#la Primary Care Diabetes Society

[goolmore]

These fruits which look after us

To nourish itself well is of primary importance to be maintained in form. If to consume at least 5 fruit and vegetables per day are fundamental for healthy and balanced food, certain fruits could also help to fight certain diseases. Explanations.

A study undertaken by the international research Center on cancer (CIRC) proved that better food could reduce the risk of cancer considerably. Obesity is also a pointed the finger as being a true factor of risk in the development of cancers, especially at the sedentary people. If the mal bouffe and the overweight are responsible of more than 5% of the new cases of cancer in France, it is necessary to decrease its consumption of processed products and to privilege certain food which can fight the diseases. Presented at the time of the congress Nutrition 2018 of American Society for Nutrition (Boston), of many research the astonishing capacities of cure of various food revealed. Expenses, juicy, refreshing or greedy, certain fruits abound in benefits and can come to end from the problems from health.

Fruits: miracle cures?

Apples and pears

Whereas the apple relieves persistent coughs, the fever, and the colics, it also improves breathing and prevents the cancer of the colon. The pear, as for it, could prevent the formation of hémorroïdes and would support the retention, in the body, of calcium coming from food.

The melon and the watermelon

A rich person out of potassium, carotene and vitamin C, the melon purifies and regenerates fabrics. One of the least heating fruits, it contains much water and has a true capacity diuretic. It also reduces the risk of congenital malformations and the diseases cardiovascular. Fruit of the summer par excellence, the watermelon abounds in benefits. Composed with more than water 90%, this fruit also contains citrulline, which would make it possible to relieve muscular pains. Certainly one of the reasons for which the sportsmen raffolent of this food!

Plums and fishings

The plum contributes to renal elimination and to unchoke the liver. Fishing abounds in vitamin B and E and improves the transit: it is about the fruit headlight of the sportsmen for their physical activities most intense!

Grapes

To daily integrate grape in its food could reduce the risks of cancers effectively, in particular of the lung. A rich person in flavonoïdes, their pips also have antioxidant virtues and relieve chronic asthma and bronchitides.

The banana

The rich person out of fibers and nutrients, the banana abounds in virtues for health. It makes it possible to take care of the cardiovascular system and to cure the ulcers. According to a Swedish study carried out in 2005, the banana could prevent the cancer of the kidney. The fruit also reinforces immunizing defenses. Its consumption stimulates the production of antibodies and assistance to prevent infections. Its strong content of vitamins as its benefits health make banana par excellence the fruit pregnant women!

Citrus fruits

Oranges, grapefruits or lemons, the citrus fruits are known for their many benefits health. A rich person in bioflavonoïdes (chemical substances which fights against the ignition at the cellular level), the citrus fruits have properties anti-inflammatory drugs. These juicy fruits help to gum the blows of tiredness and with better resisting the microbial aggressions. To consume citrus fruits daily could inhibit the proliferation of cancerous cells, in particular on the glands mammary thanks to the flavonoïdes which they contain) and thus decrease the risks of breast cancer. With their important content of vitamin C, the citrus fruits are true antioxidant cocktails. This composition confers a capacity anti-age to them. They also act against hypertension and support the resistance and the capacity of dilation of the blood vessels. The citrus fruits also have another common benefit: their important source out of minerals: all abound in calcium and potassium which decreases the retention of water, thus reinforcing the solidity of the bones.

The mango

The mango would be beneficial for the health of the heart and the blood vessels. True remedy counters the cardiovascular diseases, this fruit would make it possible to reduce the blood pressure, in particular at the women ménopausées according to a study undertaken in June 2018 by the researchers of the University of California.

The lawyer

Oui, l’avocat est un fruit et pas des moindres ! Très riche en lipides, cet aliment originaire du Mexique contient de précieux acides gras mono insaturés, bénéfiques pour la santé cardiovasculaire. L’avocat participe également à la régulation du mauvais cholestérol tout en préservant le bon. De quoi largement justifier le qualificatif “d’or vert” de ce délicieux fruit exotique.

Red fruits, of the antioxidant treasures

Bays, cornflowers and blackberries

Rented for their nutritional richness, the red fruits such as bays, the cornflowers or the blackberries, are known to be concentrated antioxidant truths, vitamins, minerals, and trace elements. Impossible to circumvent allied health, these superfruits purple fights against the free radicals – which act on the premature aging of the cells and protect from the risks of cancer. The cornflower also improves memory and the bays of goji reinforce the immune system and help the organization to fight against tiredness.

Strawberries and raspberries

Thanks to their rich person content of vitamin C and ellagic acid (antioxidant polyphenol), the strawberries can prevent cardiovascular cancer and diseases. A study undertaken in 2011 by researchers of Université of Ohio showed the effectiveness of the strawberries against the cancer of the esophagus. Also, to consume these red fruits daily would allow decreasing the risk of infarction. Fiber-rich person, the raspberry fights against the digestive disorders, rheumatisms as well as the menstrual delays.

The cranberry

This fruit would protect from the cancer of the prostate and would reduce the effect of the athérosclérose. Also called cranberry (its English name), the large cranberry of North America can prevent urinary infections. It is also the case of the cherry tails which, prepared out of infusion, relieve these infections. In general, the cherry enjoys a rate record of beta-carotene, a substance that supports the sight and contributes to the health of the skin.

Capacities of the nuts on health

If the benefits health of nuts and other nuts are not any more to prove, a study undertaken in April 2018 by the researchers of École of public health of the University of Loma Linda (California) evaluated the effects of the diets rich in nuts on the cardiovascular diseases. Result: the protein consumption coming from nuts would be beneficial for cardiac health, the risk of cardiovascular disease being a tiny room of 40%.

Nuts

According to a study of the University of Toronto carried out in 2011, the nuts would make it possible to reduce considerably the rate of “bad” cholesterol of the diabetics and thus to better control their glycemia. A phytochemical-rich person in compounds, the nuts improve the correct operation of the brain, support the memory and the bonds between the neurons. Thanks to the fatty acids poly-unsaturates which they contain, they fight against the ignition and the oxidation of the cells. More than one simple food tendency and goûteux, the nut could thus play a part counters the degenerative diseases like Alzheimer’s.

Nuts of pécan

A research of the University of Boston published in May 2018 revealed that the nut consumption of pécan could influence considerably on the biomarkers of the cardiac diseases. A small handle of these delicious dry fruits would support the improvement of the sensitivity to insulin and the prevention of cardiovascular diseases. The nuts of pécan contain antioxidants which make it possible to fight against the free radicals and take part in the reduction of the cholesterol level. Abounding with vitamins and minerals, they would also make it possible to fight against the diabetes of type 2, accounting for 90% of the cases of diabetes.

Almonds

Known since millennia, the benefits of almonds are numerous. These nuts are also of excellent allies for immunizing defenses. In addition to their strong content of nutrients, the almonds have true antioxidant properties. Only one daily handle could contain a number of polyphenols (antioxidants) equivalent to that of a bowl of broccoli or green tea. Brain, digestion, skin… there is extremely to bet that the secrecies of almonds all were not elucidated.

[juancarlosdiazosorio]

Diabetes mellitus tipo 2, un alerta a los padres

#CubaEsSalud Diabetes mellitus tipo 2, un alerta a los padres #11Noviembre #FelizInicioDeSemana

En la XIX Jornada Científica de Profesores Consultantes auspiciada por la Universidad de Ciencias Médicas de La Habana y celebrada en el Centro de Investigaciones Médico Quirúrgicas (CIMEQ) en La Habana, el pasado sábado 2 de noviembre, presentamos un  trabajo científico sobre la diabetes mellitus tipo 2 en pacientes menores de 24 años de edad. (more…)

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Best Herbs And Food To Cure Erectile Dysfunction Naturally

Ginseng is found throughout temperate areas of the Northern Hemisphere. The abiu fruit is primarily grown in southeast Brazil and Australia, but can also be found on the coastal regions of south Florida. The fruit is believed to be an effective cure for erectile dysfunction, and is also said to be a natural aphrodisiac. Erectile dysfunction treatment bangladesh a good diet combined with regular exercise is the best natural erectile dysfunction therapy treatment.. Best herbal supplements for erectile dysfunction 2016 pni 0:23:12:1d:36: best herbal supplements for erectile dysfunction 2016 freeman. That’s why nitric oxide supplements help greatly. Picking herbal supplements free from harsh chemicals and preservatives reduces the risk of adverse action on users. This warning sign is also linked to a three-fold increase in the risk of coronary heart disease, stroke, online pharmacy or cardiac failure in men with diabetes. Ayurvedic treatment for erectile dysfunction in diabetes 2016 guidelines recommend screening for heart disease also when ed is a problem.. However, the converse is not true: Not everybody withthe genetic makeup that causes vulnerability to bipolar disorder who have the disease. If have been experiencing any of these symptoms, do get them checked by your doctor. Youll have certainly want a glucometer demands a microscopic amount of blood. Be sure to visit him not less than every 3 months so he can check your blood sugar levels hypertension and fats. Though not usually dangerous, hemorrhoids can be acutely painful and restrict a person's activities and enjoyment of life's basic pleasures. Having this drug after a heavy fatty meal can cause it to lose its effect. 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[dailynewswebsite]

Hispanics live longer than most Americans, but will the US obesity epidemic change things?

Juan Duran-Gutierrez kisses his new child daughter Andrea for the primary time in his house after bringing her house from the hospital on Aug. 5. Elizabeth Flores/Star Tribune through Getty Pictures

Anti-immigrant sentiments have fueled current nationwide and state-level well being coverage efforts. In 2019, Donald Trump signed a presidential proclamation that may deny visas to immigrants who couldn’t present proof of insurance coverage. He argued that they might financially burden the well being care system. Extra just lately, Missouri’s August election poll proposed Medicaid growth, and opponents warned that it might overwhelm Missouri hospitals with undocumented immigrants, despite the fact that they’re ineligible for Medicaid advantages.

We research immigrant well being and inhabitants well being. Our work means that viewing immigrants as a drain on the U.S. well being care system is essentially unfounded. For many years, analysis has proven that immigrants are typically more healthy than U.S.-born whites. Immigrants outlive U.S.-born whites, and, amongst Hispanics, each immigrants and the U.S.-born have longer life expectations than whites.

Our newest research means that Hispanic immigrants will proceed to get pleasure from longer lives than U.S.-born whites within the close to future; however the life expectancy of U.S.-born Hispanics could fall to ranges on par with U.S.-born whites. Why? Like many People, U.S.-born Hispanics more and more face a excessive danger of weight problems and obesity-related well being problems equivalent to diabetes and coronary heart illness.

