New Delhi: TV viewers may be able to switch their DTH or cable service providers without changing the set top box (STB) by the end of this year, according to regulator Trai’s Chairman R S Sharma. “Since last two years we have been trying to make STBs interoperable. Large part of problem has been resolved. There are some business challenges (which) remain… we are looking at this to happen by end of this year,” Sharma told reporters at an event here Tuesday. Also Read – Thermal coal import may surpass 200 MT this fiscalHe added that interoperability in a product should not come as an “after thought” but should be in place at the product planning stage itself. “Open systems are going to be the future. Entire back-end of Aadhaar has been developed on open source software except biometric de-duplication system,” Sharma said. The Telecom Regulatory Authority of India (Trai) chairman released a study on open ecosystem for devices in India, prepared by the Indian Cellular and Electronics Association (ICEA) and consultant firm KPMG, which showed that 89 per cent of mobile phones in the country work on open source operating systems. Also Read – Food grain output seen at 140.57 mt in current fiscal on monsoon boostSharma cited interoperability as one of the key factors behind the success of the Indian mobile phone industry where no subscriber is required to buy a new phone if he wants to change his service provider. “Many apps/services are being accessed primarily on smartphones now. Prevalence of the Open OS has also facilitated smartphones supporting multi-lingual capabilities and also led to the enhancement of the Skill India program by the government,” ICEA Chairman Pankaj Mohindroo said. The report found that Open OS mobile operating systems have expanded the smartphone market in India by reducing barriers to entry. According to the study, smartphones sold in India increased from 2 million units in 2009-10 to 117 million units in 2017-18, corresponding with the increase in smartphone makers from seven in 2009 to around 80 in 2018. India overtook the US to become the second largest mobile phone market in the world in terms of number of units, with the Indian smartphone market growing at a compound annual growth rate of 37 per cent (in value terms) to reach Rs 1.43 lakh crore in 2017.
Rabat – Jailed Moroccan student and far left activist, Mustapha Meziani, died on Wednesday after 72 days of being on a hunger strike in Fez. Moroccan human rights activists are blaming the government for his death.Mustafa Meziani has died after 72 days of a hunger strike in protest of the government’s decision to refuse his demand to be reinstated at the University of Sidi Mohammed Ben Abdellah in Fez.The Moroccan Association of Human Rights (AMDH) has blamed the Moroccan government for the student’s death and earlier this week condemned the Moroccan authorities’ negligence over the health conditions under which Mustafa Meziani was detained. On July 10, Mustafa Meziani was arrested and put surveillance over his alleged involvement in the murder of Islamist student, Abderahim El Hassnaoui.El Hassnaoui had been killed on April 25 during a bloody clash between students from two opposing factions, Al-Tajdid al-Tollabi (OREMA) and Annahj democrati Al Qaidi (or the Democratic Way), on the Fez-Dher Mehrez college campus.Meziani had reportedly denied these charges, and had claimed that his detention was punishment for his activism with the far left group Annahj democrati Al Qaidi. He had decided to go on a hunger strike on July 3 to protest his detention and his exclusion from the university, as well as to demand his right to be reinstated at the university.Meziani was transferred to a treatment room in critical condition on August 4 due to loss of hearing and sight and generally deteriorating health.After Meziani died, Maghreb Arab Presse (MAP) quoted the Fez prison administration as saying that it had done “everything possible to convince him to stop his hunger strike, after he knew that his demand to reinstate to the university had been refused, but in vain.”Meziani’s death has stirred controversy on social media. The activist community has harshly criticized the government. Some of them have accused the Moroccan authorities of persecuting activists who adopt different ideologies to the state institutions’ ideology.A statement issued by the Moroccan Association of Human Rights accused the state institutions of negligence regarding Meziani’s demands. It blamed the head of the government, Abdelillah Benkirane for his death.“We sent an open letter to the head of the government describing Mustapha Meziani’s dangerous health condition before he died, but in vain. It is as if a human being’s life is worth nothing to the Moroccan state, which claims that it respects Human Rights.”© Morocco World News. All Rights Reserved. This material may not be published, rewritten or redistributed
Casablanca — Former Haiti Prime Minister Laurent Lamothe discussed, during an interview with Le Matin, the circumstances behind his decision to withdraw recognition of the Polisario during his term. Despite the various pressures placed on Lamothe and his administration following the decision, the ex-minister told Le Matin that he decided to “do justice to Morocco, a country that has a lot of solidarity with us […] following the 2010 earthquake during which we lost more than 250,000 Haitians and had more than 500,000 injured.”Withdrawing recognition of the Polisario was not an easy decision, however. “I won’t hide that some countries even threatened to cut off the aid they gave our country in order to force our hand and force us to reverse our decision,” Lamothe continues. Many pro-Polisario lobbyists, even in Haiti, made their opinions loud and clear. “We have resisted all these pressures,” Lamothe adds.”That said, we have to stay vigilant, because they have a lot of friends in the region and they continue to put pressure to change the way of things.”“Upon my arrival as Prime Minister, we decided to review our relations with different countries,” he concluded. Haiti withdrew its recognition of the Sahrawi Arab Democratic Republic in an official statement issued on October 2, 2013 by the Haitian Ministry of Foreign Affairs.“This decision,” the ministry said in the statement, “seeks to facilitate the process aiming at resolving this issue at the UN Security Council and supports the efforts of the Secretary General and his Special Envoy to reach a political, lasting and mutually acceptable solution.
