Podcasts about population medicine

A recent study in JAMA Network Open evaluates the use of machine learning algorithms to assess the management of urinary tract infection (UTI). Author Sanjat Kanjilal, MD, MPH, professor in the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Healthcare Institute, joins JAMA Associate Editor Yulin Hswen, ScD, MPH, to discuss this topic and more. Related Content: Researchers Use Machine Learning to Put Older Clinical Guidelines to the Test Use of Machine Learning to Assess the Management of Uncomplicated Urinary Tract Infection

This episode features Amy Brown (Marie Curie Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK. Swansea University Medical School, Swansea University, Swansea, UK)   What is already known about the topic? The third World Health Organization Global Patient Safety Challenge ‘Medication without harm', emphasises the need for improved infrastructure through better reporting practices and cross-organisational learning from adverse events and near misses. Medication is implicated in one-fifth of serious palliative care patient safety incidents, with approximately 25% of these incidents involving continuous subcutaneous infusions. Inadequate analysis of continuous subcutaneous infusions as safety-critical, risk-prone interventions dependent on complex structural and human factor issues is a lost opportunity for learning.     What this paper adds? Continuous subcutaneous infusion incidents occur across all settings including the home, hospices and hospitals and particularly after the transfer of patients between settings with harm present in nearly three-quarters of reports. Multiple points of system failure were identified in continuous subcutaneous infusion incident reports including monitoring and supply (405, 31%), administration (383, 29%) and prescribing (268, 20%); recurring contributory factors included discontinuity of care within and between care settings, inadequate time, inadequate staffing and unfamiliarity with protocols. Narrative descriptions of psychological and social harm, alongside physical harm risk, are not being adequately recognised or responded to through existing approaches to measure harm in palliative care, hindering learning in practice   Implications for practice, theory, or policy The structural changes needed to minimise harm and maximise safety in palliative care are likely to be replicated in other parts of the world where patient safety reporting practices are less well established, for example, shifting from focussing on lack of experience and competency at an individual practitioner-level to addressing deficits in working environments and infrastructures for care provision. When patients move between care locations, more attention should be given to the timeliness and effective transfer of medication management (e.g. if someone is discharged from hospital to a care home that rarely uses continuous subcutaneous infusions for palliative care, this needs to be preceded by refreshing staff skills and ensuring they can access further community support if needed). Professional training and further research are needed to increase quality of reporting of psychological and social harms (including for families and other stakeholders involved) to facilitate organisational learning and pinpoint precise targets for further improvement.     Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163241287639  If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

CheloniaCast is joined by Dr. Oz Ossiboff to discuss turtle and tortoise veterinary medicine and pathology. Dr. Ossiboff is DVM/PhD at the University of Florida College of Veterinary Medicine in the Department of Comparative, Diagnostic & Population Medicine. The conversation ranges from pathology to the relationship between captive reptile keepers and exotic veterinarians. The testudine immune system is also discussed in some detail, with discussion of various diseases including testudine herpesvirus and Testudine Intranuclear Coccidiosis. The technology used in pathology is fascinating and also discussed.   To learn more about Dr. Ossiboff and view some of Dr. Ossiboff's publications check out: https://www.vetmed.ufl.edu/profile/ossiboff-robert/   Learn more about the CheloniaCast Podcast here: https://theturtleroom.org/cheloniacast/   Learn more about the CheloniaCast Podcast Fund here: https://theturtleroom.org/project/cheloniacast-podcast/   Follow the CheloniaCast Podcast on Instagram/Facebook/Twitter @cheloniacast   Host social media - Jason Wills - @chelonian.carter / Michael Skibsted - @michael.skibstedd / Jack Thompson - @jack_reptile_naturalist_302 / Ken Wang - @americanmamushi / Wyatt Keil - @wyatts_wildlife_photography / Paul Cuneo - @paul_turtle_conservation42 / Alex Mione - @alex.mione