To us, the juxtaposition of anticipated tendencies in life expectancy between Hispanic immigrants and U.S.-born Hispanics means that immigrants are usually not a drain on the U.S. well being care system. As a substitute, the U.S. is a rustic with many points that undermine the well being of Hispanics and society extra usually.

Panorama staff from Guatemala at a job in San Rafael, California. Justin Sullivan/Getty Pictures

A perplexing paradox

Hispanic immigrants to the U.S. reside three to 4 years longer than U.S.-born whites, and U.S.-born Hispanics reside two years longer than U.S.-born whites. Hispanics’ life expectancy benefit is a long-standing phenomenon that has perplexed researchers. Training and revenue are sturdy predictors of life expectancy, and on common Hispanics lag behind whites on each indicators of socioeconomic standing. This has led researchers to label Hispanics’ life expectancy benefit as an “epidemiological paradox.”

What’s behind it? One main driver is Hispanics’ traditionally low smoking charges. Smoking has lengthy been the main reason behind preventable U.S. deaths. Whites smoke greater than Hispanics, and when Hispanics do smoke, they smoke much less incessantly and persistently than whites.

Immigrants’ life circumstances additionally contribute to their longevity. Shifting to a brand new nation requires the bodily capability to work. That is particularly vital for Hispanic immigrants, as they have a tendency to have jobs that require taxing bodily labor.

Indicators for fast-food eating places line the streets within the Figueroa Hall of Los Angeles. South LA has the best focus of fast-food eating places within the metropolis. David McNew/Getty Pictures

Might weight problems and smoking change this?

In current many years, weight problems has emerged as a critical well being downside. It now joins smoking as one of many two main causes of preventable U.S. deaths. Among the many U.S. inhabitants as a complete, the growing prevalence of weight problems has not led to an anticipated life expectancy decline as a result of it has been offset by substantial declines in smoking.

Researchers have been involved that smoking and weight problems tendencies could not offset one another amongst Hispanics – particularly those that are U.S.-born. This risk has fueled hypothesis that Hispanics’ paradoxical life expectancy benefit would possibly erode as new generations age.

We needed to know if this hypothesis is warranted. We calculated how a lot smoking and weight problems modified amongst Hispanics and whites born within the six completely different many years between 1920 and 1989. We then estimated how a lot life expectancy may change on account of estimated smoking and weight problems tendencies.

We discovered that the proportion of people who smoke amongst U.S.-born whites, U.S.-born Hispanics and Hispanic immigrants declined throughout many years. But smoking declined quickest amongst Hispanic immigrants. Throughout this similar interval, the weight problems prevalence elevated for all teams, however U.S.-born Hispanics had the steepest rise.

What do these tendencies imply for the way forward for the epidemiological paradox? Our research outcomes counsel that Hispanic immigrants will doubtless retain their life expectancy benefit over whites. In distinction, U.S.-born Hispanics will doubtless lose their life expectancy benefit, as a result of their declines in smoking don’t offset their growing weight problems prevalence.

As well as, weight problems has a stronger affect on U.S.-born Hispanics’ danger of dying relative to whites. This might probably be as a result of Hispanics are much less doubtless than whites to handle diabetes and different obesity-related well being issues. Hispanics additionally use well being care providers much less incessantly than whites, regardless of stereotypes on the contrary.

Placing all of it collectively

Ought to we be alarmed concerning the erosion of the epidemiological paradox? In any case, Hispanic immigrants are anticipated to retain their life expectancy benefit, and U.S.-born Hispanics face declines in life expectancy, however to not the purpose of residing shorter lives than whites.

As researchers, our reply to this query is a powerful “sure.” Federal agendas for constructing a more healthy nation name for eliminating racial and ethnic disparities in well being. Plans to attain this objective purpose to enhance well being amongst teams with worse outcomes.

Subsequently, the converging life expectations of U.S.-born Hispanics and whites that end result from declines amongst Hispanics are usually not an end result to have fun.

Hispanic immigrants’ persistent life expectancy benefit must also be a wake-up name for all People. Life expectancy is a number one indicator of a nation’s well being. Immigrants could also be stereotyped as drains on the well being care system, however the actuality is that their well being behaviors and longevity set an ordinary which we imagine U.S.-born People ought to try to achieve.

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Indicators level in the wrong way. Common U.S. life expectancy has really declined, a phenomenon due largely to deaths from medicine, extreme alcohol use and suicide. This decline occurred even earlier than the COVID-19 pandemic, which is hitting the U.S. particularly arduous and far worse than different excessive revenue nations.

To us, projected declines in life expectancy amongst U.S.-born Hispanics because of weight problems; growing U.S. deaths from medicine, alcohol and suicide; and the toll of the COVID-19 pandemic counsel that immigrants are usually not threatening the U.S. well being care system. As a substitute, the U.S. faces a big selection of inhabitants well being issues that jeopardize how lengthy People will reside.

Michelle L. Frisco has acquired funding from the Eunice Kennedy Shriver Nationwide Institute of Youngster Well being and Human Growth and the Robert Wooden Johnson Basis.

Jennifer Van Hook has acquired funding from the Eunice Kennedy Shriver Nationwide Institute of Well being and Human Growth, the Nationwide Science Basis, and the Russell Sage Basis. She is a nonresident fellow on the Migration Coverage Institute and on the college on the Pennsylvania State College.

from Growth News https://growthnews.in/hispanics-live-longer-than-most-americans-but-will-the-us-obesity-epidemic-change-things/ via https://growthnews.in

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AI poses risks, but the White House says regulators shouldn’t “needlessly hamper” innovation

President Donald Trump speaks while touring a computer manufacturing facility that produces Apple computers in Austin, Texas, on November 20, 2019. | Mandel Ngan/Getty Images

So far, artificial intelligence’s development has outpaced regulation. Now regulation has to catch up.

Artificial intelligence is here, and it’s impacting our lives in real ways — whether it’s the Alexa smart speaker on our nightstand, online customer service chatbots, or the smart replies Google drafts for our emails.

But so far, the tech’s development has outpaced regulation. Now, government agencies are increasingly encountering AI-based tools, and they must figure out how to evaluate them. Take the Food and Drug Administration, which greenlights new medical products: It needs to review and approve new health care products that boast AI-capabilities — like this one that promises to detect eye problems related to diabetes — before they’re sold to us. Or consider the Equal Employment Opportunity Commission, which investigates employment discrimination. Today, the agency must also make decisions about AI-based hiring algorithms, like those that screen job candidates’ resumes and decide whether or not you deserve an interview.

On Wednesday at CES, the prominent Las Vegas-based technology trade show, White House officials formally announced how the Office of Science and Technology wants federal agencies to approach regulating new artificial intelligence-based tools and the industries that develop the tech.

The White House’s proposed AI guidance discusses some of the biggest concerns technologists, AI ethicists, and even some government officials have about the technology, but the guidelines are centered most on encouraging innovation in artificial intelligence and making sure regulations don’t “needlessly” get in the way.

That reflects an ongoing problem for AI, one that’s already played out in other tech sectors, where a rush to innovate without much oversight has only come to back haunt us.

While encouraging innovation in AI is certainly a consideration, critics of the technology have said that regulators must scrutinize artificial intelligence more closely as it continues to be rolled out in the real world. They argue that artificial intelligence can replicate, and even amplify, human biases. These tools often function in black boxes — meaning that they’re proprietary and operated by the companies that sell them — which makes it difficult for us to know when or how they might be harming real people (or if they even work as intended). And new AI-based tools can also raise concerns about privacy and surveillance.

For now, these new guidelines are just that — guidelines — which means that today’s memo won’t have an immediate effect on the artificial intelligence tech you might encounter in your daily life. But the memo shows how the government is thinking about AI and its potential impact on Americans. “People should care that the White House is trying to bring a framework for assessing and justifying the deployment of AI tools, because what we’re finding as these tools develop and emerge is that there are some applications that have deeper consequences than others,” said Nicol Turner-Lee, a fellow at the Brookings Institution who researches technology and equity.

The Trump administration wants a national AI effort

Trump and his administration want the US to dominate the AI industry — and they definitely want the US to be better at AI than China. Early last year, President Donald Trump signed an executive order establishing the “American A.I. Initiative,” which is meant to jumpstart AI research and help build an AI-competent US workforce, among other goals (though he didn’t give the effort any new funding).

“Federal agencies must avoid ... needlessly hamper[ing] AI innovation and growth”

Outlining 10 primary principles, today’s memo to federal departments and agencies echoes the goals of that executive order. It urges regulators to be mindful of innovation and to “consider ways to reduce barriers to the development and adoption” of AI when weighing how existing laws and potential new rules apply to the emerging technology.

“Federal agencies must avoid regulatory or non-regulatory actions that needlessly hamper AI innovation and growth,” says the memo. “Agencies must avoid a precautionary approach that holds AI systems to such an impossibly high standard that society cannot enjoy their benefits.” At the same time, the guidance also urges regulators to be conscientious of values like transparency, risk management, fairness, and nondiscrimination.

These are all fair points. By encouraging these federal departments and agencies to take action, the Trump administration also hopes to avoid a future in which American AI companies might face a patchwork of local and state regulation, or possibly overreaching federal regulation, that could impede the technology’s expansion.

AI experts told Recode that the AI guidelines are a starting point. “It will take time to assess how effective these principles are in practice, and we will be watching closely,” said Rashida Richardson, the director of policy research at the AI Now Institute. “Establishing boundaries for the federal government and the private sector around AI technology will offer greater insight to those of us working in the accountability space.”

Aaron Rieke, the managing director of the technology rights nonprofit Upturn, said in an email to Recode that, for now, he doesn’t think the memo will have much influence: “I do not think these principles will have much of an impact on the average person, especially in the short term. I think regulators will be able to justify their decisions, good or bad, without much effort.”

Importantly, the memo doesn’t actually apply to artificial intelligence that the US government itself uses (of which there’s plenty). For instance, a search of a US federal contracts database shows that the Centers for Disease Control has purchased facial recognition products (an AI-based technology), while the Department of Commerce appears to be using AI to improve its patent search system.

One of the reasons AI needs regulations: It comes with risks

AI systems are not inherently objective. Humans build these tools, and AI is often developed using flawed or biased data, which means the technology can inherit or even magnify human biases like sexism and racism. For instance, when in 2017 scientists taught a computer program to learn the English language by mining the internet, it ultimately became prejudiced against women and black people.

Critics say that risk means the government should aggressively regulate, and even ban, certain applications of artificial intelligence. And some AI tools, like facial recognition, that rely on collecting sensitive information, have also spurred concerns about how this tech could potentially create privacy and surveillance nightmares.