MONTREAL — Canadian taxpayers spent almost $500,000 on a study of Bombardier that was launched months before the Montreal company asked the federal government for US$1 billion for its CSeries commercial aircraft, according to documents obtained by The Canadian Press.Industry Canada agreed to pay $499,930 to Deloitte Inc. to prepare a financial and market assessment of Bombardier, said a revised contract obtained through an access-to-information request.That’s higher than the original contract for $464,430 before Deloitte’s deadline to compile the report by Dec. 4 was extended to March 31.Details about the objective of the report were redacted. The government declined to provide the final report, citing clauses under the Access to Information Act that prevent it from releasing information that could harm Bombardier’s competitive position.Air Canada will firm up Bombardier Inc CSeries order within ‘weeks,’ CEO saysBombardier Inc shakes up rail division’s management in EuropeThe study was ordered in August by the previous Conservative government.The Liberal government later reportedly hired Morgan Stanley to help advise it on the funding request made in December by Bombardier. Details about that contract weren’t immediately available.A spokesman for Economic Development Minister Navdeep Bains said the government hasn’t made a final decision on Bombardier’s request.Bombardier is working with the Quebec government to finalize an agreement by June 30 on its commitment to invest $1 billion in the CSeries.Quebec wants the CSeries venture to be spun off into a separate entity, with Ottawa taking a one-third stake. That would take the troubled jet program off the company’s books and boost its short-term financial results.The first of the CSeries jets is entering service in a few months after years of delays. Bombardier has received commitments for 678 planes, including 243 firm orders. It currently controls 50.5 per cent of the CSeries, while Quebec has a 49.5 per cent stake.Under Quebec’s proposal, if Ottawa matches the province’s contribution, both governments would each own one-third stakes in the CSeries, with Bombardier left with the remainder.The Canadian Press
Boyd Group buying Ontario-based Assured Automotive for $193.6 million WINNIPEG – The Boyd Group will more than double its presence in Canada by acquiring 68 collision repair centres in Ontario operated by Assured Automotive Inc. for $193.6 million.The Winnipeg-based income fund (TSX:BYD.UN) says its North American network of collision repair shops will grow to 474 locations when the deal closes, including 110 in Canada.Assured Automotive CEO Desmond D’Silva and president Tony Canade will join the Boyd management team and continue to lead the Assured operation under its own brand name.Boyd will pay for Assured with about $146.1 million in cash and $47.5 million of income fund units priced at $88.31 each, subject to adjustments.The value attached to the trust units is below their market price of $89.77 at the close of trading on Friday. by The Canadian Press Posted May 29, 2017 5:20 am MDT Last Updated May 29, 2017 at 6:20 am MDT AddThis Sharing ButtonsShare to TwitterTwitterShare to FacebookFacebookShare to RedditRedditShare to 電子郵件Email
FacebookTwitter SDPD investigate death of 20-year-old man in the Fox Canyon neighborhood KUSI Newsroom Posted: February 3, 2019 Updated: 6:10 PM KUSI Newsroom, Categories: Local San Diego News SAN DIEGO (KUSI)- A man was found dead in a drainage ditch in the Fox Canyon neighborhood this morning, police said. A 911 call came in at 11:30 a.m. reporting a man down in a ditchbehind a home on Auburn Drive near Loris Street, according to San Diego police Lt. Anthony Dupree.Officers and San Diego Fire-Rescue Department personnel quickly arrived and found a man with trauma to his upper body. He was pronounced dead at the scene, Dupree said.Homicide detectives were investigating, but there was no information on any possible suspects.The victim has not yet been identified, but he was described as an Asian man in his 20s.Police asked anyone with information on the man’s death to call SDPD homicide detectives at (619) 531-2293 or San Diego County Crime Stoppers at (888) 580-8477.Anyone with information regarding this incident is asked to call the Homicide Unit at (619) 531-2293 or Crime Stoppers at (888) 580-8477. February 3, 2019
WATCH – National Ad Features Indiana Soy Farmer and Former State Trooper Brent Bible who cautions: “Our farm and many others like ours will be one of the first casualties of a trade war.”American Soybean Association President: “Retaliation that reduces demand and prices for our crops will further harm farmers and rural communities that depend on exports.”Farmers for Free Trade today released a new national cable television advertisement that highlights the damaging impact retaliation from a series of new tariffs would have on critical American exports. The spot features Indiana soy and corn farmer, and former Indiana state trooper, Brent Bible whose soy operation, like similar producers, relies heavily on exports to China.https://www.youtube.com/watch?v=qTLHdwyMn8A&feature=youtu.be“Today, we farm about 5000 acres and raise primarily corn and soybeans,” Bible says in the 30 second spot. “I’m supportive of the Trump administration, but I have a lot of concerns about current actions that have been taken on trade and tariffs. The fact that China is our number one soy bean customer makes us very vulnerable. Our farm and many others like ours will be one of the first casualties of a trade war.”The message to the president will run for the next two weeks on cable news channels including Fox, CNN, and MSNBC. It will run in the D.C. and Florida markets. The ad will also run online and in ag publications across the country This is the second in a series of Farmers for Free Trade ads that bring the voices of real farmers across America into the trade debate. The first ad featured fourth-generation Montana farmer, Michelle Erickson-Jones. Farmers for Free Trade has also launched a Voice of the Farmer tool on their website that allows farmers to film short messages of support for ag trade that can be shared with lawmakers.Today’s ad comes following tariff announcements on steel and aluminum and on the section 301 intellectual property investigation. Already, China has announced $3 billion in retaliatory tariffs stemming from the steel and aluminum action, with the bulk of the tariffs targeting ag exports. It is expected that China will also retaliate against U.S. exports in response to the 301 tariffs.