#diagnostic test online (260)

[terselylove]

30 Weird Careers You Never Knew Existed That Might Help You Find Your Calling

1. I work in QC (Quality Control) for media.

In one company they occasionally paid me to watch porn to make sure it was in sync and in good quality for video on demand distribution.

In another company I spent years watching movies before release in secure theater-like rooms, to make sure the files are ready for distribution (subtitles and audio in sync, no picture corruptions, stuff like that). I always got to watch the biggest movies of the year in a giant screen weeks before they were released (sometimes months!).

I got the job by going to film school.

2. I spend about 80% of my day designing those large overhead signs you see on the highway.

3. I design water parks. I went to college for Graphic Design and Advertising. In my last year I had to do an internship, so I took one at an aquatic engineering firm to help organize photos. 10 years later I am a project manager and create resort deck and water park programs.

4. My boyfriend is a high rise window cleaner. There are only 4 in our city. He loves his job! Sometimes when he is working, I will go to the city to the building he is cleaning and look up at him on the street. So cute.

5. I used to work on a lavender farm! It’s totally unrelated to my field of study and incredibly difficult in terms of manual labor, but man was it a beautiful place. I tended to the plants, took care of goats, and did processing for the herbs and honey. My grandparents are farmers and so I grew up with mediocre knowledge of field work and beekeeping and when a friend’s mom decided to start a business centered around lavender she asked me to help out for the summer.

6. You know when you’re watching a sports program and you see the little pop-graphic in the corner (ie. a baseball players stats, or an advertisement for easy-mac, or “stay tuned for Saved By the Bell @ 9!”)? Yeah. That was me.

7. I work in a lab where I raise moths! I got it by telling my lab partner that I love bugs and he hooked me up.

8. I’m a chyron operator. I trigger motion graphics on live TV. I was an art student and also was in stage crew in high school. These things got me jobs backstage in theater, which got me a job in TV doing normal stuff like cameraman and stuff like that. Since I was an art major I asked if I could do graphics and they let me on the weekends, and my specialty eventually turned to the chyron which ingests the graphics that artists make and plays them back through the switcher that controls the news broadcast. It’s not technically an art position but at my job specifically I could make the graphics in after effects and photoshop during the day (if I have a computer free) and in the afternoon I play the chyron. Usually you are one or the other, because chyron operators don’t need art skills, it’s just another tech job like audio operator or camera operator or stage manager or whatever. These kinds of jobs are getting rarer because they are being automated. But since I’m also an artist I get to keep my job because if someone leaves I can take their job.

9. I used to be a hand model.

Apparently I have really really good looking hands. Although they look completely normal to me.

People were always asking me how I got into it so it was fun to bullshit people I was “discovered” on the street, now I moisturize 15 times a day and sleep with my hands in plastic bags….

The money was great but I’d have to spend long days on set being careful not to wreck my manicure. (Which they paid for of course! Also paid for the time it took to get the manicure.)

Mostly did TV commercials.

Now I tell people at parties I’m a retired international hand model but gave up show business for the much more worthwhile and rewarding career of teaching kids to read….

10. I’m a Hostage Survival Trainer.

I was working in international development within IT, and was asked to go and sort out the finance system in Iraq back in 2007. The ministry I was working in got attacked by a militia and myself along with my 4 guards got captured.

Over time the guards were killed and I got released in an exchange deal after being held for over 2.5 years.

11. I spent a year on a team reclassifying the Duke University Library system from Dewey Decimal to Library of Congress. Had to learn like four different alphabets just to label them properly.

12. Official court stenographer. I type everything everyone says in court. I was told about it in high school and thought it sounded cool so I went for it. Took 5 1/2 years in college, but I’m nationally certified to type 260 WPM and regularly push above 300 WPM in court.

13. Cameraman for Live PD. Went to film school to make movies then slowly worked through Ice Road Truckers, Ax Men, Boston’s Finest, and Nightwatch. Found out I have a perfect blend of art and athleticism that can be hard to find.

14. I make whiskey. It took a shit load of time, luck, skill and perseverance to get where I am.

15. Stagehand. I set up everything from huge concerts and Broadway shows to small private events and interviews. It’s a wonderful job and I love the people I work with.

16. I was a puppeteer for many years and I actually got that job from an ad in the classifieds. It cracks me up that there is a scene in Being John Malkovich where he tries to find “puppeteer” in the classifieds and fails.

17. I have been an online Community Manager for over 20 years.

I started in video games and moved into technology companies. I’ve worked on everything from Star Wars to telecommunications networking equipment and software that help companies move data fast.

It started as a hobby. I was a web developer so very fluent with the web. Started a fan site and grew up it large. Moved on to volunteer for another game company who eventually hired me full time.

18. My parents are escape artists and escape consultants. My dad started as a magician doing birthday parties as a teen, then got really into escapes, then became the #1 guy designing and consulting on escapes for famous top magicians.

19. I have a job tracking rodents in restaurants. I set up cameras, movement sensors, IR sensors and other gear, and get an idea of the problem and how to fix it.

20. I used to cut pictures of weewees and hohas off packaging of adult toys. All day every day. I got the job by being able to pass a drug test.