“AI systems have a potential to discriminate against the American public on the basis of race, sex, gender — every sort of criteria imaginable”

This all matters because AI already has the potential to have a real impact on your life, even if you haven’t realized it yet. Some landlords have floated requiring tenants to use facial recognition to enter their homes, even though the technology is known to be less accurate on people of color and women (and especially women with dark skin), among other groups. Another example: Though never used, a resume-screening algorithm produced by Amazon inadvertently discriminated against female applicants because it was trained on resumes the company had previously collected, which mostly came from men. Imagine losing out on your dream job because of a biased algorithm.

“AI systems have a potential to discriminate against the American public on the basis of race, sex, gender — every sort of criteria imaginable,” Albert Fox Cahn, an attorney who leads the Surveillance Technology Oversight Project at New York University, told Recode. “This could impact everything from whether you get a job offer, whether you get approved for an apartment or a mortgage, whether you get the good interest rate or the bad interest rate. It could impact college admissions and school placement.”

That’s left him disappointed with the new proposed guidelines. “Rather than provide a framework for regulators to actually address discrimination head-on, instead the White House is urging a hands-off approach which will allow AI to simply target historically marginalized communities without the interventions we need,” said Cahn. He said the memo’s references to values of nondiscrimination and transparency don’t have much force behind them.

“When you think of where most consumers are more AI-vulnerable, it’s in those areas like housing, health care, and employment — the areas that primarily make the front page of the newspaper,” said Turner-Lee. She said it’s not clear what the memo will mean for agencies like the Department of Labor and Consumer Financial Protection Bureau as compared to, say, the Department of Agriculture.

She adds that it’s also not clear whether agencies are actually prepared to identify the risks AI tech poses, or if they’re up to the job of ensuring their regulations keep pace with innovation. “There’s a lot more of the devil in the details that I’d like to see, but I think they’re just trying to give us a general framework for some kind of ethical and fair deployment.”

Now the White House wants feedback, including yours

The draft guidance isn’t set in stone. For the next several months, it will be subject to public feedback, including yours (we’ll update this piece with how to do that as soon as the information becomes available). Once the guidance is formally approved, the White House expects that agencies will report back on how they plan to meet its new AI expectations.

Open Sourced is made possible by Omidyar Network. All Open Sourced content is editorially independent and produced by our journalists.

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Insurance for 18 year old girl?

Insurance for 18 year old girl?

My daughters just passed her test would i be as much money having her on my own car insurance as she would be if she had her own car and was the main driver thanks in advance for any answers

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Europe Self-Monitoring Blood Glucose Devices Market 2024: Developments, Market Dynamics, Vendor Detail, Product Types, Market Size, Regions

The Graphical Research report provides a comprehensive analysis of the  “Europe Self-Monitoring Blood Glucose Devices (SMBG) Market based on Product, End-User, Industry Analysis Report, Regional Outlook, End-User Potential, Competitive Market Share & Forecast, 2018 – 2024”.

Europe SMBG Devices Market size is set to surpass USD 6.5 billion by 2024. Increasing number of baby boomers and rising number of people diabetic cases will act as primary driver for growth of Europe self-monitoring blood glucose devices market over the forecast timeframe.

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Presence of associations such as Primary Care Diabetes Society creating awareness about the target disease to promote adoption of diabetes monitoring tools will positively impact industry growth over the coming years. However, stringent regulations pertaining to development of SMBG devices and high cost associated with self-monitoring blood glucose monitors will hinder industry expansion to a certain extent over the forecast period.

High adoption of sedentary lifestyle along with unhealthy food habits has escalated number of people suffering from chronic conditions such as cardiovascular diseases and obesity. Majority of obese people suffer from type 2 diabetes thereby fueling industry size growth.

Growth of home healthcare sector and technological advancements in homecare SMBG devices has stimulated adoption rate. Moreover, growing demand for minimal invasive disease monitoring tools coupled with rising number of health-conscious people will stimulate growth of home healthcare self-monitoring blood glucose devices market.

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Continuous glucose monitors (CGM) product segment is anticipated to witness robust growth of 5.6% during the forecast period. These devices form an essential part of homecare diabetes monitoring as it delivers real time blood glucose readings as well as detects abnormal patterns of glycemia many folds better than conventional systems will drive business growth of CGM devices.

UK self-monitoring blood glucose devices market will witness 4.3% CAGR during the forecast period owing to technological advancements in SMBG devices and high technological adoption in the country. Growing demand for self-diabetes monitoring devices applicable to homecare setting as well as growing geriatric population base will fuel industry growth over the coming years.

Diagnostic centers and clinics end-user segment of Europe self-monitoring blood glucose devices market is forecasted to witness considerable growth owing to rising number of people suffering from abnormal blood glucose levels and growing awareness about diabetes and diabetic treatment. Increasing per capita healthcare expenditure will positively impact growth of diagnostic centers and clinics segment.  

Few notable industry players operating in Europe self-monitoring blood glucose devices market are Abbott Laboratories, All Medicus, Arkray, B. Braun Melsungen AG, Bayer Healthcare, Bionime Corporation, Dexcom, F. Hoffmann-La Roche, Johnson & Johnson, LifeScan, Medtronic, Nipro Diagnostics, Nova Biomedical, Sinocare and Trividia Health. Market players are focusing on new product development to gain significant market position and broaden product as well as costumer portfolio in the self-monitoring blood glucose devices industry.

Browse key industry insights from this report @ https://www.graphicalresearch.com/industry-insights/1020/europe-self-monitoring-blood-glucose-devices-market

Segments We Cover:

Europe Self-Monitoring Blood Glucose Devices Market, By Product Self-monitoring blood glucose meters Continuous glucose monitors Testing strips Lancets

Europe Self-Monitoring Blood Glucose Devices Market, By End-user Hospitals Home settings Diagnostic centers and clinic

The above information is provided for the following countries: Germany UK France Spain Italy Russia Ukraine Poland Switzerland Belgium Greece Czech Republic Netherlands Sweden Others

Related Reports:

1.        North America Self-Monitoring Blood Glucose Devices Market Size By Product (Self-Monitoring Blood Glucose Meters, Continuous Glucose Monitors, Testing Strips, Lancets), By End-User (Hospitals, Home Settings, Diagnostic Centers & Clinics), Industry Analysis Report, Regional Outlook (U.S., Canada), End-User Potential, Competitive Market Share & Forecast, 2018 – 2024

2.        Asia Pacific Self-Monitoring Blood Glucose Devices Market Size By Product (Self-Monitoring Blood Glucose Meters, Continuous Glucose Monitors, Testing Strips, Lancets), By End-User (Hospitals, Home Settings, Diagnostic Centers & Clinics), Industry Analysis Report, Regional Outlook (China, Japan, India, Australia, South Korea, Malaysia, Indonesia, Thailand, Singapore, Taiwan, Philippines, Vietnam), End-User Potential, Competitive Market Share & Forecast, 2018 – 2024

About Graphical Research:

Graphical Research is a business research firm that provides industry insights, market forecast and strategic inputs through granular research reports and advisory services. We publish targeted research reports with an aim to address varied customer needs, from market penetration and entry strategies to portfolio management and strategic outlook. We understand that business requirements are unique: our syndicate reports are designed to ensure relevance for industry participants across the value chain. We also provide custom reports that are tailored to the exact needs of the customer, with dedicated analyst support across the purchase lifecycle.

Contact Us:

Parikhit B. Corporate sales, Graphical Research Email: sales@graphicalresearh.com Web: https://www.graphicalresearch.com/ Connect with us: Facebook | Google+ | LinkedIn | Twitter

[omcik-blog]

New Post has been published on OmCik

New Post has been published on http://omcik.com/american-medical-association-opposes-obamacare-repeal-citing-coverage-losses-by-millions/

American Medical Association opposes Obamacare repeal, citing coverage losses by millions

The American Medical Association on Tuesday that would repeal and replace key parts of Obamacare, saying it would cause “millions” of Americans to lose affordable health insurance coverage.

Also weighing in against the Graham-Cassidy bill was the National Council for Behavioral Health, which represents more than 2,000 mental health and addiction treatment groups.

“This bill may go by a different name than previous efforts to reshape the health care system, but it maintains—and even worsens—the devastating provisions from those bills that led to a massive constituent outcry earlier this summer,” said Linda Rosenberg, president and CEO of the NCBH.

“It’s the same pig with different lipstick,” Rosenberg said.

The moves by the AMA — the largest physicians’ lobbying group — and the NCBH came a day after a group of 16 organizations lined up to oppose the so-called Graham-Cassidy bill, as did the Association for Community Affiliated Plans, a group of health insurance providers.

“Similar to proposals that were considered in the Senate in July, we believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care,” wrote AMA Executive Vice President and CEO Dr. James L. Madara in a letter to Senate Majority Leader Mitch McConnell, R-Ky., and Minority Leader Chuck Schumer, D-N.Y.

“”We sincerely urge the Senate to take short-term measures to stabilize the health insurance market by continuing to fund cost sharing reduction payments,” Madara wrote.

Those CSR payments reimburse insurers for discounts to out-of-pocket health charges they must offer by law to millions of Obamacare customers. The Trump administration has threatened to stop paying those funds to insurers, which has led to higher proposed premiums for 2018.

The 16 other groups in a signed statement said Graham-Cassidy “will negatively impact patients’ access to adequate and affordable health coverage and care.”

“This bill would limit funding for the Medicaid program, roll back important essential health benefit protections, and potentially open the door to annual and lifetime caps on coverage, endangering access to critical care for millions of Americans,” the groups said.

“Our organizations urge senators to oppose this legislation.”

The groups include the American Cancer Society Cancer Action Network, the American Diabetes Association, the American Heart Association, the American Lung Association, the Arthritis Foundation, the National Health Council and the March of Dimes.

In their statement, the organizations said they strongly supported bipartisan legislation that would stabilize the individual health insurance market,

The statement comes days after AARP, the powerful lobby group representing older Americans, came out against Graham-Cassidy, as it has against prior Republican Obamacare repeal legislation.

GOP leaders who want to pass Graham-Cassidy face a Sept. 30 deadline for final approval of the bill because the legislation is being fast-tracked through a process known as budget reconciliation.

The Senate parliamentarian has ruled that the budget resolution that authorized passage of Obamacare repeal through reconciliation expires at the end of September.

Republicans, who hold a 52-seat majority in the Senate, need at least 50 GOP senators to vote for the bill for it to win passage. No Democrat or independent is expected to support the legislation.

On Tuesday, Alaska Gov. Bill Walker said he had concerns about how the bill would affect Medicaid, the joint federal-state health coverage program for primarily poor people.