“China is looking to hit us where it hurts most. That’s why they are going after American ag exports,” said Farmers for Free Trade Co-Chair and former Montana Senator Max Baucus. “We are already seeing fruit, wine and other ag exports being targeted because of the Administration’s actions and we will likely see more tariffs on ag exports in the near future. In a trade war nearly everyone loses, but nobody pays a stiffer price than American farmers.”“The farmers whose livelihoods are on the line need to be heard,” said Farmers for Free Trade Co-Chair and former Indiana Senator Richard Lugar. “Which is why I’m proud to see Brent Bible from my home state come forward to voice the concerns of soy and corn farmers everywhere. The administration needs to understand how the unintended consequences of a tit-for-tat trade fight are going to cause pain in rural communities across the country.”“Crop prices are down 40 percent; farm income is down 50 percent, just in the last five years. Retaliation that reduces demand and prices for our crops will further harm farmers and rural communities that depend on exports” said John Heisdorffer, Iowa farmer and president of the American Soybean Association. “Through groups like Farmers for Free Trade, we’re able to shine a valuable spotlight on Brent, and the thousands of farmers like him who stand to lose if we face retaliation from our largest customer.”Farmers for Free Trade is a bipartisan, non-profit campaign to rebuild support at the grassroots level for trade policies that benefit American agriculture. Farmers for Free Trade works to amplify the voices of millions of American farmers, ranchers and agricultural businesses who want to open new markets for American ag products, protect free trade policies, and reduce risk and uncertainty. Farmers for Free Trade, which is backed by major ag organizations and commodity groups is leading efforts to warn the Administration and lawmakers of the consequences of retaliation on farmers and rural communities.For more on Farmers for Free Trade visit the website.
CLACKAMAS, Ore. – Police and TriMet are looking into an incident on a MAX train from last December after video of a girl being repeatedly hit was posted to the Internet.The incident took place on a MAX train in Clackamas County on Dec. 26. The victim says she boarded the train after shopping at Clackamas Town Center.TriMet says the assault was reported and police went to check out the incident, but when they arrived nothing was happening. No arrests were made and the victim of the assault, a 14-year-old girl, said she did not want to press charges.But a cell phone video of the teen being hit, screamed at and slapped by a group on the train has been making the rounds at local schools after being posted on YouTube. Eventually came to the attention of police and TriMet officials, who say they want to identify the attackers and ban them from riding the light rail line.In the video, no one steps in to defend the victim from her attackers and others can be heard clapping and cheering as the girl is repeatedly slapped and punched. At one point, the victim is seen cowering and holding her head in pain after several female attackers ganged up on her.
Vibe will cut its guaranteed rate base 25 percent in July to 600,000 copies (down from 800,000). The monthly magazine is also trimming its frequency to 10 times per year.“We have to run our business, including circulation, more profitably and we have to be smart about it,” CEO Steve Aaron said in a statement. “Part of that is eliminating less profitable subscriptions while maintaining our significant circulation leadership in the urban lifestyle space. This will help us achieve our goal of providing an even better brand to our audience and advertising partners.” The changes, Aaron said, will “sharpen Vibe’s business model for tomorrow’s media.” According to the Audit Bureau of Circulations, Vibe’s paid and verified circulation slid 8.6 percent during the second half of 2008. Ad pages fell 17.7 percent for the year, according to Publishers Information Bureau figures.Danyel Smith, Vibe’s vice president, editorial director and editor-in-chief, will oversee an editorial department that is shifting its focus to a broader, multiplatform content approach.The company also plans to launch a-yet-to-be-named “urban celebrity” tabloid in December. That magazine will be published twice-yearly. Vibe Media Group today announced a sweeping series of changes it says will position the company for survival and, more importantly, allow the brand to salvage its print magazine without layoffs.Among the changes: Beginning March 1, staffers will be asked to work four days per week, and have their salaries slashed 10 to 15 percent, according to a Vibe spokesperson.“While numerous other media companies (Time Inc, Condé Nast, Meredith and Hearst) have closed titles completely and laid off staff to cut costs,” the company said. “VMG has taken a smarter and more thoughtful approach to workforce adjustments.”