21. I mix fire retardant for fighting wildfires. A lot of people know that airplanes drop retardant on fires but don’t think about the millions of dollars of infrastructure that is behind that operation. Everyone who works at my base started by working at the local ski resort. It’s a good way to earn enough money in the summer to coast all winter so we keep the jobs among fellow ski bums.

22. In the summer I guard and clean the toilet units (not the toilets) for festivals. I got the job trying to find a cheap way to go to the big festivals and this organization was looking for volunteers.

So all I have to do is stand in front of the units, make sure the ground stays clean, everyone had toilet paper and clear a block of units so the cleaning team can do their job.

Another part of the job is making sure no one dies or passes out in such a unit. You can’t imagine how many drunk (often naked) people we need to get out of these units and escort them to the First Aid.

23. I’m a potter. I used to be the manager for a museum art school, and began taking classes there years ago. Eventually transitioned into being a full time potter and pottery teacher.

24. I work as an Air Traffic Controller. Not weird but not many of us around.

I pretty much fell into it after passing an aptitude and it’s just been swell since.

Albeit, the classic phrase from strangers: isn’t that the job with the most suicides?

It might be, but I don’t know anyone. It’s actually super chill and rewarding when you get it right. (We always try get it right, but when you get it super right you’re dead pleased.)

25. I’m a welder. But what I do isn’t very common. I build Virginia Class Submarines.

26. Water Quality testing. I go around and collect samples for various testing to ensure the water meets the state standards. I got lucky and met someone who was volunteering at my previous job and she told me to apply. Was not the direction I saw my career going but it was definitely worth it.

27. I cleaned grills for super rich people in Palm Beach. Even got to clean Michael Jordan’s at one point. And it was recommended to me from a friend who was in sobriety with me after I got clean.

28. I’m a House Manager for a family of four, basically I’m a female butler. I’ve worked for them for 14 years starting as the kid’s Nanny, they’re my second family pretty much! I organize trades people, holidays, birthdays, daily meals, dinner parties, housekeeping, the list goes on… It’s challenging at times but keeps me on my toes and I enjoy that.

29. Concrete petrographer. I just started this month. I studied geology in college and now my job is to look at concrete using petrographic methods I learned at school and conduct ASTM tests to determine quality of concrete. Very interesting work because concrete is engineered rock and there’s A LOT more to it than you think.

30. I work in a clinical lab where I get to play with baby sweat for a bit of my day. We are testing for chloride level. Increased chloride in sweat is one of the diagnostic markers for cystic fibrosis. I am a clinical laboratory scientist. Not all clinical labs perform this test but I am lucky enough to work at a lab where we do a couple interesting low volume tests.

[michaelwalshblog-blog]

Free SAT prep aims to level the playing field for college admissions

The College Board and the Khan Academy are offering free test preparation courses online for all high school students. (Photo: Getty Images)

Josh Simms, a student at Creative Arts Morgan Village Academy, a magnet school in Camden, N.J., wasn’t content with his PSAT score: 1020 out of 1600.

The teen signed up for a new free online SAT training course. After studying videos on math and reading comprehension and taking practice tests, he took the SAT three times. In November, he got the highest score in his school district — 1320.

“It is the most efficient program for studying for the SAT. It’s like having a personalized gym that you can go to if you want,” he told Yahoo News. “Basically, you just keep working on your weaknesses. That’s what I love about it the most. It tells you your weaknesses and you keep working on your weaknesses so that they become strengths.”

Simms was accepted into Cornell University for the fall and hopes to follow it with Harvard Law.

The College Board redesigned the SAT college entrance exam a few years ago and partnered with Khan Academy to provide free, personalized test prep for all students, partly to counteract the unfairness of expensive test prep courses — such as the Princeton Review — that benefit students from wealthier school districts.

The Khan Academy is a non-profit that offers free educational videos and supplementary practice materials online. Retired hedge fund analyst Salman “Sal” Khan founded the educational organization in 2006. It’s primarily funded through donations from philanthropic organizations.

Though Simms’ success with the program is extraordinary, the College Board recently released data that shows significant improvements for most students who used through the new Khan Academy program to improve their SAT scores.

A student studies in a library at night. (Photo: Sam Edwards/Getty Images)

Others achieved remarkable results as well. Matthew Blue, of Houston, Texas, improved his score by more than 200 points. D’Andre Weaver, of Orlando, Fla., increased his score by 260 points. And Omaria Murray-Broadwater, of Columbia, SC., improved her SAT score by 340 points.

“For a lot of programs, normally you have to pay for tutors. With Khan Academy, they have people that train you for free. So, take advantage of it,” Murray-Broadwater said.

The College Board-Khan Academy analysis, which looked at nearly 250,000 students from the class of 2017 who took the PSAT and SAT within the past year, shows 20 hours of practice with the program was associated with an average increase of 115 points from the PSAT to the SAT. That’s nearly double the increase experienced by students who did not enroll in the program.

Shorter practice times were associated with smaller gains. More than 16,000 SAT students improved their scores from the PSAT to the SAT by at least 200 points. And according to researchers, these improvements were consistent across various groups, including gender, ethnicity, socio-economic class and high school GPA.