“Given Alaska’s current fiscal challenges, any proposal to shift federal costs to the states would likely result in drastic cuts to our Medicaid program,” Walker said,

The governor said he believed states should have a chance to comment on how Graham-Cassidy could affect health care for their residents, according to the newspaper.

Alaska’s senators include Lisa Murkowski, one of three Republicans whose opposition to a prior Obamacare repeal bill led to its defeat in a vote in late July. The other two were Susan Collins of Maine, and John McCain of Arizona.

Murkowski has not yet said if she will vote for or against Graham-Cassidy. But on Monday

According to the News-Miner, Alaska’s other senator, Republican Daniel Sullivan, also has not taken a position on the bill.

Collins and McCain likewise have not said how they will vote. Rand Paul, the Republican senator from Kentucky who supported the prior, failed repeal bill, said he will not vote for Graham-Cassidy.

On Monday, Louisiana’s secretary of health, Dr. Rebekah Gee, wrote the bill’s co-sponsor, Sen. Bill Cassidy, R-La., and warned that “the harm to Louisiana from this legislation far outweighs any benefit.”

Gee noted that in the past year, Louisiana has provided Medicaid coverage to an additional 433,000 state residents as a result of adoption of expanded Medicaid eligibility standards under Obamacare.

She wrote that those people have received “more than one hundred thousand primary care visits, tens of thousands of screenings for cancer, and thousands of new mental health services.”

“These treatments have said lives,” Gee wrote. “Because this bill eliminates Medicaid expansion in 2020, all of our efforts would end, and thousands of Louisiana citizens would lose coverage and access to critical health care services.”

[healthserv]

Will Senate Republicans Get 50 Votes to Repeal the ACA?

By DAVID INTROCASO

THCB readers are well aware this coming week Senate Republicans plan to begin debate on passing their amended version of the House-passed American Health Care Act (AHCA), titled the Better Care Reconciliation Act.   As of today, June 23rd, immediate reactions by Republican senators to the June 22nd released discussion draft have been limited largely because members immediately left town after the draft’s release. The Congressional Budget Office’s (CBO’s) score, that will again be influential, is expected this Monday or Tuesday. Senate debate on the legislation will likely begin next Wednesday with a vote expected late Friday or early Saturday morning, or just prior to their week-long July 4th recess.   Here is an assessment of the legislation’s prospects.

What’s at Stake

One of the best or most thorough assessments of US population health is the 2013 National Academies report titled, Shorter Lives, Poorer Health. As the title plainly indicates the report found that compared to residents in 16 peer countries Americans experience higher mortality and comparative inferior health status. Americans live shorter lives and suffer pervasive health disadvantages throughout their life course.

For example, the report found the US experiences higher rates of infant mortality, injuries, particularly automotive, and homicides, higher rates of teenage pregnancy and STDs, higher rates of HIV/AIDs, higher drug and alcohol-related mortality and morbidity, higher rates of diabetes and obesity, more heart and chronic lung disease and more disabilities including arthritis, and all without any compression of disease.

Senate Republican Motivations

Congressional Republicans have obeen promising to repeal the Affordable Care Act (ACA) since it became law in 2010. They believe they need to keep this promise. If not, they fear, particularly House Republicans, getting primaried, as former House Majority Leader, Eric Cantor, was in 2014 (though his defeat was due largely to his immigration reform position). Their other primary motivation is tax reform. The House bill cuts $834 billion in Medicaid spending over the ten year budget window largely pay for less generous individual tax credits. The Senate bill largely does the same. With a massive reduction in Medicaid spending Republicans are also able to repeal ACA taxes on corporations and on higher income earners. For example, under the House AHCA, those earning over $1 million annually would see $144 billion in tax relief and those earning $200,000 to $900,000 would see $274 billion in tax abatements over the next 10 years. Cutting ACA taxes also lowers the government’s tax revenue baseline. This sets up Republicans to pass a tax reform bill that would allow for approximately $1 trillion in less revenue while still being defined as revenue neutral.

Congressional Budget Office (CBO) Scoring

The CBO concluded the House-passed AHCA would reduce the number of covered lives by 14 million in 2018 and by 23 million in 2026. The bill would cut Medicaid spending, as noted, by $834 million. By 2020, state marketplaces would become unstable for about one-sixth of the population. This is because AHCA waivers would allow states to drop the essential health benefit requirement and would allow insurance underwriting for those that had not demonstrated continuous coverage. For example, the CBO estimated for a single individual age 64 with an income of $26,500, or 175 percent of the Federal Poverty Level (FPL), their premium would increase from $1,700 to upwards of $16,100. A similar score of the Senate’s proposed legislation is likely.

Stakeholder or Lobbying Efforts

In sum, stakeholder opposition to the AHCA has been limited if not anemic. This is explained in part by fear of retaliation, for example, the administration would cut off cost saving reduction repayments. Repealing the ACA means health care companies, including pharmaceuticals and medical device manufacturers, would receive a tax cut estimated at $200 billion. The industry is also hoping for further favorable tax treatment when the Republicans move on to rewriting the tax code. Others believe Republican efforts will collapse under its own weight. Medicaid managed care organizations including Molina and Blue Shield of California, have been obviously vocal. The hospital industry has as well in part over concerns fewer covered lives means more bad debt and how Republicans have structured Disproportionate Share Hospital (DSH) funding. The AARP, the American Academy of Pediatrics, the American College of Physicians, the Association of American Medical Colleges (AAMC), the American Medical Association (AMA), disease groups like the American Cancer Society and patient advocacy groups like Families USA and related others have also expressed opposition.

Among those on the sidelines, the American Health Insurance Plans (AHIP) has not weighed in. Association criticism is though muted or offset by their continued funding of Republican leadership re-election campaigns. Republican governors in Medicaid expanded states, for example, Ohio’s John Kasich and Maryland’s Larry Hogan have stated respectively “deep concerns,” or argued legislators “should go back to the drawing board.” Despite the fact Arkansas has added 300,000 Medicaid under ACA expansion, Governor Asa Hutchinson stated “there are significant positive changes in the Senate bill.”

The Senate Parliamentarian, Reconciliation and the Byrd Rule

Since Senate Republican efforts fall under budget reconciliation rules, that allow them to pass their health bill with a simple majority vote, provisions within the bill must conform to the so called Byrd rule. Simply explained, this means provisions that are considered extraneous, i.e., generally do not increase spending or decrease revenues, the Senate Parliamentarian, Ms. Elizabeth MacDonough, must strike from the legislation. There are provisions that may not meet Byrd rule requirements. These include the cost sharing reduction payments, state stabilization funds (moneys to stabilize state marketplaces) and the House ban on the use of federal tax credits for abortion. If these provisions are struck, Republicans will move these to Medicaid CHIP legislation in September and/or likely find other ways to address.

Timing and Process

Majority Leader McConnell is pushing for a vote before the July 4th recess for at least three reasons. The Senate needs to move on to other matters including raising the debt ceiling, the desire for a legislative win before the August recess and, leaving aside the potential for extraneous variables and crowd out, there’s no guarantee McConnell would be successful should he work the bill through the latter half of the year. Also of note, Republicans cannot move on to tax reform legislation, that they’ll forward under a 2018 reconciliation resolution such that again they can pass with a simple Senate majority vote, until they dispense with the ACA repeal-related 2017 budget resolution.

As has been widely reported McConnell drafted the Senate bill in secret. All Republican meetings were closed to the press. There were no committee hearings and will be no committee markups. This has enabled his members to credibly say when asked about the bill, that they have no comment because they’ve seen no language. Legislating in the dark subverts media coverage or criticism. Media Matters reported the three major networks ran a total of three related segments between June 1 and June 14.

Since the Senate bill is again being considered under reconciliation, Senate floor debate is limited to 20 hours. The time is equally divided between the majority and minority. There is no limit to the number of amendments members can offer during consideration of the bill. Once the 20 hours have expired, amendments not withdrawn are voted on with no debate via what’s termed a “vote-a-rama.”

Senate Republican Votes

None of the 48 Democratic Senators are expected to vote for the Republican bill. No House Democrat voted for the AHCA.

With a 52 member caucus, McConnell can only lose two votes. If he loses two, Vice President Pence will vote to break the tie. Republican votes in play are on the extremes. On the far right is Ted Cruz (TX), Mike Lee (UT) and Rand Paul (KT). Cruz, representing the state with the highest percent of uninsured, is up for re-election next year with current polling showing Texas voters only “leaning” Republican. This is offset by the fact Cruz already has a substantial campaign war chest and is not expecting a primary challenge. The moderates likely in play are seven: Shelly Moore Capito (WV); Bill Cassidy (LA); Susan Collins (ME); Jeff Flake (AZ); Dean Heller (NV); Lisa Murkowski (AK); and, Rob Portman (OH).

Despite a June 22 press release stating “we are not yet ready to vote for this bill” by Cruz, Lee, Paul and Ron Johnson (WI), it appears Cruz, Johnson and Lee will ultimately vote for the bill. Paul will likely vote against. He has consistently stated he does not want to end up with “Obamacare lite.” He wants full repeal. Nebraska’s Senator Ben Sasse may also be a no vote. This means McConnell can only lose one or two more votes.

Among the moderates Flake and Heller are particularly on the bubble. Both Arizona and Nevada expanded Medicaid coverage under the ACA. Both are up for re-election next year and current polling shows voters in both states are also only “leaning” Republican. Heller is more hard pressed. Hillary Clinton easily won Nevada in 2016 by eight points, the popular Nevada Governor, Brian Sandoval, has been a strong supporter of ACA Medicaid expansion that has enabled the state to increase coverage by 33 percent. He has warned Nevada would lose $100s of millions of federal Medicaid funding if Congressional Republicans were to succeed. Heller is presently polling at 39 percent versus 46 percent for any Democratic opponent. Not surprisingly late today, June 23rd, Heller announced he cannot support the Senate bill. Also not surprising immediately after Heller made his announcement a Republican super PAC announced it would spend seven figures on advertising to “influence” the freshman senator.

Concerning the three female senators, West Virginia expanded its Medicaid program under the ACA largely because the state has the seventh highest percent of Medicaid residents, or three in ten. Also, unlike most states West Virginia’s Medicaid beneficiaries tend to remain Medicaid beneficiaries over time. For Senator Murkowski, Alaska is one of the most expensive cost-of-living states due in part to high health insurance premiums. The state has 14,000 enrolled in its marketplace with currently one insurance plan participating. Of those enrolled 90 percent receive subsidies. The Center for Budget and Policy Priorities (CBPP) estimated under the AHCA, Alaskans would pay an average of $12,599 more per year of out-of-pocket for health care costs. For Senator Collins, Republican policy is to decrease premiums for young adults while substantially increasing costs for older Americans presents a problem because Maine has the oldest residents in the US with a median age 44. For Murkowski and Collins, the only two pro choice Republicans, Planned Parenthood funding matters. Ohio’s Senator Portman, who saw an over 20 percent increase in drug overdose deaths between 2014 and 2015, has similar or related concerns.

