Procura Attains Mobile Milestone Topping 3 Million Mobile Healthcare Visits

The Procura Group of Companies announced today that a new record has been achieved with their industry leading mobile healthcare solution securing their position as the most successful provider of mobile community and home care services worldwide.

Today, the Procura Mobile platform has successfully supported the delivery of 3.4 million visits. Additionally, the growth in mobile device use on the Procura platform is growing faster than any other mobile solutions with 1 million visits served every three months. This is forecasted to increase to 1 million visits per month by 2015. The Procura Mobile platform has been in use globally since 2011 providing a mobile solution for home and community care providers across the globe. As the innovators in mobile, Procura continues to bring great technology that allows providers perform their care in the home through the convenience of a mobile device. The Procura Mobile platform supports healthcare visits across a wide range of devices, form factors and operating systems.

"Procura has always seen the use of mobile devices as a critical component in the delivery of the vision of Population Healthcare Management," stated Scott Overhill, CEO The Procura Group of Companies. "Our dedication to blending technology across the continuum of care reflects our vision of healthcare to focus the right tool for the right purpose. As an example, our smart phone solution is ideal for personal support services and routine nursing visits."


American Sentinel University Announces Redesigned Online Master of Science Information Systems Management Program

American Sentinel University, a leading online accredited university offering degree programs focused on the needs of high-growth sectors, today announced it will be offering a redesigned online Master of Science Information Systems Management (MSISM) program beginning in the winter 2014 term.

The MSISM is a nationally accredited 36-credit hour (12 courses) online program designed to focus on the demand for information systems managers in the health care community and its increasing information technology needs. The redesigned program places greater emphasis and exposure on information systems integration and management created by current industry trends such as big data, cloud computing and mobile computing advances.

“American Sentinel’s Master of Science in Information Systems Management program teaches the skills needed in management of current and evolving technology practices with a focus on the health care industry, while providing an educational foundation for professional growth,” says Kurt Linberg, Ph.D., provost at American Sentinel University.

Program Shaped by IT and Health Care Leaders The program blends theory and practice and leverages action learning with a technology curriculum delivered by expert faculty with real-world health technology exp

erience that help students master skills applicable to real-word needs. As a result, students in the MSISM program will develop a thorough knowledge of the field and master the following skills for future professional growth:

Apply advanced information systems tools, techniques and methodologies to solve and prevent problems in health care organizations.

Incorporate ethical principles into business strategies and project management.

Manage health care information systems development projects from inception to conclusion.

Identify future strategic initiatives for a health care organization’s information systems/IT function.

Identify opportunities and problems in a health care system, critically analyze possible solutions and tools relevant to these topics and clearly communicate a recommended system specification.

Advantages for IT Professionals and Career Changers

The North American health care information technology market (HCIT) is forecast to grow at a compound annual growth rate of 7.4 percent and is expected to reach $31.3 billion by 2017 due to increasing demand for clinical information technology and administrative solutions and services. Dr. Linberg notes that as health care continues to rely on computer systems in their organizations, there will be an even greater demand for professionals who have mastered these important technology skills.

He notes that the MSISM program is ideal for those seeking a transition to a new career in health care or for technology professionals looking to enhance their credentials with management integration and advanced technology skills.

“Expertise in information systems integration and management, expanding your computer skills and increasing your knowledge in big data, cloud and mobile technology ensures that professionals will be proficient in solving technology challenges,” says Dr. Linberg. “Our MSISM program will help make a professional invaluable in the current health care job market and in the future.”

American Sentinel University’s MSISM program is accredited by the Distance Education and Training Council (DETC) and is an approved education partner of 36 major U.S. hospital systems. The university offers real-world application, experienced faculty and learning outcomes that support clinical or administration decision-making to meet the latest operational, legislative and accrediting requirements.


Combined Fluoroscopy Solution Provides Excellent Image Quality At Eastbourne DGH

Eastbourne District General Hospital, part of East Sussex Healthcare NHS Trust, is benefitting from high quality images for enhanced clinical diagnosis following the installation of an AXIOM Luminos dRF™ from Siemens Healthcare.