What is the MOSAIC-NLP project around structured and unstructured EHR data? Why is structured data not really enough for drug safety studies? And to what degree is NLP speeding up access to data and research results? We will learn all that and more in this episode of Research in Action with Dr. Darren Toh, Professor at Harvard Medical School and Principal Investigator at Sentinel Operations Center. www.oracle.com/health www.oracle.com/life  www.sentinelinitiative.org -------------------------------------------------------- Episode Transcript: 00;00;00;00 - 00;00;26;14 What is the MOSAIC and LP project around structured and unstructured data? Why is structured data not really enough for drug safety studies? And to what degree is NLP speeding up access to data and research results? We'll find all that out and more on this episode of Research in Action. Hello and welcome to Research in Action, brought to you by Oracle Life Sciences.   00;00;26;14 - 00;00;50;14 I'm Mike Stiles. And today our guest is Dr. Darren Toh, professor at Harvard Medical School and principal investigator at Sentinel Operations Center. He's got a lot of expertise in Pharmacoepidemiology as well as comparative effectiveness research and real-world data. So, Darren, really glad to have you with us today. Thank you. My pleasure to be here. Well, tell us how you wound up where you are today.   00;00;50;14 - 00;01;26;22 What what attracted you in the beginning to public health? Good question. So I trained in pharmacy originally, and I got my Masters degree in Pharmaceutical Outcomes Research at a University of Chicago, Illinois, Chicago. And it's where I first learned about a field called Pharmacoepidemiology, which sort of very interesting to me because I like to solve problems with methods and data and pharmacoepidemiology.   00;01;26;22 - 00;02;00;29 It seems to be able to teach me how to do that. So I got into the program at the Harvard School of Public Health, and when I was finishing up, I was deciding between staying in academia and going somewhere and getting a real job. And that's when I found out about an opportunity within my current organization and I've heard great things about this organization.   00;02;00;29 - 00;02;29;26 So I thought I would give it a try. And the timing turned out to be perfect because when I joined, our group was responding to a request for proposal for what is called a mini sentinel pilot, which ultimately became the sentinel system that we have today. So I've been involved in the Sentinel system since the very beginning or before we began.   00;02;29;28 - 00;03;02;25 And for the past 15 years I've been with the system and the program and because I really like its public health mission and I'm also very drawn to the dedication of FDA, our partners and my colleagues to make this a successful program. Well, so now here you are, a principal investigator. What exactly is the Sentinel Operations Center? What's what's the mission there and what part do you specifically play in it?   00;03;02;27 - 00;03;52;26 Sentinel is a pretty unique system because it is a congressionally mandated system. So the Congress passed what is called the FDA Amendments Act in 2007. And within that FDA, the Congress asked FDA to create a new program to complement FDA existing systems to monitor medical product safety and more specifically, the Congress, US FDA, to create a post-market risk identification and analysis system that will be using data from multiple sources that will cover at least 1 million lives to to look at the safety of medical products after they are approved and marketed.   00;03;52;28 - 00;04;33;07 So in response to this congressional mandate, FDA launched what is called a Sentinel initiative in 2008 and in 2009 as I mentioned, FDA issued its request for proposal to launch the Mini Sentinel Pilot program, and the program grew into the sentinel system that we have today. So it's for my involvement. It sort of grew over time. So when I joined, as I mentioned, we were responding to this request for a proposal and we were very lucky to be awarded the contract.   00;04;33;09 - 00;05;04;05 So when it was starting, I serve as a one of the many epidemiologists on the team and I led several studies and I gradually took on more leadership responsibility and became the principal investigator of the Sentinel Operations Center in 2022. So I've been very fortunate to have a team of very professional and very dedicated colleagues within the operations center.   00;05;04;05 - 00;05;27;26 So on a day to day basis, we work with FDA to make sure that we can help them answer the questions they would like to get addressed. And we also work with our partners to make sure that they have the resources that they need to answer the questions for FDA. And most of the time I'm just the cheerleader in chief just to share my colleagues and our collaborators.   00;05;27;28 - 00;06;11;23 Now that's great. And and then specifically, there's the Mosaic NLP project that you're involved with. What is that trying to achieve and what are the collaborations being leveraged to get that done? So Sentinel Systems has always had access to medical claims data and electronic health record data or year data. One of the main goals for the current sentinel system is to incorporate even more data, both structured and unstructured, into the sentinel system and to combine it with advanced analytic methods so that FDA can answer even more regulatory questions.   00;06;11;25 - 00;06;40;09 So the Mosaic and NLP project was one of the projects that FDA funded to accomplish this goal. So the main goal of this project is to demonstrate how billing claims and data from multiple sources when combined with advanced machine learning and natural language processing methods, could be used to extract useful information from unstructured clinical data to perform a more robust drug safety assessment.   00;06;40;11 - 00;07;21;18 When we tried to launch this project, we decided that we would issue our own request for proposal. So there was an open and competitive process, and Oracle, together with their collaborators, were selected to lead this project. So I want to talk in broad or general terms right now about data sharing, the standards and practices around that. It kind of feels silly for anyone to say it's not needed, that we can get a comprehensive view and analysis of diseases and how they're impacting the population without it.   00;07;21;20 - 00;07;46;15 NIH is on board. It updated the DMS policy to promote data sharing. You know, the FDA obviously is leaning into this. So is data sharing now happening and advancing research as expected, or are there still hang ups? So I think we are making good progress. So I think the good news is data are just being accrued at an unprecedented rate.   00;07;46;17 - 00;08;28;21 So there are just so much data now for us to potentially access and analyze. There's always this concern about proper safeguard of individual privacy. And through our work, we also became very appreciative of other considerations, for example, the fishery responsibilities of the delivery systems and payers to protect patient data and make sure that they are used properly. So you mentioned the recent changes, including in data management, ensuring policy, which I think are moving us in the right direction.   00;08;28;26 - 00;08;56;23 But if you look closer at the NIH policy, it makes special considerations for proprietary data. So I would say that we have made some progress, but access to proprietary data remains very challenging. And the FDA, the NIH policy doesn't actually fully resolve that yet. When you think about the people who do make that argument for limited data sharing, they do mostly talk about what you just said about patient privacy.   00;08;56;23 - 00;09;25;20 IT proprietary data. Pharma is especially sensitive to that, I would imagine. So how do we incentivize the reluctant how can we ease their risks and concerns or can we? Yeah, it's a tough question. I think that this require a multi-pronged approach and I can only comment on some aspects of this. So I would say that at least based on our experience, the willingness or ability to share data often depends on the purpose.   00;09;25;23 - 00;09;55;29 That is, why do we need the data? Many data partners participate in Sentinel because of its public health mission, and our consideration is how would the data be used again, Is there proper safeguard of patient privacy and institutional interest? There are other ways to share data. For example, instead of asking the data to come to us, we can send analysis to where the data is.   00;09;56;06 - 00;10;34;22 And that is actually the principle follow by federated system like Sentinel. So we don't pull the data centrally. We send an analysis to the data partners and only get back what we need it. And it's usually in the summary level format. So that actually encourages more data sharing instead of less sharing. I would say that recent advances in some domains, such as tokenization and encryption, might also reduce some concern about a data sharing, a patient privacy concerns in academic settings.   00;10;34;29 - 00;11;24;26 We've been talking a lot about days, for example, for individual who collect the data and the people I propose to offer them authorship or proper acknowledgment if they are willing to share their data. But that is not sufficient in many cases outside of academic settings. If you look at what is happening in the past ten years or so, there are now a lot of what people call data aggregators that are able to bring together data from multiple delivery systems or health plans, and they seem to be able to develop a pretty effective model to convince the data provider to share that data in some way.   00;11;24;29 - 00;11;55;28 And a way to do that could be to help these data providers to manage their data more efficiently or to help them identify individuals who might be eligible for clinical trials. More quickly. So there are some incentives that we could think of to allow people to to share that data more openly but personally, I think that scientific data should be considered public good and hopefully that will become a reality one day.   00;11;56;00 - 00;12;23;21 Yeah, that's really interesting because it sounds like it's both a combination of centralized and decentralized tactics in terms of of data sharing and gathering. Why is it so important to use unstructured data in pharmacoepidemiology studies? And does NLP really make a huge difference in overcoming the limitations and extracting that data? So in the past, I think that that's true.   00;12;23;21 - 00;12;58;07 Now, many pharmaco epidemiologic studies rely on data. They are not collected for research purposes. So we use a lot of medical claims, data that are maintained by payers. We use each our data that are maintained by delivery systems. So this data are not created for research purposes and much of this data, at least for claim, is data stored in structured format using established coding systems like ICD ten.   00;12;58;10 - 00;13;39;06 Coding system and structured data sometimes are not granular enough for a given drug safety study and certain data or set of variables that are required for claims reimbursements or other business purposes might not be collected at all. And people felt that, well, maybe the information that we need could be extracted from unstructured data because as part of clinical care, the physicians or nurse practitioner or the health care provider might include that information in the notes, but use user data also pretty messy, especially that unstructured data.   00;13;39;08 - 00;14;05;25 So instead of going through the unstructured notes manually to extract this information manually, technique by natural language processing could help us do this task much more efficiently so that we can mind a larger model of unstructured data. Well, obviously, when it comes to real world evidence, you're a fan. Tell us what excites you about using it to complement clinical research.   00;14;05;25 - 00;14;42;07 Get us more evidence based insights and help practitioners make better decisions. Yeah, that's a great question. Yes, I'm a fan of so I personally don't quite like the dichotomy between conventional, randomized, controlled trial and real world data studies because they actually sit along a continuum. But is true that conventional randomized trials cannot address all the questions in clinical practice.   00;14;42;09 - 00;15;30;17 So that's where real data and real data studies come in, because real data like we discussed come from clinical practice. So they capture what happens in day to day clinical practice. So if we are thoughtful enough, we will be able to analyze the data properly and generate useful information to fill some of the knowledge gap. The truth is we have been using real data throughout the lifecycle of medical product development for many years now, ranging from understanding the natural history or burden of diseases to using real data as controls for single arm trials, and that we have been doing this before the term real data became popular.   00;15;30;19 - 00;15;57;11 So I see real data to complement what we could do in conventional randomized trials. So real data studies don't replace clinical trials. I see them to be complementary, and real data studies sometimes are the only way for us to get certain evidence. We already talked about Mosaic and LP that project, but I kind of want to go a little deeper with it.   00;15;57;11 - 00;16;42;02 The idea is to tackle the challenges of using link data structured and unstructured at scale. Tell us about a use case for that project and why it was chosen for this project. We actually, Cerner proposed to use the association between Montelukast, which is an asthma drug and neuropsychiatric events as a motivating example. It is also important to note that the project is not designed to answer this particular safety question, because if you look at the label of Montelukast, there's also already a box warning on neuropsychiatric events.   00;16;42;02 - 00;17;18;26 So FDA already has some knowledge about this being a potential adverse event associated with the medication. The reason why or recalls is has proposed this project was because we actually did look at this association in a previous sentinel study that only used structured data, although the study provided provided some very useful information. We also recognized that certain information that we needed was available in such a data, but may be available in unstructured data.   00;17;18;28 - 00;17;42;18 So if we are able to get more data from unstructured data, we might be able to understand this association better. So that's why this motivating example was chosen. Well, this is an Oracle podcast and Oracle is involved in Mosaic, so I think it's fair to ask you about the technology challenges that are involved in what you're trying to do.   00;17;42;19 - 00;18;17;24 What does the technology have to be able to do for you to experience success? So Mosaic in LP is I was at a very ambitious project because it is using an LP to extract multiple variables that are important for the study. That includes the study outcome, which when you look at it, is a composite of multiple clinical outcomes and it's also trying to extract important covariates that could help us reduce the bias associated with real data study.   00;18;17;26 - 00;19;01;24 So I think technology comes in well is powerful in many ways. First, thanks to technology, the project is able to access very large amount of data from millions of patients who seek care in more than 100 healthcare delivery systems across the country. So this was hard to imagine maybe ten or 15 years ago. But now we have access to lots and lots of data at our fingertips because of advances in technology, because of the large amount and the complexity of the data methods side and LP becomes even more important.   00;19;01;26 - 00;19;33;19 And for this project, we are also particularly interested in whether an LP algorithm developed in one year trial system could be applied to another system, which has been a challenge in our field because each year our system is created very differently. So one, an algorithm that works in one system might not work in another. So we are hoping that through advanced methods and technology, we will be able to address this problem.   00;19;33;21 - 00;19;57;15 So without this technology advances, we might not be able to do this study as efficiently as we could all So the task might might not be possible. So where are we going with this? I mean, let's say the project is a success. What will that mean in terms of the FDA's goals and how NLP gets applied in medical therapeutics safety surveillance?   00;19;57;18 - 00;20;38;03 The hope is that Sentinel system can answer even more questions than it can address today. And the way that we are trying to accomplish that is to see whether or how this complex, unstructured data, we combine it with advanced analytic methods can help us answer questions that could not be addressed by structured data alone. I think through this project we also learned a lot about how the challenges associated with analyzing a very large amount of data from multiple sources.   00;20;38;06 - 00;21;11;14 Again, service data is compiled from more than 100 systems, so it is big but also very complex. And in many of our studies we really need that large amount of data just to be able to answer the question because we may be focusing on rare exposures or real come. So you really need to start with very large from our data just to get to maybe the ten patients that are taking a medication.   00;21;11;17 - 00;21;44;15 And what you learn with Mosaic, can that get applied to addressing other public health issues like disparate ease and asthma diagnosis and treatment, especially when you think about diverse groups? Yeah, that's a great question. So is the project is not designed to address these important questions, but if we are able to better understand the completeness of social drivers of health in these data sources, then we will be able to leverage this data to answer these questions in the future.   00;21;44;18 - 00;22;04;26 I think about how a project like this gets a evaluated at various steps along the way. I guess that's my question. How I mean, what what methods are used to ensure the validity of real world evidence? So the good news is in the past few decades we have been using real data, even though we might not be using the term.   00;22;04;28 - 00;22;36;22 So there's been a lot of progress in the field to improve the validity of Real-World Data studies. So we now have a pretty good framework to identify fit for purpose data, and we also have very good understanding of appropriate design and analytic methods. So to target trial emulation and propensity score methods. So this project and many other projects in Sentinel are following this principle.   00;22;36;24 - 00;23;14;03 And one thing to also note that this project is also following the overall sentinel principle in transparency. So everything we do will be in the public domain to allow people to reproduce, so replicate the analysis. So the protocol is available in public domain, and when we are done with the study, everything will be made publicly available. So that's one way to make sure that the the work at least is reproducible or replicable.   00;23;14;05 - 00;23;43;00 And through that process, we hope to be able to improve the validity of this study. And what about comparisons? How do you compare the results from different data sources like claims data, structured data? You know, I extracted unstructured data, all of that. How was that done, the comparisons? So if you're talking about the Mosaic and LP study, so we have a pretty structured approach to address that question.   00;23;43;02 - 00;24;13;14 So we are using this proven principle of changing one thing and keeping everything else fixed to see what happens. So the project will start by using only claims data to replicate the previously done Sentinel study. And then we are going to add on such data to see whether the results are different. And then we add on an LP extract that unstructured data one at a time to see whether the results change.   00;24;13;21 - 00;24;40;24 So by fixing everything else to be constant and changing one thing, we'll be able to assess the added value of each how data, both structure and structure. And that's how we are going to do it within the Mosaic and LP study. And then what about scalability? How would you make sure the NLP models that you develop are scalable and transportable across all these different health systems of which there are many?   00;24;40;27 - 00;25;10;10 Yeah. The question again is about transport ability. So one thing that is unique about this study, as we briefly discussed earlier, was that the the survey yesterday to actually come from multiple healthcare systems. So the end up models that we are developing will be trained in tune on a sample of patients from this system and not from a single hospital network.   00;25;10;10 - 00;25;42;18 So at the development phase, we are already taking into account the potential diversity of different delivery system. And as part of this project, we also include another delivery system to apply and test the method as part of the transport ability assessment. So we are doing that to make sure that the LPI models that we are developing for this project will be useful for other system as well.   00;25;42;20 - 00;26;12;29 Unknown There is a larger question about computational resources, so that will be the issue that would still need to be addressed because a train and tuning this and NLP models within such a huge amount of data requires a lot of computing resources. So that is something that we could only partially address in our study. But if we want to apply or do the same thing in our system, that would be something to consider.   00;26;13;02 - 00;26;43;13 We talked a little bit about the collaboration with your tech partner, but these things usually have so many stakeholders and disciplines and silos. Tell us first why collaboration is a good thing and unavoidable anyway, and then what the challenges of collaboration are. Maybe some tips on how to best make them work. The problems that we face, at least many of the problems that I face quite complex and they require expertise from multiple domains.   00;26;43;13 - 00;27;18;19 So that calls for collaboration from multiple stakeholders. And we always have our blind spots. So we only see things in a certain way and we always miss things. So that's why I think collaboration is important. But it's really hard sometimes because we all have our priorities and perspectives and sometimes they don't align. And I also learned throughout the years that we don't communicate enough and we may also not have time to communicate or we may be under pressure to deliver.   00;27;18;21 - 00;27;47;21 So all of that sort of contribute to the challenges of collaborating effectively, especially when you collaborate across disciplines, because we might be using different languages to mean the same thing or use the same term to describe different things. So even though we can all speak the same language less English, we might not be talking about the same thing and not communicate at all.   00;27;47;21 - 00;28;17;25 Because because we are using different joggers and terminology. So that has been tough. But I think we are getting better. And so I think that it is for us within the center of operation center, we try to communicate honestly and respectfully and we try to understand different perspectives and we try to find common ground. And but I think ultimately what brings us together is that we have a shared common goal.   00;28;17;27 - 00;28;44;17 A lot of the work that we do. So for music and NLP, we are all trying to answer the same question, which is that how do we use unstructured data and advanced analytic methods to answer safety question? So once we apply on this common goal, things become easier because we start to understand each other better or be able to communicate more effectively.   00;28;44;19 - 00;29;19;16 Just out of curiosity, what are the different stakeholders involved in Mosaic? Who falls on the roster? we have people from different disciplines, so we have experts in natural language processing and artificial intelligence. We have epidemiologists, both statisticians, clinicians, we experts in psychiatric conditions and respiratory disease. We have data scientists, we have engineers, we have project managers. So it's a very big group of individuals with different expertise in this project.   00;29;19;18 - 00;29;46;14 Well, you probably noticed Oracle's really thrown itself into and committed huge resources to health and life sciences. Things got really exciting with the acquisition of Cerner and Cerner and Visa. What's Oracle doing right and what do you think it should be doing to make itself even more valuable in health and life sciences? Well, this is a great but very difficult question, so I cannot comment too much what Oracle is doing or will be doing.   00;29;46;17 - 00;30;23;06 But I can say more generally that there have been a number of technology companies that have tried to foray into health or life sciences. I would say with mixed results. And one reason is that our health care system remains highly fragmented and complex, so it takes a lot of energy to break the status quo. So you probably know that we were one of the last countries in the world to transition from ICD nine to ICD ten coding system, and we are soon going to move into the ICD 11 system.   00;30;23;06 - 00;31;00;05 So I'll be interested to see whether the US is ready for that. And that again, is maybe a reflection of just how complex and fragmented our system is and disruptive innovation and I think are great, but they may or may not translate into successes when they applied to health care. That is not to say tempesta mistake. I'm actually pretty optimistic that the perspectives and solutions and ideas brought by technology companies could help us solve a lot of problems that we have today.   00;31;00;07 - 00;31;31;26 But I think that it will be good to engage people who will be struggling with these issues early on and to work together with them to develop solutions that are not just good on paper, but also feasible in practice. So at least in my very limited experience, we have seen some very cool technology that ended up not being useful for health care just because it's very hard to change what people have been doing.   00;31;31;28 - 00;31;56;09 So again, disruptive innovations are good, but sometimes it's just very hard to adopt, at least not quickly enough for for us to see meaningful changes. Yeah, that's really fascinating. It's, you know, it is disruptive innovation, but it's not always applicable to the to the goals you're pursuing. But it does feel like technology where that's concerned, the future is coming at us faster and faster.   00;31;56;11 - 00;32;32;21 So what are the technologies that are most interesting to you? Is it A.I. or what big advances in public health do you see coming? Maybe sooner than we thought. Yeah. Yeah. You know, I feel like you said some of this came too fast. Like, I wish I. And closer to retirement, I don't worry about this. But so even though I say disruptive innovation sometime might not work in health care, but I will say generative A.I. seems to be a recent exception.   00;32;32;24 - 00;33;10;14 So I would say that generative is definitely on the list of things that surprised me in a very nice way. I will also say that the continue fast accrual of better real data is also something that excites me and the continue recognition or increased recognition of the potential real data of. It's also something that I think is good to have for things that came sooner than I found it again, generative.   00;33;10;19 - 00;33;44;13 AI So if you ask me when, we'll be ready for generally. AI Last year or two years ago, I would say not yet, but now we in the era where everything seems possible. So I remain extremely optimistic about generative in some of these last language models that will help us analyze unstructured data even more efficiently. Well, therein it's deeply fascinating and exciting stuff.   00;33;44;14 - 00;34;10;27 Thanks again for letting me pester you with these questions. If our listeners want to learn more about Sentinel, Operation Center or Mosaic or you, what's the best way for them to do that? So Sentinel has a poverty website where we post everything that we do. So is Sentinel initiative dot org. So I am a member of the Department of Population Medicine at Harvard Medical School.   00;34;10;29 - 00;35;00;16 So our website's population is a thought, but these would be two places that would be very informative for audience. Who wants to know more? All right. We appreciate that. And to our listeners, go ahead and subscribe to the show. Feel free to listen to past episodes because they are free. There's a lot to learn here. And if you want to learn more about how Oracle can accelerate your own life sciences research, just go to Oracle dot com slash life dash sciences and we'll see you next time on Research in Action.

