text: So much more Archive Spiral Nature Membership Program By Spiral Nature Spiral Nature is launching a membership site to help fund its expansion. We welcomeContinue reading » Linkage: Vigilance, Abramelin, and the superego By Spiral Nature An aging succubus lowers standards. A collection of recipes for Abramelin Oil. Demons andContinue reading » Linkage: Fairytales, Satanism, and Tibetan aliens By Spiral Nature Shitty Horoscopes sounds amazing. Meow Wolf sounds like an amusement park I'd like toContinue reading » Linkage: Mercury retrograde, happiness, and ghosts By Spiral Nature Great advice for explaining magick to people who just aren't that into it, andContinue reading » Linkage: Linguistics, healing, and mirth By Spiral Nature Some fairy tales may be 6,000 years old and other linkage.Continue reading » Poll: Do you work with a patron deity? By Spiral Nature May's poll asks, Do you work with a patron deity?Continue reading » Linkage: Vain magicians, Druidry, and magical girls By Spiral Nature Was the Buddha a feminist? Can hierarchy and harmony co-exist? Is kabbalah overrated? Maybe?Continue reading » Linkage: Mercury, anarchy, and tarot By Spiral Nature Anarchy and magick -- two of my favourite subjects, and more linkage.Continue reading » Linkage: Fools, racists, and a happy marriage By Spiral Nature Did Zeus and Hera have a perfect marriage? And other linkage.Continue reading » Poll: Do you keep a journal of your practice? By Spiral Nature April's poll asks, Do you keep a journal of your spiritual practice?Continue reading » Stories behind the most popular good luck charms By Psyche, Editor-in-Chief Do you believe in good luck charms? The notion that certain objects hold aContinue reading » Linkage: Community, ethics, and ancient wines By Spiral Nature Those pseudo-intellectual quotes you see on social media probably aren't doing anyone any good,Continue reading »‹ Previous12345Next ›Last »


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How many Borel-measurable functions from $\mathbb{R}$ to $\mathbb{R}$ are there? The motivation is from this answer of mine on MathOverflow.
Sune, there are as many Borel-measurable functions as there are reals.
It is easy to see that a function is Borel-measurable iff the preimage of each open interval with rational end-points is a Borel set. Moreover, the function is completely determined by the sequence of pairs $(I,B)$ where $I$ varies over the intervals and $B$ is the preimage of $I$.
There are countably many possible $I$ and to each corresponds one of ${\mathfrak c}=|{\mathbb R}|$ many possible Borel sets. The total number of Borel functions is then bounded above by $|{\mathbb R}^{\mathbb N}|={\mathfrak c}$. Since each constant function is Borel-measurable, ${\mathfrak c}$ is also a lower bound.

subset: commoncrawl


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The IPv6 Skills Crisis As IPv6 adoption ramps up, there aren't nearly enough experts and trainers to fulfill the demand. Here's how to start educating yourself.
4 IT Cultures: Which One Are You? From White Knight to Curmudgeon, IT cultures fall into four categories. Which one describes your organization?
Cloud WLANs: Weighing Pros And Cons Cloud-managed wireless networks offer significant benefits, but IT must consider cloud downsides to make an informed choice.
Shadow IT Is An Opportunity, Not A Problem Shadow IT isnt a scourge. Its an opportunity for IT to engage the business and add value, says CBS Interactives Steve Comstock.
Let's Experiment On Facebook Facebook angered lots of people with its experiments to manipulate users moods. What might happen if 800 million users decide to return the favor?
BYOD Expectations Just Keep Rising: InformationWeek Video Wasn't BYOD supposed to be easier for IT to manage by now? That was before it became bring your own everything.
Finding Talent: What IT Can Learn From Baseball IT organizations and pro baseball teams both need talented players. IT can take lessons from a small-market team that stays competitive in a league dominated by big payrolls.


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Codeigniter Jobs and ContestsCodeigniter jobs are for experts who understand computer programming. If you are one of these professionals, then you can start earning money today, working on many projects on Freelancer.com.
Codeigniter refers to a framework used in web application development. This tool is mostly used in creating websites that use PHP. Codeigniter eliminates the process of starting a project from scratch, thus sparing developers from dealing with all the codes which in effect saves them time.
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|Customization of existing website I have a job website built in CodeIgniter MVC, the project is pretty much all done just a few bugs need fixing and the websites front-end needs to look modern, unique, fresh, and professional. This is not a big project at all and I am in no rush to get it done. Please send your bids in, reasonable bids only.
|PHP, CSS, Codeigniter, HTML, MVC
|Jul 29, 2016
|Today6d 20h
|Full time wordpress developer
|I am looking to hire a full-time WordPress developer to work with me in my successful 12+ years web development company. Ideally, I would like someone whom I can work with online at least for part of the day in my timezone GMT+10, but if no suitable candidates apply I will be willing to view those from the other side of the globe. The bulk of the work consists of creating wordpress sites ba...
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|Build a Website with Bitcoin Payment system
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|Expert codeigniter
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|Completely re-write an existen php script but you need to use codeigniter and bootstrap
|Hello, I purchased a member area (I have the source code) but I want to completely re-write again for using codeigniter and bootstrap. The code is not organized! So you need to rewrite it but based on the current code. The script to re-write is ZL-Membre http://php-info.info/zl_index.php ; a demo at http://rh-recrutement.fr/demo/zl/index.php You can use the design of your choice or use an e...
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Priyanka Chopra's first Hollywood venture 'Quantico' was premiered on Sunday and received accolades from ever quarter but along with appreciation came embracement when ABC mistook Yukta Mookhey as Priyanka Chopra and show her Miss World victory footage on Nightline, ABC's late night news bulletin
MISS WORLD 2000 Yukta Mookhey Final Walk
yukta mookhey
Former beauty queen and Bollywood actress Yukta Mookhey gets legally separated from her husband Prince Tuli on mutual consent. The criminal allegations filed by Yukta against her husband and in-laws had been quashed and family court granted divorce to Yukta and Tuli. Tuli's lawyer Filji Fredrick
Reacting to the complaint lodged by former beauty queen Yukta Mookhey against her businessman husband Prince Tuli of unnatural sex and domestic viloence over the years, her husband Tuli threatened her to leak few inappropria
Latest Bollywood News
- TV couple Daljeet, Shaleen to file for divorce on Monday
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- Arjun Bijlani gets injured while rehearsing for 'Jhalak Dikkhla Jaa 9'
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Nov 4
Oct 29
Sep 8
Sounds Like: Eric Clapton, Jorma Kaukonen יורמה קאוקונן, John Hammond Jr., Jerry Garcia, Bob Dylan
Label: Beat Down Dog
Bio: Delta, Ragtime & Holy Blues with some Americana style! Originals and covers. Seasoned live performer. My influences include Robert Johnson & Rev. Gary Davis. They are atop my list of many. I use CF Martin, Gibson & National Steel Guitars. I have my own Label & Studio. I'm available For solo gigs,...See Full Bio


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Color Country Entrada 2 Bedroom 2 Bath Home
From $225 / night
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Description from the manager
Description from the manager
Bedrooms: 2/
Bathrooms: 2/
Sleeps: 4/
Type: House
Book this 2 bedroom, 2 bathroom house in Saint George today! A total of 4 people can sleep here comfortably. This property has been booked 4 times.
Guests can enjoy a hot tub, air conditioning, and internet access among other amenities offered by this rental.
Travelers are sharing their opinions on this property. It has an overall rating of 5/5 thanks to an average of 5 reviews.
Costs vary, with the average weekly rate as low as $1,575.00, depending on travel dates.
The owner responds to 100% of inquiries and last updated the property's calendar 6 days ago.
About the manager
About the manager
Lem Lucia
Lem Lucia
- Response rate: 100%
- Response time: A few hours
- Calendar updated: 6 days ago
Overall rating:
5.0 / 5.0
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Posted on January 2, 2014 | 1573 views
In this special two-part "twin sticks" edition of our Ultimate Test Drive videos, Equipment Editor Jim Park visits Mack's test track in Allentown, Pa., to experience first-hand 50 years of advancements in transmission technology.
Tags: Automated Manual Transmissions, Mack, Test Drive, Transmissions, Ultimate Test Drive
Is there a reason that Jim Parks does not use his turn signals as he starts out with the new truck nor stop for the stop sign, not something a professional such as my self would not notice
We offer e-newsletters that deliver targeted news and information for the entire fleet industry.