David Coleman, the president and CEO of the College Board, said for too long people have viewed standardized tests as a sentence: something that tells you who you are rather than who you could be through practice.

“It was never a good idea that there was this one high-stakes moment that defines your future and could fill you with anxiety,” Coleman told Yahoo News.

The old SAT was largely an aptitude test but the new SAT — introduced March 2016 — measures straightforward reading, writing and math skills that can improve with practice. Coleman said the obscure SAT words and math problems have been replaced with questions one would reasonably confront in high school or college. The new exam also removes the guessing penalty for wrong answers.

David Coleman, the president and CEO of The College Board, speaks at the National Association for College Admission Counseling conference in Columbus, Ohio, U.S. September 22, 2016. (Photo: Jay LaPrete/Reuters)

The PSAT should no longer be seen as a “practice test” but as the “beginning of practice” — calling attention to places where students can improve.

Khan, who is also the chief executive officer of Khan Academy, said the new test prep teaches student to fill gaps in their knowledge rather than learn tricks for strategic guessing when stumped by a difficult question.

“The SAT is not a measure of IQ. It’s a measure of how well they can grasp the basic stuff in the first few years of high school. It’s a measure of college readiness,” Khan told Yahoo News.

Khan said the PSAT is now the country’s “largest personalized learning diagnostic” and that the Khan Academy’s software can help with “weak-point training.”

“You can follow these students over two years in a longitudinal way that you really couldn’t do before,” he said.

According to Coleman, the whole SAT revamp stems from a democratic impulse that the test should not be about “what you have” but about “the dedication you show through practice.”

“The data show that practice is an equal opportunity employer, that across income groups, across race, it advances you. We’re seeing students of all races and backgrounds devoting themselves to it,” he said.

Salman Khan, the founder and executive director of Khan Academy, speaks on stage during day one of TechCrunch Disrupt SF 2012 event at the San Francisco Design Center Concourse in San Francisco, California on September 10, 2012. (Photo: Stephen Lam/Reuters)

Robert Schaeffer, the public education director at Fair Test, the National Center for Fair & Open Testing, advocates for replacing the SAT, ACT and similar tests with test-optional college admissions. He’s long been critical of claims that coaching for these sorts of standardized tests is not possible.

“If the SAT were not coachable, it would be about the only human endeavor that is not,” Schaeffer told Yahoo News. “When getting one question right or wrong is about ten points, you don’t need a lot more question right to go up about one hundred or more,”

For this reason, he said wealthy parents buy their children a leg up on the competition by signing them up for test-prep programs offered by Kaplan or the Princeton Review.

“Grab a local Yellow Pages and look at the addresses of where coaching centers were located. In New York City, they’re going to be on the Upper West Side and Scarsdale-type suburbs,” Schaeffer said. “They don’t tend to be in central Harlem or other low-income areas. It’s not because the coaching companies are racist. They only care about one color and it’s green: they go where the money is.”

Schaeffer is skeptical of claims that the latest revision of the SAT will make it a fairer or more accurate tool, though he said improvements have been made. (Though he thinks the test was revamped to make the test more consumer-friendly after the ACT overtook the SAT as the nation’s most popular college admissions exam in 2012, for the first time in its history.)

Coleman and Khan don’t merely want the new testing program to have a democratizing effect — they also want it to encourage the sort of learning habits that enable grownups to sink or swim in today’s accelerating market.

“We’re really trying to turn the SAT and the PSAT into an invitation to practice, into an inspiration as it were. A challenge that changes you rather than a challenge that defines you.”

Citing a column by Tom Friedman in the New York Times, Coleman said all people need to own their future in our rapidly changing society — whoever they are. Jobs and the economy are changing rapidly and one will need to continually refresh his or her skills and education in order to keep up, he said.

“I want the new SAT to become a symbol to the people that through practice they can take command of their lives. They can become something different from who they are,” he said. “I think that’s the big idea here.”

Read more from Yahoo News:

Trump lawyer: President’s tweet about ‘being investigated’ did not confirm probe

Will Congress let Mary Klein decide how to die?

Health Care Declassified: Behind the Senate’s secrecy

Is it too soon to miss George W. Bush? Not in the age of Trump.

Photos: Gunmen attack resort in Mali

[global-news-station]

HANOI: Southeast Asian leaders pledged to keep trade routes open to protect food supplies and stockpile medical equipment at a summit held online Tuesday, as they warned of the crippling economic cost of the coronavirus.

Led by Vietnam — which chaired the Association of Southeast Asian Nations (ASEAN) meeting — leaders agreed to share resources and fight to limit further damage to the region’s tourism and export-reliant economies, already ravaged by COVID-19.

But an emergency fund proposed by Hanoi to tackle the pandemic did not appear to have been given the go-ahead.

In a joint declaration, leaders committed “to keeping ASEAN’s markets open for trade and investment… with a view to ensuring food security”.

They also pledged to cooperate to ensure adequate supplies of personal protective equipment and diagnostic tools, as well as using “reserve warehouses to support the needs of ASEAN Member States in public health emergencies”.

China later said it planned to set up a special fund to help ASEAN countries combat the pandemic, but declined to say how much money will be allocated.