What to Watch

Medicaid: Compared to the House, the Senate’s bill delays the ACA’s Medicaid expansion by three years. However, the Senate’s annual Medicaid update factor beginning in 2025 is less generous than the House. This latter issue is inherently problematic under either update formula because a fixed update percent, particularly the Senate’s that will track less accurately with actual medical spending growth, does not account for varying patterns of spending due to epidemics or other public health realities, for example weather extremes caused by the climate penalty. In an effort to mitigate the effect of lost lives, or to specifically to win Senator Murkowski’s vote, the Senate bill includes a provision whereby the government will redistribute two percent of Medicaid funds by reducing reimbursements from states that spend more generously on Medicaid beneficiaries to states than spend less generously except for high spending states with low population densities, like Alaska. To win Senator Portman’s vote the Senate bill also excludes the Medicaid ACE (Advancing Care for Exceptional Kids) demonstration program. By intention, because of the phase out is delayed (as well as a less realistic update factor) the number of lives lost under Medicaid may likely be scored somewhat lower than the House bill which CBO determined would drop 14 million lives by 2026. Since the Senate bill succeeds of fails largely on its Medicaid provision, the CBO’s score is particularly relevant to the moderates since all but Maine expanded their Medicaid programs under the ACA. Whether CBO’s score meets whatever lost lives tolerance level the moderates have set for themselves is the begged question.

Tax Credits: From a CBO scoring prospective, tax credits could prove to be as contentious as cuts to Medicaid. Per the CBPP, compared to ACA subsidies, in 2020 the House AHCA’s plan would reduce tax credits for Alaskans by over $10,000, for West Virginians by over $4,200 and in Louisiana and Maine by over $2,600. For those over 60, premium costs would almost triple. Under the Senate bill, beginning in 2020 tax credits would be bench marked at 58 percent of actuarial value (AV) of the median premium marketplace plan. This is substantially less generous than current ACA subsidies at 70 percent of AV. This effect may mitigated by the Senate’s lowering the availability of credits from 400 percent to 350 percent of the FPL and the fact that the Senate bill also allows states to use, ironically, the ACA’s 1332 waiver process to drop the essential health benefit requirement and the requirement that plans meeting certain actuarial values. Under a far more liberal 1332 wavier, states could also close down their ACA marketplaces. Not surprisngly, Senate Republicans incent states to submit 1332 waivers via $2 billion in grants. Like the House bill, the Senate includes a 5:1 age rating band and drops the individual and employer mandates. It appears these provisions, in sum, would, as CBO concluded in scoring the AHCA, cause the non-group market to become unstable for a significant percent of the population, or leave individuals and families unable to purchase insurance at premiums comparable to those under current law.

Cost Sharing Reduction (CSR) Payments: The Senate bill is more generous than the House in that it extends CSR payments through calendar 2019. (It’s at least ironic Republicans have generally termed these payments “bail outs” and challenged them in court since 2003 Republican-led Medicare Part D legislation made these programs permanent.) The combination of a changing 2020 individual market rules with no guard rails for insurer participation may cause moderate senators to pause particularly if the CBO validates their concern. The Senate bill does propose two “stabilization” funds but these moneys are modest, between $5 and $15 billion per year, and expire in 2021.

Opioid Funding: The seven moderate senators identified represent states that have the highest drug related deaths in 2015. West Virginia had the nation’s highest age adjusted drug related death rate. The Senate bill appropriates $2 billion in 2018 for grants to states to support substance abuse disorder treatment and recovery. Considering the fact opioid abuse fatalities in 2015 numbers over 33,000, a 16 percent increase over 2014, both the amount and duration of funding appears to be far from inadequate. The $2 billion may be purposeful since McConnell could likely raise the amount substantially to win particularly Capito’s vote.

Planned Parenthood: Like the House bill, the Senate will also cut Planned Parenthood funding, approximately $550 million or 30 percent of the organization’s budget, for one year. This, despite the fact Planned Parenthood, which operates 700 clinics nation-wide, and other abortion providers are already banned from billing taxpayer-funded programs for the procedure. The 2015 ACA repeal bill that President Obama vetoed in early 2016, included defunding Planned Parenthood. Collins and Murkowski supported an amendment to strike the provision. This may also be an issue for Senator Heller since Nevada has the 5th highest percentage of births to unwed mothers.

Amendments: The fate of the Senate bill may come down to amendments during the floor debate (and/or McConnell offering a substitute bills prior to and/or during floor debate). Look for Republican offered amendments, along with Democratic offered amendments, related to these issues and others that in sum will illustrate or attempt to reinforce each faction’s position or in the Democrats case further divide the two.

McConnell: Unlike House members, Senators are far more independent or less willing to bend to caucus leadership and/or White House pressure. Nevertheless, McConnell can and does exert considerable influence over his members. To what extent the Majority Leader pressures or provides his moderates with life boat provisions will substantially determine the outcome. It has been reported over and again McConnell is “agnostic” concerning the outcome, in part, because, again, he’d prefer to move on to tax reform. Many suspect or believe he actually would have preferred the House to have quit after they initially failed on March 24th. He also knows well Senate Republicans will lose by winning since they’ll own every inevitable adverse consequence that can reasonably tied to his legislation.

House and White House Response

Should the Senate Republicans prevail, despite posturing this past week by the House Freedom Caucus and the Republican Study Committee, it is difficult if not impossible to believe the House will attempt to rewrite the Senate bill, nor will House and Senate leaders appoint conferees to a conference committee to resolve their differences, or draft a third bill both House and Senate Republicans can accept. (One problem with the ACA was there was no conferencing the Senate and House versions.) This is to say the House will pass the Senate’s version or in DC parlance the Senate will jam the House. President Trump will sign the legislation before the Congress takes its scheduled five-week summer recess.

What Does Failure or Success Mean?

Failure means a few Senate Republicans were willing to believe the CBO and not dramatically cut Medicaid, a program that provides health care services to nearly one-quarter of Americans, or approximately 70 million poor perinatal, pregnant women, disabled children and adults and the frail elderly. That they were sensitive to public opinion polling that shows less than 20 percent, and not a single state, supports the House AHCA. That they at least defacto believe the ACA’s individual market is not in a “death spiral” or that per Standard and Poor’s analysis, last year most plans found a stable and profitable price points and/or per Oliver Wyman, two-thirds of higher premiums are due to political uncertainty. Perhaps more importantly they were neither interested in disguising the legislation’s intent by delaying its implementation by a few years nor ultimately in discounting the future.

Success constitutes a lifetime win for the ideological right. Success means the vast majority if not the entirety of Republican Senators repealed, or more accurately partially repealed, the ACA in order redistribute wealth from the poor and middle class to the nation’s wealthiest. Though too infrequently defined in this way, the ACA is, or was, essentially wealth transfer bill. Although it took him seven years to say it, in his recent Facebook post former President Obama wrote the Senate Republican bill is ‘not a health care bill” but instead “a massive transfer of wealth . . . to the richest people in America.” Success means Republican Senators view access to and coverage for health care as simply a product or commodity and that providing all Americans with health care services is not a priority. Success in the face of certain public disapproval means as Gilens and Page concluded in a 2014 study that the “American public actually have little influence over the policies our government adopts,” or phrased another way, “when a majority of citizens disagrees with economic elites or with organized interests,” Gilens and Page concluded, “they generally lose.”

Will Senate Republicans Get 50 Votes to Repeal the ACA? published first on http://ift.tt/2sUuvu3

[isaacscrawford]

Will Senate Republicans Get 50 Votes to Repeal the ACA?

By DAVID INTROCASO

THCB readers are well aware this coming week Senate Republicans plan to begin debate on passing their amended version of the House-passed American Health Care Act (AHCA), titled the Better Care Reconciliation Act.   As of today, June 23rd, immediate reactions by Republican senators to the June 22nd released discussion draft have been limited largely because members immediately left town after the draft’s release. The Congressional Budget Office’s (CBO’s) score, that will again be influential, is expected this Monday or Tuesday. Senate debate on the legislation will likely begin next Wednesday with a vote expected late Friday or early Saturday morning, or just prior to their week-long July 4th recess.   Here is an assessment of the legislation’s prospects.

What’s at Stake or Our Health Status

One of the best or most thorough assessments of US population health is the 2013 National Academies report titled, Shorter Lives, Poorer Health. As the title plainly indicates the report found that compared to residents in 16 peer countries Americans experience higher mortality and comparative inferior health status. Americans live shorter lives and suffer pervasive health disadvantages throughout their life course. For example, the report found the US experiences higher rates of infant mortality, injuries, particularly automotive, and homicides, higher rates of teenage pregnancy and STDs, higher rates of HIV/AIDs, higher drug and alcohol-related mortality and morbidity, higher rates of diabetes and obesity, more heart and chronic lung disease and more disabilities including arthritis, and all without any compression of disease.

Senate Republican Motivations

Congressional Republicans have of course been promising, or attempting, to repeal the Affordable Care Act (ACA) since it became law in 2010. They believe they need to keep this promise. If not, they fear, particularly House Republicans, getting primaried, as former House Majority Leader, Eric Cantor, was in 2014 (though his defeat was due largely to his immigration reform position). Their other primary motivation is tax reform. The House bill cuts $834 billion in Medicaid spending over the ten year budget window largely pay for less generous individual tax credits. The Senate bill largely does the same. With a massive reduction in Medicaid spending Republicans are also able to repeal ACA taxes on corporations and on higher income earners. For example, under the House AHCA, those earning over $1 million annually would see $144 billion in tax relief and those earning $200,000 to $900,000 would see $274 billion in tax abatements over the next 10 years. Cutting ACA taxes also lowers the government’s tax revenue baseline. This sets up Republicans to pass a tax reform bill that would allow for approximately $1 trillion in less revenue while still being defined as revenue neutral.

Congressional Budget Office (CBO) Scoring

The CBO concluded the House-passed AHCA would reduced the number of covered lives by 14 million in 2018 and by 23 million in 2026. The bill would cut Medicaid spending, as noted, by $834 million. By 2020, state marketplaces would become unstable for about one-sixth of the population. This is because AHCA waivers would allow states to drop the essential health benefit requirement and would allow insurance underwriting for those that had not demonstrated continuous coverage. For example, the CBO estimated for a single individual age 64 with an income of $26,500, or 175 percent of the Federal Poverty Level (FPL), their premium would increase from $1,700 to upwards of $16,100. A similar score of the Senate’s proposed legislation is likely.