The expert, Brian Fletcher from Eaton, will answer your questions
Gates Offers 6 Heavy-Duty Water Pumps
Reyco Granning DM400e is Lighter Than Predecessor
Baldwin Filters Offers Aftermarket Filter Designed for Kenworth Models
ARI Introduces Driver Scorecard for Simple Analysis


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I have a table with a series of buttons down the left side. These buttons have an onClick handler that selects items and adds them to that line in the table. I am trying to change the function of the button so that it edits the line of data after it has been used to add the line of data.
linebutton.value='Edit'; // i.e. change the button label (this works)
linebutton.setAttribute("onclick","openpopup('edititem.php?line='"+lineno+"',400,200,'',0,0,0,0,0);" );
// This succeeds in changing the
// the code stored in the onclick
// attribute, but it will not execute
When I click on the button (now labeled 'Edit'), nothing happens. I suspect the event handler must be re-activated somehow, but I can't seem to figure it out. Would someone please give me some guidance?


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July 19, 2016
Starting your own business isn't for the faint of heart. It helps if you are inspired by an ancestor who did the same. Here's the story of how Pablo Guerrero made his own mark while honoring his grandfather.
June 29, 2016
Nonwelders who aren't interested in learning more about the science don't have an appreciation for what it takes to repair different items. One repair may take a few minutes, and another considerably longer. It depends on many things.
June 23, 2016
The measure of your success as a welder lies in the quality of your weld. For female welder Sam Riggin, the quality of her welds also has earned her respect in a male-dominated profession.
June 14, 2016
Independent fabricators and artists need workspace. On his search for space in Detroit, Josh Welton came across an interesting alternative to the typical offerings modeled on a similar, successful venture in New York. He's excited about the prospect of working in this environment.
June 1, 2016
The U.S recently celebrated Memorial Day, a day set aside to remember the people who died while serving in the country's armed forces. To commemorate this occasion, Josh Welton has turned the podium over to his better half, Darla, who honors her dad and his fellow soldiers killed in action in this moving tribute.
May 23, 2016
Interested in a career in welding and fabrication? Take advantage of opportunities to learn more, and you might find yourself on a fulfilling career path, just like Jonathan Lewis.
May 19, 2016
Times have changed. We live in the information and stimulation age. Many things vie for our attention, and it can be difficult to focus on a single activity or life plan. Is that good or bad? Here's Josh Welton's take, based on his own experience.
May 2, 2016
Remember when the U.S. government bailed out Detroit? Many people were up in arms over the action. Perhaps knowing more about the automakers' contributions to winning WWII might have softened some opinions. Here's a short story about Chrysler's role.
April 25, 2016
Welder and inspector Lucca Ilbert, who trained at the Robert Morgan Educational Center in Miami, loves fabricating and repairing aircraft parts. He hopes one day to have his own FAA-approved custom fabricating shop.
April 20, 2016
Repeating certain exercises is a fundamental part of learning a skill. Running stringers is one such exercise for anyone learning to weld. It also helps to listen to the instructor explain how it's done.
April 7, 2016
Do any of your earliest memories involve work? Josh Welton remembers using a drawknife and a hatchet to help his parents prepare wood for a log home. It was a communal labor of love that likely fostered his love of making things by hand.
March 29, 2016
There are dream cars and dream jobs. Combining both has allowed J.D. Hendrickson to achieve his dream career. Here's the short story of how he got there.
March 15, 2016
How much do you know about welding? The best welders recognize that there is always room for improvement and more to learn.
March 1, 2016
The first time welder and metal artist Josh Welton displayed his art at a show was at the 2010 Detroit Autorama. Six years later, he's still participating and enjoying not only the show but the people, including some who have become valued friends and mentors. He also appreciates the opportunity to talk shop and share his passion for welding.
February 17, 2016
With the right skills and support, it's possible for talented welding students to move directly into a good job with growth potential.


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HOMES FOR SALE: CASA DE CAMPO exclusive section of Palmetto Bay. You will enter gated Casa de Campo for privacy and relaxation. Exquisite and spacious water front with great floor plan. Fantastic for children with outstanding schools in the area. Ready now. GAMA Realty...More info Email a friend
HOMES FOR SALE: Great Investment Opportunity on Westchester area. Daycare Property for sale, currently rented for $2650 a month. Located on huge corner lot, the 5/4 house is zoned educational and licensed for 29 children. Tenant pays for all utilities and repairs. Keep...More info Email a friend
CONDOS FOR SALE: Condo on the intra-coastal, 3 bedrooms, 3 full bathrooms, 18th floor, hurricane shutters on all windows and sliding glass doors, 2 terraces, new upgraded kitchen w/ stainless steel appliances, granite counter-tops, wood cabinets, plantation shutters on ...More info Email a friend
MISC FOR SALE: Foreclosure & Commercial Properties Any Price Place or Condition AS-IS No Repair No Inspection Fast Closing Luxury Real Estate Group LLCMore info Email a friend
CONDOS FOR SALE: PUBLIC AUCTION FRIDAY, AUG. 5th Bellini at Williams Island 3/3 Condo 2,235 sf- private elevator, Corner-water view-high luxury 8% BP - Info how to Bid visit www.BELLINIAUCTION.com (305) 984-0694 Lidio Britto, Auctioneer AU3541More info Email a friend
HOMES FOR SALE: Miami Beach waterfront home 4/3 walk to beach, htd pool. 50' on wide bay. owner/ agent Natalie Nichols 786-877-9700 FL Realty of Miami. $1,690,000 1541 Stillwater Drive.More info Email a friend
DUPLEX FOR SALE: Miami Beach Waterfront 4-plex No bridges, Rare opportunity Live in private 3 bed/1bth unit on water, no bridges, collect income on 3 one-bedroom apts. 807 86 street $1,550,000 Owner/agent Natalie Nichols. 786-877-9700 FloridaRealty of MiamiMore info Email a friend
HOMES FOR SALE: KEYSTONE POINT WATERFRONT OPEN SATURDAY & SUNDAY 1-3PM 2260 ARCH CREEK DR. Boaters Dream, unobstructed Bay & Ocean access. 75ft on wide canal. 2 sets of davits. 5 ton with motor drive boom + 3 ton manual boom. New roof 2015, pool completely redone...More info Email a friend
LOTS FOR SALE: LAKE FRONT LIQUIDATION! Saturday July 30th 5+/Acres $9,900 Breathtaking Lake views Dont' miss out! Call TODAY to book your appt Call 1-888-270-4695More info Email a friend
HOMES FOR SALE: PALM BEACH COUNTY 5 BEAUTIFUL ACRES: private paradise gated estate home 4/3.5 All upgrades: Fabulous spacious interiors: awesome granite chef kitchen. Screened pool /spa /cabana /dining / BBQ / firepit /entertainment lanais & vistas, tennis ct, horse paddocks...More info Email a friend
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I've got a DSP audio aglo in C# that I'd like to incorporate into iOS. A friend suggested that I convert to C++ instead of Objective-C, as it would be platform agnostic. Is this a good practice, any pitfalls to be aware of? My instinct is to keep it native with Obj-C. How would I access C++ functions within iOS?
Thank you


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- Swimmer Ryan Lochte reveals one of his worst dates - US Weekly
- Get the latest on Dr. Dre's arrest - TMZ
- Despite rumors, Eddie Murphy's daughter is not pregnant - Gossip Cop
- The Vampire Diaries star Michael Trevino steps out for a good cause - Just Jared Jr
- Are Blac Chyna and Kylie Jenner on good terms? - Radar
- Blue Ivy is just as stylish as her mom Beyonce! - Lainey Gossip
- This Narcos star confirms he's not coming back for another season of the show - The Hollywood Reporter
06 June 2014 at 12:36 PM
Demi Lovato Debuts 'Nightingale' During 'GMA' Concert Series
About this photo set: Demi Lovato rocks hot pink lipstick with her new purple hair during the Good Morning America Concert Series in Central Park, New York City on Friday morning (June… Read More Here
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Pharmacy Students' Facebook Activity and Opinions Regarding Accountability and E-Professionalism
Cain, Jeff
Scott, Doneka R.
Akers, Paige
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To assess pharmacy students' Facebook activity and opinions regarding accountability and e-professionalism and determine effects of an e-professionalism education session on pharmacy students' posting behavior.