Following the summit — which was joined by leaders from China, Japan and South Korea — Chinese Premier Li Keqiang also declared his support for a $5 billion recovery package proposed by Beijing-backed Asian Infrastructure Investment Bank (AIIB).

“We welcome the AIIB’s proposal of a COVID-19 Recovery Facility with an initial capitalization of 5 billion U.S. dollars,” Li said, according to state media.

‘Badly impacted people’s lives’

In opening remarks via video conference, Vietnam premier Nguyen Xuan Phuc hailed the work of ASEAN in fighting the virus.

But he warned the disease “has badly impacted people’s lives, their socio-economic situation… challenging stability and social security”.

Vietnam has had some success in containing the virus through extensive quarantines and social distancing.

It has recorded 265 infections and no deaths, while Thailand has also kept its numbers relatively low with just over 2,500 cases and 40 deaths.

The situation is mixed elsewhere across the region, with fears that limited testing in Indonesia has played out into the low caseload — and under 400 deaths — for the country of 260 million.

Similarly, threadbare health systems from Myanmar to Laos are widely believed to be missing the true scale of infections.

A recent surge in cases in Singapore has raised fears the pandemic could rebound in places which had batted back the initial outbreak.

Vietnam used the 10-member summit to propose funding to deal with the pandemic, an idea backed by both Malaysia and the Philippines.

Philippines President Rodrigo Duterte warned he was “particularly concerned with food security”.

The whole region has been hit hard by the virus.

In Vietnam many factories are still running, but, in a sign of the ongoing risks, dozens of workers at a Samsung unit in the north were ordered into quarantine after one tested positive for the virus.

The Thai economy, the second-largest in ASEAN, is expected to shrink by 5.3 percent this year — a 22-year low — with millions left jobless in the politically febrile kingdom.

The post As virus bites, ASEAN leaders make vow on food and medicine supply appeared first on ARY NEWS.

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[eathealthylivefree]

Waiting? Breathe…

One of my friends underwent a cancer biopsy this week. She is waiting the results of a pathology lab for diagnosis. Will it be cancer with a treatment plan of some sort, or will her results be benign?

Waiting on results from an important medical test or pathology report is enough to make anyone’s anxiety soar. It seems the waiting is sometimes worse than the diagnosis. The unknown. The period of limbo. Holding your breath… afraid to exhale.

When the stakes are high, waiting on a diagnosis can escalate stress and take a toll on you. A study from the National Institute of Health found that awaiting diagnosis of cancer after a biopsy was associated with higher anxiety than waiting for invasive and potentially risky treatment. This stress can weaken one’s immune system and slow healing. The longer the wait time, the more anxiety tends to increase. Thanks to online medical portals and new technology in diagnosis, sometimes the wait time is shortened. Part of the struggle in the waiting is the feeling of vulnerability and helplessness. Once you receive a diagnosis, you can at least work with your doctor to implement a treatment plan. But what can you do while you’re waiting?

You can do some pre-diagnostic coping to help yourself reduce anxiety.

Do whatever has helped you reduce stress in the past.

Eat healthy during times of stress.

Distract yourself with a good book, a hobby, work, or a good movie.

Try meditation and journaling.

Keep the situation in perspective, don’t awful-ize it!

Mindful breathing can be a life-saver.

Find support in family, friends, support groups, mental health counselor and faith-based organizations.

As I write this blog article, my friend is still awaiting her results. She seems to be handling it well and when I asked her how, she responded… “I woke up the morning of my biopsy with this phrase in my head: ‘God’s got this, I’m just along for the ride.’” Her faith is a source of support for her, along with family, friends and co-workers. These same sources of support will continue to be there for her even after diagnosis, whatever it may be.

If you are awaiting medical results (or any other big potentially stressful news) surround yourself with support and don’t hesitate to ask for help. And keep breathing… deeply.

Written by: Shannon Carter, Extension Educator, Ohio State University Extension, Fairfield County.

Reviewed by:  Michelle Treber, Extension Educator, Ohio State University Extension, Pickaway County.

Sources:

Barlage, L. Have you tried “Journaling” your Stressors?? Live Healthy Live Well. 2015, May 15.

Brinkman, P. Eating Better During Stressful Times. Live Healthy Live Well. 2015, May 7.

Carter, S. Don’t Awful-ize It! Live Smart Ohio. 2015, Sep 11.

Carter, S. Breathing… Live Smart Ohio. 2015, July 31.

Flory N & Lang E. Distress in the radiology waiting room. Radiology. 2011 Jul;260(1):166-73. doi: 10.1148/radiol.11102211. Epub 2011 Apr 7.

Lang E, Berbaum K & Lutgendorf S. Large-core breast biopsy: abnormal salivary cortisol profiles associated with uncertainty of diagnosis. Radiology. 2009 Mar;250(3):631-7. doi: 10.1148/radiol.2503081087.

  from Live Healthy Live Well https://ift.tt/2LK7Dv7

[nancygduarteus]

Why Egypt Is at the Forefront of Hepatitis C Treatment

Just five years ago, with the best medical therapies available, the odds of curing a person infected with hepatitis C were no better than a coin toss. Eliminating the disease from a whole country was unthinkable.