News Billie Eilish Among Headliners For Mad Decent Fest billie-eilish-major-lazer-miguel-play-mad-decent-block-party-festival Email Billie Eilish, Major Lazer, Miguel To Play Mad Decent Block Party Festival Twitter Facebook Set to take place July 20-21 at Gillette Stadium in Foxborough, Mass, the block party will also feature performances by G-Eazy, RL Grime, Zeds Dead, Flosstradamus, A Boogie Wit Da Hoodie, Dillon Francis, Rezz, Pusha T, Jpegmafia and more.According to Variety, this will be the only installation of the Mad Decent Block Party event in North America this year, and will also offer activities, games, and activations, including The World’s Largest Bounce House, go karts, and paintball.Tickets go on sale Friday, Apr. 12 at 10:00a.m. EDT here, with VIP package info on the festial’s website.How Billie Eilish’s Debut LP Proves Album Streaming Still Alive Among Youth In 2019Read more The Diplo-hosted fest will also feature G-Eazy, A Boogie Wit Da Hoodie, Dillon Francis, Rezz and many moreNate HertweckGRAMMYs Apr 8, 2019 – 5:31 pm Not-so-humbly billed as Diplo Presents The Super Mega Ultra Giant Mad Decent Block Party Festival, this year’s Mad Decent block lineup, led by Billie Eilish, Miguel, G-Eazy and Diplo’s own Major Lazer, is worthy of its title.
Like Wilmington Apple on Facebook. Follow Wilmington Apple on Twitter. Follow Wilmington Apple on Instagram. Subscribe to Wilmington Apple’s daily email newsletter HERE. Got a comment, question, photo, press release, or news tip? Email email@example.com.Share this:TwitterFacebookLike this:Like Loading… RelatedOBITUARY: Lawrence “Mike” Considine, 63In “Obituaries”Textron Announces New President & CEO Of Textron SystemsIn “Business”Selectmen Concerned About Future Of Textron Property: Fear Of Condos, 40B Project Or Long-Term VacancyIn “Business” WILMINGTON, MA — Below is an announcement from the U.S. Department of Defense:Textron Defense Systems, of Wilmington, Massachusetts, has been awarded a $51,263,809 firm-fixed-price contract modification to the previously awarded $10,209,413 contract for the Minuteman III Intercontinental Ballistic Missile weapon system multiprobe antenna procurement.Work will be performed at its Wilmington location and is expected to be completed by July 13, 2029.—Textron’s Wilmington location laid off approximately 200 employees in 2016 and another approximately 50 employees in 2017. It is believed that only 50 employees currently remain on the 60-acre site. It’s not yet known if this significant DoD contract will result in Textron increasing its Wilmington workforce.
Police in a special raid arrested two local leaders of BNP and Jatiyatabadi Jubo Dal from Kandipara area of Brahmanbaria town on Thursday night, reports UNB.A team of police conducted the raid and arrested ABM Mominul Haque, joint secretary of district BNP, and the Jubo Dal leader Sharif, said Nabir Hossain, officer-in-charge of Sadar Model police station.
Author and historian Lawrence Jackson has returned home to Baltimore as a Bloomberg distinguished professor of English and history at Johns Hopkins University.Author and historian Lawrence Jackson. (Screengrab from YouTube video)Jackson is known for his scholarship on African-American culture and literature. He wrote a 2002 biography of writer Ralph Ellison, author of the award-winning novel “Invisible Man” and is set to release a biography on writer Chester Himes this summer. Jackson published a memoir of his family in 2012 titled “My Father’s Name: A Black Virginia Family After the Civil War,” and has penned many other books, essays and articles.In keeping with his return to Baltimore, Jackson is set to launch a project celebrating and preserving the culture, arts and history of Charm City, and examining how those assets could become “tools of liberation.” The project, which will begin in 2018 through Johns Hopkins’ Center for Africana Studies, will collaborate with neighborhoods and cultural institutions in the city.Jackson also plans to establish a free jazz concert to honor Baltimore’s jazz legacy, according to Hopkins’ Hub newspaper.“As an innovative, conscientious scholar and biographer, Professor Jackson has recast the study of modern African-American literature and culture,” Beverly Wendland, dean of the Krieger School of Arts and Sciences, said in a statement. “We expect that his new role at Hopkins will only broaden his influence. Beyond that, we look forward to the exciting programs he plans for the university to engage more meaningfully with the city of Baltimore.”Jackson began his teaching career at Howard University, and spent 14 years at Emory University in Atlanta before joining Hopkins.