A 21-item questionnaire was developed, pilot-tested, revised, and administered to 299 pharmacy students at 3 colleges of pharmacy. Following a presentation regarding potential e-professionalism issues with Facebook, pharmacy students with existing profiles answered an additional question concerning changes in online posting behavior.
Incoming first-year pharmacy students' Facebook usage is consistent with that of the general college student population. Male students are opposed to authority figures' use of Facebook for character and professionalism judgments and are more likely to present information they would not want faculty members, future employers, or patients to see. More than half of the pharmacy students planned to make changes to their online posting behavior as a result of the e-professionalism presentation.
There is high social media usage among pharmacy students and many do not fully comprehend the issues that arise from being overly transparent in online settings. Attitudes toward accountability for information supplied via social networking emphasize the need for e-professionalism training of incoming pharmacy students.
online social networking; e-professionalism; Facebook; technology; professionalism
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Social media provide another avenue for community development that patients, particularly those with cancer, are often seeking.
The penetration of social media into modern society has become a worldwide cultural phenomenon. Social media use widely accessible Web-based and mobile technologies to facilitate the creation and sharing of user-generated content in a collaborative and social manner. The uptake of social media in medicine provides new opportunities for health care professionals and institutions to interact with patients and other professionals. Oncologists may use social media as a platform for patient education and authoritative health messaging, for professional development and knowledge sharing, and for direct patient interaction, although this may be fraught with important legal and privacy concerns. In this article, a working group of the ASCO Integrated Media and Technology Committee explores how oncologists might responsibly use social media in their professional lives. Existing social media policies from hospitals, health systems, and pharmaceutical industries are examined to identify common concepts informing the development of future guidelines. Key principles identified include establishing institutional ownership of social media activities and safeguarding protected health information. Furthermore, oncologists must not confuse the roles of provider of information and provider of care, must understand regulations related to state licensure and medical records, and must recognize the importance of transparency and disclosure of potential conflicts of interest. social media may be particularly useful for raising the awareness of and recruitment to clinical trials, but compliance with federal and state regulations and areas under the purview of a local institutional review board must also be ensured. Examples of constructive use of social media in oncology with Facebook, Twitter, and YouTube are provided.
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e-Health, m-Health and healthier social media reform: the big scale view
Bahagon, Yossi
Jacobson, Orit
International Journal of Integrated Care
In the upcoming decade, digital platforms will be the backbone of a strategic revolution in the way medical services are provided, affecting both healthcare providers and patients. Digital-based patient-centered healthcare services allow patients to actively participate in managing their own care, in times of health as well as illness, using personally tailored interactive tools. Such empowerment is expected to increase patients' willingness to adopt actions and lifestyles that promote health as well as improve follow-up and compliance with treatment in cases of chronic illness. Clalit Health Services (CHS) is the largest HMO in Israel and second largest world-wide. Through its 14 hospitals, 1300 primary and specialized clinics, and 650 pharmacies, CHS provides comprehensive medical care to the majority of Israel's population (above 4 million members). CHS e-Health wing focuses on deepening patient involvement in managing health, through personalized digital interactive tools. Currently, CHS e-Health wing provides e-health services for 1.56 million unique patients monthly with 2.4 million interactions every month (August 2011). Successful implementation of e-Health solutions is not a sum of technology, innovation and health; rather it's the expertise of tailoring knowledge and leadership capabilities in multidisciplinary areas: clinical, ethical, psychological, legal, comprehension of patient and medical team engagement etc. The Google Health case excellently demonstrates this point. On the other hand, our success with CHS is a demonstration that e-Health can be enrolled effectively and fast with huge benefits for both patients and medical teams, and with a robust business model.
CHS e-Health core components
They include:
1. The personal health record layer (what the patient can see) presents patients with their own medical history as well as the medical history of their preadult children, including diagnoses, allergies, vaccinations, laboratory results with interpretations in layman's terms, medications with clear, straightforward explanations regarding dosing instructions, important side effects, contraindications, such as lactation etc., and other important medical information. All personal e-Health services require identification and authorization.
2. The personal knowledge layer (what the patient should know) presents patients with personally tailored recommendations for preventative medicine and health promotion. For example, diabetic patients are push notified regarding their yearly eye exam. The various health recommendations include: occult blood testing, mammography, lipid profile etc. Each recommendation contains textual, visual and interactive content components in order to promote engagement and motivate the patient to actually change his health behaviour.
3. The personal health services layer (what the patient can do) enables patients to schedule clinic visits, order chronic prescriptions, e-consult their physician via secured e-mail, set SMS medication reminders, e-consult a pharmacist regarding personal medications. Consultants' answers are sent securely to the patients' personal mobile device.
On December 2009 CHS launched secured, web based, synchronous medical consultation via video conference. Currently 11,780 e-visits are performed monthly (May 2011). The medical encounter includes e-prescription and referral capabilities which are biometrically signed by the physician. On December 2010 CHS launched a unique mobile health platform, which is one of the most comprehensive personal m-Health applications world-wide. An essential advantage of mobile devices is their potential to bridge the digital divide. Currently, CHS m-Health platform is used by more than 45,000 unique users, with 75,000 laboratory results views/month, 1100 m-consultations/month and 9000 physician visit scheduling/month.
4. The Bio-Sensing layer (what physiological data the patient can populate) includes diagnostic means that allow remote physical examination, bio-sensors that broadcast various physiological measurements, and smart homecare devices, such as e-Pill boxes that gives seniors, patients and their caregivers the ability to stay at home and live life to its fullest. Monitored data is automatically transmitted to the patient's Personal Health Record and to relevant medical personnel.
The monitoring layer is embedded in the chronic disease management platform, and in the interactive health promotion and wellness platform. It includes tailoring of consumer-oriented medical devices and service provided by various professional personnel—physicians, nurses, pharmacists, dieticians and more.
5. The Social layer (what the patient can share). Social media networks triggered an essential change at the humanity 'genome' level, yet to be further defined in the upcoming years. Social media has huge potential in promoting health as it combines fun, simple yet extraordinary user experience, and bio-social-feedback. There are two major challenges in leveraging health care through social networks:
a. Our personal health information is the cornerstone for personalizing healthier lifestyle, disease management and preventative medicine. We naturally see our personal health data as a super-private territory. So, how do we bring the power of our private health information, currently locked within our Personal Health Record, into social media networks without offending basic privacy issues?
b. Disease management and preventive medicine are currently neither considered 'cool' nor 'fun' or 'potentially highly viral' activities; yet, health is a major issue of everybody's life. It seems like we are missing a crucial element with a huge potential in health behavioural change—the Fun Theory. Social media platforms comprehends user experience tools that potentially could break current misconception, and engage people in the daily task of taking better care of themselves.
CHS e-Health innovation team characterized several break-through applications in this unexplored territory within social media networks, fusing personal health and social media platforms without offending privacy. One of the most crucial issues regarding adoption of e-health and m-health platforms is change management. Being a 'hot' innovative 'gadget' is far from sufficient for changing health behaviours at the individual and population levels.
CHS health behaviour change management methodology includes 4 core elements:
1. Engaging two completely different populations: patients, and medical teams. e-Health applications must present true added value for both medical teams and patients, engaging them through understanding and assimilating "what's really in it for me". Medical teams are further subdivided into physicians, nurses, pharmacists and administrative personnel—each with their own driving incentive. Resistance to change is an obstacle in many fields but it is particularly true in the conservative health industry. To successfully manage a large scale persuasive process, we treat intra-organizational human resources as "Change Agents". Harnessing the persuasive power of ~40,000 employees requires engaging them as the primary target group. Successful recruitment has the potential of converting each patient-medical team interaction into an exposure opportunity to the new era of participatory medicine via e-health and m-health channels.
2. Implementation waves: every group of digital health products that are released at the same time are seen as one project. Each implementation wave leverages the focus of the organization and target populations to a defined time span. There are three major and three minor implementation waves a year.
3. Change-Support Arrow: a structured infrastructure for every implementation wave. The sub-stages in this strategy include:
Cross organizational mapping and identification of early adopters and stakeholders relevant to the implementation wave
Mapping positive or negative perceptions and designing specific marketing approaches for the distinct target groups
Intra and extra organizational marketing
Conducting intensive training and presentation sessions for groups of implementers
Running conflict-prevention activities, such as advanced tackling of potential union resistance
Training change-agents with resistance-management behavioural techniques, focused intervention for specific incidents and for key opinion leaders
Extensive presence in the clinics during the launch period, etc.