Vape users inhale not just harmful chemicals, but toxic metals into their lungs. Synopsis: Every first Wednesday of the month, The Straits Times helps you make sense of health matters that affect you. E-cigarettes or vapes can contain less chemicals than cigarettes, but did you know that the former can expose users to toxic metals?  Is vaping safer than smoking and just how harmful is vaping? Find out these and more in the latest Health Check episode with ST senior health correspondent Joyce Teo, as she dives into the topic with two experts from Tan Tock Seng Hospital. They are Adj Asst/Prof Clive Tan, Public Health Specialist and Senior Consultant, Department of Preventive & Population Medicine and Adj Asso/Prof Puah Ser Hon, Head and Senior Consultant from the Department of Respiratory & Critical Care Medicine. With vaping on the rise here, despite it being illegal, they also talk about the help available to a vape user who wants to quit the habit, and what can be done about the vaping problem here. In Singapore, simply purchasing, using or owning an electronic vapouriser or vape, can attract fines of up to $2,000 per offence. Yet, vaping is on the rise here. The purchase, use or possession of vapes jumped 58 per cent to about 7,900 cases in 2023, from about 5,000 cases in 2022, according to data from the Ministry of Health. Highlights (click/tap above): 3:33 Are vapes safer than cigarettes? 8:17 Inhaling chemicals and toxic metals 20:35 Considering an amnesty for vape users 27:42 You can get the help that you need to quit vaping Produced by: Joyce Teo (joyceteo@sph.com.sg), Ernest Luis, and Eden Soh Edited by: Eden Soh Follow Health Check Podcast here every month and rate us: Channel: https://str.sg/JWaN Apple Podcasts: https://str.sg/JWRX Spotify: https://str.sg/JWaQ SPH Awedio app: https://www.awedio.sg/ Website: http://str.sg/stpodcasts Feedback to: podcast@sph.com.sg Read Joyce Teo's stories: https://str.sg/JbxN --- Discover more ST podcast channels: All-in-one ST Podcasts channel: https://str.sg/wvz7  The Usual Place: https://str.sg/wEr7u COE Watch: https://str.sg/iTtE Asian Insider: https://str.sg/JWa7 Health Check: https://str.sg/JWaN Green Pulse: https://str.sg/JWaf Your Money & Career: https://str.sg/wB2m Hard Tackle: https://str.sg/JWRE #PopVultures: https://str.sg/JWad Music Lab: https://str.sg/w9TX --- ST Podcast website: http://str.sg/stpodcasts ST Podcasts YouTube: https://str.sg/4Vwsa --- Special edition series: True Crimes Of Asia (6 eps): https://str.sg/i44T The Unsolved Mysteries of South-east Asia (5 eps): https://str.sg/wuZ2 Invisible Asia (9 eps): https://str.sg/wuZn Stop Scams (10 eps): https://str.sg/wuZB Singapore's War On Covid (5 eps): https://str.sg/wuJa --- Get The Straits Times' app, which has a dedicated podcast player section: The App Store: https://str.sg/icyB Google Play: https://str.sg/icyX #healthcheckSee omnystudio.com/listener for privacy information.

Vape users inhale not just harmful chemicals, but toxic metals into their lungs. Synopsis: Every first Wednesday of the month, The Straits Times helps you make sense of health matters that affect you. E-cigarettes or vapes can contain less chemicals than cigarettes, but did you know that the former can expose users to toxic metals?  Is vaping safer than smoking and just how harmful is vaping? Find out these and more in the latest Health Check episode with ST senior health correspondent Joyce Teo, as she dives into the topic with two experts from Tan Tock Seng Hospital. They are Adj Asst/Prof Clive Tan, Public Health Specialist and Senior Consultant, Department of Preventive & Population Medicine and Adj Asso/Prof Puah Ser Hon, Head and Senior Consultant from the Department of Respiratory & Critical Care Medicine. With vaping on the rise here, despite it being illegal, they also talk about the help available to a vape user who wants to quit the habit, and what can be done about the vaping problem here. In Singapore, simply purchasing, using or owning an electronic vapouriser or vape, can attract fines of up to $2,000 per offence. Yet, vaping is on the rise here. The purchase, use or possession of vapes jumped 58 per cent to about 7,900 cases in 2023, from about 5,000 cases in 2022, according to data from the Ministry of Health. Highlights (click/tap above): 3:33 Are vapes safer than cigarettes? 8:17 Inhaling chemicals and toxic metals 20:35 Considering an amnesty for vape users 27:42 You can get the help that you need to quit vaping Produced by: Joyce Teo (joyceteo@sph.com.sg), Ernest Luis, and Eden Soh Edited by: Eden Soh Follow Health Check Podcast here every month and rate us: Channel: https://str.sg/JWaN Apple Podcasts: https://str.sg/JWRX Spotify: https://str.sg/JWaQ SPH Awedio app: https://www.awedio.sg/ Website: http://str.sg/stpodcasts Feedback to: podcast@sph.com.sg Read Joyce Teo's stories: https://str.sg/JbxN --- Discover more ST podcast channels: All-in-one ST Podcasts channel: https://str.sg/wvz7  The Usual Place: https://str.sg/wEr7u COE Watch: https://str.sg/iTtE Asian Insider: https://str.sg/JWa7 Health Check: https://str.sg/JWaN Green Pulse: https://str.sg/JWaf Your Money & Career: https://str.sg/wB2m Hard Tackle: https://str.sg/JWRE #PopVultures: https://str.sg/JWad Music Lab: https://str.sg/w9TX --- ST Podcast website: http://str.sg/stpodcasts ST Podcasts YouTube: https://str.sg/4Vwsa --- Special edition series: True Crimes Of Asia (6 eps): https://str.sg/i44T The Unsolved Mysteries of South-east Asia (5 eps): https://str.sg/wuZ2 Invisible Asia (9 eps): https://str.sg/wuZn Stop Scams (10 eps): https://str.sg/wuZB Singapore's War On Covid (5 eps): https://str.sg/wuJa --- Get The Straits Times' app, which has a dedicated podcast player section: The App Store: https://str.sg/icyB Google Play: https://str.sg/icyX #healthcheckSee omnystudio.com/listener for privacy information.

Tommy talks with Dr. Ben Springgate, Professor and Chief of Community and Population Medicine, and a practicing Addiction Medicine physician, at LSU Health New Orleans

What's the difference between population medicine and the kind of care a veterinarian gives to an individual animal? We learn on Ask a Vet with Dr. Danielle Jongkind.

Dr. Karen Switkowski is an epidemiologist with training in nutrition and public health. She is a Senior Research Scientist in the Department of Population Medicine at Harvard Pilgrim Health Care Institute and a Principal Associate at Harvard Medical School. Dr. Switkowski works with Project Viva, an ongoing longitudinal study following a cohort of mother-child pairs from pregnancy through young adulthood. Her research is focused on prenatal and childhood nutrition, and she is particularly interested in the complementary feeding period and the impact of early feeding behaviors and nutritional exposures on later diet quality and health outcomes, including food allergies. She also writes a newsletter, Just One Bite (https://justonebite.substack.com/)  

Dr. Karen Switkowski is an epidemiologist with training in nutrition and public health. She is a Senior Research Scientist in the Department of Population Medicine at Harvard Pilgrim Health Care Institute and a Principal Associate at Harvard Medical School. Dr. Switkowski works with Project Viva, an ongoing longitudinal study following a cohort of mother-child pairs from pregnancy through young adulthood. Her research is focused on prenatal and childhood nutrition, and she is particularly interested in the complementary feeding period and the impact of early feeding behaviors and nutritional exposures on later diet quality and health outcomes, including food allergies. She also writes a newsletter, Just One Bite (https://justonebite.substack.com/) New boost

Hao Yu is an associate professor in the Department of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. T. Ramesh, M. Horvitz-Lennon, and H. Yu. Opening the Door Wider to International Medical Graduates — The Significance of a New Tennessee Law. N Engl J Med 2023;389:1925-1928.

Tommy talks with Dr. Elyse Stevens, Assistant Professor of Community & Population Medicine at LSU Health New Orleans School of Medicine