Stakeholder or Lobbying Efforts

In sum, stakeholder opposition to the AHCA has been limited if not anemic. This is explained in part by fear of retaliation, for example, the administration would cut off cost saving reduction repayments. Repealing the ACA means health care companies, including pharmaceuticals and medical device manufacturers, would receive a tax cut estimated at $200 billion. The industry is also hoping for further favorable tax treatment when the Republicans move on to rewriting the tax code. Others believe Republican efforts will collapse under its own weight. Medicaid managed care organizations including Molina and Blue Shield of California, have been obviously vocal. The hospital industry has as well in part over concerns fewer covered lives means more bad debt and how Republicans have structured Disproportionate Share Hospital (DSH) funding. The AARP, the American Academy of Pediatrics, the American College of Physicians, the Association of American Medical Colleges (AAMC), the American Medical Association (AMA), disease groups like the American Cancer Society and patient advocacy groups like Families USA and related others have also expressed opposition.

Among those on the sidelines, the American Health Insurance Plans (AHIP) has not weighed in. Association criticism is though muted or offset by their continued funding of Republican leadership re-election campaigns. Republican governors in Medicaid expanded states, for example, Ohio’s John Kasich and Maryland’s Larry Hogan have stated respectively “deep concerns,” or argued legislators “should go back to the drawing board.” Despite the fact Arkansas has added 300,000 Medicaid under ACA expansion, Governor Asa Hutchinson stated “there are significant positive changes in the Senate bill.”

The Senate Parliamentarian, Reconciliation and the Byrd Rule

Since Senate Republican efforts fall under budget reconciliation rules, that allow them to pass their health bill with a simple majority vote, provisions within the bill must conform to the so called Byrd rule. Simply explained, this means provisions that are considered extraneous, i.e., generally do not increase spending or decrease revenues, the Senate Parliamentarian, Ms. Elizabeth MacDonough, must strike from the legislation. There are provisions that may not meet Byrd rule requirements. These include the cost sharing reduction payments, state stabilization funds (moneys to stabilize state marketplaces) and the House ban on the use of federal tax credits for abortion. If these provisions are struck, Republicans will move these to Medicaid CHIP legislation in September and/or likely find other ways to address.

Timing and Process

Majority Leader McConnell is pushing for a vote before the July 4th recess for at least three reasons. The Senate needs to move on to other matters including raising the debt ceiling, the desire for a legislative win before the August recess and, leaving aside the potential for extraneous variables and crowd out, there’s no guarantee McConnell would be successful should he work the bill through the latter half of the year. Also of note, Republicans cannot move on to tax reform legislation, that they’ll forward under a 2018 reconciliation resolution such that again they can pass with a simple Senate majority vote, until they dispense with the ACA repeal-related 2017 budget resolution.

As has been widely reported McConnell drafted the Senate bill in secret. All Republican meetings were closed to the press. There were no committee hearings and will be no committee markups. This has enabled his members to credibly say when asked about the bill, that they have no comment because they’ve seen no language. Legislating in the dark subverts media coverage or criticism. Media Matters reported the three major networks ran a total of three related segments between June 1 and June 14.

Since the Senate bill is again being considered under reconciliation, Senate floor debate is limited to 20 hours. The time is equally divided between the majority and minority. There is no limit to the number of amendments members can offer during consideration of the bill. Once the 20 hours have expired, amendments not withdrawn are voted on with no debate via what’s termed a “vote-a-rama.”

Senate Republican Votes

None of the 48 Democratic Senators are expected to vote for the Republican bill. No House Democrat voted for the AHCA.

With a 52 member caucus, McConnell can only lose two votes. If he loses two, Vice President Pence will vote to break the tie. Republican votes in play are on the extremes. On the far right is Ted Cruz (TX), Mike Lee (UT) and Rand Paul (KT). Cruz, representing the state with the highest percent of uninsured, is up for re-election next year with current polling showing Texas voters only “leaning” Republican. This is offset by the fact Cruz already has a substantial campaign war chest and is not expecting a primary challenge. The moderates likely in play are seven: Shelly Moore Capito (WV); Bill Cassidy (LA); Susan Collins (ME); Jeff Flake (AZ); Dean Heller (NV); Lisa Murkowski (AK); and, Rob Portman (OH).

Despite a June 22 press release stating “we are not yet ready to vote for this bill” by Cruz, Lee, Paul and Ron Johnson (WI), it appears Cruz, Johnson and Lee will ultimately vote for the bill. Paul will likely vote against. He has consistently stated he does not want to end up with “Obamacare lite.” He wants full repeal. Nebraska’s Senator Ben Sasse may also be a no vote. This means McConnell can only lose one or two more votes.

Among the moderates Flake and Heller are particularly on the bubble. Both Arizona and Nevada expanded Medicaid coverage under the ACA. Both are up for re-election next year and current polling shows voters in both states are also only “leaning” Republican. Heller is more hard pressed. Hillary Clinton easily won Nevada in 2016 by eight points, the popular Nevada Governor, Brian Sandoval, has been a strong supporter of ACA Medicaid expansion that has enabled the state to increase coverage by 33 percent. He has warned Nevada would lose $100s of millions of federal Medicaid funding if Congressional Republicans were to succeed. Heller is presently polling at 39 percent versus 46 percent for any Democratic opponent. Not surprisingly late today, June 23rd, Heller announced he cannot support the Senate bill. Also not surprising immediately after Heller made his announcement a Republican super PAC announced it would spend seven figures on advertising to “influence” the freshman senator.

Concerning the three female senators, West Virginia expanded its Medicaid program under the ACA largely because the state has the seventh highest percent of Medicaid residents, or three in ten. Also, unlike most states West Virginia’s Medicaid beneficiaries tend to remain Medicaid beneficiaries over time. For Senator Murkowski, Alaska is one of the most expensive cost-of-living states due in part to high health insurance premiums. The state has 14,000 enrolled in its marketplace with currently one insurance plan participating. Of those enrolled 90 percent receive subsidies. The Center for Budget and Policy Priorities (CBPP) estimated under the AHCA, Alaskans would pay an average of $12,599 more per year of out-of-pocket for health care costs. For Senator Collins, Republican policy is to decrease premiums for young adults while substantially increasing costs for older Americans presents a problem because Maine has the oldest residents in the US with a median age 44. For Murkowski and Collins, the only two pro choice Republicans, Planned Parenthood funding matters. Ohio’s Senator Portman, who saw an over 20 percent increase in drug overdose deaths between 2014 and 2015, has similar or related concerns.

What to Watch

Medicaid: Compared to the House, the Senate’s bill delays the ACA’s Medicaid expansion by three years. However, the Senate’s annual Medicaid update factor beginning in 2025 is less generous than the House. This latter issue is inherently problematic under either update formula because a fixed update percent, particularly the Senate’s that will track less accurately with actual medical spending growth, does not account for varying patterns of spending due to epidemics or other public health realities, for example weather extremes caused by the climate penalty. In an effort to mitigate the effect of lost lives, or to specifically to win Senator Murkowski’s vote, the Senate bill includes a provision whereby the government will redistribute two percent of Medicaid funds by reducing reimbursements from states that spend more generously on Medicaid beneficiaries to states than spend less generously except for high spending states with low population densities, like Alaska. To win Senator Portman’s vote the Senate bill also excludes the Medicaid ACE (Advancing Care for Exceptional Kids) demonstration program. By intention, because of the phase out is delayed (as well as a less realistic update factor) the number of lives lost under Medicaid may likely be scored somewhat lower than the House bill which CBO determined would drop 14 million lives by 2026. Since the Senate bill succeeds of fails largely on its Medicaid provision, the CBO’s score is particularly relevant to the moderates since all but Maine expanded their Medicaid programs under the ACA. Whether CBO’s score meets whatever lost lives tolerance level the moderates have set for themselves is the begged question.

Tax Credits: From a CBO scoring prospective, tax credits could prove to be as contentious as cuts to Medicaid. Per the CBPP, compared to ACA subsidies, in 2020 the House AHCA’s plan would reduce tax credits for Alaskans by over $10,000, for West Virginians by over $4,200 and in Louisiana and Maine by over $2,600. For those over 60, premium costs would almost triple. Under the Senate bill, beginning in 2020 tax credits would be bench marked at 58 percent of actuarial value (AV) of the median premium marketplace plan. This is substantially less generous than current ACA subsidies at 70 percent of AV. This effect may mitigated by the Senate’s lowering the availability of credits from 400 percent to 350 percent of the FPL and the fact that the Senate bill also allows states to use, ironically, the ACA’s 1332 waiver process to drop the essential health benefit requirement and the requirement that plans meeting certain actuarial values. Under a far more liberal 1332 wavier, states could also close down their ACA marketplaces. Not surprisngly, Senate Republicans incent states to submit 1332 waivers via $2 billion in grants. Like the House bill, the Senate includes a 5:1 age rating band and drops the individual and employer mandates. It appears these provisions, in sum, would, as CBO concluded in scoring the AHCA, cause the non-group market to become unstable for a significant percent of the population, or leave individuals and families unable to purchase insurance at premiums comparable to those under current law.

  Cost Sharing Reduction (CSR) Payments: The Senate bill is more generous than the House in that it extends CSR payments through calendar 2019. (It’s at least ironic Republicans have generally termed these payments “bail outs” and challenged them in court since 2003 Republican-led Medicare Part D legislation made these programs permanent.) The combination of a changing 2020 individual market rules with no guard rails for insurer participation may cause moderate senators to pause particularly if the CBO validates their concern. The Senate bill does propose two “stabilization” funds but these moneys are modest, between $5 and $15 billion per year, and expire in 2021.

Opioid Funding: The seven moderate senators identified represent states that have the highest drug related deaths in 2015. West Virginia had the nation’s highest age adjusted drug related death rate. The Senate bill appropriates $2 billion in 2018 for grants to states to support substance abuse disorder treatment and recovery. Considering the fact opioid abuse fatalities in 2015 numbers over 33,000, a 16 percent increase over 2014, both the amount and duration of funding appears to be far from inadequate. The $2 billion may be purposeful since McConnell could likely raise the amount substantially to win particularly Capito’s vote.

Planned Parenthood: Like the House bill, the Senate will also cut Planned Parenthood funding, approximately $550 million or 30 percent of the organization’s budget, for one year. This, despite the fact Planned Parenthood, which operates 700 clinics nation-wide, and other abortion providers are already banned from billing taxpayer-funded programs for the procedure. The 2015 ACA repeal bill that President Obama vetoed in early 2016, included defunding Planned Parenthood. Collins and Murkowski supported an amendment to strike the provision. This may also be an issue for Senator Heller since Nevada has the 5th highest percentage of births to unwed mothers.