The entire process is monitored and managed continuously by a review team.
4. Closing Phase: each wave is analyzed and a "lessons-learned" session concludes the changes required in the modus operandi of the e-health project team.
e-Health; mobile health; personal health record; online visit; patient empowerment; knowledge prescription
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Social Media: A Review and Tutorial of Applications in Medicine and Health Care
Grajales III, Francisco Jose
Sheps, Samuel
Ho, Kendall
Novak-Lauscher, Helen
Eysenbach, Gunther
Journal of Medical Internet Research
Social media are dynamic and interactive computer-mediated communication tools that have high penetration rates in the general population in high-income and middle-income countries. However, in medicine and health care, a large number of stakeholders (eg, clinicians, administrators, professional colleges, academic institutions, ministries of health, among others) are unaware of social media's relevance, potential applications in their day-to-day activities, as well as the inherent risks and how these may be attenuated and mitigated.
We conducted a narrative review with the aim to present case studies that illustrate how, where, and why social media are being used in the medical and health care sectors.
Using a critical-interpretivist framework, we used qualitative methods to synthesize the impact and illustrate, explain, and provide contextual knowledge of the applications and potential implementations of social media in medicine and health care. Both traditional (eg, peer-reviewed) and nontraditional (eg, policies, case studies, and social media content) sources were used, in addition to an environmental scan (using Google and Bing Web searches) of resources.
We reviewed, evaluated, and synthesized 76 articles, 44 websites, and 11 policies/reports. Results and case studies are presented according to 10 different categories of social media: (1) blogs (eg, WordPress), (2) microblogs (eg, Twitter), (3) social networking sites (eg, Facebook), (4) professional networking sites (eg, LinkedIn, Sermo), (5) thematic networking sites (eg, 23andMe), (6) wikis (eg, Wikipedia), (7) mashups (eg, HealthMap), (8) collaborative filtering sites (eg, Digg), (9) media sharing sites (eg, YouTube, Slideshare), and others (eg, SecondLife). Four recommendations are provided and explained for stakeholders wishing to engage with social media while attenuating risk: (1) maintain professionalism at all times, (2) be authentic, have fun, and do not be afraid, (3) ask for help, and (4) focus, grab attention, and engage.
The role of social media in the medical and health care sectors is far reaching, and many questions in terms of governance, ethics, professionalism, privacy, confidentiality, and information quality remain unanswered. By following the guidelines presented, professionals have a starting point to engage with social media in a safe and ethical manner. Future research will be required to understand the synergies between social media and evidence-based practice, as well as develop institutional policies that benefit patients, clinicians, public health practitioners, and industry alike.
social media; blogging; social network
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Online Social Networking Issues Within Academia and Pharmacy Education
Cain, Jeff
American Journal of Pharmaceutical Education
Online social networking sites such as Facebook and MySpace are extremely popular as indicated by the numbers of members and visits to the sites. They allow students to connect with users with similar interests, build and maintain relationships with friends, and feel more connected with their campus. The foremost criticisms of online social networking are that students may open themselves to public scrutiny of their online personas and risk physical safety by revealing excessive personal information. This review outlines issues of online social networking in higher education by drawing upon articles in both the lay press and academic publications. New points for pharmacy educators to consider include the possible emergence of an "e-professionalism" concept; legal and ethical implications of using online postings in admission, discipline, and student safety decisions; how online personas may blend into professional life; and the responsibility for educating students about the risks of online social networking.
online social networking; e-professionalism; Facebook; MySpace; technology
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Mind the Gap: Social Media Engagement by Public Health Researchers
Keller, Brett
Labrique, Alain
Jain, Kriti M
Pekosz, Andrew
Levine, Orin
Journal of Medical Internet Research
The traditional vertical system of sharing information from sources of scientific authority passed down to the public through local health authorities and clinicians risks being made obsolete by emerging technologies that facilitate rapid horizontal information sharing. The rise of Public Health 2.0 requires professional acknowledgment that a new and substantive forum of public discourse about public health exists on social media, such as forums, blogs, Facebook, and Twitter.
Some public health professionals have used social media in innovative ways: to surveil populations, gauge public opinion, disseminate health information, and promote mutually beneficial interactions between public health professionals and the lay public. Although innovation is on the rise, most in the public health establishment remain skeptical of this rapidly evolving landscape or are unclear about how it could be used. We sought to evaluate the extent to which public health professionals are engaged in these spaces.
We conducted a survey of professorial- and scientist-track faculty at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, USA. We asked all available faculty via email to complete a 30-question survey about respondent characteristics, beliefs about social media, and usage of specific technologies, including blogs, Facebook, Twitter, and YouTube.
A total of 181 (19.8%) of 912 professor- and scientist-track faculty provided usable responses. The majority of respondents rarely used major social media platforms. Of these 181 respondents, 97 (53.6%) had used YouTube, 84 (46.4%) had used Facebook, 55 (30.4%) had read blogs, and 12 (6.6%) had used Twitter in the prior month. More recent degree completion was the best predictor of higher usage of social media. In all, 122 (67.4%) agreed that social media is important for disseminating information, whereas only 55 (30.4%) agreed that social media is useful for their research. In all, 43 (23.8%) said social media was helpful for professional career advancement, whereas 72 (39.8%) said it was not. Only 43 (23.8%) faculty said they would employ a full- or part-time social media consultant, and 30 (16.6%) currently employed one.
Despite near-universal appreciation of the potential for social media to serve as a component of public health strategy, a small minority are actually engaged in this space professionally, whereas most are either disinterested or actively opposed to professional engagement. Social media is seen by most as more useful for spreading information than obtaining it. As public discourse on a number of critical health topics continues to be influenced and sometimes shaped by discussions online from Twitter to Facebook, it would seem that greater discourse is needed about when and how public health professionals should engage in these media, and also how personal, institutional, and professional barriers to greater use of social media may be overcome.
Internet; social media; public health; blogging
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Viewpoint discrimination and contestation of ideas on its merits, leadership and organizational ethics: expanding the African bioethics agenda
Chima, Sylvester C
Mduluza, Takafira
Kipkemboi, Julius
BMC Medical Ethics
2013;14(Suppl 1):S1.
The 3rd Pan-African Ethics Human Rights and Medical Law (3rd EHRML) conference was held in Johannesburg on July 7, 2013, as part of the Africa Health Congress. The conference brought together bioethicists, researchers and scholars from South Africa, Zimbabwe, Kenya and Nigeria working in the field of bioethics as well as students and healthcare workers interested in learning about ethical issues confronting the African continent. The conference which ran with a theme of "Bioethical and legal perspectives in biomedical research and medical practice in Africa with a focus on: Informed consent, HIV-AIDS & Tuberculosis, leadership & organizational ethics, patients and healthcare workers rights," was designed to expand the dialogue on African bioethics beyond the traditional focus on research ethics and the ethical dilemmas surrounding the conduct of biomedical research in developing countries. This introductory article highlights some of areas of focus at the conference including issues of leadership, organizational ethics and patients and healthcare workers rights in Africa. We analyze the importance of free speech, public debate of issues, argumentation and the need to introduce the teaching and learning of ethics to students in Africa in accordance with UNESCO guidelines. This article also focuses on other challenges confronting Africa today from an ethical standpoint, including the issues of poor leadership and organizational ethics which are main contributors to the problems prevalent in African countries, such as poverty, poor education and healthcare delivery systems, terrorism, social inequities, infrastructural deficits and other forms of 'structural violence' confronting vulnerable African communities. We believe that each of the eight articles included in this supplement, which have been rigorously peer-reviewed are a good example of current research on bioethics in Africa, and explore some new directions towards broadening the African bioethics agenda as we move forward to a new dawn for Africa in the 21st century.
Africa; argumentation; bioethics; leadership; organizational ethics; structural violence; viewpoint discrimination; vulnerable populations
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Prevalence and Global Health Implications of Social Media in Direct-to-Consumer Drug Advertising
Liang, Bryan A
Mackey, Timothy K
Journal of Medical Internet Research
Direct-to-consumer advertising (DTCA), linked to inappropriate medication use and higher health care expenditures, is the fastest growing form of pharmaceutical marketing. DTCA is legal only in the United States and New Zealand. However, the advent of online interactive social media "Web 2.0" technologies—that is, eDTCA 2.0—may circumvent DTCA legal proscriptions.