The two-in-one fully digital radiography and fluoroscopy system produces instant images via the fixed 43cm x 43cm detector in the table and the wireless detector. The system’s flexibility is allowing Eastbourne DGH to use it for a wide variety of fluoroscopy imaging procedures on a daily basis as well as digital x-ray imaging. The Luminos dRF was primarily chosen due to its CARE (Combined Applications to Reduce Exposure) features which support excellent image quality at the lowest achievable X-ray dose.

Throughput has also been enhanced due to the versatility and mobility of the wireless detector and the low table which allows geriatric and bariatric patients to use it with minimal handling and eliminating the use of a hoist. The Luminos dRF benefits from advanced post-processing features such as its enhanced DiamondViewPlus software. This helps the hospital to optimise the detail contrast and noise level of images to further improve quality and reduce the need for retakes. In turn this assists with maximising productivity, allowing clinicians to make accurate decisions in a short amount of time.

“We were facing challenges due to patients with limited mobility struggling to get on the previous table. The Luminos dRF solves this by providing a low table and enhanced weight capacity, meaning minimal handling is needed to position the patient,” states Kathryn Dixon, Clinical Modality Manager of General, Interventional, Mammography and Fluoroscopy at Eastbourne District General Hospital. “The Luminos dRF system has already proven to be as easy-to-use and intuitive as our other Siemens systems on site and the applications team was superb when it came to installation and training.”

“As the NHS faces challenges such as an ageing population and an increasing numbers of bariatric patients, everyday imaging systems need to be flexible and accommodating to meet these changes. The Luminos dRF tabletop can go as low as 48cm, making positioning easier for heavier or immobile patients,” states Paul Vaughan, Regional Sales Manager at Siemens Healthcare. “We are delighted Eastbourne DGH is benefiting from improved departmental workflow and an enhanced patient experience as a result of the installation.”


Charlotte Area Hospice Uses Technology to Improve Patient Care

Catawba Regional Hospice's 200 employees are committed to providing top-notch care to the seriously ill in need of palliative care.

With a 34-year history serving patients in the communities of Newton and Hickory, N.C., the facility has turned to technology to improve operations. Catawba Regional Hospice recently began using Android-based CellTrak devices and mobile-Internet enabling air cards to automate workflow and reduce costs. Daily rounds for nurses are comprised of visiting patients at their homes, and CellTrak has simplified each nurse's routine. CellTrak automatically records mileage and provides a comprehensive report complete with driving directions sent to the nurse's smartphone. The device also relays patient status and records back to headquarters over Verizon's 4G LTE wireless network.

"With new technology, our clinical staff now spend more time with patients and their families instead of filling out paper reports," said Tammy Jensen, finance director for Catawba Regional Hospice. "The result has been improved operational efficiencies that translate into reduced costs. We've already seen a $70,000 per year savings since adopting CellTrak and other Verizon Wireless devices."

The hospice's nursing team is now able to visit 90 additional patients each week. Jensen says, "Since our high-tech makeover, our patients and their families report being more satisfied with the level of care they receive. Verizon helped craft a way for our company to become better at what we do, and we're grateful for that."

Catawba Regional Hospice recently was named a winner of the 2013 Wireless Technology Innovation Awards - a competition for small and mid-sized businesses - and awarded a $10,000 grand prize for using technology in an innovative way.


Child at St. Louis Children's Hospital One of First in the Midwest to Receive Implantable Heart Pump

Ten-year-old Jacque Fair is one of the first children in the St. Louis area to receive an implantable heart device commonly used in adults.

“The internal ventricular assist device has been used in adults for years,” explains Mary Mehegan, RN, VAD coordinator for St. Louis Children’s Hospital, “but it’s only recently become an option for smaller patients due to Heartware’s smaller technology.”

Jacque, who was diagnosed this summer with myocarditis and cardiomyopathy, became the hospital’s fourth patient to receive a Heartware device since it began using the technology in 2012. Jacque will likely require a heart transplant. First, her organs need a chance to recover from several months of deterioration. Her problems began over the summer, when she started having trouble breathing. She assumed it was asthma. “I have a history of asthma,” she says. “I was back and forth from the emergency room for weeks.” X-rays at her hometown hospital revealed an enlarged heart, so doctors referred her to the children’s hospital in Kansas City. Further medical evaluation revealed the complexity of Jacque’s needs, so the team transferred her to St. Louis Children’s Hospital, where the medical team led by Dr. Charlie Canter, determined her heart failure had progressed to the extent she’d need an assist device to bridge her to a heart transplant.