Amendments: The fate of the Senate bill may come down to amendments during the floor debate (and,/or McConnell offering a substitute bills prior to and/or during floor debate). Look for Republican offered amendments, along with Democratic offered amendments, related to these issues and others that in sum will illustrated or attempt to reinforce each faction’s position or in the Democrats case further divide the two.

McConnell: Unlike House members, Senators are far more independent or less willing to bend to caucus leadership and/or White House pressure. Nevertheless, McConnell can and does exert considerable influence over his members. To what extent the Majority Leader pressures or provides his moderates with life boat provisions will substantially determine the outcome. It has been reported over and again McConnell is “agnostic” concerning the outcome, in part, because, again, he’d prefer to move on to tax reform. Many suspect or believe he actually would have preferred the House to have quit after they initially failed on March 24th. He also knows well Senate Republicans will lose by winning since they’ll own every inevitable adverse consequence that can reasonably tied to his legislation.

House and White House Response

Should the Senate Republicans prevail, despite posturing this past week by the House Freedom Caucus and the Republican Study Committee, it is difficult if not impossible to believe the House will attempt to rewrite the Senate bill, nor will House and Senate leaders appoint conferees to a conference committee to resolve their differences, or draft a third bill both House and Senate Republicans can accept. (One problem with the ACA was there was no conferencing the Senate and House versions.) This is to say the House will pass the Senate’s version or in DC parlance the Senate will jam the House. President Trump will sign the legislation before the Congress takes its scheduled five-week summer recess.

What Does Failure or Success Mean

Failure means a few Senate Republicans were willing to believe the CBO and not dramatically cut Medicaid, a program that provides health care services to nearly one-quarter of Americans, or approximately 70 million poor perinatal, pregnant women, disabled children and adults and the frail elderly. That they were sensitive to public opinion polling that shows less than 20 percent, and not a single state, supports the House AHCA. That they at least defacto believe the ACA’s individual market is not in a “death spiral” or that per Standard and Poor’s analysis, last year most plans found a stable and profitable price points and/or per Oliver Wyman, two-thirds of higher premiums are due to political uncertainty. Perhaps more importantly they were neither interested in disguising the legislation’s intent by delaying its implementation by a few years nor ultimately in discounting the future.

Success constitutes a lifetime win for the ideological right. Success means the vast majority if not the entirety of Republican Senators repealed, or more accurately partially repealed, the ACA in order redistribute wealth from the poor and middle class to the nation’s wealthiest. Though too infrequently defined in this way, the ACA is, or was, essentially wealth transfer bill. Although it took him seven years to say it, in his recent Facebook post former President Obama wrote the Senate Republican bill is ‘not a health care bill” but instead “a massive transfer of wealth . . . to the richest people in America.” Success means Republican Senators view access to and coverage for health care as simply a product or commodity and that providing all Americans with health care services is not a priority. Success in the face of certain public disapproval means as Gilens and Page concluded in a 2014 study that the “American public actually have little influence over the policies our government adopts,” or phrased another way, “when a majority of citizens disagrees with economic elites or with organized interests,” Gilens and Page concluded, “they generally lose.”

Article source:The Health Care Blog

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Diet program helped limit pregnancy weight gain, study says

New Post has been published on http://type2diabetestreatment.net/diabetes-research/diet-program-helped-limit-pregnancy-weight-gain-study-says/

Diet program helped limit pregnancy weight gain, study says

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by Molly Walker Staff Writer, MedPage Today January 26, 2017

This article is a collaboration between MedPage Today® and:

Action Points

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

While a diet and lifestyle intervention was linked with significantly less weight gain among overweight and obese pregnant women, there was no difference in pregnancy outcomes.

Note that the study results may call into question previously described associations between excess gestational weight gain and pregnancy outcomes.

LAS VEGAS -- While a diet and lifestyle intervention was linked with significantly less weight gain among overweight and obese pregnant women, there was no difference in pregnancy outcomes, a randomized trial presented here found.

Compared with patients who received usual care, those in the intervention arm gained fewer pounds from the time of enrollment (less than 16 weeks gestation) through 36 weeks gestation (19.1 versus 23.7 pounds, P<0.001), reported Alan M. Peaceman, MD, chief of Maternal Fetal Medicine of Northwestern University in Chicago.

However, there were no significant differences between the two treatment groups in adverse pregnancy outcomes, such as diagnoses of gestational diabetes, preeclampsia, gestational hypertension, or birth weight over 4,000 grams.

"This may call into question previously described associations between excess gestational weight gain and pregnancy outcomes," Peaceman said in his report at the Society for Maternal-Fetal Medicine annual pregnancy meeting. "However, this is only an initial data evaluation, and it should not lead to a conclusion that efforts to control gestational weight gain should now be abandoned."

He added that studies have shown that half of pregnant women exceeded the 2009 Institute of Medicine guidelines for weight gain during pregnancy. While there is now a "strong" relationship between gestational weight gain and childhood obesity, there have been mixed results about the link to obstetric outcomes, he noted.

The Maternal-Offspring Metabolics: Family Intervention Trial (MOMFIT) was part of a consortium of seven sites in the U.S. and Puerto Rico, called Lifestyle Interventions for Expectant Mothers (LIFE-Moms). Each site had distinct interventions, but common definitions were used to measure outcomes.

Peaceman and his colleagues examined data from 276 pregnant women, who were randomized to receive either the intervention or usual care. The intervention consisted of an individualized, dietitian-prescribed, calorie-specific DASH (dietary approaches to stop hypertension)-type diet, along with recommendations for physical activity, internet-based monitoring, and weekly coaching calls, while usual care consisted of information from websites, electronic newsletters, and non-diet related pregnancy resources.

There were no significant between-group differences in baseline characteristics, the team found. Participants were overweight to obese, with a body mass index of 25 to 40, although they were similar in mean age (about 32), and the majority of both groups were white. Obstetrician/gynecologists were unaware of their patient's group assignment.

Overall, a significantly smaller portion of women in the intervention group were associated with weight gain exceeding the Institute of Medicine guidelines (68% versus 86%, P<0.001), although Peaceman noted that a majority of women still gained an excess amount of weight while pregnant. The rate of weight gain was also significantly lower (0.9 versus 1.1 pounds per week, P<0.001).

There was a significantly higher rate of caesarean delivery among the intervention group compared with the usual-care group (40% versus 27%, P=0.023), but Peaceman said those results were likely due to "random chance," since the other study sites did not have similar findings.

Asked for her opinion of the study, Loralei Thornburg, MD, of the University of Rochester Medical Center in New York, said that the reason there was no difference in obstetric outcomes was likely because there was not a major difference in weight gain between the two groups: "I am very interested to see how the scoring of the quality of the diets, the weight retention, and the fetal/maternal metabolic markers changed -- i.e., does teaching change the type of foods consumed and improve infant outcomes without changing weight gain -- but the data is still being evaluated," she told MedPage Today via email.

Thornburg, who was not associated with the research, also said that there was likely some "Hawthorne effect" in this study, where the "control" group also changed their dietary and eating habits simply because they were asked about their diet.

Peaceman said that his group would continue to investigate the relationship between gestational weight gain and pregnancy outcomes, and hypothesized that the intervention perhaps had been started too late or that there are other factors that contribute to a woman's tendency to gain weight during pregnancy. However, he said, it will not be possible to look at long-term outcomes, since the research was funded to follow mothers and babies only through a year.

"If you'd like to advocate for us getting longer-term funding, we'd appreciate it," he said.

The authors did not report any conflicts of interest or other disclosures.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

2017-01-26T17:06:14-0500

Primary Source

Society for Maternal-Fetal Medicine

Source Reference: Peaceman AM, et al "MOMFIT: A randomized clinical trial of an intervention to prevent excess gestational weight gain in overweight and obese women" SMFM 2017; Abstract 2.

take posttestType 2 Diabetes Treatment Type 2 Diabetes Diet Diabetes Destroyer Reviews Original Article

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Heart Transplant Alternatives

Dr. Rahul Patil MBBS, MD (MED), DNB (CARD), MNAMS, FICN, FESC, FACC ( USA), FSCAI ( USA) Consultant Cardiologist Ruby Hall Clinic, Pune Academic Attachments Hon. Associate Professor, Sassoon General Hospital & B J Medical College, Pune.

Dr. Rahul Raosaheb Patil is an accomplished Interventional Cardiologist in Pune, practicing since 2006. He is Director, Interventional Cardiology, at Hridayam Heart Care Clinic in Pune, and has also serving as a Consultant Cardiologist at Ruby Hall Clinic since 2006. In addition, Dr. Patil teaches at BJ Medical College & Sassoon General Hospital, in the capacity of Assistant Professor. 

As an Interventional Cardiologist, Dr. Rahul Patil’s main clinical focus areas are Complex Coronary Angiography, Chronic Total Occlusions, Percutaneous Aortic Valve Replacement, Cardiovascular Disease, Mitral Valvuloplasty and Coronary Artery Disease.Dr. Patil received the MBBS and MD (Medicine) degrees in 1999 and 2002, through NM University and Pune University (both in Maharashtra), respectively. From 2003, he studied and trained at Medwin Hospital in Hyderabad, for the Diplomate of National Board (DNB) Cardiology examination, which he cleared in 2006. In 2008 he underwent advanced training in Interventional Cardiology at Tokyo in Japan, and also completed a Fellowship in Interventional Cardiology in the Netherlands in 2009.

Membership / Activities in Professional And Scintific Societies:

Life Member of National Academy of Medical Sciences, India

Awords & Achievement:

International:

● Invited Faculty at Heart Failure Scientific Forum, Region Asia Pacific,Middle east and Africa, Dubai 9-10 oct 2015.

● Invited Faculty for 2 Case Presentations:

1)PDA Occluder Embolised to Abdominal Aorta after successful deployment:Nightmare in Cath Lab.

2)Management of Embolised undeployed stent in Left Main – Circumflex.At Endovascular Cardiac Complication (ECC) Lausanne, Switzerland 2013

● Attended a CRT Hands on Workshop on ‘Introduction into CRT and up to 8 Ventricular Lead Implantations, AV/VV – optimization with ECHO’ led by Dr. Dietmar Schmitz at Ruhrgebiet, Germany – 2011

● Invited Faculty for Case Presentation –‘Tips & Tracks to perform BMV in Severe Mitral Stenosis with LA Appendage Thrombus’. At Singapore Live, 2010.

● Awarded the ‘Best Challenging Case Award’ for Complex Angioplasty in a patient of Road Traffic Accident with Intracranial Bleed. At TCT Washington, 2010.