When Tian Xiaorun, a male teacher in Hangzhou, Zhejiang province, flew to the Hong Kong special administrative region to be vaccinated against HPV in January, his friends and family members questioned his decision.浙江省杭州市的男教师田晓润今年1月飞往香港特别行政区接种人乳头瘤病毒疫苗，他的朋友和家人对他的决定表示疑惑。"Even the doctor in Hong Kong was surprised to see me — a male from the mainland — come to get vaccinated against HPV," said the 30-year-old.30岁的他说：“看到我一个来自内地的男性来接种人乳头瘤病毒疫苗，连香港的医生都感到惊讶。”HPV vaccines are mainly used to prevent cervical cancer, which kills 342,000 women a year worldwide. But men also benefit from getting vaccinated to protect against genital and colon cancers and those in the head and neck, among others. Some countries and regions have approved HPV vaccines for use among both genders.HPV疫苗主要用于预防宫颈癌，全世界每年有34.2万名妇女死于宫颈癌。但男性也可以通过接种疫苗来预防生殖器癌、结肠癌以及头颈部癌症等。一些国家和地区已经批准男性和女性接种人乳头瘤病毒疫苗。"I first learned that men could receive vaccines against HPV when I was an exchange student in the United States, but at that time, I simply shrugged off the risk of the virus," he said.他说：“我在美国做交换生时第一次知道男性可以接种人乳头瘤病毒疫苗，但当时我只是简单地回避了病毒的风险。”"The COVID-19 pandemic prompted me to increase self-care, and after doing some research, I believe that getting vaccinated is worthwhile because it would not only protect myself against genital warts, but also my female partners."“新冠疫情促使我加强自我保健，在做了一些研究后，我认为接种疫苗是值得的，因为这不仅能保护自己免受生殖器疣的侵害，还能保护我的女性伴侣。”A small but growing number of men in China have considered or opted to obtain HPV vaccines outside the mainland — where the dose is not currently approved for use among men.中国有一小部分男性考虑或选择在中国大陆以外的地区接种人乳头瘤病毒疫苗，但这一人数在不断增加。While hailing the growing awareness and acceptance of the cancer-preventing shot, experts said that in China, the priority group for HPV vaccination remains females aged 9 to 45, especially young girls and adolescents.专家们对越来越多的人认识和接受这种预防癌症的疫苗表示欢迎，但同时表示，在中国，接种HPV疫苗的重点人群仍然是9至45岁的女性，尤其是少女和青少年。Wu Yinglan, director of the women's health department at the Hunan Provincial Maternal and Child Health Hospital, said that men could not only prevent HPV-related conditions by getting the vaccine, but could also protect their female partners by lowering women's risk of exposure to HPV viruses via sexual contact.湖南省妇幼保健院妇女保健科主任吴颖岚说，男性不仅可以通过接种疫苗预防与HPV相关的疾病，还可以通过降低女性通过性接触接触HPV病毒的风险来保护他们的女性伴侣。"Cervical cancer is common and deadly for females. As the domestic manufacturing capacity of HPV vaccines is not large enough to protect both men and women, we should prioritize female vaccination," she said during an interview with Xiaoxiang Morning Herald, a newspaper based in Hunan province.“宫颈癌是女性常见的致命疾病。”她在接受《潇湘晨报》采访时说：“由于国内HPV疫苗的生产能力不足以同时保护男性和女性，我们应该优先考虑女性接种。”"In case of sufficient supplies in the future, mass vaccination for both men and women could become a trend," she added.她补充说：“在未来供应充足的情况下，为男性和女性大规模接种疫苗可能会成为一种趋势。”Qiao Youlin, a professor at the School of Population Medicine and Public Health at Peking Union Medical College, said during a previous interview that HPV vaccines should be prioritized for girls aged under 15.中国医学科学院北京协和医学院特聘教授乔友林此前在接受采访时说，应优先为15岁以下的女孩接种人乳头瘤病毒疫苗。"Human papillomavirus is mainly transmitted through sexual contact, and males should get vaccinated but they are only the third priority," he said.他说：“人类乳头瘤病毒主要通过性接触传播，男性应该接种疫苗，但他们只是第三优先。”Cho Kyu-hyun, a South Korean singer and television host, said during a recent television program that he had obtained his first HPV vaccine. He said he hoped his decision could help break stereotypes about the vaccine as a female-exclusive product and spread awareness about the significance of preventing HPV infections.韩国歌手兼电视节目主持人曹圭贤在最近的一次电视节目中说，他已经接种了第一针人乳头瘤病毒疫苗。他说，他希望自己的决定有助于打破疫苗是女性专属产品的陈旧观念，并提高人们对预防人乳头瘤病毒感染重要性的认识。A hashtag related to his vaccination became one of the most-discussed topics on China's microblogging platform Sina Weibo on Aug 9.8月9日，一个与曹圭贤接种疫苗有关的标签成为中国微博平台新浪微博上讨论最多的话题之一。Some netizens said they were surprised to learn that men could get HPV vaccines and applauded his move, while some said even their female friends have not been vaccinated yet due to low awareness and limited supplies.一些网民表示，他们对男性可以接种HPV疫苗感到惊讶，并为曹圭贤的举动点赞；而一些网民则表示，由于认识不足和供应有限，甚至他们的女性朋友也还没有接种疫苗。Chai Yan, director of consulting firm IQVIA Biotech, said that HPV vaccination coverage among women aged 4 to 45 is uneven across China. More efforts are needed to boost inoculation rates in small cities and towns, as well as for younger girls aged 9 to 15.咨询公司IQVIA Biotech的主任柴岩说，中国4至45岁女性的HPV疫苗接种覆盖率参差不齐。需要加大力度提高小城市和乡镇的接种率，以及9至15岁年轻女孩的接种率。He added that several domestic vaccines are projected to gain market approval by around 2026, which will greatly boost the country's manufacturing capacity.他补充说，预计到2026年左右，将有几种国产疫苗获得市场批准，这将大大提高中国的生产能力。Cervical 英/ˈsɜːvɪk(ə)l/ 美/ˈsɜːrvɪk(ə)l/adj.颈的；子宫颈的Vaccinate英/ˈvæksɪneɪt/ 美/ˈvæksɪneɪt/v.给……接种疫苗；接种疫苗

Tommy talks to Dr. Benjamin Springgate, Chief of Community & Population Medicine at LSU Health New Orleans School of Medicine.

Dr. Benjamin Springgate, Chief of Community & Population Medicine at LSU Health New Orleans School of Medicine, joins guest host Ian Hoch about the rise in COVID cases and hospitalization in Louisiana.  

In this Hall of Fame Episode: Join Dr. Roark and the wizard, the legend "Uncle Mickey Schaer" as they talk about that case that terrifies us all - the venomous snake bite! LINKS: Uncharted Practice Leader Summit: https://unchartedvet.com/practice-leaders-summit-2023/ Dr. Andy Roark Exam Room Communication Tool Box Team Training Course: https://drandyroark.com/on-demand-staff-training/ Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/ Dr. Andy Roark Swag: drandyroark.com/shop All Links: linktr.ee/DrAndyRoark ABOUT OUR GUEST: Dr. Michael Schaer received his D.V.M. degree from the University of Illinois in 1970. He then went to the Animal Medical Center (AMC) in New York City where he served as an intern and then as a medicine resident between1970-73. After the residency, he remained at the AMC as a staff member in the Department of Medicine until 1977. He then joined a private small animal practice in New Jersey until late 1978 at which time he joined the faculty at the University of Florida, College of Veterinary Medicine where he has remained until the present time. He has published several papers and book chapters and he has lectured nationally and internationally. Dr Schaer is also the author of five textbooks: Clinical Medicine of the Dog and Cat – 1st, 2nd, and 3rd editions and Clinical Signs in Small Animal Medicine, 1st and 2nd editions. At the U of F, Dr. Schaer functions mainly as a clinician and a teacher. His previous UF professional duties included: Professor and Associate Chairman-Department of Small Animal Clinical Sciences, Associate Chief of Staff-Small Animal Hospital, and Service Chief-Small Animal Medicine. Dr. Schaer served as Interim Chair, Department of Comparative, Diagnostic, and Population Medicine from February 2017-September 2018. He is currently Professor Emeritus and Adjunct Professor in Emergency and Critical Care Medicine, while still doing active teaching in the classroom and in the critical care unit. Dr. Schaer is board certified in internal medicine (ACVIM) and emergency and critical care (ACVECC).

A walk in the woods can bring serenity and peace of mind. You can bring back souvenirs such as a beautiful leaf, or a pine cone. Sometimes your souvenir is less lovely - a tick. Dogs, cats, and even horses can suffer from tick bites and responsible pet owners regularly check their companions for these unwelcome parasites.Ticks can carry and transmit bacteria, viruses, and parasites that cause Lyme disease, anaplasmosis, Powassan virus, babesiosis, and erlichiosis.Climate change is making new regions more tick-friendly, which is bad news for people and animals.Dr. Katie Clow is an Assistant Professor in One Health in the Department of Population Medicine at the Ontario Veterinary College at Canada's University of Guelph. She's working on better ways to track ticks and their spread. She's also got a website with useful information about ticks for people and pet owners.In this episode of One World, One Health, listen as Katie explains why people need to keep an eye out for ticks, why simply clearing wildlife such as deer won't help control ticks, and how climate change is helping ticks thrive in more regions of the world.

We hope you enjoy this conversation between Lesley Moser and previous AASRP Emerging Leader, Mike Pesato. Dr. Pesato is the current chair of the College Liaison Committee for AASRP and an assistant clinical professor in the Department of Pathobiology and Population Medicine at Mississippi State University's College of Veterinary Medicine. As you will appreciate, he is a passionate small ruminant practitioner and educator of veterinary students. In this episode, Dr. Pesato tells us more about the AASRP Student Symposium, an exciting opportunity for students to gain insight into small ruminant and camelid practice from clinicians in the private and public sectors. If you have any questions about this episode, the 2023 AASRP Student Symposium, or opportunities to get involved in AASRP, feel free to contact us: AASRP website: aasrp.orgAnn DiPastina, DVMann.dipastina@gmail.comLesley Moser, DVMtrmvetc@gmail.com

Reproductive performance is key to maintaining a cow productive and guaranteeing the next lactation. To achieve good results, we need to improve our knowledge about the reproduction of transition cows: how do we manage them in order to be reproductively successful? With that in mind, our guest Dr. Stephen LeBlanc and I discuss, in this episode of The Dairy Podcast Show, the main challenges in the reproduction of transition cows, metritis management, goals for reproductive parameters, and the use of technology to detect early reproductive diseases. “So that's our challenge: keeping cows healthy, giving them the inputs of nutrition and management, and so on and so forth, so that they are set up with what they need for the success of their reproduction.” – Dr. Stephen LeBlanc What you'll learn:Highlight (00:00)Introduction (1:15)The influence of the transition period on the reproductive performance of cows (2:25)The indicators of success in reproductive performance  (8:39)Resilient cows and reproduction (15:34)Pregnancy rates: what's the new goal? (21:01)Advances in the treatment of metritis (25:03)The use of sensors for metritis diagnosis (31:56)More milk, less fertility: is that true? (36:11)The final questions (40:29)Meet the guest: Dr. Stephen LeBlancExperience:Current: Professor in the Department of Population Medicine at the Ontario Veterinary College; Director of Dairy at Guelph – The Centre for Dairy Research and Innovation, at the University of Guelph.Background:D.V.S. (University of Guelph)D.V.M. (University of Guelph)B.Sc., Animal Science (McGill University)Connect with the guest on Social Media: LinkedIn

Tommy talks with Dr. Ben Springgate, Chief of Community and Population Medicine at LSU Health New Orleans School of Medicine.

Basem Gohar, Assistant professor in the Department of Population Medicine and an adjunct professor in the Psychology Department at the University of Guelph, tells us about the defects of the healthcare system and the impact on the well-being of its workers. HEY, DO YOU LIKE PODCASTS? Why not subscribe to ours? find it on Apple, Google, Spotify & Tune In

We introduce the newest member of the Shift. Duncan Elias, originally from Singapore and now in Calgary joins us as he fills in for Ryan O'Donnell.  Basem Gohar, Assistant professor in the Department of Population Medicine and an adjunct professor in the Psychology Department at the University of Guelph, tells us about the defects of the healthcare system and the impact on the well-being of its workers. Also, Aaron Boley, Associate Professor, Department of Physics and Astronomy at UBC and Canada Research Chair in Planetary Astronomy on who owns the Moon and why agreements are important to prevent conflict. HEY, DO YOU LIKE PODCASTS? Why not subscribe to ours? find it on Apple, Google, Spotify & Tune In