News | July 28, 2008 FDA Clears BrainLAB’s Monte Carlo Dose Engine July 29, 2008 – BrainLAB said it received 510(k) clearance for its Monte Carlo Dose Calculation Algorithm, which is already being used at several clinical cooperation sites worldwide.The BrainLAB Monte Carlo Dose Calculation software is a high performance Monte Carlo algorithm for therapeutic photon beams supporting nearly all linear accelerator and multi-leaf collimator (MLC) types. Monte Carlo is now available as an option on the iPlan RT Dose treatment planning software. Dose calculations can be completed within seconds for conformal beam and dynamic arc treatments and within a few minutes for complex IMRT cases.This dose calculation engine provides an advanced level of integration, which means its use is not limited to a single machine, multi-leaf collimator, energy or treatment modality and can be seamlessly integrated to drive treatment with Varian, Siemens and Elekta MLCs and linear accelerators. The multitude of treatment plans supported by the Monte Carlo Dose Calculation Algorithm, which include conformal beam, static and dynamic arc, and IMRT treatment modalities.For more information: www.brainlab.com FacebookTwitterLinkedInPrint分享 News | Radiation Therapy | August 15, 2019 First Patient Enrolled in World’s Largest Brain Cancer Clinical Trial Henry Ford Cancer Institute is first-in-the-world to enroll a glioblastoma patient in the GBM AGILE Trial (Adaptive… read more News | Proton Therapy | August 08, 2019 MD Anderson to Expand Proton Therapy Center The University of Texas MD Anderson Cancer Center unveiled plans to expand its Proton Therapy Center during a… read more News | Patient Positioning Radiation Therapy | August 07, 2019 Qfix kVue One Proton Couch Top Validated by Mevion Medical Systems Qfix and Mevion Medical Systems announced that a special version of the kVue One Proton couch top is now both validated… read more Related Content News | Proton Therapy | August 06, 2019 IBA Signs Contract to Install Proton Therapy Center in Kansas IBA (Ion Beam Applications S.A.) recently signed a contract and received the first payment for a Proteus One solution… read more Following radiation, the bone marrow shows nearly complete loss of blood cells in mice (left). Mice treated with the PTP-sigma inhibitor displayed rapid recovery of blood cells (purple, right). Credit: UCLA Broad Stem Cell Research Center/Nature Communications News | Patient Positioning Radiation Therapy | August 15, 2019 Mevion and C-RAD Release Integration for Improved Proton Therapy Treatment Quality Mevion Medical Systems and C-RAD announced the integration between the C-RAD Catalyst PT and the Mevion S250i proton… read more News | Radiation Therapy | August 02, 2019 Varian Showcases Cancer Care Systems and Software at AAPM 2019 Varian showcased systems and software from its cancer care portfolio, including the Identify Guidance System, at the… read more Catalyst PT image courtesy of C-RAD News | Radiation Therapy | August 16, 2019 Drug Accelerates Blood System’s Recovery After Radiation, Chemotherapy A drug developed by UCLA physician-scientists and chemists speeds up the regeneration of mouse and human blood stem… read more The MD Anderson Proton Therapy Center expansion is expected to be completed in 2023. Rendering courtesy of Stantec. Feature | August 05, 2019 | Dave Fornell, Editor Most Popular Radiology and Radiotherapy Topics in July 2019 August 5, 2019 — Here is the list of the most popular content on the Imaging Technology New (ITN) magazine website fr read more The top piece of content in July was a video interview explaining how Princess Margaret Cancer Center is using machine learning to create automated treatment plans. This was a hot topic at the American Association of Physicists in Medicine (AAPM) 2019 meeting in July. News | Brachytherapy Systems | August 14, 2019 Efficacy of Isoray’s Cesium Blu Showcased in Recent Studies August 14, 2019 — Isoray announced a trio of studies recently reported at scientific meetings and published in medica read more News | Radiation Oncology | July 31, 2019 Laura Dawson, M.D., FASTRO, Chosen as ASTRO President-elect The members of the American Society for Radiation Oncology (ASTRO) elected four new officers to ASTRO’s Board of… read more
News | PET-MRI | May 23, 2019 Study Explores Magnetic Nanoparticles as Bimodal Imaging Agent for PET/MRI Researchers from Bourgogne University in Dijon, France, showed that use of superparamagnetic iron oxide nanoparticles (… read more Linking medical imaging to patient outcomes has long been a struggle for the medical community. But when Columbia University released results from a study showing increased utilization of advanced medical imaging improved life expectancy rates by a significant factor1, it appeared that the connection was clear.Less than a year later, however, Congress continues to target medical imaging as a means to cut healthcare costs, ignoring its positive impact on patient outcomes. This has left the medical community wondering if the government’s hard line on medical imaging contradicts its goal to promote comparative effectiveness research (CER), which will inevitably increase the use of medical imaging. Mandate for CEROne of the biggest factors changing the way medicine will be practiced in the United States is CER. It will be a key metric by which the government will establish reimbursement for different medical technologies and treatments.CER, as defined by the Institute of Medicine (IOM), is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care.Since the American Recovery and Reinvestment Act allocated $1.1 billion to the CER initiative, the Federal Coordinating Council for Comparative-Effectiveness Research has been tasked with outlining how to spend the budget. One of the first steps was for the council and IOM to release their recommendations on which diseases CER should start focusing. Top CER DiseasesCancer is the second leading cause of deaths in the United States and is one of the costliest diseases to treat. It is no surprise cancer fell under the six recommended primary CER topics, including screening technologies for colorectal and breast cancers, as well as the use of imaging technologies for diagnosing, staging and monitoring all cancers. Also on the top six list are neurological disorders. These involve diagnostic imaging used for diagnosing neurological conditions; for treating headaches, multiple sclerosis and epilepsy; and for the detection, treatment, and management of Alzheimer’s disease and other dementias.2Another top priority is researching cardiovascular and peripheral vascular disease as they relate to ischemic heart disease, heart failure and cardiac arrhythmias. Two topics