“Application of this technology in children may eventually allow physicians to ‘defer’ a decision on transplantation and give a child’s native heart a better chance for recovery,” says Dr. Canter, director of the heart transplant program at St. Louis Children’s Hospital and the Lois B. Tuttle and Jeanne B. Hauck Professor of Pediatrics at Washington University School of Medicine. “It also allows patients with end-stage heart failure who are not heart transplant candidates to have effective therapy.”

Relatively new to the pediatric population, it is believed fewer than ten children’s hospitals in the nation have used implantable ventricular assist devices.

“This is the forefront for care of children with heart failure resistant to medical management,” explains Dr.Umar Boston, pediatric cardiothoracic surgeon, who implanted Jacque’s Heartware. “We don’t have an ideal device for kids right now, but we’re learning how to adapt this adult device successfully in adolescent sized children.”

Heartware is a disk-like device sewn into the heart’s left ventricle that pumps blood when the heart is too weak to do so on its own. It is connected by a lead through the abdominal wall (drive-line) to a controller and battery pack that fit into a small handbag and weigh less than 4 pounds, making it possible for a child to be discharged from the hospital and return to normal activity while awaiting transplant. Teenagers and children as small as 65 pounds can now be candidates for the internal pump. “We discharged a child on the device late last year and that child has actually returned to school,” says Mehegan.

“That’s a really big deal.” Small children and infants don’t have the space in their small chest cavities to accommodate most implantable technology currently available to adults. Smaller kids would still use a Berlin heart, an external pumping device that was championed and FDA-approved – with help from St. Louis Children’s Hospital – for children of all sizes, including infants. Both internal and external pumps allow patients in heart failure to become more stable.

“They allow a patient to build strength and rehabilitate before having a transplant,” says Mehegan. It also buys them time to wait for donor organs. Jacque hopes to go home from the hospital with her Heartware pump in the next 1-2 weeks. “I’m not sure if I’ll be comfortable sending her back to school,” says Jacque’s mom, Katrina. “That will depend on how willing the school is to learn about managing the device.” But it will allow Jacque the opportunity to be home-schooled, play with her three siblings, and continue building back her strength as she awaits a heart transplant.


World Mobile Healthcare (mHealth) Market 2013-2018 - eHealth, Telemedicine & Health Informatics

The recent explosion in mobile communications has been driven by increased uptake of devices such as the smartphone and tablet.

Synonymous with these devices are app stores which offer a huge array of downloadable programs and services, many of which apply to the healthcare field. As 4G and LTE promise to transform bandwidth , we expect the usage of mobile devices to expand to encompass many fields, especially that of healthcare. Visiongain has determined that the value of the global mHealth market in 2013 will reach $2bn.

The potential benefits of mHealth solutions include improving healthcare system processes, collecting and retrieving crucial medical data and patients being able to manage chronic conditions better. Mobile communications can also transform how subscribers who live in remote or rural areas access health advice and how patients in these areas communicate with their healthcare practitioners. Dedicated devices that perform medical functions can utilise mobile technologies such as the cloud allowing data to be uploaded and downloaded instantly. The mHealth ecosystem includes mobile operators who are set to reap revenues from increased data consumption. Healthcare practitioners will find workloads decreased and greater efficiency in treatments.

Software and app developers will gain wide revenue streams from the creation of popular apps or solutions either through consumer purchase or subsidised purchase by health insurance companies. Governmental bodies and pharmaceutical companies can also increase savings and revenues from mHealth. The report covers leading companies in the mHealth space and provides information on global revenues, regional revenues, service types and end user perspectives. There are two exclusive interviews from leading members of the mHealth ecosystem provide insider information and analysis reinforcing visiongain forecasts.

Get a copy at:


d-Wise Technologies Partners with Futrix Health to Deliver Healthcare Analytics and Business Intelligence Platform for Population Risk Management

d-Wise Technologies, a leading life science and healthcare technology solution provider and Futrix Health, a leading healthcare business analytic software solution provider, announced today that they have signed a formal partnership to provide consulting, implementation and integration services for Futrix Health - a Risk-Management Solutions Platform - throughout the United States and Europe.