英语新闻︱九价HPV疫苗接种年龄放宽China's top drug regulator has expanded the use of an imported vaccine against nine strains of the cancer-causing human papillomavirus to girls as young as nine and adults up to age 45.近日，九价人乳头瘤病毒疫苗（酿酒酵母），也称九价HPV疫苗，获得中国国家药品监督管理局批准，适用接种人群拓展至9-45岁适龄女性。While hailing the decision as part of China's endeavor to accelerate elimination of cervical cancer, experts said that given the tight supply of the 9-valent vaccine and increasing evidence of the efficacy of homegrown vaccines, it is wise to receive any approved HPV vaccines available.专家称赞此举彰显了中国加速消除宫颈癌的决心。鉴于九价HPV疫苗一针难求，且国产HPV疫苗也能有效预防宫颈癌，因而接种任一获批HPV疫苗都是明智之举。The National Medical Products Administration first granted authorization to Gardasil 9, a 9-valent HPV vaccine created by global pharmaceutical giant Merck, for use in females aged 16 to 26 in 2018. On Tuesday, the administration said that its use is now broadened to females aged 9 through 45.2018年，药企默沙东研发的九价HPV疫苗“佳达修9”首次获批用于16岁至26岁的女性。8月30日，国家药品监督管理局宣布该疫苗适用接种人群拓展至9岁至45岁的适龄女性。Currently, three imported HPV vaccines and two domestic vaccines have been approved for use on the mainland. Gardasil 9 is the only one that can shield nine strains of HPV, while the others offer protection against either two or four strains.目前我国已有五款HPV疫苗获批注册，包含了三款进口HPV疫苗和两款国产疫苗。“佳达修9”是唯一能够预防九种HPV病毒类型的疫苗，而其他疫苗则可以抵御两种或四种HPV病毒类型。Qiao Youlin, a professor at the School of Population Medicine and Public Health at the Peking Union Medical College, said that HPV vaccines work best among teenage girls and those who have not had a sexual encounter, but sexually active women can still benefit from getting vaccinated.中国医学科学院北京协和医学院群医学及公共卫生学院乔友林教授指出，青少年女孩接种HPV疫苗，容易激发更好的免疫反应，未发生性行为的女性接种HPV疫苗将获得最佳预防效果。"Expanding the age group eligible for the 9-valent vaccine will offer more options for Chinese females of different ages to prevent HPV infection and protect their health, and advance China's action to accelerate the elimination of cervical cancer," he said in a news release published by Merck on Tuesday.8月30日，乔友林教授在默沙东公众号发布的文章中表示：“九价HPV疫苗获批扩龄更是令我们倍感振奋，其将为我国不同年龄层的女性预防HPV感染和降低相关疾病风险带来更多守护健康的选择，并进一步推动我国加快消除宫颈癌的步伐。”In China, nearly 110,000 women were diagnosed with cervical cancer last year, and 59,000 had died of the disease, said Zhao Fanghui, a professor at the National Cancer Center and Chinese Academy of Medical Sciences' Cancer Hospital, citing data from the Global Cancer Observatory, a cancer data platform associated with the World Health Organization.国家癌症中心、中国医学科学院肿瘤医院的赵方辉教授援引世界卫生组织国际癌症研究机构的数据称，2020年我国宫颈癌新发病例约11万，死亡病例约5.9万。"Official data also show that the incidence of cervical cancer in China is rising and the average age of patients is getting younger, which is highly concerning," she said.赵方辉说：“官方数据显示，我国宫颈癌呈现发病率上升、发病年轻化的趋势，这是非常令人担忧的。”Eliminating the disease would require consolidated efforts in boosting the vaccination rate, especially among those aged under 15, as well as promoting early screening and treatment. Due to limited supplies and low awareness, China is now lagging far behind some leading countries in terms of immunization coverage, according to Zhao.赵方辉表示，消除宫颈癌还需加强努力，提高疫苗接种率，尤其是15岁以下人群的接种率，促进癌症筛查和早诊早治。由于HPV疫苗供应有限，公众认知不高，中国目前的疫苗覆盖率仍处于较低水平。However, the rising number of highly effective domestic vaccines available on the market is expected to ramp up the efforts.不过，具有高保护效力的国产HPV疫苗数量逐年增加，为中国宫颈癌防治事业增添了新动力。Six homegrown 9-valent HPV vaccines have entered the third stage of clinical trials, according to information shared by Dong Shaozhong, a researcher at Walvax Biotechnology, during a forum held during the weekend. Doses that protect against even more strains are also under research.沃森生物研究员董少忠表示，6种国产九价HPV疫苗已经进入Ⅲ期临床试验阶段，预防更多HPV病毒类型的疫苗也在研发中。Even though the highly-coveted 9-valent vaccine is not easily available at present, Zhao said unvaccinated groups should not hesitate to receive a dose that protects against two strains.赵方辉表示，九价HPV疫苗一针难求，适龄女性不必盲目等待高价次疫苗，可尽早接种二价HPV疫苗。A new study published in the journal The Lancet Infectious Disease on Friday shows that Cecolin, the first domestic vaccine that protects against two HPV strains, is 100 percent effective in protecting against genital lesions－a precancerous condition－and 97.3 percent effective against persistent infection.8月26日，《柳叶刀-感染病学》发表的一项新研究表明，国产HPV疫苗馨可宁可有效预防HPV16型和18型病毒类型，对HPV16型和/或18型感染相关的病变终点的保护率为100.0%，对HPV16型和/或18型持续性感染（6月以上）的保护率为97.3%。Zhao, who is involved in the study, said the data shows that the domestic vaccine's efficacy is on par with its international alternatives.参与此项研究的赵方辉教授表示，数据显示，国产疫苗与进口疫苗的疗效不相上下。Moreover, the two types of HPV that the vaccine is capable of protecting against cause about 84.5 percent of cervical squamous cancer cases－the most common form of cervical cancer－in China, higher than the global average of 70 percent.馨可宁能够预防约84.5%的宫颈癌鳞癌病例，宫颈癌鳞癌是我国宫颈癌当中最为常见的类型，发病率高于全球平均水平七成。"The follow-up study that tracks more than 7,300 women for about 5.5 years adds evidence to the long-term protection provided by the domestic vaccine," she said. "It can also inform the formulation of public health policies and boost public confidence in and acceptance of domestic vaccines," she said.赵方辉介绍说：“研究团队对7300多名志愿者进行了为期5年半的随访，为国产疫苗的高保护率提供了数据支撑”赵方辉说道：“研究结果为公共卫生政策的制定提供了必要信息，还有利于提高公众对国产疫苗的信心与接受度。”While the latest authorization for Gardasil 9 means that more well-off groups can access the vaccine, Zhao suggested the general public not hesitate to receive available vaccines as soon as possible.虽然“佳达修9”接种年龄放宽意味着更多富人能够打上疫苗，但赵方辉建议公众不必执着高价数疫苗，及早接种疫苗。记者：王小予cervical英[ˈsɜ:vɪkl]；美[ˈsɜrvɪkl]adj. [解]颈的;子宫颈的shield英[ʃiːld]；美[ʃiːld]vt.保护;掩护;庇护;给…加防护罩n.盾;护罩;盾形奖牌;保护人eligible英[ˈelɪdʒəbl]；美[ˈelɪdʒəbl]adj.有资格的;（作为结婚对象）合适的alternative英[ɔːlˈtɜːnətɪv]；美[ɔːlˈtɜːrnətɪv]n. 可供选择的事物adj.替代的，备选的;另类的

The Hamilton Today Podcast with Ted Michaels: Ted Michaels is back in the saddle and ready to roll while Scott is on vacation. Longtime CTV National News anchor Lisa LaFlamme broke her silence after being let go by Bell Media, saying she was blindsided and shocked by the “business decision” to end her contract after 35 years. Ted has some opinions for you, and he shares them with PR expert Elissa Freeman. Ted also digs into the Great Resignation, the worsening mental health of Canada's farmers, Ontario's sharp increase in distracted driving charges, the “Strong Mayor” plan from Ford, and an update on the Arrive CAN app. It is all coming up on the Hamilton Today Podcast. Guests: Barry Choi, Personal Finance & Travel Expert. Andria Jones-Bitton, D.V.M., Ph.D. Professor, Department of Population Medicine; Director of Well-Being Programming, Ontario Veterinary College; Co-Chair, AAVMC Academic Veterinary Wellbeing Professionals Leadership Group; University of Guelph. Michael Taube is a columnist for Troy Media and Loonie Politics, contributor to the National Post and Washington Times, and was a speechwriter to former Prime Minister Stephen Harper. David Parkinson, Economics Columnist, The Globe and Mail. Elissa Freeman, PR and Pop Culture Expert. Brian J. Patterson, President of the Ontario Safety League. Marty York, who provided decades of sports coverage at The Globe, TSN, Sportsnet + Metro newspapers. Host – Ted Michaels Content Producer – William Erskine Technical/Podcast Producer - William Webber Podcast Co-Producer – Ben Straughan News Anchors – David Woodard Want to keep up with what happened in Hamilton Today? Subscribe to the podcast! https://omny.fm/shows/scott-thompson-show

5 DELICIOUS DINNER RECIPES to support your weight loss: https://www.chefaj.com/5-delicious-lo... ------------------------------------------------------------------------------------ MY LATEST BESTSELLING BOOK: https://www.amazon.com/dp/1570674086?... -------------------------------------------- Dr. Renae Thomas, is an Australian living in the USA, and a triple board-certified Physician in Family Medicine, General Preventive Medicine and Public Health, and Lifestyle Medicine Physician. She completed medical school in Australia at Monash University. Her residency in Family and Preventive Medicine, and Master's of Public Health in Population Medicine were completed at Loma Linda University in California. She has also completed an internship at True North Health Center, and yoga teacher training in India. Renae served four years on the ACLM Trainee board, with two years as president. She is a published co-author on vegetarianism and cancer, and author of an ACLM and WIC-collaborated guide to healthy eating for less than $4 per day, as well as numerous online, print, and audio content collaborations. Renae's research has been in clinical lifestyle medicine, and lifestyle medicine curricula in medical education. She has presented at numerous conferences on evidence-based and clinically-relevant nutrition and health, both in the USA and internationally. Renae's professional content largely focuses on evidence-based nutritional and lifestyle medicine for both physicians and patients. As a doctor, she strives to be a compassionate and understanding support system to her patients, helping to uncover the root cause of illness, and working with them to achieve their greatest health and happiness. Dr. Thomas is currently the Medical Director of Fasting Escape and provides lifestyle medicine focused telehealth consultations. You can schedule an appointment with Dr. Thomas here: https://go.oncehub.com/RenaeThomas Find Dr. Thomas online at: Website: https://www.drrenaethomas.com/ Instagram: @drrenaethomas Fasting Escape: https://www.fastingescape.com/drthomas Facebook: https://www.facebook.com/Drrenaethomas/ YouTube: https://www.youtube.com/channel/UCG99... Max Thomas is a largely retired school teacher, who specialized in computer science, physical education and Dad jokes. He lives in rural Western Australia on an Organic Farm, where he grows most of his own food. He spends his days occupied with a variety of farm duties, and playing with his doberman ‘Bomber'. Max transitioned to a plant-based diet in 1994 after he was diagnosed with metastatic cancer. While he did undergo standard medical therapy, he attributes his complete remission, tolerance of treatment, and ongoing good health to his lifestyle changes, especially his diet. Max is Dr. Thomas's father, and he raised her on a plant-based diet, largely free of sugar, oil and salt. He inspired her to be the kind of doctor she strives to be today, not only in helping people improve their nutrition and health, but to be kind, compassionate, and to always have infectious optimism. This is the Bill Maher clip we referred to: https://www.youtube.com/watch?v=yfiWj... ----------------------------------------------------------- VIDEO CHAPTERS: 00:00 Guest introductions and bios with Chef AJ Q & A 0:14:30 Viewer and continued Chef AJ Q & A 1:03:35 Final thoughts and show wrap

In this week's episode, Martin talks to Dr Michael Klompas, Infectious Disease physician, Hospital Epidemiologist, and Professor of Population Medicine at Harvard Medical School and Brigham and Women's Hospital, Boston, USA. We discuss the complexities of undertaking surveillance of Ventilator-associated pneumonia (VAP) and the USA approach to looking at the wider issue of Ventilator-associated Events (VAE) that removes subjectivity from the surveillance of these important complications. We also discuss the recent SHEA/IDSA/APIC/AMA prevention strategies paper that is the latest state of the art guidance on VAP/VAE prevention. Useful reading here: 1. Klompas M, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022;43(6):687-713.  https://doi.org/10.1017/ice.2022.88 2. Weinberger JF, et al. Changes in the epidemiology of ventilator-associated events over the course of the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol. 2021:1-3. https://doi.org/10.1017/ice.2021.459 3. Klompas M. Ventilator-Associated Events: What They Are and What They Are Not. Respir Care. 2019;64(8):953-961.  https://doi.org/10.4187/respcare.07059 4. Klompas M. Ventilator-associated conditions versus ventilator-associated pneumonia: different by design. Curr Infect Dis Rep. 2014;16(10):430.  https://doi.org/10.1007/s11908-014-0430-0 5. Klompas M, et al. Risk of misleading ventilator-associated pneumonia rates with use of standard clinical and microbiological criteria. Clin Infect Dis. 2008;46(9):1443-1446.  https://doi.org/10.1086/587103

