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Vejez de los conocimientos en medicina

by System Administrator - Thursday, 9 October 2014, 11:17 AM
 
La pobreza del lenguaje y las historias clínicas

La vejez de los conocimientos en medicina

Las historias clínicas carecen hoy de la profundidad y de la riqueza informativa de antaño

Autor: Leonardo Strejilevich | Fuente: IntraMed | Por Dr. Leonardo Strejilevich

La medicina experimentó una importante pérdida: las grandes descripciones y sus artífices, que antaño fueran su gloria, parecieron desvanecerse.

Se asume, injustificadamente, que los conocimientos antiguos o viejos son inservibles, piezas de museo o búsquedas inútiles de historiadores y de ratas de biblioteca. Este tipo de conceptualización se da también en la medicina y en las ciencias fácticas. Hoy se han olvidado y se desconocen las descripciones inefables en sus originales de Paul Georges Dieulafoy (1839 – 1911),  Alois Alzheimer (1864 – 1915), William Heberden (1710 – 1801),James Parkinson (1755 – 1824), William  Harvey(1578 – 1657), Santiago Ramón y Cajal (1852 – 1934) y muchos otros.

Por ejemplo, al estudiar las viejas historias clínicas de los pacientes internados en asilos y en hospitales públicos encontramos observaciones clínicas y fenomenológicas sumamente detalladas, presentadas a menudo en forma de relatos de riqueza y de densidad casi novelescas.

Tras la institucionalización de rígidos criterios, de manuales de diagnóstico estadístico, de algoritmos (=conjunto ordenado y finito de operaciones o de datos que permite hallar el diagnóstico, la explicación y la solución de un problema) absolutos, la minuciosa y rica descripción de los fenómenos desaparece, y es sustituida por breves notas que no ofrecen una imagen real del paciente o de su mundo, sino que reducen a éste, y a su enfermedad, a una mera lista de criterios de diagnóstico «mayores» y «menores».

Las historias clínicas  carecen hoy de la profundidad y de la riqueza informativa de antaño, y apenas sirven para realizar esa síntesis tan necesaria entre ciencia y su aplicación concreta al caso particular. Por ello las «viejas» historias clínicas seguirán siendo sumamente valiosas.

En opinión de Goethe, la realidad no está en las simplificaciones e idealizaciones de la física, sino en la compleja realidad fenomenológica de la experiencia.

¿Qué hace que una observación o una idea nueva resulte aceptable, discutible, memorable? ¿Qué es lo que impide que sea así, pese a su importancia y su valor?

En general, las nuevas ideas nos resultan profundamente amenazadoras  y por ello le cerramos el paso o bien nos enamoramos de ellas decretando la obsolescencia de las viejas ideas. Esto es cierto en muchos casos y no se reduce todo a la psicodinámica y a la motivación que pretenden explicar este fenómeno.

No basta con aprehender algo, con «captar» algo, fugazmente. La mente debe ser capaz de acomodarlo, de retenerlo. Este proceso de acomodación, de creación de un espacio mental, de una categoría con conexiones potenciales y la voluntad de hacerlo determina si una idea o un descubrimiento se arraigará y dará fruto, o si, por el contrario, será olvidado, se desvanecerá y morirá sin dejar rastro.

Debemos permitirnos a nosotros mismos salir al paso de las nuevas ideas para transformarlas en conciencia plena y estable, y en darles forma conceptual reteniéndolas en nuestra mente aun cuando no encajen con los conceptos, las creencias o las categorías existentes, o incluso las contravengan. Los ejemplos negativos o excepciones son de gran  importancia; es esencial tomar nota de las excepciones y no olvidarlas, o juzgarlas triviales y oponerse a las simplificaciones y sistematizaciones prematuras en el ámbito científico que pueden cegarnos, anquilosar la ciencia e impedir su crecimiento vital.

«Toda ciencia», escribía Kohler, «posee una especie de desván al que van a parar, casi automáticamente, todas las cosas que no pueden usarse en el momento, que no llegan a encajar. Estamos continuamente desechando, infrautilizando, un material sumamente valioso que conduce al bloqueo del progreso científico» (1913).

Es frecuente el desprecio de la ciencia dura hacia la medicina clínica, y especialmente hacia los casos concretos. Todos los casos clínicos serios, son rigurosamente científicos y encarnan una ciencia de lo individual tan dura como la física o la biología molecular.

Las descripciones de enfermedades (= patografías) eran muy detalladas en la antigüedad y ofrecían una importante cantidad de información. A mediados y a finales del siglo XIX fue un período en el que se describieron miles de trastornos y enfermedades claramente diferenciados, con minuciosidad no superada desde entonces. Fue ésta una época de amplia apertura a la experiencia, de amor por los fenómenos, de talento para describirlos, y dotada de una suerte de pasión cartográfica por su clasificación y ubicación aunque no se pensara demasiado en su naturaleza o en su significado.