But today, Egypt is wiping the disease from its population at an unprecedented pace. The effort was made possible by revolutionary new drugs—but no country, including the United States, has come close to deploying them at equivalent scale. Egypt has shown that dramatic improvements in public health are possible when drugs are priced affordably—and a government makes an effort to systematically deploy them. But Egypt is also the exception that proves the rule that while modern society has proven capable of developing transformative medical innovations, it’s far less proficient at maximizing their use.

The hepatitis C epidemic in Egypt—the country with the highest prevalence of the disease in the world—started around 50 years ago, when the government was attempting to get rid of one plague and ended up substituting it for another. For millennia the Nile Delta has been an ideal breeding ground for schistosomiasis, a parasite spread to humans by freshwater snails. In the mid-20th century, the Egyptian government conducted multiple mass-treatment campaigns using an injectable emetic—and needles were repeatedly reused. Hepatitis C virus, not yet known but transmitted efficiently by blood, was inadvertently spread to many citizens. By 2008, one in 10 Egyptians had chronic hepatitis C.

The virus causes progressive liver damage that only becomes apparent over a decade or more, when it culminates in cancer or liver failure. By 2015 hepatitis C accounted for 40,000 deaths per year in Egypt—7.6 percent of all deaths there—and depressed national GDP growth by 1.5 percent.

While infection is more common in rural and poor areas, few segments of Egyptian society are untouched by it. John Ward, who led the CDC’s division of viral hepatitis for more than 13 years and is now a director at the nonprofit Task Force for Global Health, says he sees its impact even among Egyptian expatriates he meets by chance in Washington, D.C. “I’ll be in a cab, I’ll say I work on hepatitis C, and that starts the whole conversation going about family, friends, in-laws, fathers lost to hepatitis C. So it’s a very big problem.”

The outlook for the disease changed in late 2013 with the advent of effective but expensive new cures. Whereas prior treatments induced fatigue and other side effects and cleared the infection in fewer than half of patients, the new therapies were painless and cured the disease over 90 percent of the time. Gilead Sciences introduced the first such drug to the U.S. market at $84,000 per patient. At that price, treating the entire infected Egyptian population would have cost half a trillion dollars, nearly double the country’s gross domestic product.

The circumstances recalled the introduction of AIDS drugs two decades ago, when drugmakers set high prices that countries in the greatest need were least able to afford. The Egyptian government wanted to make hepatitis C treatment available to every citizen who needed it. But that would require a sufficiently low price to purchase the huge volume necessary, a system to deliver the drugs to those already diagnosed, and a campaign to screen everyone else for the disease.

As the Egyptian government began price negotiations with Gilead, the country was also scrutinizing the drug company’s application for a patent. (They did not issue one, allowing generic manufacturers to enter the Egyptian market.) “I’d call the conversations friendly but they are good negotiators,” recalled Gregg Alton, an executive vice president at Gilead who represented the company in the meetings.

Gilead ultimately agreed to license the drugs for sale in Egypt and a number of other countries at $300 per one-month supply, or $900 for the whole 12-week course of treatment. Generic manufacturers eventually drove the price in Egypt to $84 per patient.

Wahid Doss, the chairman of Egypt’s National Committee for Control of Viral Hepatitis, says that the country’s determination to provide treatment at a massive scale helped them make their case. “Part of the success story and why Gilead agreed was that they saw that we really wanted to have an impact in our country.” Gilead ultimately sold their hepatitis C drugs to over 160,000 Egyptian patients, according to Alton. “They made some money as well,” Doss points out. “It wasn’t an act of charity.”

With affordable drugs secured, the country set out to distribute them at a scale never before attempted. In 2014, they debuted an online portal for those with the disease to register for treatment; within three days, 200,000 people had signed up. Over the next three years, more than 1.6 million Egyptians received hepatitis C treatment, according to data from the World Bank. That is more than all the patients treated during that time in the United States and Europe combined.

But that first flood of Egyptians seeking a cure were largely those already diagnosed with hepatitis C, and over time the challenge has shifted from making the drugs available to identifying additional people who need them. “The people going to those treatment centers tend to dry up,” explains Ward. “Obviously if you’re not testing, you’re not diagnosing, and you don't have anyone to treat.”

So in 2017, the Ministry of Health initiated a nationwide screening program. More than 260 teams of community-health workers are proceeding village by village. By late 2017, they’d screened 1,200 communities. Still, treatment has slowed from a high-point in 2016. According to the CDA Foundation, which compiles epidemiological data on viral hepatitis, the number of Egyptians treated in 2017 fell by roughly 30 percent compared to 2016, despite an estimated 4 million people still infected in the country.

With the promise of free drugs from the government for those diagnosed, civil-society organizations from factories to churches to mosques have gotten involved in screening, too. The prevalence of hepatitis C is around twice as high in the poorest quintile of the population compared to the wealthiest, but J. Stephen Morrison, the senior vice president of the Center for Strategic and International Studies, says the epidemic cuts across society in a way that has benefited the elimination efforts. “[Hepatitis C] may carry a stigma but there are few families in Egypt who haven’t had some loved one who has struggled with this.”