In this week's episode, Martin talks to Dr Michael Klompas, Infectious Disease physician, Hospital Epidemiologist, and Professor of Population Medicine at Harvard Medical School and Brigham and Women's Hospital, Boston, USA. We discuss the complexities of undertaking surveillance of Ventilator-associated pneumonia (VAP) and the USA approach to looking at the wider issue of Ventilator-associated Events (VAE) that removes subjectivity from the surveillance of these important complications. We also discuss the recent SHEA/IDSA/APIC/AMA prevention strategies paper that is the latest state of the art guidance on VAP/VAE prevention. Useful reading here: 1. Klompas M, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022;43(6):687-713.  https://doi.org/10.1017/ice.2022.88 2. Weinberger JF, et al. Changes in the epidemiology of ventilator-associated events over the course of the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol. 2021:1-3. https://doi.org/10.1017/ice.2021.459 3. Klompas M. Ventilator-Associated Events: What They Are and What They Are Not. Respir Care. 2019;64(8):953-961.  https://doi.org/10.4187/respcare.07059 4. Klompas M. Ventilator-associated conditions versus ventilator-associated pneumonia: different by design. Curr Infect Dis Rep. 2014;16(10):430.  https://doi.org/10.1007/s11908-014-0430-0 5. Klompas M, et al. Risk of misleading ventilator-associated pneumonia rates with use of standard clinical and microbiological criteria. Clin Infect Dis. 2008;46(9):1443-1446.  https://doi.org/10.1086/587103

RUOK with the Lost and Found? Ontario's right to disconnect law is now in effect but will it work? Dr. Basem Gohar, psychologist and assistant professor at the department of population medicine at the University of Guelph, helps us understand how we can successfully disconnect from work and why it's so hard to do in the first place.  Handy Andy Baryer is back and continues on his journey to be the laziest and most efficient gardener in Canada! He also breaks down all the amazing features coming to Apple users this year. HEY, DO YOU LIKE PODCASTS? Why not subscribe to ours? find it on Apple, Google, Spotify & Curiouscast.ca    See omnystudio.com/listener for privacy information.

On this episode of the podcast, I talk to Dr. David Renaud.  Dave is a veterinary epidemiologist in the Department of Population Medicine at the University of Guelph.  His research focuses on the health and welfare of dairy calves, Dave teaches in both the veterinary and undergraduate curriculum. As one producer put it to me, "raising calves can be the most rewarding or the most soul sucking endeavor on the farm".  This producer wasn't wrong.  Dave and my discussion helps shed some light on how to make it the most rewarding job on the farm.  In this episode we cover colostrum, nutrition and management considerations. If you have any questions regarding the podcast, or any of the projects his team is working on, you can reach out to Dave by emailing him at renaudd@uoguelph.ca and you can follow him on Twitter @DavRenaud I hope you enjoy this episode of the podcast.  If you have any questions about this episode or on future episodes of the podcast, please feel free to reach out to me by email at keith.schweitzer@trouwnutrition.com or by phone at 1 (226) 236-3227 and please follow me on twitter @keithschweitzer

Dr. Michel Accad has a direct cardiology practice and a direct primary care practice; he has authored a book (Moving Mountains: a Socratic Challenge to the Theory and Practice of Population Medicine) and he blogs (www.alertandoriented.com) and podcasts (www.accadandkoka.com).Dr. Accad explains why he left traditional insurance-based practice and started his direct cardiology practice where patients pay directly for services and insurance is not involved.  He later added a direct primary care (DPC) practice that primarily serves older people and operates on a membership basis like many other DPC practices. We discussed the increasing interest in direct specialty care. We imagined a “healthy branch” of healthcare delivery where DPC is the foundation, patients have coverage for catastrophic expenses but insurance is not used for routine expenses, leading to dramatic savings on insurance premiums, and patients are empowered to save for their own healthcare expenses in an HSA or similar account.  Dr. Accad does not see navigating this healthier patient-centered delivery system as a significant barrier to care, as it is the responsibility of DPC doctors to help patients through the process of finding and receiving downstream care.  The bigger challenges would be patient understanding and engagement leading to their interest in this approach, and the difficulty of contractually defining what specific care is catastrophic and thus covered by insurance.  We also need more primary care and specialty care physicians using direct approaches for the “healthy branch” to grow.We discussed population health and Dr. Accad's book Moving Mountains.  He characterizes population health as an idea promoted by academics focused on health policy.  They think about populations in terms of averages.  While increasing population metrics like the number of people screened for cancer or the number of diabetics with hemoglobin A1c in the desired range may be a worthy goal, such metrics don't always translate well to care of individual patients. It's not difficult to imagine a diabetic patient whose A1c is not the top concern, particularly if the patient has other chronic conditions.  Population metrics should not dictate the care of individual patients.Finally, we touched on Dr. Accad's view of the biggest problems in healthcare.  His response touched on personal responsibility, moral hazard, and how our focus on technical solutions to natural health problems increases the public's anxiety about their health.

This week on the Cone….. Dr. Andy Roark talks again with the living legend “Uncle Mikey” Schaer about best practices for handling parvo puppies when money is tight. You don't want to miss this one! It might even save a life. Let's get into it! About Our Guest: Dr. Michael Schaer Dr. Michael Schaer received his D.V.M. degree from the University of Illinois in 1970. He then went to the Animal Medical Center (AMC) in New York City where he served as anintern and then as a medicine resident between1970-73. After the residency, he remained at the AMC as a staff member in the Department of Medicine until 1977. He then joined a private small animal practice in New Jersey until late 1978 at which time he joined the faculty at the University of Florida, College of Veterinary Medicine where he has remained until the present time. He has published several papers and book chapters and he has lectured nationally and internationally. Dr. Schaer is also the author of five textbooks: Clinical Medicine of the Dog and Cat – 1st, 2nd, and 3rdeditions and Clinical Signs in Small Animal Medicine, 1st and2nd editions. At the U of F, Dr. Schaer functions mainly as a clinician and a teacher. His previous UF professional duties included: Professor and Associate Chairman-Department of Small Animal Clinical Sciences, Associate Chief of Staff-Small Animal Hospital, and Service Chief-Small Animal Medicine. Dr. Schaer served as Interim Chair, Department of Comparative, Diagnostic, and Population Medicine from February 2017-September 2018. He is currently Professor Emeritus and Adjunct Professor in Emergency and Critical Care Medicine, while still doing active teaching in the classroom and in the critical care unit. Dr. Schaer is board certified in internal medicine (ACVIM) and emergency and critical care (ACVECC). Links: Personal Branding w/Dr. Andy Roark: https://unchartedvet.com/personal-branding/ Dr. Andy Roark Swag: https://drandyroark.com/swag Editor: Dustin Bays dustin.bays@baysbrass.com @Bays4Bays Twitter/Instagram

Dr. Bob calls up infectious disease epidemiologist Julia Marcus to discuss risk, a concept many of us thought more about in the past year than ever before. Julia, a Harvard professor and contributor to The Atlantic, talks about why people take risks, the danger in stigmatizing risk-taking, and how to weigh the benefits and costs surrounding risk during the pandemic. They also cover pandemic fatigue and how Julia envisions the return to a new normal. Plus, the first Andy update from Lana!   Follow Dr. Bob on Twitter @Bob_Wachter and check out In the Bubble’s new Twitter account @inthebubblepod.   Follow Julia Marcus on Twitter @JuliaLMarcus.    Keep up with Andy in D.C. on Twitter @ASlavitt and Instagram @andyslavitt.   In the Bubble is supported in part by listeners like you. Become a member, get exclusive bonus content, ask Andy questions, and get discounted merch at https://www.lemonadamedia.com/inthebubble/    Support the show by checking out our sponsors!   Click this link for a list of current sponsors and discount codes for this show and all Lemonada shows: https://drive.google.com/file/d/1NEJFhcReE4ejw2Kw7ba8DVJ1xQLogPwA/view    Check out these resources from today’s episode:    Read Julia’s latest article for The Atlantic, “Vaccinated People Are Going to Hug Each Other:”  https://www.theatlantic.com/ideas/archive/2021/01/giving-people-more-freedom-whole-point-vaccines/617829/  Check out all of Julia’s COVID-19 Atlantic articles here: https://www.theatlantic.com/author/julia-marcus/  Read what Bob and other experts have to say about what’s safe to do post-vaccine in this Washington Post article: https://www.washingtonpost.com/health/2021/02/01/vaccinated-people-precautions/ Learn more about Julia’s work with Harvard Medical School’s Department of Population Medicine: https://www.populationmedicine.org/jmarcus  Learn more about Dr. Bob Wachter and the UCSF Department of Medicine here: https://medicine.ucsf.edu/    To follow along with a transcript and/or take notes for friends and family, go to www.lemonadamedia.com/show/in-the-bubble shortly after the air date.   Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia. For additional resources, information, and a transcript of the episode, visit lemonadamedia.com. See omnystudio.com/listener for privacy information.

Thanks to an incredible scientific effort, vaccines for COVID-19 have arrived in the UK and GPs, and other primary care health professionals, are now being faced with the monumental challenge of vaccinating high volumes of patients in a matter of days, whilst maintaining a COVID-safe environment, and fielding the myriad questions and concerns patients may have around the vaccine. In this week's episode, we talk about the practical difficulties in preparing and administering the vaccine. We discuss the rationale behind extending the interval between the first and second doses, and the controversy it has caused. How do we assuage these worries, and how do we temper patients' expectations regarding immunity, and the speed at which life may go back to normal? Finally, we talk about some lessons we can learn from HIV prevention to ensure equitable covid vaccination. Our guests: Mark Porter MBE is a GP in South Gloucestershire, and an award-winning journalist. He anchors the series ‘Inside Health' on BBC Radio 4, he is the medical correspondent for The Times, and a columnist for Saga Magazine. Andrew Pollard is a professor of Paediatric Infection and Immunity at the University of Oxford, an honorary consultant paediatrician at Oxford Children's Hospital, and the director of the Oxford Vaccine Group. Julia Marcus is an infectious disease epidemiologist and an assistant professor at Harvard Medical School's Department of Population Medicine . She is also an HIV researcher.