La medicina experimentó una importante pérdida: las grandes descripciones y sus artífices, que antaño fueran su gloria, parecieron desvanecerse. Y con el fin de esta tradición, cierta sensación de pérdida, de amnesia, se apoderó de la medicina.

 

Dr. Leonardo Strejilevich: Médico. Master en Gerontología Social Universidad Autónoma de Madrid. Dedicado a la Neurogerontología– Neurogeriatría y Gerontología  Social. Periodista científico. Ensayista. Ex – Docente Facultad de Medicina y Facultad de Farmacia y Bioquímica de la Universidad de Buenos Aires. Ex Profesor Regular Adjunto  Facultad de Ciencias de la Salud de la Universidad Nacional de Salta. Ex - Director General Comisión Permanente de Carrera del Ministerio de Salud Pública del Gobierno de la Provincia de Salta. Ex – Miembro activo del Laboratorio de Investigaciones Neuroanatómicas  Facultad de Medicina de la Universidad de Buenos Aires.

Link: http://www.intramed.net

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Vendor-neutral, cloud-based medical image archiving

by System Administrator - Tuesday, 25 November 2014, 10:28 PM
 

Vendor-neutral, cloud-based medical image archiving

Healthcare organizations worldwide struggle to manage the exploding growth and complexity of digital patient information―across disparate facilities, applications, and data silos. If your health organization is like most, you may not be equipped for the demand this deluge creates on your IT resources.

Traditional solutions, including picture and archiving communication systems (PACS), continue to manage patient information using proprietary formats. With clinical content locked away in these systems, patient care and safety may be compromised. A lack of data liquidity and accessibility can increase complexity, making it difficult and costly to pursue new opportunities, clinical strategies, business models, acquisitions, and other initiatives. Vendor-neutral archive (VNA) solutions―from Perceptive Software, powered by Acuo, and leveraging the Microsoft Azure cloud platform—can help your health organization reduce the cost and complexity of clinical data management. 

    • Eliminate PACS and storage vendor shackles on clinical information, delivering true data liquidity and interoperability.
    • Help reduce the time, cost, and complexity of managing and maintaining medical imaging content.
    • Scale up or down quickly in response to market opportunities and fluctuating business needs.
    • Help ensure business continuity and disaster recovery, with less technical effort and capital expense.

Please read the attached whitepaper.

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Violencia contra el personal sanitario

by System Administrator - Saturday, 2 August 2014, 1:03 AM
 

Violencia contra el personal sanitario

Diariamente nos enteramos y padecemos ataques físicos y verbales, secuestros y muertes, en servicios de emergencia, ambulancias y centros de salud.
“La tasa de asaltos en trabajadores de la salud es mas alta que en otras ocupaciones: 8 cada 10.000 comparada con 2 cada 10.000 en los lugares de trabajo en general”. (The Lancet, 19-4-2014).

Continuar leyendo

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VirtualRehab

by System Administrator - Monday, 11 May 2015, 11:57 PM
 

 

VirtualRehab, primer producto de rehabilitación virtual que recibe el marcado CE 

VirtualRehab es el primer producto de rehabilitación virtual que utiliza dispositivos como Microsoft® Kinect o LeapMotion que obtiene el marcado de conformidad con la directiva de la Comunidad Económica Europea (CE) como producto sanitario (PS), algo fundamental para su comercialización internacional en hospitales y centros de rehabilitación europeos.

 

VirtualRehab® es un software de rehabilitación virtual clínicamente validado y diseñado en colaboración con expertos neurólogos, médicos rehabilitadores, y fisioterapeutas, dirigido a clínicas, hospitales y centros de salud para el tratamiento rehabilitador de pacientes con algún grado de discapacidad física.  El producto se ha beneficiado de los avances en el ámbito de la realidad virtual, videojuegos y serious games en pro de la rehabilitación física.   Ante la aparición de nuevos dispositivos de bajo coste, como en este caso Kinect (un sistema de captura de movimiento) VirtualRehab permite realizar tareas y ejercicios, de una manera lúdica para los pacientes a un coste muy reducido.

Actualmente, además de numerosos centros en España, internacionalmente ya lo están utilizando en Londres, en el centro Queen Square de UCL (University College London) dentro del Hospital Nacional de Neurología y Neurocirugía (NHNN). “Queen Square cuenta con una extensa experiencia en el uso de soluciones innovadoras para proporcionar a sus pacientes el mejor tipo de terapia. Conscientes de los beneficios del uso de videojuegos tradicionales con algunos de nuestros pacientes, VirtualRehab despertó todo nuestro interés, especialmente por su variedad de juegos y su capacidad de monitorización de los pacientes. Por ello, no dudamos en incorporarlo a nuestros servicios y después de haberlo utilizado hemos obtenido muy buenos resultados y experiencias por parte tanto de los pacientes como de los fisioterapeutas. Creo firmemente que soluciones como VirtualRehab son una parte importante en las terapias de rehabilitación para mejorar la calidad de vida de los pacientes” afirma el Dr. Nick Ward, Neurólogo y Neurocientífico del NHNN y the UCL Instituto de Neurología.