Futrix Health is a revolutionary data analysis solution for payers, providers, and other healthcare organizations that require population-based metrics for analyzing complex and disparate healthcare data. Data analytics for population risk management and business intelligence (BI) remain a primary focus for the healthcare industry—both in terms of delivering effective outcomes and getting ever-escalating costs under control.

The Futrix Health platform features flexible, “drill-anywhere” self-service business intelligence coupled with an analytic engine that empowers users to create virtually any kind of measure, grouping, or viewpoint and then freely analyze it across all relevant data sources. d-Wise specializes in delivering technology solutions and services to support data management, data warehousing, programming, analytics, and reporting. Over the past decade d-Wise has earned a reputation for exacting quality through numerous technology implementations by leveraging an extensive knowledge of SAS, systems implementation, integration and validation.

The ACA allows and encourages states to create health insurance exchanges (HIE) designed to make health insurance more competitive and affordable. These health exchanges provide a treasure-trove of primary data. To leverage that data asset, states can create their own business intelligence (BI) platform, utilize third-party self-service analytics, or make a substantial investment in one of the major solution providers of business intelligence and predictive modeling. The d-Wise/Futrix Health Risk Management solution provides a unique and affordable alternative that can rapidly deliver new insights and business value.

“Futrix Health’s Risk Management solution platform’s business focus, ease-of-use and affordability made a formal partnership quite attractive for d-Wise,” said Jack Shoemaker, VP Healthcare Practice, d-Wise. The platform has many advanced features that make it ideal for the analysis of population-based metrics. “We’re excited to be partnering with Futrix Health to help deliver this solution to the healthcare market, where we can leverage our extensive knowledge of SAS as well as our experience with healthcare systems, processes and data to deliver a complete self-service business intelligence platform.”

“The combination of d-Wise’s healthcare and risk management domain expertise along with the Futrix Health’s game changing healthcare analytic functionality provides a powerful solution for the healthcare industry,” adds Jack Duncan, CEO of Futrix Americas.


UK’s First Integrated MR/PET System Marks One Year Of Pioneering Research

The University College Hospital Macmillan Cancer Centre, part of University College London Hospitals NHS Foundation Trust, is celebrating the one year anniversary of the installation of the UK’s first MR/PET system, the BiographTM mMR from Siemens Healthcare. The world’s first fully integrated MR and PET scanner has expanded horizons for research to better understand, diagnose and address priority diseases including heart attack, stroke and dementia. It allows for the simultaneous acquisition of MR scans with their excellent anatomical and functional information together with PET scans which can depict cellular activity.

Siemens Healthcare, the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre and NHS patients have all worked in partnership to drive forward the technological advances that impact on key diseases. The Biograph mMR is used for clinical and research purposes at the University College Hospital Macmillan Cancer Centre, and was installed in 2012 to help investigate and improve the understanding of cancer, as well as to help deliver new improved patient treatment pathways. There are 20 active research projects utilising the system and it is hoped the combination of clinical applications, innovative technology, leading researchers and industry support will allow the Biograph mMR to deliver immediate benefits and continue to evolve to meet its full potential.

The use of a combined MR and PET system provides benefits for the hospital and the patient, producing excellent image quality and helps to improve the diagnosis and monitoring of cancer. The Biograph mMR can provide information on blood flow to monitor a tumour’s response to chemotherapy utilising its powerful 3T MR imaging capability. The combination of high quality MR imaging with simultaneous PET, increases the power of both methods, enabling clinicians and researchers to monitor cell activity levels, potentially removing a requirement for two separate examinations. The single seamless examination offers comprehensive diagnostic imaging for the delivery of critical information used in the early detection and effective staging of disease. The Biograph mMR also allows for the more precise alignment of MR and PET, beneficial in several applications including staging, prostate cancer imaging and evaluation of smaller lesions.

“The Biograph mMR installation at UCLH was a landmark in innovation driving clinical work and oncology research in the UK, made possible by a close collaboration between Siemens and the Biomedical Research Centre,” states Peter Harrison, Managing Director UK at Siemens Healthcare.

“The innovative MR/PET system delivers comprehensive diagnostic imaging that is critical during the early detection and staging process and we look forward to its discoveries and crucial steps towards the advancement of cancer research and care.”