● Invited Faculty for Case Presentation – ‘Simultaneous Kissing Stent’ New Technique in Renal Angioplasty. At TCT Washington, 2008.

● Awarded the ‘Best of Young Interventionalist’ At Singapore Live, 2008.

● Presented a Case of ‘Anchor Technique in Chronic total occlusion of Anomalous RCA’ At Advanced Course in Interventional Cardiology, Tokyo, Japan, 2008.

National:

● Live Case Demonstration of IVUS and FFR WORKSHOP at Sassoon General Hospital and BJ Medical College, Cardiology Department, Pune, along with CSI Pune on 27/02/2016

● “Hridaya” Sept 2015, Speaker for Recent advances in Cardiometabolic diseases, CME at Lonawala.

● Highlights of ESC 2015 live, Cochaired with Dr Sunil Sathe and Dr Rajesh Badani at Courtyard Marriot, Pune station in sept 2015.

● Course Director for Manthan CME Program at Lonawala May 2015 :Combination of Antihypertensive : Evidence based approach.

● Chairperson for RSSDI May 2015, Pune : Ambulatory BP Vs Home BP.

● Presented a Case of ‘Multiple Scaffold Absorb Plasty at BVS Conclave’ on 15th Dec 2013 at Mumbai.

● Participated in 11th International Symposium on Diabetes held at Mumbai, India – 2012.

● Presented a case of Bifurcation Angioplasty at ACVS in partnership with TCT2012 India Conference held at Hyderabad, India 2012.

● Invited Faculty as Speaker, Topic – ‘Management of AMI – Update’ at GPCON held at Pune, India – 2009.

● Invited Faculty for ‘Management of Thrombus in Primary Angioplasty’ at National Interventional Council Meeting – 2008.

● Presented a Case of ‘VSD with Pulmonary Hypertension’ at Post Graduate Update in Clinical Cardiology held at Chennai, India – 2006.

● Successfully completed ‘Hands on Training’ at IInd Indo French Trans-radial Angioplasty Work Shop held at Secunderabad, India – 2006.

● Attended Cardiology Updates at 4th Annual CUP 2006, held at Vellore, India -2006.

● Participated in the 10th Annual Conference of Indian Academy of Echocardiography held at Udaipur, India – 2005.

● Invited Faculty for ‘Management of A Case of Eisenmenger Syndrome’ in CME at DDH & RC, Hyderabad, India – 2005.

● Participated in the ‘Comprehensive Course in Clinical Cardiology’ held at Kochi,India – 2004.

● Presented a Paper on ‘Evaluation of Diastolic Dysfunction on Echocardiography’ at 9th Annual Conference of Indian Academy of Echocardiography held at Bhubaneshwar, India – 2004.

Leadership Activities in Community:

● Served at the Medical & Emergency Health Services at 82nd Plenary Session of All India Congress Committee, held at Hyderabad, India – 2006.

● Awarded the ‘Manawata Puraskar’ (Humanitarian Award) by President of All India Anti Corruption Committee, Pune, Maharashtra, India, 2010.

● Awarded the ‘Khandesh Bhushan Puraskar’ (Pride of Khandesh) by Mayor of Pune, Maharashtra, India, 2011.

● Cardiac Health Awareness Campaign on Regional / National Television, 2010 & 2013.

● Regular Healthy Heart Camps are being conducted for the Community with Free Heart Checkups and treatment.

Contact Us For More Details.

[vinayv224]

President Donald Trump speaks while touring a computer manufacturing facility that produces Apple computers in Austin, Texas, on November 20, 2019. | Mandel Ngan/Getty Images

So far, artificial intelligence’s development has outpaced regulation. Now regulation has to catch up.

Artificial intelligence is here, and it’s impacting our lives in real ways — whether it’s the Alexa smart speaker on our nightstand, online customer service chatbots, or the smart replies Google drafts for our emails.

But so far, the tech’s development has outpaced regulation. Now, government agencies are increasingly encountering AI-based tools, and they must figure out how to evaluate them. Take the Food and Drug Administration, which greenlights new medical products: It needs to review and approve new health care products that boast AI-capabilities — like this one that promises to detect eye problems related to diabetes — before they’re sold to us. Or consider the Equal Employment Opportunity Commission, which investigates employment discrimination. Today, the agency must also make decisions about AI-based hiring algorithms, like those that screen job candidates’ resumes and decide whether or not you deserve an interview.

On Wednesday at CES, the prominent Las Vegas-based technology trade show, White House officials formally announced how the Office of Science and Technology wants federal agencies to approach regulating new artificial intelligence-based tools and the industries that develop the tech.

The White House’s proposed AI guidance discusses some of the biggest concerns technologists, AI ethicists, and even some government officials have about the technology, but the guidelines are centered most on encouraging innovation in artificial intelligence and making sure regulations don’t “needlessly” get in the way.

That reflects an ongoing problem for AI, one that’s already played out in other tech sectors, where a rush to innovate without much oversight has only come to back haunt us.

While encouraging innovation in AI is certainly a consideration, critics of the technology have said that regulators must scrutinize artificial intelligence more closely as it continues to be rolled out in the real world. They argue that artificial intelligence can replicate, and even amplify, human biases. These tools often function in black boxes — meaning that they’re proprietary and operated by the companies that sell them — which makes it difficult for us to know when or how they might be harming real people (or if they even work as intended). And new AI-based tools can also raise concerns about privacy and surveillance.

For now, these new guidelines are just that — guidelines — which means that today’s memo won’t have an immediate effect on the artificial intelligence tech you might encounter in your daily life. But the memo shows how the government is thinking about AI and its potential impact on Americans. “People should care that the White House is trying to bring a framework for assessing and justifying the deployment of AI tools, because what we’re finding as these tools develop and emerge is that there are some applications that have deeper consequences than others,” said Nicol Turner-Lee, a fellow at the Brookings Institution who researches technology and equity.

The Trump administration wants a national AI effort

Trump and his administration want the US to dominate the AI industry — and they definitely want the US to be better at AI than China. Early last year, President Donald Trump signed an executive order establishing the “American A.I. Initiative,” which is meant to jumpstart AI research and help build an AI-competent US workforce, among other goals (though he didn’t give the effort any new funding).

“Federal agencies must avoid ... needlessly hamper[ing] AI innovation and growth”

Outlining 10 primary principles, today’s memo to federal departments and agencies echoes the goals of that executive order. It urges regulators to be mindful of innovation and to “consider ways to reduce barriers to the development and adoption” of AI when weighing how existing laws and potential new rules apply to the emerging technology.

“Federal agencies must avoid regulatory or non-regulatory actions that needlessly hamper AI innovation and growth,” says the memo. “Agencies must avoid a precautionary approach that holds AI systems to such an impossibly high standard that society cannot enjoy their benefits.” At the same time, the guidance also urges regulators to be conscientious of values like transparency, risk management, fairness, and nondiscrimination.

These are all fair points. By encouraging these federal departments and agencies to take action, the Trump administration also hopes to avoid a future in which American AI companies might face a patchwork of local and state regulation, or possibly overreaching federal regulation, that could impede the technology’s expansion.

AI experts told Recode that the AI guidelines are a starting point. “It will take time to assess how effective these principles are in practice, and we will be watching closely,” said Rashida Richardson, the director of policy research at the AI Now Institute. “Establishing boundaries for the federal government and the private sector around AI technology will offer greater insight to those of us working in the accountability space.”

Aaron Rieke, the managing director of the technology rights nonprofit Upturn, said in an email to Recode that, for now, he doesn’t think the memo will have much influence: “I do not think these principles will have much of an impact on the average person, especially in the short term. I think regulators will be able to justify their decisions, good or bad, without much effort.”

Importantly, the memo doesn’t actually apply to artificial intelligence that the US government itself uses (of which there’s plenty). For instance, a search of a US federal contracts database shows that the Centers for Disease Control has purchased facial recognition products (an AI-based technology), while the Department of Commerce appears to be using AI to improve its patent search system.

One of the reasons AI needs regulations: It comes with risks

AI systems are not inherently objective. Humans build these tools, and AI is often developed using flawed or biased data, which means the technology can inherit or even magnify human biases like sexism and racism. For instance, when in 2017 scientists taught a computer program to learn the English language by mining the internet, it ultimately became prejudiced against women and black people.

Critics say that risk means the government should aggressively regulate, and even ban, certain applications of artificial intelligence. And some AI tools, like facial recognition, that rely on collecting sensitive information, have also spurred concerns about how this tech could potentially create privacy and surveillance nightmares.

“AI systems have a potential to discriminate against the American public on the basis of race, sex, gender — every sort of criteria imaginable”

This all matters because AI already has the potential to have a real impact on your life, even if you haven’t realized it yet. Some landlords have floated requiring tenants to use facial recognition to enter their homes, even though the technology is known to be less accurate on people of color and women (and especially women with dark skin), among other groups. Another example: Though never used, a resume-screening algorithm produced by Amazon inadvertently discriminated against female applicants because it was trained on resumes the company had previously collected, which mostly came from men. Imagine losing out on your dream job because of a biased algorithm.

“AI systems have a potential to discriminate against the American public on the basis of race, sex, gender — every sort of criteria imaginable,” Albert Fox Cahn, an attorney who leads the Surveillance Technology Oversight Project at New York University, told Recode. “This could impact everything from whether you get a job offer, whether you get approved for an apartment or a mortgage, whether you get the good interest rate or the bad interest rate. It could impact college admissions and school placement.”

That’s left him disappointed with the new proposed guidelines. “Rather than provide a framework for regulators to actually address discrimination head-on, instead the White House is urging a hands-off approach which will allow AI to simply target historically marginalized communities without the interventions we need,” said Cahn. He said the memo’s references to values of nondiscrimination and transparency don’t have much force behind them.

“When you think of where most consumers are more AI-vulnerable, it’s in those areas like housing, health care, and employment — the areas that primarily make the front page of the newspaper,” said Turner-Lee. She said it’s not clear what the memo will mean for agencies like the Department of Labor and Consumer Financial Protection Bureau as compared to, say, the Department of Agriculture.

She adds that it’s also not clear whether agencies are actually prepared to identify the risks AI tech poses, or if they’re up to the job of ensuring their regulations keep pace with innovation. “There’s a lot more of the devil in the details that I’d like to see, but I think they’re just trying to give us a general framework for some kind of ethical and fair deployment.”

Now the White House wants feedback, including yours

The draft guidance isn’t set in stone. For the next several months, it will be subject to public feedback, including yours (we’ll update this piece with how to do that as soon as the information becomes available). Once the guidance is formally approved, the White House expects that agencies will report back on how they plan to meet its new AI expectations.

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