focused on the treatment and management of peripheral vascular disorders. Since all of these diseases are largely diagnosed, treated and monitored using imaging studies, CER in all of these areas would increase the use of medical imaging. This is in direct conflict with Congress’ aim to cut healthcare costs by reducing the number of medical imaging exams, and poses an added challenge to those taxed with carrying out CER studies on major diseases. SNM Takes the LeadThe challenge now is to tie imaging to outcomes. Taking the lead on that is Michael M. Graham, Ph.D., M.D., president, Society of Nuclear Medicine (SNM), professor of radiology, director of nuclear medicine, department of radiology. He has established a task force to develop high-quality, comparative effectiveness PET imaging studies as part of the government directive to balance healthcare costs and effectiveness.Dr. Graham has stated that as president of SNM, his vision encompasses three main goals: first, to protect and expand appropriate reimbursement for nuclear medicine procedures; secondly, to provide essential education to members; and thirdly, to preserve and expand funding to support nuclear medicine research and development.Imaging Technology News (ITN) spoke with Dr. Graham about his approach to developing CER for comparative-effectiveness criteria for PET imaging. ITN: Does your initiative to develop high-quality, comparative-effectiveness PET imaging studies tie into these three goals?Dr. Graham: Yes. One of our concerns in PET imaging is that it is under utilized, and it is a very cost-effective procedure, in some settings decreasing unnecessary surgery or chemotherapy, which avoids expensive and ineffective treatment. ITN: How will comparative-effectiveness PET imaging studies balance healthcare costs and effectiveness?Dr. Graham: One of the problems with the way that CMS folks look at imaging is that it’s increasing more rapidly than the costs of medicine. [They] see it as getting out of control and as a major expense to rein in somehow. Their approach is to decrease reimbursement. This is alarming because on one side, they are decreasing the amount of inappropriate imaging that has been done, which is part of the problem with cost of medical imaging, but it is also making it more difficult to do imaging where it is appropriate.We need hard data brought to the argument, and this is where our literature is kind of weak. We are establishing guidelines for developing those studies. We submitted a proposal to the Agency for Healthcare Research and Quality (AHRQ) to fund a workshop to do just that, likely in July. We’ve put together a proposed agenda there, but haven’t confirmed it yet because we are waiting to hear if we will be funded by AHRQ. If we get funded, we’ll shift into high gear, and hope to have the meeting on the NIH (National Institute of Health) campus. We have also put together a smaller meeting on cost and comparative effectiveness…to help us put together the meeting for the summer. Other organizations interested in this area are RSNA (Radiological Society of North America) and ACR (American College of Radiology). Last May, the entire issue on JACR (the ACR journal) was on comparative effectiveness and cost effectiveness. Plus, RSNA [hosted] an exploratory workshop in February in the Chicago area on comparative effectiveness and cost effectiveness.ITN: Does comparative effectiveness tie into the appropriateness criteria that the ACR has been developing?Dr. Graham: Yes, it does because the whole point of cost effectiveness is that it is medical imaging in the appropriate clinical setting. It should be cost effective if it’s appropriate. That is part of the thinking that goes into identifying the appropriateness criteria, and I think going forward the connection between comparative effectiveness and appropriateness criteria will be more explicit. ITN: Has comparative effectiveness proven cost effective for nuclear medicine in the past?Dr. Graham: There is modest literature in nuclear medicine and probably the best has been in using PET imaging for staging of lung cancer. The case is made quite well that it really is cost effective. The problem is that it doesn’t seem to be widely accepted in the oncology community. It’s getting into NCCN (National Comprehensive Cancer Network) guidelines, but there’s an additional job that has to be done to educate the oncologists. This is a difficult task, and it’s one we’re approaching by collaborating with the large oncology societies like ASTRO (American Society for Therapeutic Radiology and Oncology) and ASCO (American Society of Clinical Oncology). We’re sharing speakers between the two organizations, so they can educate us in terms of the viewpoint of the oncologist, and we’re speaking at their meetings to teach them about the capabilities of the imaging approach. I think this is going to lead to more appropriate use of the methodology. The approach to medical care doesn’t change very rapidly, and it takes a long-term commitment to do this. There is a tendency to think that I’ve been using CT, and I don’t need a newer, more expensive test because the one I have is adequate. But does this make a difference in the survival or quality of life of a patient? If you avoid an operation, you avoid the morbidity as well as the expense associated with that. If it was going to be a futile operation, you have saved a great deal. But convincing the surgeons and oncologists of this is a long-term process. Even publishing an article in the New England Journal of Medicine doesn’t necessarily change their behavior. The question that hasn’t been adequately answered is: does this make a difference in the survival of the patient or the quality of life of the patient? We contend that it does. ITN: Do these studies influence CMS (Centers for Medicare and Medicaid Services) in its decision making?Dr. Graham: Yes, you have put your finger on a critical government organization. We need to convince CMS, and it is likely that good cost effectiveness data will convince CMS. But we also have to convince the referring physician. That is an essential educational effort that we have to do and, since the Society of Nuclear Medicine is an educational organization, that is what we are prepared to do, and that is what we are doing. ITN: What are the challenges of developing the criteria for comparative-effectiveness studies?Dr. Graham: The big challenge is relating the imaging study to the patient outcome. There are multiple levels of evaluating imaging studies — from accuracy at the low end to the effect on patient survival and quality of life at the other end. We can show that the PET study changes patient management 30 to 40 percent of the time. We would like to