Research infrastructure provided by the NIHR University College London Hospitals Biomedical Research Centre has enabled £1.6million of research activity on the scanner over 3 years as well as funding a dedicated MR/PET clinical scientist to work on the system. The UCLH Charity helped to fund the initial capital outlay required to spur the research into action.

NIHR funding with grants from other research councils such as the European Research Council and the Engineering and Physical Sciences Research Council has supported UCLH’s ambitions. The unit has also been able to attract funding from charitable institutions including Wolfson Brain and Cancer Research UK. Industrial sponsorship has also been attracted from GlaxoSmithKline, who are supporting an ambitious programme investigating the role of fibrosis in many diseases.

“The Institute of Nuclear Medicine is at the forefront of clinical imaging; we were the first in the UK and fifth in the world for clinical PET-CT. When seeking simultaneous MR and PET imaging, we looked to Siemens who brought something unique to the market with the Biograph mMR,” states Professor Ashley Groves, Head of the Institute of Nuclear Medicine at UCL and Academic Lead at the Department of Nuclear Medicine at University College Hospital. “The system is being used for translational research, ensuring that we are transforming scientific knowledge into visible clinical benefits at UCH.”

“The applications for the system are wide-ranging, from providing early diagnosis in dementia, individualised treatment in oncology to better understanding of a range of conditions such as myocardial disease,” continues Professor Ashley Groves. “The overarching objective is to better understand, diagnose and address priority diseases including heart attack, stroke and dementia. The research has been groundbreaking in the way we have been able to better characterise individual tumours, enabling the most suitable treatment is provided and facilitating early detection. We look forward to witnessing the first clinical benefits of this research over the coming months.”

Dr Bomanji, Clinical Lead at the Department of Nuclear Medicine at University College Hospital states “The Siemens Biograph mMR is a novel machine and prospective data is being acquired to establish its use. In our experience, there is potential for MR/PET to further refine staging. Monitoring treatment response in tumours and radiotherapy planning are also potential uses of MR/PET. MR/PET imaging may benefit patients with dementia and epilepsy. These prospective indications might have a significant effect on patient outcomes.” A wide range of healthcare professionals including clinical imagers, technologists and physicists worked closely with Siemens to gain the desired output from the state-of-the-art MR/PET imaging system in its first year at the University College Hospital Macmillan Cancer Centre.


HTM Speaks With Frank Lievens, Secretary/Treasurer, ISfTeH

HTM Speaks With Frank Lievens, Secretary/Treasurer, ISfTeH

Frank Lievens is the Secretary/Treasurer of the ISfTeH, an NGO in official relations with the World Health Organisation. With a Master in Economic and Diplomatic Sciences since 1989, Frank has been involved in Telemedicine since 1989 via a keen interest in Home Care Applications. Frank is also the Managing Director of LIEVENS-LANCKMAN BVBA and AKROMED FRANCE, two companies involved in the manufacturing and global distribution of Medical Devices.

Fact File

  • International Coordinator of MED-e-TEL in Luxembourg
  • Board member, Secretary and Treasurer of the ISfTeH
  • Was involved in the creation of MED-e-TEL, the International Educational & Networking Forum for eHealth, Telemedicine & Health ICT, taking place yearly in Luxembourg and acts as its Director.
  • Was elected to the Board of the ISfTeH (International Society for Telemedicine & eHealth) in September 2003 as Treasurer, and re-elected in December 2007 as Secretary-Treasurer.
  • Has been attending many Telemedicine Conferences and Events in various countries 

He was involved in the creation of MED-e-TEL, the International educational & Networking Forum for eHealth, Telemedicine & Health ICT, taking place yearly in Luxembourg and acts as its International coordinator. He was elected to the Board of the ISfTeH (International Society for Telemedicine & eHealth) in September 2003 as Treasurer, and re-elected in December 2007 as Secretary-Treasurer.