This week, Uncle Mikey Schaer is back! Together Dr. Schaer and Dr. Andy Roark run through the diagnosis and treatment of "the great pretender," Addison's disease. Get a quick refresher on all the electrolyte oddities you should be looking for, prognostic indicators and treatment options you have at your disposal. Links: Dr. Andy Roark Swag: https://drandyroark.com/swag About Our Guest: Dr. Michael Schaer received his D.V.M. degree from the University of Illinois in 1970. He then went to the Animal Medical Center (AMC) in New York City where he served as an intern and then as a medicine resident between1970-73. After the residency, he remained at the AMCas a staff member in the Department of Medicine until 1977. He then joined a private small animal practice in New Jersey until late 1978 at which time he joined the faculty at the University of Florida, College of Veterinary Medicine where he has remained until the present time. He has published several papers and book chapters and he has lectured nationally and internationally. Dr. Schaer is also the author of five textbooks: Clinical Medicine of the Dog and Cat – 1st, 2nd, and 3rdeditions and Clinical Signs in Small Animal Medicine, 1st and2nd editions. At the U of F, Dr. Schaer functions mainly as a clinician and a teacher. His previous UF professional duties included: Professor and Associate Chairman-Department of Small Animal Clinical Sciences, Associate Chief of Staff-Small Animal Hospital, and Service Chief-Small Animal Medicine. Dr. Schaer served as Interim Chair, Department of Comparative, Diagnostic, and Population Medicine from February 2017-September 2018. He is currently Professor Emeritus and Adjunct Professor in Emergency and Critical Care Medicine, while still doing active teaching in the classroom and in the critical care unit. Dr. Schaer is board certified in internal medicine (ACVIM) and emergency and critical care (ACVECC). Editor: Dustin Bays dustin.bays@baysbrass.com @Bays4Bays Twitter/Instagram

An infectious disease specialist and a veterinary epidemiologist discuss zoonotic disease risks and the benefits of integrating a One Health approach to veterinary and human medical practice. The recent pandemic highlights the risks associated with animal - human disease transmission (zoonosis). Dr. Martha Fulford, a medical doctor and specialist in Infectious Diseases from McMaster University, and Dr. Jane Parmley, a veterinary epidemiologist and associate professor in the Department of Population Medicine at the Ontario Veterinary College, University of Guelph, join us to discuss the importance of zoonosis to the current medical landscape, the variety of ways that veterinarians and medical doctors discuss zoonotic diseases with their clients and patients, and how a One Health approach to medicine can help us to meet future disease challenges. Links of Interest: Centre for Disease Control Information on Zoonotic Diseases  Worms and Germs Blog  Community for Emerging and Zoonotic Diseases 

Join Dr. Roark and the wizard, the legend "Uncle Mickey Schaer" as they talk about progressive weakness in a cat! Let's get into this case! WORKSHOP ALERTS: Charming the Angry Client: https://drandyroark.com/angry-clients/ Team Communication: https://unchartedvet.com/team-communication/ ABOUT OUR GUEST: Dr. Michael Schaer received his D.V.M. degree from the University of Illinois in 1970. He then went to the Animal Medical Center (AMC) in New York City where he served as an intern and then as a medicine resident between1970-73. After the residency, he remained at the AMCas a staff member in the Department of Medicine until 1977. He then joined a private small animal practice in New Jersey until late 1978 at which time he joined the faculty at the University of Florida, College of Veterinary Medicine where he has remained until the present time. He has published several papers and book chapters and he has lectured nationally and internationally. Dr. Schaer is also the author of five textbooks: Clinical Medicine of the Dog and Cat – 1st, 2nd, and 3rdeditions and Clinical Signs in Small Animal Medicine, 1st and2nd editions. At the U of F, Dr. Schaer functions mainly as a clinician and a teacher. His previous UF professional duties included: Professor and Associate Chairman-Department of Small Animal Clinical Sciences, Associate Chief of Staff-Small Animal Hospital, and Service Chief-Small Animal Medicine. Dr. Schaer served as Interim Chair, Department of Comparative, Diagnostic, and Population Medicine from February 2017-September 2018. He is currently Professor Emeritus and Adjunct Professor in Emergency and Critical Care Medicine, while still doing active teaching in the classroom and in the critical care unit. Dr. Schaer is board certified in internal medicine (ACVIM) and emergency and critical care (ACVECC).

Join Dr. Roark and the wizard, the legend "Uncle Mickey Schaer" as they talk about that case that terrifies us all - the venomous snake bite! ABOUT OUR GUEST: Dr. Michael Schaer received his D.V.M. degree from the University of Illinois in 1970. He then went to the Animal Medical Center (AMC) in New York City where he served as an intern and then as a medicine resident between1970-73. After the residency, he remained at the AMCas a staff member in the Department of Medicine until 1977. He then joined a private small animal practice in New Jersey until late 1978 at which time he joined the faculty at the University of Florida, College of Veterinary Medicine where he has remained until the present time. He has published several papers and book chapters and he has lectured nationally and internationally. Dr. Schaer is also the author of five textbooks: Clinical Medicine of the Dog and Cat – 1st, 2nd, and 3rdeditions and Clinical Signs in Small Animal Medicine, 1st and2nd editions. At the U of F, Dr. Schaer functions mainly as a clinician and a teacher. His previous UF professional duties included: Professor and Associate Chairman-Department of Small Animal Clinical Sciences, Associate Chief of Staff-Small Animal Hospital, and Service Chief-Small Animal Medicine. Dr. Schaer served as Interim Chair, Department of Comparative, Diagnostic, and Population Medicine from February 2017-September 2018. He is currently Professor Emeritus and Adjunct Professor in Emergency and Critical Care Medicine, while still doing active teaching in the classroom and in the critical care unit. Dr. Schaer is board certified in internal medicine (ACVIM) and emergency and critical care (ACVECC).

Dr. Julia Marcus, PhD, MPH is an infectious disease epidemiologist and Associate Professor in the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute, and Adjunct Faculty at The Fenway Institute. Her research focuses on improving the implementation of preexposure prophylaxis (PrEP) to prevent new HIV infections and promote sexual health. In addition to her research, Dr. Marcus has contributed timely op-eds on current events, including a series of articles in The Atlantic on public health communication during the coronavirus pandemic. You can follow her on Twitter and learn more about her research.We talk about the blame, shame and judgment underlying COVID-19 stigma, and how it harms prevention initiatives. We also discuss the danger in focusing on individual risk practices rather than the responsibilities of larger social and institutional structures. Dr. Marcus encourages us take action (and create heat) for positive social change. Episode hosted by Dr. Carmen Logie. Supported by funding from the Canada Foundation for Innovation and Canada Research Chairs program. Original music and podcast produced by Jupiter Productions, who have various production services available to support your podcast needs.

COVID-19 and Data Decisions after Disruptions - Part 2. Got data? That is a question of the day it seems. In the midst of this pandemic our interest in data has never been great. Welcome to the panel discussion on data and decision making during the time of disruption. It's hosted by the Arrell Food Institute at the University of Guelph. Jeff Wichtel, Dean of the Imperial Veterinary College chairs a panel of University of Guelph experts. Rozita Dara, an associate professor school of computer science, Amy Greer Research Chair in Population Disease Modeling and associate professor, Department of Population Medicine. Simon Somogyi, an Arrell chair in Business of Food and associate professor school of Hospitality Food and Tourism Management. And Alfons Weersink professor, department of Food Agriculture and Resource Economics. Part 2 of the webinar. More info: https://arrellfoodinstitute.ca/webinars/

Got data? That is a question of the day it seems. In the midst of this pandemic our interest in data has never been great. Welcome to the panel discussion on data and decision making during the time of disruption. It's hosted by the Arrell Food Institute at the University of Guelph. Jeff Wichtel, Dean of the Imperial Veterinary College chairs a panel of University of Guelph experts. Rozita Dara, an associate professor school of computer science, Amy Greer Research Chair in Population Disease Modeling and associate professor, Department of Population Medicine. Simon Somogyi, an Arrell chair in Business of Food and associate professor school of Hospitality Food and Tourism Management. And Alfons Weersink professor, department of Food Agriculture and Resource Economics. More info: https://arrellfoodinstitute.ca/webinars/

The relaxation of the COVID-19 lockdown regulations is raising a lot of questions, both for doctors and for patients. This week, we discuss how the lack of clarity and coherence in public health messages over the past few months has caused anxiety and confusion for our patients, especially those who have been told to shield. We talk about GPs tailoring shielding advice to suit the individuals they treat, the politicisation of mask wearing, and the flaws of ‘abstinence-only' health messaging. How do we balance prompting overall health, rather than just working to prevent disease, and how do we start taking baby steps towards returning to normality? Our guests: Julia Marcus is an infectious disease epidemiologist and Assistant Professor at Harvard Medical School's Department of Population Medicine . She is also an HIV researcher. Carol Liddle, a COPD patient, is a patient advocate on the panel for NACAP (National asthma and COPD audit), as well as a patient representative for the Taskforce for Lung Health, which is run by the British Lung Foundation. Tom, Navjoyt and Jenny mentioned some resources they have found useful while looking at racism in medicine - which we have compiled into this document https://bit.ly/DBIRacismResources

The relaxation of the COVID-19 lockdown regulations is raising a lot of questions, both for doctors and for patients. This week, we discuss how the lack of clarity and coherence in public health messages over the past few months has caused anxiety and confusion for our patients, especially those who have been told to shield. We talk about GPs tailoring shielding advice to suit the individuals they treat, the politicisation of mask wearing, and the flaws of ‘abstinence-only' health messaging. How do we balance prompting overall health, rather than just working to prevent disease, and how do we start taking baby steps towards returning to normality? Our guests: Julia Marcus is an infectious disease epidemiologist and Assistant Professor at Harvard Medical School's Department of Population Medicine . She is also an HIV researcher. Carol Liddle, a COPD patient, is a patient advocate on the panel for NACAP (National asthma and COPD audit), as well as a patient representative for the Taskforce for Lung Health, which is run by the British Lung Foundation. Tom, Navjoyt and Jenny mentioned some resources they have found useful while looking at racism in medicine - which we have compiled into this document https://bit.ly/DBIRacismResources

This episode features Dr Emily Harrop (Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK). The support needs of people experiencing bereavement vary significantly. Bereavement support in palliative care involves different types and levels of provision to accommodate these needs. Specialist grief therapy is known to be effective for those with high-level risk and needs. Bereavement interventions were wide ranging and included bereavement support and social groups, psychological and counselling interventions and other types of support such as arts-based, befriending and relaxation interventions. Good quality randomised controlled trial evidence was only available for targeted family therapy and a non-targeted group–based therapy intervention, both of which were introduced during the caregiving period and found to be partially effective. The synthesis of qualitative evidence identified three core impacts which were common across interventions: ‘loss and grief resolution’, ‘sense of mastery and moving ahead’ and ‘social support’. The qualitative evidence suggests the value of peer support alongside opportunities for reflection, emotional expression and restoration-focused activities for those with moderate-level needs. These findings suggest the relevance of resilience and public health–based approaches to bereavement care. Full paper available from:     https://journals.sagepub.com/doi/10.1177/0269216320920533 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

Jessica Young, PhD is a biostatistician in the Department of Population Medicine at Harvard Medical School who joins the show to discuss the ins and outs of her interesting and important work. Tune in to learn the following: How confounding factors in a study can influence the findings of the study, and how/why the gold standard of randomized trials can address this What is meant by the “fundamental challenge of causal inference” and how this explains why assumptions are always necessary in order to claim that a statistical analysis is unbiased Why large subject numbers or data points can't overwhelm biases; why bias is a function of the thing being studied Dr. Young's job is two-fold: she works on both the applications of statistical methods for public health and clinical medicine, and also on the development of methods in these areas. She focuses on causal inference, which is the formal process of understanding how to estimate causal effect from data collected in real-world studies. Through examples including a longitudinal study on nurses starting in the 1970s to present day studies revolving around the coronavirus pandemic, Dr. Young discusses confounding factors in studies and the effect they have on interpretations of findings, the importance of randomization, the presence of bias regardless of how statistically significant a finding is, meta-analyses, where she sees the field of biostatistics heading in the near future, and more.   To learn about the basics of causal inference, Dr. Young recommends reading The Book of Why: The New Science of Cause and Effect. Visit https://www.populationmedicine.org/JYoung to learn more about her work and publications.