The purpose of this study was to assess the prevalence of DTCA of leading pharmaceutical company presence and drug product marketing in online interactive social media technologies (eDTCA 2.0).
We conducted a descriptive study of the prevalence of eDTCA 2.0 marketing in the top 10 global pharmaceutical corporations and 10 highest grossing drugs of 2009.
All pharmaceutical companies reviewed (10/10, 100%) have a presence in eDTCA 2.0 on Facebook, Twitter/Friendster, sponsored blogs, and really simple syndication (RSS) feeds. In addition, 80% (8/10) have dedicated YouTube channels, and 80% (8/10) developed health care communication-related mobile applications. For reviewed drugs, 90% (9/10) have dedicated websites, 70% (7/10) have dedicated Facebook pages, 90% (9/10) have health communications-related Twitter and Friendster traffic, and 80% (8/10) have DTCA television advertisements on YouTube. We also found 90% (9/10) of these drugs had a non-corporate eDTCA 2.0 marketing presence by illegal online drug sellers.
Pharmaceutical companies use eDTCA 2.0 to market themselves and their top-selling drugs. eDTCA 2.0 is also used by illicit online drug sellers. Regulators worldwide must take into account the current eDTCA 2.0 presence when attempting to reach policy and safety goals.
Illegal pharmacies; social media; pharmaceutical marketing; direct-to-consumer-advertising; internet pharmacies; global health; law; health policy
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Harnessing Online Peer Education (HOPE): Integrating C-POL and Social Media to Train Peer Leaders in HIV Prevention
Jaganath, Devan
Gill, Harkiran K.
Cohen, Adam Carl
Young, Sean D.
AIDS Care
Novel methods, such as Internet-based interventions, are needed to combat the spread of HIV. While past initiatives have used the Internet to promote HIV prevention, the growing popularity, decreasing digital divide, and multi-functionality of social networking sites, such as Facebook, make this an ideal time to develop innovative ways to use online social networking sites to scale HIV prevention interventions among high-risk groups. The UCLA HOPE [Harnessing Online Peer Education] study is a longitudinal experimental study to evaluate the feasibility, acceptability, and preliminary effectiveness of using social media for peer-led HIV prevention, specifically among African American and Latino Men who have Sex with Men (MSM). No curriculum currently exists to train peer leaders in delivering culturally aware HIV prevention messages using social media. Training was created that adapted the Community Popular Opinion Leader (C-POL) model, for use on social networking sites. Peer leaders are recruited who represent the target population and have experience with both social media and community outreach. The curriculum contains the following elements: discussion and role playing exercises to integrate basic knowledge of HIV/AIDS, awareness of sociocultural HIV/AIDS issues in the age of technology, and communication methods for training peer leaders in effective, interactive social media-based HIV prevention. Ethical issues related to Facebook and health interventions are integrated throughout the sessions. Training outcomes have been developed for long-term assessment of retention and efficacy. This is the first C-POL curriculum that has been adapted for use on social networking websites. Although this curriculum has been used to target African American and Latino MSM, it has been created to allow generalization to other high-risk groups.
HIV prevention; social networking; facebook; c-pol; popular opinion leader
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Disagreements with implications: diverging discourses on the ethics of non-medical use of methylphenidate for performance enhancement
Forlini, Cynthia
Racine, Eric
BMC Medical Ethics
There is substantial evidence that methylphenidate (MPH; Ritalin), is being used by healthy university students for non-medical motives such as the improvement of concentration, alertness, and academic performance. The scope and potential consequences of the non-medical use of MPH upon healthcare and society bring about many points of view.
To gain insight into key ethical and social issues on the non-medical use of MPH, we examined discourses in the print media, bioethics literature, and public health literature.
Our study identified three diverging paradigms with varying perspectives on the nature of performance enhancement. The beneficial effects of MPH on normal cognition were generally portrayed enthusiastically in the print media and bioethics discourses but supported by scant information on associated risks. Overall, we found a variety of perspectives regarding ethical, legal and social issues related to the non-medical use of MPH for performance enhancement and its impact upon social practices and institutions. The exception to this was public health discourse which took a strong stance against the non-medical use of MPH typically viewed as a form of prescription abuse or misuse. Wide-ranging recommendations for prevention of further non-medical use of MPH included legislation and increased public education.
Some positive portrayals of the non-medical use of MPH for performance enhancement in the print media and bioethics discourses could entice further uses. Medicine and society need to prepare for more prevalent non-medical uses of neuropharmaceuticals by fostering better informed public debates.
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Use of Social Media by Pharmacy Preceptors
Kukreja, Pavnit
Heck Sheehan, Amy
Riggins, Jennifer
American Journal of Pharmaceutical Education
Objective. To define current use patterns of Facebook and Twitter among pharmacy preceptors and assess perceptions regarding use of social media within professional practice.
Methods. An electronic survey instrument was sent to 315 pharmacists registered as advanced pharmacy practice experience (APPE) preceptors for Purdue University College of Pharmacy.
Results. Approximately 60% of the 155 respondents used a Facebook account and 9% used a Twitter account. Respondents were willing to complete continuing education (CE) credit (46%) using social media, and were interested in following professional organizations (39%) on social media; however, the majority were not interested in obtaining drug or disease-state information, identifying employment opportunities, or participating in clinical discussion forums via social media.
Conclusion. Despite the growing popularity of social media across multiple disciplines, the majority of pharmacy preceptors surveyed were not willing to use these venues in professional practice.
social networking; Facebook; Twitter; technology; advanced pharmacy practice experience
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The use of Facebook in medical education – A literature review
Pander, Tanja
Pinilla, Severin
Dimitriadis, Konstantinos
Fischer, Martin R.
GMS Zeitschrift für Medizinische Ausbildung
Background: The vogue of social media has changed interpersonal communication as well as learning and teaching opportunities in medical education. The most popular social media tool is Facebook. Its features provide potentially useful support for the education of medical students but it also means that some new challenges will have to be faced.
Aims: This review aimed to find out how Facebook has been integrated into medical education. A systematical review of the current literature and grade of evidence is provided, research gaps are identified, links to prior reviews are drawn and implications for the future are discussed.
Method: The authors searched six databases. Inclusion criteria were defined and the authors independently reviewed the search results. The key information of the articles included was methodically abstracted and coded, synthesized and discussed in the categories study design, study participants'phase of medical education and study content.
Results: 16 articles met all inclusion criteria. 45-96% of health care professionals in all phases of their medical education have a Facebook profile. Most studies focused on Facebook and digital professionalism. Unprofessional behavior and privacy violations occurred in 0.02% to 16%. In terms of learning and teaching environment, Facebook is well accepted by medical students. It is used to prepare for exams, share online material, discuss clinical cases, organize face-to-face sessions and exchange information on clerkships. A few educational materials to teach Facebook professionalism were positively evaluated. There seems to be no conclusive evidence as to whether medical students benefit from Facebook as a learning environment on higher competence levels.
Discussion: Facebook influences a myriad of aspects of health care professionals, particularly at undergraduate and graduate level in medical education. Despite an increasing number of interventions, there is a lack of conclusive evidence in terms of its educational effectiveness. Furthermore, we suggest that digital professionalism be integrated in established and emerging competency-based catalogues.
Medical Education (MeSH [I02.358.399]); Social Media; Facebook
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Methodological and ethical issues in research using social media: a metamethod of Human Papillomavirus vaccine studies
Gustafson, Diana L
Woodworth, Claire F
BMC Medical Research Methodology
Online content is a primary source of healthcare information for internet-using adults and a rich resource for health researchers. This paper explores the methodological and ethical issues of engaging in health research using social media.
A metamethod was performed on systematically selected studies that used social media as a data source for exploring public awareness and beliefs about Human Papillomaviruses (HPV) and HPV vaccination. Seven electronic databases were searched using a variety of search terms identified for each of three concepts: social media, HPV vaccine, and research method. Abstracts were assessed for eligibility of inclusion; six studies met the eligibility criteria and were subjected to content analysis. A 10-item coding scheme was developed to assess the clarity, congruence and transparency of research design, epistemological and methodological underpinnings and ethical considerations.