Last year, in the upscale neighborhood of Katameya Heights in New Cairo, a chapter of the Rotary Club arranged a hepatitis C screening for the neighborhood residents and their household staff. One of the organizers was Mohamed Ziwar, who had recently retired from a leadership role at the drug company Bayer. He says the club contracted nurses from a local lab that does genetic analysis to spend three days in the neighborhood, where they screened about 1,000 people, and then arranged treatment for the 30 who tested positive. “After we finished this, we got other requests from relatives of these people, that they would love to go through the investigation,” Ziwar said.

Ziwar estimated that the club ended up spending about $5,000. It could have been much higher but since it was a charitable effort, the lab did the blood analysis nearly at cost. But screening the whole group was significantly more expensive than the price of the drugs needed to treat the 30 infected residents. This is proving to be true at the national level as well. While the diagnostics are inexpensive, as many as 20 people must be screened to identify one new person who is infected, and it adds up. To ensure all the residents of a given community get tested, screening teams must sometimes return multiple times.

How fast Egypt eliminates the disease hinges on how swiftly it diagnoses the people infected, and authorities there are still determining the scale of their screening program and gathering the resources to pay for it. At the rate the country is currently screening and treating patients it would cut disease prevalence in half by 2023; if it substantially scales up the program, at an additional cost of $530 million, it could essentially eliminate the disease by then.

The magnitude of Egypt’s efforts may make it easier for other countries to follow. Amr Elshalakani, a health specialist at the World Bank, points out that bulk purchases of screening kits used for diagnosis may drive up worldwide production capacity and reduce their cost. “There’s an Egypt-specific benefit but also a global public-health good,” he said. “Those changes in prices can have global implications for other countries that are looking to address hepatitis C.”

And while the new drugs revolutionized the treatment of individual patients, luring the epidemic out of the shadows is now the central challenge worldwide. In 2016, only one in five people globally with chronic hepatitis C has been diagnosed, according to the World Health Organization, and in low-income countries, it is fewer than one in 10. Until those tens of millions of people are screened and diagnosed, they will never benefit from the latest medications. “What is happening in Egypt is just a preview of what every other country is going to face,” says Homie Razavi, the CDA Foundation’s managing director.

Only a handful of countries are charting a similar path towards elimination of hepatitis C. Many countries with far more resources at their disposal are nowhere close to treating their entire population. For example, of people with hepatitis C in the United States, fewer than 20 percent have received treatment.

In the long-term, the benefits of eliminating hepatitis C are unambiguous—Egypt’s campaign will avert tens of thousands of deaths and reduce overall health-care expenditures—but the costs of screening must be paid up-front. “Economically, it makes absolute sense to treat versus not to treat, but the governments hold off. They say ‘We’re only in office four years, we’ll never see the benefit,’” says Razavi. “What is different in Egypt is there was a political commitment to action, and they took that information and ran with it.”

It wouldn’t have been possible without affordable drugs, either, and for a country to obtain a price within reach, wealth might actually be a disadvantage. In poorer countries like Egypt, pharmaceutical companies have been more willing to offer drugs at or near the cost of manufacturing, to reflect the countries’ ability to pay. In another example, last summer Pfizer announced that it would drastically discount a number of its patented chemotherapies in the six sub-Saharan countries where 44 percent of Africa’s cancer cases occur.

But in upper middle–income countries, pharmaceutical companies see an opportunity for profit and are not showing the same flexibility. In China and Brazil, where drugmakers have priced their hepatitis C therapies well above the marginal cost of production, the governments are considering whether to pay—or to deny or legally skirt their patents so generic competition can drive prices down. Experts say that conflicts over drug prices in such markets may only increase as the burden of disease in those countries continues to shift from infectious diseases to those like cancer or diabetes that have effective but costly therapies.

How countries will muster funding to address hepatitis C—and how much—are still open questions. According to the World Health Organization, by the end of 2017 more than 80 countries had developed national plans to eliminate hepatitis C, an almost fivefold increase over 2012, but fewer than half attached a financial commitment. Without resources, few people infected with hepatitis C will be diagnosed and still fewer treated.

In contrast with the past two decades’ efforts to address other infectious diseases like HIV, tuberculosis, and malaria, in which international donors made significant contributions and also managed much of how the campaigns were run, countries increasingly have to go it alone. Robert Hecht, the president of Pharos Global Health Advisors, says this represents a shift in global health. “I think the era of these large donor funds for diseases where the money helps pay for the drugs and delivery of care, I think we’re seeing the end of that era.”

On the whole, it seems easier for global society to develop efficacious drugs than to effectively deploy them. Much of the potential benefit of new therapies often goes unrealized, because high prices render them unaffordable or because governments forgo the effort necessary to deploy them at scale. The monumental impacts that are possible depend as much on willpower, funding, and detailed policy strategy—the nuts and bolts of public health—as on the cures themselves.

from Health News And Updates https://www.theatlantic.com/health/archive/2018/05/why-egypt-is-at-the-forefront-of-hepatitis-c-treatment/561305/?utm_source=feed

[ionecoffman]

Why Egypt Is at the Forefront of Hepatitis C Treatment

Just five years ago, with the best medical therapies available, the odds of curing a person infected with hepatitis C were no better than a coin toss. Eliminating the disease from a whole country was unthinkable.