presume the change of management is in the right direction that results in a better outcome, but that has not been well established, and that is what we need to be able to show. The huge challenge in doing that rigorously is ideally you would have a control group. You would have a group of patients and a group of physicians who didn’t use PET in the management of disease, and then you would have another that did. The way things have developed, it’s very hard to do that. We’re having trouble convincing them to do it [because] you get into ethical questions in trying to run trials like that. It is a huge challenge, and one of the things I want to address at the workshop with health technology assessment experts, and bring people from CMS and the FDA (Food and Drug Administration) in to understand how we develop the data we need to establish the cost effectiveness of these procedures. Randomized clinical trials are really unlikely to be the way that we go. What we are trying to assess are the cost effectiveness of the studies for which CMS has already approved reimbursement. If we successfully show that and communicate that to the physicians, we will actually have a net decrease in the cost of healthcare.It’s possible that we will have an increase in the cost of medical imaging. This is an argument we must make very clearly to CMS; they shouldn’t just look at medical imaging in isolation, since the increasing costs of medical imaging are likely to be more than offset by the huge savings derived from avoiding many ineffective clinical treatments. ITN: Could you apply the patient-registry approach?Dr. Graham: Yes, with the patient registry approach there is huge power in going in that direction. I think that a large multi-site study with outcomes is the way to go. This may be a multimillion dollar project involving hundreds of institutions throughout the United States. We intend to do this and build on another major initiative within SNM — that’s our Clinical Trials Network. There we are building a network of sites to participate in clinical trials of PET imaging, and there are well over 200 sites that have already expressed interest in participating in that. I think these same sites would likely be interested in participating in a multi-site registry, if we can do it properly. These are two major issues I wanted to take on as president: clinical trials and cost effectiveness.ITN: How will clinical trials help to improve patient care?Dr. Graham: They will help us avoid ineffective imaging and weed out studies that are not particularly cost effective. We’ll be able to clearly identify areas where we can implement personalized medicine and identify if a treatment is or is not working very early in the course of the therapy. If it’s not working, you save the time and expense, and shift to a more effective treatment. There is a lot of potential for improving patient care, quality of life and outcome. ITN: As for cost effectiveness, how much will comparative-effectiveness for PET cut costs? Do you have a fiscal goal?Dr. Graham: There is not a fiscal goal, and it is going to vary significantly from procedure to procedure. Our initial estimates are in one particular setting, patients with liver metastases with recurrent colon cancer who are candidates for surgical excision of those metastases. In that setting, PET imaging identifies additional disease outside the liver in about one-third of the patients. Those patients don’t undergo surgery, but instead undergo chemotherapy because the surgery would not be effective in extending their lives and would cause a significant decrease in their quality of life. Some years ago, when I did a study at University of Washington, we calculated that it would be cost neutral if we identified one patient out of 17, and instead we were identifying about one in three. The amount of money you are going to save depends on the cost of the operation, but the average savings per patient is in the order of a few thousand dollars, and there is an increased quality of life. So it’s in the right direction for both measures in that you save money and you make the patient more comfortable. We can make a very strong argument that it’s cost effective.[As for developing comparative effectiveness criteria for PET studies,] we know where we’re going, but we don’t know how to get there, and that is why we are organizing these workshops. References:1. Lichtenberg, Ph.D., F. “The Quality of Medical Care, Behavioral Risk Factors, and Longevity Growth.” NBER Working Paper No. 15068. www.nber.org/papers/w15068. June 2009.2. Iglehart, John K. Prioritizing Comparative-Effectiveness Research — IOM Recommendations. NEJM.org. June 30, 2009. 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No related posts. LONDON – Soccer’s governing body warned that it would move World Cup matches should Brazilian cities fail to complete construction projects in time for next year’s event.FIFA’s general secretary, Jerome Valcke, is examining some of the venues being used for the Confederations Cup, an eight-team competition seen as a warm-up for the World Cup, sport’s most-watched event. He said the stadium in São Paulo, which will host the opening match, will be ready, after Tuesday saying delays could mean Brazil’s commercial hub would miss out.“We can’t reduce any requirement: On any competition that would be fine except at the World Cup,” Valcke told reporters after inspecting the Maracana Stadium, the Rio de Janeiro venue that will host both the finals of the World Cup and the Confederations Cup. “The World Cup is 99 percent of the FIFA system. The World Cup has to be perfect. The World Cup is the diamond of FIFA.”FIFA, based in Zurich, makes almost all of its $1.2 billion in annual income from the quadrennial tournament through sales of television rights and sponsorship agreements with companies including Adidas, Coca-Cola and Visa.Several cities have struggled to meet deadlines imposed by FIFA. Valcke, who was joined on Wednesday’s visit by the country’s Sports Minister Aldo Rebelo and Rio Governor Sergio Cabral, was asked several times about the Arena Corinthians in São Paulo, which beat competition from national capital Brasilia and Belo Horizonte to stage the World Cup’s first game.Valcke Wednesday said the São Paulo site would be ready by December, even though construction company Odebrecht said installing the temporary seating needed to increase the 48,000- seat facility to the required 70,000 for the World Cup would take until at least February. The World Cup opens June 12, 2014.Valcke, who oversees the World Cup for FIFA, said his organization would meet with politicians and other stakeholders, including Odebrecht, in the next few days to ensure the stadium is ready.