The designs of the six selected studies were sound, although most studies could have been more transparent about how they built in rigor to ensure the trustworthiness and credibility of findings. Statistical analysis that intended to measure trends and patterns did so without the benefit of randomized sampling and other design elements for ensuring generalizability or reproducibility of findings beyond the specified virtual community. Most researchers did not sufficiently engage virtual users in the research process or consider the risk of privacy incursion. Most studies did not seek ethical approval from an institutional research board or permission from host websites or web service providers.
The metamethod exposed missed opportunities for using the dialogical character of social media as well as a lack of attention to the unique ethical issues inherent in operating in a virtual community where social boundaries and issues of public and private are ambiguous. This suggests the need for more self-conscious and ethical research practices when using social media as a data source. Given the relative newness of virtual communities, researchers and ethics review boards must work together to develop expertise in evaluating the design of studies undertaken with virtual communities. We recommend that the principles of concern for welfare, respect for person, and justice to be applied in research using social media.
Metamethod; Social media; Data collection; HPV vaccination; Ethics; Methodology
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How Doctors View and Use Social Media: A National Survey
Brown, James
Ryan, Christopher
Harris, Anthony
Journal of Medical Internet Research
Doctors are uncertain of their ethical and legal obligations when communicating with patients online. Professional guidelines for patient-doctor interaction online have been written with limited quantitative data about doctors' current usage and attitudes toward the medium. Further research into these trends will help to inform more focused policy and guidelines for doctors communicating with patients online.
The intent of the study was to provide the first national profile of Australian doctors' attitudes toward and use of online social media.
The study involved a quantitative, cross-sectional online survey of Australian doctors using a random sample from a large representative database.
Of the 1500 doctors approached, 187 participated (12.47%). Most participants used social media privately, with only one-quarter not using any social media websites at all (48/187, 25.7%). One in five participants (30/155, 19.4%) had received a "friend request" from a patient. There was limited use of online communication in clinical practice: only 30.5% (57/187) had communicated with a patient through email and fewer than half (89/185, 48.1%) could offer their patients electronic forms of information if that were the patients' preference. Three in five participants (110/181, 60.8%) reported not being uncomfortable about interacting with patients who had accessed personal information about them online, prior to the consultation. Most of the participants (119/181, 65.8%) were hesitant to immerse themselves more fully in social media and online communication due to worries about public access and legal concerns.
Doctors have different practices and views regarding whether or how to communicate appropriately with patients on the Internet, despite online and social media becoming an increasingly common feature of clinical practice. Additional training would assist doctors in protecting their personal information online, integrating online communication in patient care, and guidance on the best approach in ethically difficult online situations.
social media; Internet; professional practice; health communication; ethics; health policy; patient-physician relations
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Adoption and use of social media among public health departments
Thackeray, Rosemary
Neiger, Brad L
Smith, Amanda K
Van Wagenen, Sarah B
BMC Public Health
Effective communication is a critical function within any public health system. Social media has enhanced communication between individuals and organizations and has the potential to augment public health communication. However, there is a lack of reported data on social media adoption within public health settings. The purposes of this study were to assess: 1) the extent to which state public health departments (SHDs) are using social media; 2) which social media applications are used most often; and 3) how often social media is used interactively to engage audiences.
This was a non-experimental, cross sectional study of SHD social media sites. Screen capture software Snag-It® was used to obtain screenshots of SHD social media sites across five applications. These sites were coded for social media presence, interactivity, reach, and topic.
Sixty percent of SHDs reported using at least one social media application. Of these, 86.7% had a Twitter account, 56% a Facebook account, and 43% a YouTube channel. There was a statistically significant difference between average population density and use of social media (p = .01). On average, SHDs made one post per day on social media sites, and this was primarily to distribute information; there was very little interaction with audiences. SHDs have few followers or friends on their social media sites. The most common topics for posts and tweets related to staying healthy and diseases and conditions. Limitations include the absence of a standard by which social media metrics measure presence, reach, or interactivity; SHDs were only included if they had an institutionally maintained account; and the study was cross sectional.
Social media use by public health agencies is in the early adoption stage. However, the reach of social media is limited. SHDs are using social media as a channel to distribute information rather than capitalizing on the interactivity available to create conversations and engage with the audience. If public health agencies are to effectively use social media then they must develop a strategic communication plan that incorporates best practices for expanding reach and fostering interactivity and engagement.
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Where are you going, where have you been: a recent history of the direct-to-consumer genetic testing market
Borry, Pascal
Cornel, Martina C.
Howard, Heidi C.
Journal of Community Genetics
In recent years, various private companies have been marketing and offering genetic tests directly to consumers. This article reviews the recent history of this commercial phenomenon. In particular, we discuss and describe the following subjects: (1) the factors that allowed for the creation of the direct-to-consumer (DTC) genetic testing (GT) market; (2) information regarding the size and potential success or failure of the DTC GT market; (3) recent changes in the DTC GT market; and (4) the recent events that may have an impact on the regulatory oversight of DTC genetic testing and the future evolution of this market. This review of factors suggests that despite the possibility of a change of business model as well as increased regulation, the commercialization of genetic testing is here to stay. As such it is important to pay close attention not only to the science underlying these tests but also to the ethical, legal, and social issues.
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Where are you going, where have you been: a recent history of the direct-to-consumer genetic testing market
Borry, Pascal
Cornel, Martina C.
Howard, Heidi C.
Journal of community genetics
In recent years, various private companies have been marketing and offering genetic tests directly to consumers. This article reviews the recent history of this commercial phenomenon. In particular, we discuss and describe the following subjects: (1) the factors that allowed for the creation of the direct-to-consumer (DTC) genetic testing (GT) market; (2) information regarding the size and potential success or failure of the DTC GT market; (3) recent changes in the DTC GT market; and (4) the recent events that may have an impact on the regulatory oversight of DTC genetic testing and the future evolution of this market. This review of factors suggests that despite the possibility of a change of business model as well as increased regulation, the commercialization of genetic testing is here to stay. As such it is important to pay close attention not only to the science underlying these tests but also to the ethical, legal, and social issues.
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The Use of Social Media by State Tobacco Control Programs to Promote Smoking Cessation: A Cross-Sectional Study
Duke, Jennifer C
Hansen, Heather
Kim, Annice E
Curry, Laurel
Allen, Jane
Journal of Medical Internet Research
The promotion of evidence-based cessation services through social media sites may increase their utilization by smokers. Data on social media adoption and use within tobacco control programs (TCPs) have not been reported.
This study examines TCP use of and activity levels on social media, the reach of TCP sites, and the level of engagement with the content on sites.
A cross-sectional descriptive study of state TCP social media sites and their content was conducted.
In 2013, 60% (30/50) of TCPs were using social media. Approximately one-quarter (26%, 13/50) of all TCPs used 3 or more social media sites, 24% (12/50) used 2, and 10% (5/50) used 1 site. Overall, 60% (30/50) had a Facebook page, 36% (18/50) had a Twitter page, and 40% (20/50) had a YouTube channel. The reach of social media was different across each site and varied widely by state. Among TCPs with a Facebook page, 73% (22/30) had less than 100 likes per 100,000 adults in the state, and 13% (4/30) had more than 400 likes per 100,000 adults. Among TCPs with a Twitter page, 61% (11/18) had less than 10 followers per 100,000 adults, and just 1 state had more than 100 followers per 100,000 adults. Seven states (23%, 7/30) updated their social media sites daily. The most frequent social media activities focused on the dissemination of information rather than interaction with site users. Social media resources from a national cessation media campaign were promoted infrequently.
The current reach of state TCP social media sites is low and most TCPs are not promoting existing cessation services or capitalizing on social media's interactive potential. TCPs should create an online environment that increases participation and 2-way communication with smokers to promote free cessation services.
social media; tobacco; smoking; public health; mass media
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"Harnessing genomics to improve health in India" – an executive course to support genomics policy
Acharya, Tara
Kumar, Nandini K
Muthuswamy, Vasantha
Daar, Abdallah S
Singer, Peter A
Health Research Policy and Systems
The benefits of scientific medicine have eluded millions in developing countries and the genomics revolution threatens to increase health inequities between North and South. India, as a developing yet also industrialized country, is uniquely positioned to pioneer science policy innovations to narrow the genomics divide. Recognizing this, the Indian Council of Medical Research and the University of Toronto Joint Centre for Bioethics conducted a Genomics Policy Executive Course in January 2003 in Kerala, India. The course provided a forum for stakeholders to discuss the relevance of genomics for health in India. This article presents the course findings and recommendations formulated by the participants for genomics policy in India.