But today, Egypt is wiping the disease from its population at an unprecedented pace. The effort was made possible by revolutionary new drugs—but no country, including the United States, has come close to deploying them at equivalent scale. Egypt has shown that dramatic improvements in public health are possible when drugs are priced affordably—and a government makes an effort to systematically deploy them. But Egypt is also the exception that proves the rule that while modern society has proven capable of developing transformative medical innovations, it’s far less proficient at maximizing their use.

The hepatitis C epidemic in Egypt—the country with the highest prevalence of the disease in the world—started around 50 years ago, when the government was attempting to get rid of one plague and ended up substituting it for another. For millennia the Nile Delta has been an ideal breeding ground for schistosomiasis, a parasite spread to humans by freshwater snails. In the mid-20th century, the Egyptian government conducted multiple mass-treatment campaigns using an injectable emetic—and needles were repeatedly reused. Hepatitis C virus, not yet known but transmitted efficiently by blood, was inadvertently spread to many citizens. By 2008, one in 10 Egyptians had chronic hepatitis C.

The virus causes progressive liver damage that only becomes apparent over a decade or more, when it culminates in cancer or liver failure. By 2015 hepatitis C accounted for 40,000 deaths per year in Egypt—7.6 percent of all deaths there—and depressed national GDP growth by 1.5 percent.

While infection is more common in rural and poor areas, few segments of Egyptian society are untouched by it. John Ward, who led the CDC’s division of viral hepatitis for more than 13 years and is now a director at the nonprofit Task Force for Global Health, says he sees its impact even among Egyptian expatriates he meets by chance in Washington, D.C. “I’ll be in a cab, I’ll say I work on hepatitis C, and that starts the whole conversation going about family, friends, in-laws, fathers lost to hepatitis C. So it’s a very big problem.”

The outlook for the disease changed in late 2013 with the advent of effective but expensive new cures. Whereas prior treatments induced fatigue and other side effects and cleared the infection in fewer than half of patients, the new therapies were painless and cured the disease over 90 percent of the time. Gilead Sciences introduced the first such drug to the U.S. market at $84,000 per patient. At that price, treating the entire infected Egyptian population would have cost half a trillion dollars, nearly double the country’s gross domestic product.

The circumstances recalled the introduction of AIDS drugs two decades ago, when drugmakers set high prices that countries in the greatest need were least able to afford. The Egyptian government wanted to make hepatitis C treatment available to every citizen who needed it. But that would require a sufficiently low price to purchase the huge volume necessary, a system to deliver the drugs to those already diagnosed, and a campaign to screen everyone else for the disease.

As the Egyptian government began price negotiations with Gilead, the country was also scrutinizing the drug company’s application for a patent. (They did not issue one, allowing generic manufacturers to enter the Egyptian market.) “I’d call the conversations friendly but they are good negotiators,” recalled Gregg Alton, an executive vice president at Gilead who represented the company in the meetings.

Gilead ultimately agreed to license the drugs for sale in Egypt and a number of other countries at $300 per one-month supply, or $900 for the whole 12-week course of treatment. Generic manufacturers eventually drove the price in Egypt to $84 per patient.

Wahid Doss, the chairman of Egypt’s National Committee for Control of Viral Hepatitis, says that the country’s determination to provide treatment at a massive scale helped them make their case. “Part of the success story and why Gilead agreed was that they saw that we really wanted to have an impact in our country.” Gilead ultimately sold their hepatitis C drugs to over 160,000 Egyptian patients, according to Alton. “They made some money as well,” Doss points out. “It wasn’t an act of charity.”

With affordable drugs secured, the country set out to distribute them at a scale never before attempted. In 2014, they debuted an online portal for those with the disease to register for treatment; within three days, 200,000 people had signed up. Over the next three years, more than 1.6 million Egyptians received hepatitis C treatment, according to data from the World Bank. That is more than all the patients treated during that time in the United States and Europe combined.

But that first flood of Egyptians seeking a cure were largely those already diagnosed with hepatitis C, and over time the challenge has shifted from making the drugs available to identifying additional people who need them. “The people going to those treatment centers tend to dry up,” explains Ward. “Obviously if you’re not testing, you’re not diagnosing, and you don't have anyone to treat.”

So in 2017, the Ministry of Health initiated a nationwide screening program. More than 260 teams of community-health workers are proceeding village by village. By late 2017, they’d screened 1,200 communities. Still, treatment has slowed from a high-point in 2016. According to the CDA Foundation, which compiles epidemiological data on viral hepatitis, the number of Egyptians treated in 2017 fell by roughly 30 percent compared to 2016, despite an estimated 4 million people still infected in the country.

With the promise of free drugs from the government for those diagnosed, civil-society organizations from factories to churches to mosques have gotten involved in screening, too. The prevalence of hepatitis C is around twice as high in the poorest quintile of the population compared to the wealthiest, but J. Stephen Morrison, the senior vice president of the Center for Strategic and International Studies, says the epidemic cuts across society in a way that has benefited the elimination efforts. “[Hepatitis C] may carry a stigma but there are few families in Egypt who haven’t had some loved one who has struggled with this.”