“I can tell you this stadium will be delivered in December 2013,” Valcke said.FIFA is also facing delays with World Cup stadiums in Natal, Coritbia and Cuiaba. Valcke described the Maracana as a “Mecca” of soccer and congratulated workers on their efforts to get it ready before the Confederations Cup. Construction missed several deadlines and the facility will only have one match at capacity — a June 2 exhibition between Brazil and England — before the June 15 start of the tournament.The Maracana was built for the 1950 World Cup, the only other time Brazil hosted the tournament. Its three-year refurbishment at a cost of more than $500 million has faced criticism over delays in construction, costs and plans to privatize the venue.“I know that the refurbishing of Maracana to a certain extent was faced with controversy compared to the first construction of the stadium,” Sports Minister Rebelo said. “I think the visit to Maracana in this last phase after refurbishing the stadium gives us the conviction that Brazil and Rio de Janeiro in fact do have the stadium back with a stage that will be at the right standard for the final match of the World Cup.”FIFA faced similar delays and problems with construction when South Africa in 2010 became the first African country to stage the tournament. Valcke reminded reporters that then, unlike now, one of the Confederations Cup venues, Port Elizabeth, had to be withdrawn over concerns it wouldn’t be ready.“It created a lot of noise and tension between the city and us,” he said. “But this different here, we have been active, we have been helping, often criticizing and pushing. I have to recognize the marvelous job which has been done by the different cities in order to deliver the stadiums beyond deadline but definitely before the Confederations Cup.”© 2013, Bloomberg News Facebook Comments
Facebook Comments Related posts:Where is the environmental discussion in Costa Rica’s presidential campaign? Johnny Araya to launch ‘gratitude tour’ next week Non-career politician Luis Guillermo Solís wins Costa Rica presidential runoff in a landslide Winning on the cheap: Solís campaign spent a quarter of what Araya spent in the last election Rodolfo Piza stumps for the presidency on a horse. (via Instagram) The raucous Palmares Festival kicked off Thursday with the tope, a traditional horse parade. Not surprisingly, some of the country’s presidential candidates made appearances there. If taking the equine vote can determine a country’s president, ruling party candidate Johnny Araya has just moved into the lead. Araya and fifth-place candidate Rodolfo Piza asked for votes while on horseback at the event, not an uncommon method of stumping here. Yes, from atop a high horse. Araya – who is from the northwestern Central Valley coffee town of Palmares – has been doing the tope circuit for years, though this is the first time the ex-San José mayor has done so as a presidential candidate.In late December, Araya participated in the Tope Nacional in the capital. There he was joined by candidates Piza, Oscar López, José Manuel Echandi and one of his top rivals, Otto Guevara.Guevara, atop the horse Rómulo and ever the heartthrob, rode through a crowd of swooning women. La Prensa Libre sighingly described the scene, saying “As per usual Guevara took the catcalls of hundreds of women.” The Libertarian Movement Party candidate is tied with Araya and José María Villalta, of the Broad Front Party, in the latest presidential poll.The tope is a captivating tradition. Candidates are wise to show up there. But what about discussing your platform. Is a horse parade the right place to be taken seriously when speaking about an issue, like say, abortion? López thought so last month.“The tope was very pretty, very well organized and I got to ride the horse La Curul, while promoting my message ‘No to Abortion,’” López told La Prensa Libre.Piza, of the once-strong Social Christian Unity Party, attempted to gain ground in the race by riding again at Palmares. In an interview during La Nación’s live broadcast of the Tope, Piza pleaded for votes while on a steed named Caché.Piza proudly posted his ride to Instagram as a photomontage. Maybe the maneuver will endear himself more with Costa Ricans. Showmanship can work in any election in the world. Still, there’s something farcical about a candidate posting a collage of himself on a horse, as if he were a teenager pasting them into a diary, and appending the photos with the pointless phrase: #UnPresidenteSerio. “A Serious President”
BELGRADE, Serbia (AP) – Serbian ultranationalists held a rally on Tuesday to accuse their country’s president of treason for agreeing to hold talks with the president of Kosovo.The talks between Serbian President Tomislav Nikolic and Kosovo leader Atifete Jahjaga _ scheduled to take place in Brussels on Wednesday _ are part of an EU-brokered effort to improve ties between the former foes. The war ended in 1999 when NATO used a bombing campaign to chase Serbian troops out of Kosovo. Today the mostly ethnic Albanian province is recognized as an independent country by some 90 countries, including the U.S. and most EU members, even though Russia continues to back Serbia’s claim on the territory.Serbian nationalists still consider Kosovo as the medieval cradle of the Serbian state and the Orthodox religion, and they have pledged never to give it up.But Serbia’s government knows it must normalize relations with Kosovo to advance its bid to join the European Union.On Tuesday, dozens of followers of the extreme nationalist Serbian Radical Party rallied outside the Serbian presidency building in downtown Belgrade, waving flags and anti-EU banners. “Nikolic’s decision is clear and obvious treason,” said senior party official Nemanja Sarovic.An elderly man, who identified himself only as Luka, added: “I came here to protest against Kosovo being handed over to the Albanians.”Nikolic is a former ultranationalist who backed the onslaught by Serbian forces on separatists that NATO stopped in Kosovo, but he toned down his rhetoric and proclaimed himself pro-European Union before becoming Serbia’s president last year.In another sign of progress, Serbia’s government on Monday night named its first liaison officer to Pristina. Mary Coyle ice cream to reopen in central Phoenix Former Arizona Rep. Don Shooter shows health improvement Construction begins on Chandler hospital expansion project Top Stories Sponsored Stories Get a lawn your neighbor will be jealous of Comments Share (Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.) Bottoms up! Enjoy a cold one for International Beer Day 5 people who need to visit the Ultrastar Multi-tainment Center 4 ways to protect your company from cyber breaches