The course goals were to familiarize participants with the implications of genomics for health in India; analyze and debate policy and ethical issues; and develop a multi-sectoral opinion leaders' network to share perspectives. To achieve these goals, the course brought together representatives of academic research centres, biotechnology companies, regulatory bodies, media, voluntary, and legal organizations to engage in discussion. Topics included scientific advances in genomics, followed by innovations in business models, public sector perspectives, ethics, legal issues and national innovation systems.
Seven main recommendations emerged: increase funding for healthcare research with appropriate emphasis on genomics; leverage India's assets such as traditional knowledge and genomic diversity in consultation with knowledge-holders; prioritize strategic entry points for India; improve industry-academic interface with appropriate incentives to improve public health and the nation's wealth; develop independent, accountable, transparent regulatory systems to ensure that ethical, legal and social issues are addressed for a single entry, smart and effective system; engage the public and ensure broad-based input into policy setting; ensure equitable access of poor to genomics products and services; deliver knowledge, products and services for public health. A key outcome of the course was the internet-based opinion leaders' network – the Indian Genome Policy Forum – a multi-stakeholder forum to foster further discussion on policy.
We expect that the process that has led to this network will serve as a model to establish similar Science and Technology policy networks on regional levels and eventually on a global level.
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Framing the Use of Social Media Tools in Public Health
Stoll, Jennifer
Quartarone, Richard
Torres-Urquidy, Miguel
Online Journal of Public Health Informatics
Recent scholarship has focused on using social media (e.g., Twitter, Facebook) as a secondary data stream for disease event detection. However, reported implementations such as (4) underscore where the real value may lie in using social media for surveillance. We provide a framework to illuminate uses of social media beyond passive observation, and towards improving active responses to public health threats.
User-generated content enabled by social media tools provide a stream of data that augment surveillance data. Current use of social media data focuses on identification of disease events. However, once identification occurs, the leveraging of social media in monitoring disease events remains unclear (2, 3). To clarify this, we constructed a framework mapped to the surveillance cycle, to understand how social media can improve public health actions.
This framework builds on extant literature on surveillance and social media found in PubMed, Science Direct, and Web of Science, using keywords: "public health", "surveillance", "outbreak", and "social media". We excluded articles on online tools that were not interactive e.g., aggregated web-search results. Of 2,064 articles, 23 articles were specifically on the use of social media in surveillance work. Our review yielded five categories of social media use within the surveillance cycle (Table 1). This framing within surveillance illuminates a range of roles for social media tools beyond disease event detection. [Insert Image #1 here]
Finally, we used the 1918 Influenza Pandemic to illustrate an application of this framework (Fig 1), if it were part of the public health toolkit. In 1918, America was already becoming a "mass media" society. Yet a key difference in mass communications today is the enabling of public health to be more adaptive through the interactivity of social media.
We used this "pre-social media" disease event to underscore where the real value of social media may lie in the surveillance cycle. Thus for 1918, early detection of disease could have occurred with many, e.g., sailors aboard ships in New York City's port sharing their "status updates" with the world. [Insert Image #2 here]
After detection, social media use could have shifted to help connect and inform. In 1918, this could include identifying and advising the infected on current hygiene practices and how to protect themselves. Social media would have enabled the rapid sharing of this information to friends and family, allowing public health officials to monitor the response. Then, to support multiple intervention efforts, public health officials could have rapidly messaged on local school closures; they could also have encouraged peer behavior by posting via Twitter or by "Pinning" handkerchiefs on Pinterest to encourage respiratory etiquette, and then monitored responses to these interventions, adjusting messaging accordingly.
The interactivity of social media moves us beyond using these tools solely as uni-directional, mass-broadcast channels. Beyond messaging about disease events, these tools can simultaneously help inform, connect, and intervene because of the user-generated feedback. These tools enable richer use beyond a noisy data stream for detection.
Surveillance; Public Health; Social Media
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Theory and practice of informed consent in the Czech Republic
Krizova, Eva
Simek, Jiri
Journal of Medical Ethics
The large‐scale change of Czech society since 1989 has involved the democratic transformation of the health system. To empower the patient was one important goal of the healthcare reform launched immediately after the Velvet Revolution. The process has been enhanced by the accession of the Czech Republic to the European Union and the adoption of important European conventions regulating the area. The concept of informed consent and a culture of negotiation are being inserted into a traditionally paternalistic culture. Our article describes the current situation on the issue of the communication of information on state of health and treatment, and on the question of the participation of the patient in decisions on treatment. We present empirical results of a public opinion survey on this issue. The results show a still prevailing submissive attitude towards the physicians, despite the fact that the concept of informed consent has become more and more publicly familiar (42% of respondents gave the completely correct answer regarding informed consent). The impact of age, education and sex on answers to the questionnaire was analysed. Men, younger and more educated respondents were more likely to show the autonomous attitude, whereas women, older and less educated people tended to show the traditional submissive attitude. Further, our article raises the question of the cultural and historical background within which the current ethically and legally binding norms (products of western democracies, in fact) are interpreted. The question is how far cultural modifications are tolerable in the practical implementation of universal ethical constructs (informed consent).
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Evaluation of clinical trials by Ethics Committees in Germany - Experience of applicants with the review of requests for opinion of the Ethics Committees - results of a survey among members of the German Association of Research-Based Pharmaceutical Companies (VFA)
Russ, Hagen
Busta, Susanne
Riedel, Axel
Zöllner, Gereon
Jost, Bertfried
GMS German Medical Science
The review of requests for a positive opinion of the ethics committees (application procedure) as a requirement to start a clinical trial in Germany has been completely redesigned with the transposition of EU Directive 2001/20/EC in the 12th Amendment of the German Medicines Act in August 2004. The experience of applicants (sponsors, legal representatives of sponsors in the EU and persons or organizations authorized by the sponsors to make the application, respectively) in terms of interactions with the ethics committees in Germany has been positive overall, especially with respect to ethics committee adherence to the statutory timelines applicable for review of requests. However, inconsistencies between ethics committees exist in terms of the form and content of the requirements for application documents and their evaluation.
With the objective of further improving both the quality of applications and the evaluation of those applications by ethics committees, a survey among members of the German Association of Research-Based Pharmaceutical Companies (VFA) was conducted from January to April 2008. Based on reasoned opinions issued by the respective ethics committee in charge of the coordinating principal investigator (coordinating ethics committee), the type and frequency of formal and content-related objections to applications according to § 7 of the German Good Clinical Practice (GCP) Regulation were systematically documented, and qualitative and quantitative analyses performed. 21 out of 44 members of the VFA participated in the survey. 288 applications for Phase I–IV studies submitted between January and December 2007 to 40 ethics committees were evaluated.
This survey shows that about one in six applications is incomplete and has formal and/or content objections, respectively, especially those that pertain to documents demonstrating the qualification of the investigator and/or suitability of the facilities. These objections are attributable to some extent to the differing and/or unclear requirements of the individual ethics committees on the content and comprehension of the submission documents. However, applicants also need to pay more attention to the completeness and validity of the submission documents. The majority of content-related objections apply to the patient information and consent documents and study protocols submitted. Applicants on average acted upon only 3 out of 4 objections, for various reasons: the relevant information was already given in the submitted documents, but had not been taken into consideration by the ethics committees; objections were not applicable; objections lacked a legal basis. In such cases the applicants made reference to the specific information already submitted or gave reasons for not acting on the objection. This course of action was accepted by the ethics committees, with few exceptions. The survey sheds light on the existing inconsistencies in the evaluations of applications by the various ethics committees and suggests ways in which the existing constructive dialogue between applicants and ethics committees may provide a basis to further harmonize both the requirements regarding form and content of application documents, and the criteria for evaluation of applications by ethics committees within the legal framework.
ethics committees; application procedure; formal and content-related objections; clinical trials
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Legal aspects with regard to integrated care: a long way to go
Werinos, Stefanie
International Journal of Integrated Care
The main purpose of this abstract is to raise awareness of the unsatisfactory legal situation with regard to integrated care. The abstract focuses on two major legal issues. First, I picture the actual legal situation regarding cross-border healthcare. Secondly, I describe the duties care providers and patients may face when entering into integrated care programs.