Last year, in the upscale neighborhood of Katameya Heights in New Cairo, a chapter of the Rotary Club arranged a hepatitis C screening for the neighborhood residents and their household staff. One of the organizers was Mohamed Ziwar, who had recently retired from a leadership role at the drug company Bayer. He says the club contracted nurses from a local lab that does genetic analysis to spend three days in the neighborhood, where they screened about 1,000 people, and then arranged treatment for the 30 who tested positive. “After we finished this, we got other requests from relatives of these people, that they would love to go through the investigation,” Ziwar said.

Ziwar estimated that the club ended up spending about $5,000. It could have been much higher but since it was a charitable effort, the lab did the blood analysis nearly at cost. But screening the whole group was significantly more expensive than the price of the drugs needed to treat the 30 infected residents. This is proving to be true at the national level as well. While the diagnostics are inexpensive, as many as 20 people must be screened to identify one new person who is infected, and it adds up. To ensure all the residents of a given community get tested, screening teams must sometimes return multiple times.

How fast Egypt eliminates the disease hinges on how swiftly it diagnoses the people infected, and authorities there are still determining the scale of their screening program and gathering the resources to pay for it. At the rate the country is currently screening and treating patients it would cut disease prevalence in half by 2023; if it substantially scales up the program, at an additional cost of $530 million, it could essentially eliminate the disease by then.

The magnitude of Egypt’s efforts may make it easier for other countries to follow. Amr Elshalakani, a health specialist at the World Bank, points out that bulk purchases of screening kits used for diagnosis may drive up worldwide production capacity and reduce their cost. “There’s an Egypt-specific benefit but also a global public-health good,” he said. “Those changes in prices can have global implications for other countries that are looking to address hepatitis C.”

And while the new drugs revolutionized the treatment of individual patients, luring the epidemic out of the shadows is now the central challenge worldwide. In 2016, only one in five people globally with chronic hepatitis C has been diagnosed, according to the World Health Organization, and in low-income countries, it is fewer than one in 10. Until those tens of millions of people are screened and diagnosed, they will never benefit from the latest medications. “What is happening in Egypt is just a preview of what every other country is going to face,” says Homie Razavi, the CDA Foundation’s managing director.

Only a handful of countries are charting a similar path towards elimination of hepatitis C. Many countries with far more resources at their disposal are nowhere close to treating their entire population. For example, of people with hepatitis C in the United States, fewer than 20 percent have received treatment.

In the long-term, the benefits of eliminating hepatitis C are unambiguous—Egypt’s campaign will avert tens of thousands of deaths and reduce overall health-care expenditures—but the costs of screening must be paid up-front. “Economically, it makes absolute sense to treat versus not to treat, but the governments hold off. They say ‘We’re only in office four years, we’ll never see the benefit,’” says Razavi. “What is different in Egypt is there was a political commitment to action, and they took that information and ran with it.”

It wouldn’t have been possible without affordable drugs, either, and for a country to obtain a price within reach, wealth might actually be a disadvantage. In poorer countries like Egypt, pharmaceutical companies have been more willing to offer drugs at or near the cost of manufacturing, to reflect the countries’ ability to pay. In another example, last summer Pfizer announced that it would drastically discount a number of its patented chemotherapies in the six sub-Saharan countries where 44 percent of Africa’s cancer cases occur.

But in upper middle–income countries, pharmaceutical companies see an opportunity for profit and are not showing the same flexibility. In China and Brazil, where drugmakers have priced their hepatitis C therapies well above the marginal cost of production, the governments are considering whether to pay—or to deny or legally skirt their patents so generic competition can drive prices down. Experts say that conflicts over drug prices in such markets may only increase as the burden of disease in those countries continues to shift from infectious diseases to those like cancer or diabetes that have effective but costly therapies.

How countries will muster funding to address hepatitis C—and how much—are still open questions. According to the World Health Organization, by the end of 2017 more than 80 countries had developed national plans to eliminate hepatitis C, an almost fivefold increase over 2012, but fewer than half attached a financial commitment. Without resources, few people infected with hepatitis C will be diagnosed and still fewer treated.

In contrast with the past two decades’ efforts to address other infectious diseases like HIV, tuberculosis, and malaria, in which international donors made significant contributions and also managed much of how the campaigns were run, countries increasingly have to go it alone. Robert Hecht, the president of Pharos Global Health Advisors, says this represents a shift in global health. “I think the era of these large donor funds for diseases where the money helps pay for the drugs and delivery of care, I think we’re seeing the end of that era.”

On the whole, it seems easier for global society to develop efficacious drugs than to effectively deploy them. Much of the potential benefit of new therapies often goes unrealized, because high prices render them unaffordable or because governments forgo the effort necessary to deploy them at scale. The monumental impacts that are possible depend as much on willpower, funding, and detailed policy strategy—the nuts and bolts of public health—as on the cures themselves.

Article source here:The Atlantic

[ucnu]

What You Need To Do First Is Check Within Your Handbag To Obtain The Tag Which Will Offer The Was …

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from ucnu http://ucnu.org/what-you-need-to-do-first-is-check-within-your-handbag-to-obtain-the-tag-which-will-offer-the-was/

[scentedstrangertyphoon-blog]

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