As the coronavirus pandemic drags on, people are slowly expanding their "bubbles" of people they see. Julia Marcus, infectious disease epidemiologist and assistant professor in the department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute, talks about what's safe to do, and how people can begin to inch toward some social interactions -- especially since many people are doing it already, anyway. https://www.theatlantic.com/ideas/archive/2020/05/quarantine-fatigue-real-and-shaming-people-wont-help/611482/

What started as a mysterious new illness that effectively shutdown the Chinese city of Wuhan is now a global health emergency as medical professionals around the world are trying to diagnose, quarantine, and contain the Coronavirus, or COVID-19 as the kids are calling it. New cases seem to be popping up on an hourly basis, but how concerned should we be? Let's talk to the professionals! This week on the podcast, we're going to hear from Doctor Nicola Mercer, the Medical Officer of Health for Wellington-Dufferin-Guelph Public Health, and Doctor Amy Greer, the Canada Research Chair in Population Disease Modeling and Associate Professor in the Department of Population Medicine at the Ontario Veterinary College of the University of Guelph. First, we will hear from Doctor Mercer about local strategy and preparedness should COVID-19 make an appearance in Guelph or Wellington County, and what lessons they’re taking from other jurisdictions already combating cases of the disease. Mercer will also talk about co-ordinating with other agencies and levels of government, what the media should be doing to keep people up-to-date, where to get the best information, and why Canada’s health system might be well-suited to tackle the unique challenges of COVID-19. Second, we'll talk to Doctor Greer, whose full-time job is studying how diseases spread, and the best strategies to mitigate potential pandemics. Doctor Greer talks about her research, how COVID-19 compares to other recent health emergencies like SARS and H1N1, and whether the response by the government and our health services is equal to the challenge. She also talks about the tricky balancing act in keeping people informed versus creating panic, and the unique challenges of dealing with a disease that for most people is indistinguishable from the common cold, and right in the middle of cold and flu season. So let's talk about the plan against COV-19 on this week's Guelph Politicast! The Government of Ontario has established a one-stop webpage for all the latest Coronavirus news, and you can find it here. For local updates, you can got to the Wellington-Dufferin-Guelph Public Health website here. The host for the Guelph Politicast is Podbean. Find more episodes of the Politicast here, or download them on your favourite podcast app at iTunes, Stitcher, Google Play, and Spotify. Also, when you subscribe to the Guelph Politicast channel and you will also get an episode of Open Sources Guelph every Monday, and an episode of End Credits every Friday.

Personal Versus Population Medicine How much of your medical care is tailored specifically to YOU? How much is dictated by POPULATION statistics and POPULATION guidelines? How did it happen that so much of what constitutes YOUR medical care is really not about you at all? Join me in this podcast to learn all about this.

Personal Versus Population MedicineHow much of your medical care is tailored specifically to YOU? How much is dictated by POPULATION statistics and POPULATION guidelines? How did it happen that so much of what constitutes YOUR medical care is really not about you at all? Join me in this podcast to learn all about this.

Dr. Roberto Cardarelli, Chief of the Division of Population Medicine and Chair of the Department of Family and Community Medicine at UK HealthCare is a Quality Improvement Guru. He is an expert in Population Health, which Wikipedia defines as: "the health outcomes of a group of individuals, including the distribution of such outcomes within the group. It is an approach to health that aims to improve the health of an entire human population.”In our interview, he explains why population health management is so important, especially for states like Kentucky, which struggles with poor health outcomes. He takes population health management, a seemingly huge task, and breaks it into small, bite-size pieces: access and analyze your data; start with small tests of change; look at TCM (Transitional Care Management) and CCM (Chronic Care Management) to increase reimbursements; and lastly, be creative.

Access to clean and safe water is a human need and is a right. However, for over 2 billion people, this simply is not the case. What’s worse is that in countries that have enjoyed the luxury of treated water, there is a troubling trend. From boil water orders to breaks in the system to massive outbreaks, our water supply is at risk. On this week’s show, we’re going to explore why we should be worried about our water. We first talk with Natalie Hull, an assistant professor of civil, environmental and geodetic engineering at the Ohio State University. Her work has explored the risks to the domestic water supply and we hear of the various factors involved such as increased pollution, climate change, and the water pipeline microbiome. We also learn how the situation might be improved by changing our focus from the water treatment plant to our taps. One way to improve water safety particularly from microbial pathogens is to use ultraviolet light, which is known to kill microorganisms. It can be used both at the treatment facility as well as in the home. We continue the conversation with Dr. Hull and venture into her research on the use of UV light to improve water safety. According to her findings, we may be able to keep our water safe without overburdening our city and home budgets. In our SASS Class, we take a wider approach to water safety with our guest teacher, Amy Greer. She’s a Tier 2 Canada Research Chair in population disease modelling and an associate professor in the Department of Population Medicine at the Ontario Veterinary College of the University of Guelph. She has looked at the various factors involved in keeping water safe and as you’ll hear, it comes down to an overarching goal known as One Health. From animals to climate to human activities, there are numerous ways water can become undrinkable and only by understanding all the parameters can we find ways to ensure we have access to water we can drink. If you enjoy The Super Awesome Science Show, please take a minute to rate it on Apple Podcasts and be sure to tell a friend about the show. Thanks to you, we won the Canadian Podcast Award for Outstanding Science and Medicine Series. Let’s keep the awesome momentum going together!  Twitter: @JATetro Email: thegermguy@gmail.com Guests: Natalie Hull Web: https://ceg.osu.edu/people/hull.305 Twitter: @water_micro Amy Greer Web: https://ovc.uoguelph.ca/population-medicine/faculty/Amy-Greer Twitter: @AmyGreerKalisz

GUEST: Jennifer McWhirter, Professor in the Department of Population Medicine at the University of Guelph

https://accadandkoka.com/wp-content/uploads/2018/10/Recent-events-with-Dr.-Accad-e1538497625793.png ()Michel Accad, MD In a matter of a couple of decades, the concepts of population health and population medicine have taken center-stage in healthcare, displacing the traditional aim of medicine and distorting the doctor-patient relationship. Our guest today is your co-host, Michel Accad, who highlights the errors of the population health theory as revealed in his recently published book Moving Mountains: A Socratic Challenge to the Theory and Practice of Population Medicine. GUEST: Michel Accad, MD:  https://twitter.com/michelaccad (Twitter) LINKS: Michel Accad.  https://movingmountainsthebook.com (Moving Mountains: A Socratic Challenge to the Theory and Practice of Population Medicine) Accad, M.  http://ubplj.org/index.php/ejpch/article/view/1372/pdf (Population health:  At odds with person-centered health care) (Editorial in the European Journal of Person-Centered Healthcare) WATCH ON YOUTUBE: https://youtu.be/Ca_jh_uf8cY (Watch the episode) on our YouTube channel. Support this podcast

In this episode, Dr. Berkson and Dr. Michel Accad discuss the history of medicine, where it came from and how it came to be what it is today. You'll learn the best answers to try to get the best health care, even in the face of how things have evolved. Michel Accad, MD, is a cardiologist and internal medicine specialist in private practice in San Francisco.  He also holds a clinical faculty appointment at the University of California San Francisco.  Dr. Accad has published extensively in the peer-reviewed medical literature on a variety of topics.  Dr. Accad writes a provocative blog called AlertandOriented.com, where he writes about medical science, medical ethics, the health care system, the doctor-patient relationship, and other related matters. Dr. A is also the author of Moving Mountains: A Socratic Challenge to the Theory and Practice of Population Medicine. You can find him on Twitter, @michelaccad. Michel Accad, MD 2000 Van Ness Avenue, Suite 208 San Francisco, CA 94109 Phone: 415-567-1014 Web: www.draccad.com Go the DrLindseyBerkson.com for a fuller-write up, pic and links.

Physician and author Dr. Michel Accad reflects on his journey through system-based medicine and how his skepticism of population medicine led him to establish his own private practice.

Is health the same thing for an individual as it is for a population? This question goes to the foundation of how we practice medicine today and that of most of genomic research. Michel Accad is a cardiologist in San Francisco and the author of a new book, Moving Mountains: A Socratic Challenge to the Theory and Practice of Population Medicine, in which he uses Socrates to spar with Geoffrey Rose, a British physician and one of the architects of modern medicine.

Listen NowOver approximately the past decade the health care industry has become increasingly committed to financially incenting physicians and other clinicians, or tying performance to reimbursement.  Commonly termed "pay for performance"(P4P), these arrangements are increasingly employed in the Medicare (i.e., under the Medicare Access and CHIP Reauthorization Act, or MACRA) and Medicaid programs and by commercial insurers, most notable accountable care models and bundled payment arrangements.   One might assume because P4P models are now common there is research evidence that demonstrates they are effective in, again, improving care quality, patient outcomes and lowering spending growth.  That is not the case.  For example, a systematic review published by Cochrane in 2011 found "there is insufficient evidence to support or not support the use of financial incentives to improve the quality of primary health care."  Among other examples, for all the attention the Massachusetts' Alternative Quality Contracts (AQCs) have received since they were launched in 2009, it remains unclear if they have reduced spending or spending growth.   Because P4P models have not proved out, payers and providers, for example, England's National Health Service and in the US the integrated, 12 hospital system, Geisinger Health, have substantially reduced incentive payments or are returning to paying providers straight salaries.            During this 27 minute conversation, Professor Soumerai discusses his interest in the P4P topic, describes P4p arrangements, summarizes his and others' review of the research evidence relative to the effectiveness of P4P arrangements and suggests model designs that may be more effective.  Stephen B. Soumerai is Professor of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute.  He also co-chairs the Statistics and Evaluative Sciences concentration within Harvard University's health policy Ph.D. program.  Dr. Soumerai recently served as International Trustee for the Canadian Health Services Research Foundation.  Dr. Soumerai has published more than 250 original scientific articles in leading scientific journal, such as the New England Journal of Medicine and the Journal of the American Medical Association.  He is well known nationally and internationally for his work on the impacts of health policies and methods to improve the quality of medical practice.  He frequently advises Congress, state legislatures and federal and international agencies on the design of drug cost containment, coverage and quality-of-care policies, evidence-based health policy and his research has been used extensively to support expanded economic access to medications in Medicaid and Medicare. He is the recipient of numerous honors including numerous article of the year awards from national and international scientific societies, named lectureships, and is the recipient of the Everett Mendelsohn Excellence in Mentoring Award from the Harvard University Graduate School of Arts and Sciences.Professor Soumerai's 2015 and 2016 CDC articles noting in this discussion are at: https://www.cdc.gov/pcd/issues/2015/15_0187.htm and https://www.cdc.gov/pcd/issues/2016/16_0133.htmA summary of these works can be found at: http://www.vox.com/the-big-idea/2017/1/25/14375776/pay-for-performance-doctors-bonuses This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Today we speak with Dr. Jason Coe, Associate Professor in Population Medicine at the University of Guelph, and one of the group of researchers that founded the website b4ugetapet.ca This website is... Through its province-wide network of 50 plus Communities, the Ontario SPCA is one of the largest, most responsive animal welfare organizations in the country, providing care and shelter for tens of thousands of animals every year. The Ontario SPCA is unique amongst animal welfare organizations in Ontario: the Ontario SPCA Act mandates the Society to enforce animal cruelty laws and provides Society Branch and Affiliate investigators with police powers to do so.

Kelsey Spence is a PhD Student, Epidemiology in the Department of Population Medicine at the University of Guelph. She is currently working with a research team to help prevent the spread of equine disease within Ontario, Canada. Listen to Kelsey as she outlines her research and the wonderful work that Equine Guelph is doing to help horses healthy.

On the inaugral re-launch of our show to 'PopHealth Week' see: 'From This Week in Accountable Care to PopHealth Week' and 'Some Thoughts on Population Health, its Definition(s) and the Providers Role', David Nash, MD, MBA the founding and current Dean of the Jefferson School of Population Health joins co-hosts Fred Goldstein (@fsgoldstein), CEO, Accountable Health LLC and Gregg Masters, MPH (@2healthguru), Founder & CEO of Health Innovation Media.  Join us Wednesday May 20th, 2015 at 12 Noon Eastern/9AM Pacific as we learn more about population health and population medicine from one of the country's most distinguished voices on this subject. For more information 

Dr. Michael Klompas is an Associate Professor of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute and an infectious disease physician and epidemiologist at Brigham and Women's Hospital. Stephen Morrissey, the interviewer, is the Managing Editor of the Journal. C. Rhee, S. Gohil, and M. Klompas. Regulatory Mandates for Sepsis Care - Reasons for Caution. N Engl J Med 2014;370:1673-6.

Dr. Matthew Gillman is Professor and Director of the Obesity Prevention Program in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute. Stephen Morrissey, the interviewer, is the Managing Editor of the Journal. M.W. Gillman and D.S. Ludwig. How Early Should Obesity Prevention Start? N Engl J Med 2013;369:2173-5.