roswell Park is finalizing an application to the FDA seeking permission to conduct a U.S. clinical trial of  the cancer vaccine and that , depending on the results from that and any subsequent studies, it would likely be 5 or more years before the drug could be widely available for patients in the U.S.  

CimaVax is already an approved cancer therapy in Cuba and Peru.

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HOW IT WORKS

The injection is not like the other cancer-fighting immunotherapies being developed in hundreds of American labs, said Kelvin Lee, the chair of immunology at the Roswell Park Cancer Institute in Buffalo, N.Y.

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Lee and other doctors have visited the island nation several times to meet with its Cuban developers and hear updates on their progress –and they found that the vaccine was a promising potential breakthrough.  He wrote in a post on Roswell Park’s Cancer Talk blog:

“Unlike other immunotherapies, CimaVax does not target cancer directly and it is not personalized. Rather, the vaccine targets a growth factor (EGF) necessary for the cancer to survive,” Lee said. “By targeting and effectively depleting this growth factor, the cancer starves and its progress slows, prolonging patients’ lives.”

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The results so far show that patients’ lives were extended from six to an average of 18 months with the vaccine treatment,  but there are reports of patients treated with the vaccine living five years or more.

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Lee and the other doctors see the possibility that the vaccine’s efficacy may translate to colon, head and neck, prostrate, breast and pancreatic cancers as well, and that CimaVax may prove effective in preventing some cancers from developing or recurring.

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Some studies have shown promise in CimaVax, as it has cut back the EGF needed for the cancer to progress.

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It has done this with minimal side effects, including nausea, fever and vomiting.  Survival dramatically improved in those patients with advanced Stage 3 and Stage 4 tumors, according to a Cuban study conducted in 2007.

 

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However, the vaccine has only been administered to a few thousand people worldwide –and it is still far from FDA approval, the doctor said.

A possibility of skipping Phase I testing exists, Lee added. The FDA inspection period should end sometime this year, allowing testing to begin. Lee and the other doctors envision the vaccine’s efficacy translating over to other head and neck cancers, as well.

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Cancer Research UK urged patience in looking to CimaCax, in a statement released last year.

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“This research is promising but this is a small trial and we will need more trial results before we know exactly how well the vaccine works for people with lung cancer. A phase 3 trial is currently in progress in Cuba,” they said in a statement.

Obama announced the U.S. was “extending a hand of friendship” to Cuba – just 90 miles from Florida – in December 2014. The cooperation between Cuban and American doctors began in 2011 and gained momentum with New York Governor Andrew Cuomo’s trade mission to Cuba in  April 2015. Since then, the U.S. has restored up to 110 daily flights to Havana.

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Among the critics of Obama’s March 21 visit to the island nations are Sens. Marco Rubio and Ted Cruz, both presidential hopefuls who are of Cuban descent.

 

 

Scientists ‘find cancer’s Achilles heel’

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Scientists believe they have discovered a way to “steer” the immune system to kill cancers.

Researchers at University College, London have developed a way of finding unique markings within a tumour – its “Achilles heel” – allowing the body to target the disease.

But the personalised method, reported in Science journal, would be expensive and has not yet been tried in patients.

Experts said the idea made sense but could be more complicated in reality.

However, the researchers, whose work was funded by Cancer Research UK, believe their discovery could form the backbone of new treatments and hope to test it in patients within two years.

 

They believe by analysing the DNA, they’ll be able to develop bespoke treatment.

People have tried to steer the immune system to kill tumours before, but cancer vaccines have largely flopped.

One explanation is that they are training the body’s own defences to go after the wrong target.

The problem is cancers are not made up of identical cells – they are a heavily mutated, genetic mess and samples at different sites within a tumour can look and behave very differently.

‘Exciting’

They grow a bit like a tree with core “trunk” mutations, but then mutations that branch off in all directions. It is known as cancer heterogeneity.

The international study developed a way of discovering the “trunk” mutations that change antigens – the proteins that stick out from the surface of cancer cells.

Professor Charles Swanton, from the UCL Cancer Institute, added: “This is exciting. Now we can prioritise and target tumour antigens that are present in every cell – the Achilles heel of these highly complex cancers.

“This is really fascinating and takes personalised medicine to its absolute limit, where each patient would have a unique, bespoke treatment.”

There are two approaches being suggested for targeting the trunk mutations.

The first is to develop cancer vaccines for each patient that train the immune system to spot them.

The second is to “fish” for immune cells that already target those mutations and swell their numbers in the lab, and then put them back into the body.

‘Early days’

Dr Marco Gerlinger, from the Institute of Cancer Research, said: “This is a very important step and makes us think about heterogeneity as a problem and why this gives cancer this big advantage.

“Targeting trunk mutations makes sense from many points of view, but it is early days and whether it’s that simple, I’m not entirely sure.

“Many cancers are not standing still but they keep evolving constantly. These are moving targets which makes it difficult to get them under control.

“Cancers that can change and evolve could lose the initial antigen or maybe come up with smokescreens of other good antigens so that the immune system gets confused.”


Analysis

James Gallagher, health editor, BBC News website

Harnessing the power of the immune system – what’s known as immunotherapy – is the most exciting field in cancer and probably in all of medicine right now.

But while that excitement is justified, claims that a cure for cancer is around the corner are not.

Medical research is littered with the graves of hyped treatments that just never worked.

Two decades ago, gene therapy was “hype-central” and we’re still waiting for it to transform medicine.

This study demonstrates some spectacular science that furthers understanding of how the immune system and cancer interact.

But this new knowledge has not been used to treat a single patient. There have not even been animal studies. So there is a real risk it will not work.

Even if it does, this is an hugely expensive approach that would need to be customised to every patient in a process that takes more than a year from start to finish.


Some immunotherapy treatments work spectacularly with some patients’ cancer disappearing entirely.

They take the brakes off the immune system, freeing it up to fight cancer.

The researchers hope the combination of removing the immune system’s brakes and then taking over the steering wheel, will save lives.

Professor Peter Johnson, from Cancer Research UK, said the research had shown “impressive results in the clinic” and although “the technology is complicated and quite recent… once you start doing it the cost will come down”.

‘Elegant study’

Dr Stefan Symeonides, clinician scientist in experimental cancer medicine at the University of Edinburgh, said designing a personalised vaccine was currently impractical, especially when a patient needed treatment straight away.

But he added that the “very elegant” study did provide a ground-breaking insight into current immunotherapy drugs, which do not yet work for most people.

“It’s not just the number of antigens, it’s how many of the cancer cells have them,” he said.

“This data will be quoted in discussions for years, as we try to understand which patients benefit from immunotherapy drugs, which ones don’t, and why, so we can improve those therapies.”

Follow James on Twitter.

 

BLOG CONTACT: maria.dorfner@yahoo.com