He has attended many Telemedicine Conferences and Events in various countries: Albania, Argentina, Australia, Austria, Belgium, Bosnia & Herzegovina, Brazil, Bulgaria, Canada, China, Croatia, Czech Republic, Denmark, Egypt, Finland, France, Germany, Hungary, India, Israel, Italy, Kenya, Luxembourg, Macedonia, Malaysia, Nigeria, Norway, Poland, Romania, Russia, Slovenia, South Africa, Spain, Sweden, Switzerland, The Netherlands, U.A.E., U.K., Ukraine, U.S.A. Presentations on the Global Vision about Telemedicine/eHealth were made in: Abu Dhabi, Abuja, Antwerp, Bangalore, Berlin, Bhubaneswar, Brisbane, Brussels, Budapest, Cairo, Cape Town, Chandigarh, Chennai, Copenhagen, Dubai, Durban, Donetsk, Fiuggi, Guanzhou, Joensuu, Kuala Lumpur, Kunming, London, Luxembourg, Lyon, Mangalia, Moscow, Nairobi, New Delhi, Ottawa, Parana, Paris, Perth, Pune, Sao Paulo, Sarajevo, Saratov, Skopje, Sofia, Tarusa, Tirana, Tromsö, Vienna, Warsaw, Zagreb.

What opportunities currently exist in the global telemedicine industry?

One should actually first define “Telemedicine Industry” ! Telemedicine is covered by many different industrial applications, going from Medical Devices, via IT and Telecommunication, to even Textiles (wearables) and many others. That in itself is already quite a broad scope of opportunities. In fact, Telemedicine I not an industry by itself, but calls upon the input of many industries.

How well are caregivers adopting telemedicine technology?

This is an ongoing process, in the same way as ICT technologies made their way into our daily lives and activities over the last 30 years. Yet, since human health is involved, it goes somewhat slower. But the new generation of caregivers is already very familiar with the modern communication tools and is adopting faster and better telemedicine technology.

What applications does telemedicine suit?

Technologically it can be almost anything. All medical “specialities” can become “Tele”. But the human factor must prevail. If and when Telemedicine allows to treat and serve better the patient (also to more efficient means at the hands of the caregivers), then it fully responds to its goals and potential.

As healthcare moves towards Big data, what security risks exist in telemedicine?

In my opinion, there are no more security risks in Telemedicine than there are or were in the traditional systems so far. Security risks have always existed ! It is correct though that modern ICT allows to register and use far more data than before. But it also allows to develop better security tools. Behind any technology are humans. Therefore it is the responsibility of all partners involved in the telemedicine process to define properly all ins and out’s and to install adequate procedures.

What vital signs may be monitored with telemedicine?

As indicated before, almost any vital parts of the human body can be monitored with Telemedicine. Just refer to : Tele-Dermatology, Tele-Cardiology, Tele-Oncology, Tele-Odontology, Tele-Ophtalmology, Tele-Periodontics, Tele-Woundcare, Tele-Pediatrics, Tele-Psychiatry, etc…

Can telemedicine consultations replace face-to-face appointments?

Telemedicine will never fully “replace” face-to-face appointments. It will run in parallel or in addition. It will be most useful when the patient cannot physically cover the distance to the physician, or in order to avoid costly travels. Specific situations will determine whether a face-to face appointment is mandatory. If not, contact between the patient and the healthcare professional can now be taking place at a distance, thanks to the Telemedicine tools.

In an insurance based healthcare culture, where does telemedicine fit in?

Unfortunately it has not yet found its place. But it definitely will at some point. This will probably come in step by step, and also varying from country to country, from Insurance system to another. I consider it essential to start with establishing a Telemedicine/eHealth nomenclature, creating a list defining Telemedicine acts, products, filled in with the respective cost prices. The next step will then be to decide what will be up for reimbursement and at what level. It would be great if this could be a trans-boarder exercise (e.g. at European Union). But this may be too much asked at this point in time.

What initiatives are the ISFTeH currently spearheading in the business?

The ISfTeH at this point is essentially a “Networking” Society. Its mission is to facilitate the international dissemination of knowledge and experience in Telemedicine and eHealth and to provide access to recognized experts in the field worldwide. Emphasis is on developing and emerging countries.

How will The Telehealth Promotion Act of 2012 improve the industry?

We can only trust that it will. It is quite difficult to already evaluate at this point.

Where will the telemedicine industry be in 5 years time?

Two pieces of good news : a. there is no way back! b. the future of Telemedicine/eHealth does not evolve between two parallel lines. They evolve between two permanently enlarging axes, meaning that, as we speak, the scope become broader and the potential increases day by day. My vision and hope are that eHealth/Telemedicine will grow in such a controlled way that, maybe within the 10…20…50 years, there will be no more need to talk about it, as it will have melted entirely in the common practice of medicine and health policies.

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