Cross-border healthcare
Currently, we lack an European legislative framework that regulates cross-border healthcare. One reason for this fact is that Article 152 EC treaty states that "Community Action in the field of public health shall fully respect the responsibilities of the Member States for the organisation and delivery of health services and medical care" [1]. Therefore, it's up to each Member State to provide regulations with regard to cross-border healthcare services. Hence, patients need to deal with various national—often inconsistent—provisions when considering consuming cross-border healthcare. As a consequence, patients easily felt overstrained and the unclear legal situation prevents them from crossing a border to obtain healthcare. This often averts the establishment of integrated care models. As a result, patients lose the opportunity to receive more or different healthcare services and products in Member States other than the State in which they are living or are insured.
Nevertheless, it was the European Court of Justice (ECJ) with its continuous rulings in respect to cross-border healthcare that started with the harmonization process of cross-border healthcare legislation. The ECJ judges have ruled that freedom to cross EU borders for the best and quickest treatment is a right for all [2]. However, litigation before the ECJ suffers from deficiencies in this respect. In particular, the case law of the ECJ on the issue clearly shows the unsatisfactory nature of case-by-case ex post procedures for a complex and developing policy area. Further, litigation always leads to a winner and a loser, but does not foster an iterative, deliberate process in which the optimal accommodation of all affected interests is reached because the ECJ always decides on a particular case [3]. As a consequence, the European Commission has presented a proposal for a directive on the application of patient's rights in cross-border healthcare which reflects the decisions of the ECJ [4]. The aim of the proposed directive is—expressed in simplified terms—to ensure and to clarify the conditions for exercising patient's right to cross-border healthcare, and to create a framework for increasing cooperation between Member States. The proposal directive covers cross-border healthcare irrespective of how it is organised, financed or provided and whether it is private or public. The outcome of the proposed directive would be the reduction of obstacles faced when crossing the border in order to obtain healthcare. In case the proposed directive will be approved and will come into force, a major step in order to enlarge the possibilities to achieve integrated care is done. However, the Member States (e.g. Austria) take a critical stance towards the proposed directive and no one currently knows whether it will ever be approved [5].
The actor's duties with respect to integrated care programs
Entering into an integrated care program leads to legal challenges with regard to the actors. In particular, the question which duties are faced when entering into an integrated care program has not been raised yet. Therefore, patients find themselves in situations with a deficit of information and do not see the legal consequences when entering into an integrated care program. Patients often do not realise that they conclude an agreement with a health insurance company. They bind themselves for a certain period (sometimes several years) and they are contractually not allowed to rescind from the agreement. In general, integrated care programs offered from health insurance companies oblige the patient to consult the healthcare providers that are covered from the agreement. As a consequence, in case patients are not satisfied with the healthcare provider because of medical or personal reasons, no change to another healthcare provider is possible. Further, patients always enter into an implied health treatment agreement with the healthcare provider. In turn, healthcare providers do not have any certainties to be appointed from health insurance companies and, therefore, may lose essential revenues. In addition, healthcare providers are obliged to fulfil certain requirements (technical and organisational) in order to be appointed. In case they are not able anymore to continuously fulfil these requirements, health insurance companies may rescind their contracts. Having these issues in mind, one can assume that entering into an integrated care program implies various—often unseen—duties from different perspectives.
At a glance, the legal background of integrated care still raises a lot of unsolved problems both on a national and on a European level. As a next step, legal uncertainties should be made transparent in order to give the actors the possibility to discuss them. A consequence of this public discussion would be a cornerstone for more consumer-friendly healthcare models that would lead to better patient treatment and would enhance integrated healthcare.
cross-border healthcare; legislation; European Court of Justice; patient's rights; legal duties; integrated care program
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Ethical Issues in Using Twitter for Public Health Surveillance and Research: Developing a Taxonomy of Ethical Concepts From the Research Literature
Conway, Mike
Journal of Medical Internet Research
The rise of social media and microblogging platforms in recent years, in conjunction with the development of techniques for the processing and analysis of "big data", has provided significant opportunities for public health surveillance using user-generated content. However, relatively little attention has been focused on developing ethically appropriate approaches to working with these new data sources.
Based on a review of the literature, this study seeks to develop a taxonomy of public health surveillance-related ethical concepts that emerge when using Twitter data, with a view to: (1) explicitly identifying a set of potential ethical issues and concerns that may arise when researchers work with Twitter data, and (2) providing a starting point for the formation of a set of best practices for public health surveillance through the development of an empirically derived taxonomy of ethical concepts.
We searched Medline, Compendex, PsycINFO, and the Philosopher's Index using a set of keywords selected to identify Twitter-related research papers that reference ethical concepts. Our initial set of queries identified 342 references across the four bibliographic databases. We screened titles and abstracts of these references using our inclusion/exclusion criteria, eliminating duplicates and unavailable papers, until 49 references remained. We then read the full text of these 49 articles and discarded 36, resulting in a final inclusion set of 13 articles. Ethical concepts were then identified in each of these 13 articles. Finally, based on a close reading of the text, a taxonomy of ethical concepts was constructed based on ethical concepts discovered in the papers.
From these 13 articles, we iteratively generated a taxonomy of ethical concepts consisting of 10 top level categories: privacy, informed consent, ethical theory, institutional review board (IRB)/regulation, traditional research vs Twitter research, geographical information, researcher lurking, economic value of personal information, medical exceptionalism, and benefit of identifying socially harmful medical conditions.
In summary, based on a review of the literature, we present a provisional taxonomy of public health surveillance-related ethical concepts that emerge when using Twitter data.
social media; twitter messaging; ethics
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Communicating Genetics and Smoking Through Social Media: Are We There Yet?
de Viron, Sylviane
Suggs, L Suzanne
Brand, Angela
Van Oyen, Herman
Journal of Medical Internet Research
Social media is a recent source of health information that could disseminate new scientific research, such as the genetics of smoking.
The objectives were (1) to evaluate the availability of genetic information about smoking on different social media platforms (ie, YouTube, Facebook, and Twitter) and (2) to assess the type and the content of the information displayed on the social media as well as the profile of people publishing this information.
We screened posts on YouTube, Facebook, and Twitter with the terms "smoking" and "genetic" at two time points (September 18, 2012, and May 7, 2013). The first 100 posts were reviewed for each media for the time points. Google was searched during Time 2 as an indicator of available information on the Web and the other social media that discussed genetics and smoking. The source of information, the country of the publisher, characteristics of the posts, and content of the posts were extracted.
On YouTube, Facebook, and Twitter, 31, 0, and 84 posts, respectively, were included. Posts were mostly based on smoking-related diseases, referred to scientific publications, and were largely from the United States. From the Google search, most results were scientific databases. Six scientific publications referred to within the Google search were also retrieved on either YouTube or Twitter.
Despite the importance of public understanding of smoking and genetics, and the high use of social media, little information on this topic is actually present on social media. Therefore, there is a need to monitor the information that is there and to evaluate the population's understanding of the information related to genetics and smoking that is displayed on social media.
genetics; Internet; public health genomics; smoking; social media; Web 2.0
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Macworld UK: 'Bundle iTunes', Apple exec urges PC makers
"Speaking on the Inside Digital Media show, Lowe said: "We suggest that manufacturers on any platform looking for a jukebox to carry with their products should take a look at us. iTunes is the best jukebox and the best music store as well."
Lowe, director of marketing for application services, went on to repeat Apple's claim that one million Windows users downloaded iTunes software within three-and-a-half days of its release, and that a million song sales also took place."
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that would be great - apple softcare coming pre-installed on a windows PC! I wonder if microsoft would try to block/discourage that?
Posted by me in Irvine, CA on November 3, 2003 at 9:59 AM (CST)
Microsoft trying to unfairly block competition? I couldn't imagine it!
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Variance-covariance-based risk allocation in credit portfolios
Merton-type models, also referred to as structural models, such as PortfolioManager (Kealhofer, 2001) and CreditMetrics (Gupton, Finger & Bhatia, 1997), have become the standard choice for financial institutions' credit risk economic capital frameworks. In these models, default correlations between different borrowers are modelled using a set of common systematic risk factors associated with the state of the economy. Computationally heavy Monte Carlo simulations are usually used for calculations...
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Add an unexpected contemporary accent to your room with the modern style of the Voyager lamp. Featuring a chrome and dark espresso finished tripod base topped with a crisp hard back white linen shade, this lamp takes two 60 Watt maximum bulbs.
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