Obtener el certificado CE de VirtualRehab supone un hito importante y materializa nuestra apuesta para que este producto cumpla todas las regulaciones necesarias en el mercado nacional e internacional. Además es el primer producto de estas características en obtener el marcado CE en Europa.” afirma Unai Extremo, CEO de Virtualware, empresa fabricante. “Permite al fisioterapeuta planificar las diferentes sesiones para trabajar las funciones motoras afectadas en cada uno de sus pacientes, que se enfrentan a esos ejercicios terapéuticos a través de diferentes videojuegos, de una manera lúdica sin ningún tipo de cable ni sensor, sino con el movimiento de su propio cuerpo.  Adicionamente VirtualRehab permite dar continuidad al tratamiento y realizar las actividades también desde casa” explica Extremo.

Un estudio reciente presentado en el 8º Congreso Mundial de Neurorrehabilitación celebrado en Turquía, ha demostrado las ventajas de utilizar VirtualRehab®. Los resultados obtenidos muestran una notable mejoría en varias funciones, especialmente en equilibrio estático y dinámico, en el nivel de fatiga y en el grado de independencia funcional. El estudio concluye que VirtualRehab® es una herramienta eficaz para los pacientes de EM combinado con rehabilitación tradicional.

Hasta la fecha, VirtualRehab® ha superado la cifra de 8500 sesiones de juego, y está cerca de las 900 horas de juego realizadas entre los diferentes tipos de pacientes que los están utilizando, principalmente con enfermedades neurológicas y cerebrovasculares (daño cerebral adquirido, esclerosis múltiple, Parkinson, Alzheimer, distrofias y esclerosis múltiple).

Enlaces relacionados

Más información en la Página Oficial de VirtualRehab

 

 

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Want a Connected Healthcare System? You Are the Missing Key

by System Administrator - Thursday, 23 April 2015, 7:36 PM
 

Want a Connected Healthcare System? You Are the Missing Key

 

by John Hammergren | CEO at McKesson

Editor’s Note: John H. Hammergren is chairman, president and chief executive officer of McKesson Corporation.

How often do we visit the doctor’s office and think, “This again?” when handed a long medical form to fill out? Don’t we all wonder why our medical information can’t be automatically transferred from our primary care physician to the specialist? Or to the hospital or outpatient surgery center? 

The answer is this: we don’t currently have a national network of connectivity that allows for the safe and secure sharing of health information between all locations of care or with patients. The good news is that such a system is possible and, with the right industry and political leadership, could be in place in the next few years. But it won’t happen without consumer engagement.

Why should consumers care about sharing their health information – aside from the aggravation of repeatedly filling out the same forms?

We should care because we are all patients and currently we are at the mercy of a disconnected healthcare system. The status quo leads to fragmented and lower quality patient care. Wouldn’t it be better for patients if emergency department staff had immediate access to a patient’s medical history and medications? Wouldn’t it be better for the patient if, when filling a prescription, their pharmacist could see all prescribed medicines to check for drug interactions? And wouldn’t it be better if we could view our health information in the comfort of our home any time, day or night?

There are hurdles to overcome before a national system to share medical information becomes a reality. Today, many in the healthcare industry have been narrow in their approach to supporting a robust network of connectivity. Some healthcare IT vendors and even some providers focus exclusively on the patient’s electronic health record (EHR), arguing that if it’s technically possible to share a patient’s information from point A to point B or from EHR to EHR (often for a fee), then they’ve “checked the box” and achieved connectivity.

But this is a shortsighted view – and puts the needs of the patient last. If it is acceptable to claim success when two healthcare IT systems can technically communicate – but are not actively sharing information – then the bar is set far too low. Patients deserve better; we all deserve better. Our nation needs a broader, seamless system of interconnectivity that allows providers and patients to have the right information for the right patient at the right time, regardless of the technology platform used or the location of care. 

As healthcare reform continues to evolve, the care choices that consumers have will also evolve. Patients are already receiving care in a variety of new settings and monitoring their care with an array of tools. The rapid proliferation of mobile applications and the increasing adoption of telehealth services will also give healthcare providers additional patient information—often in real-time.  These new tools will also allow for the creation of personalized health and treatment plans for individual patients.

True connectivity will allow the patient, their providers and a patient’s designated caregivers to see a complete view of their health record, creating more engaged, informed patients and caregivers. A successful network also will put the needs of the patient first to ensure that the patient’s entire care team has 24/7 access to all of the information necessary to select the most effective care plan and support services. 

The benefits of real healthcare connectivity are numerous—but how will such a system be achieved?

Fortunately, the healthcare technology industry is already at work creating the infrastructure framework needed for a truly connected system. Trade alliances such as the CommonWell Health Alliance, comprised of competitors, providers and patient groups, are creating a seamless flow of patient health information between hospitals, doctor’s offices, labs, pharmacies and nursing homes—regardless of the technology platform used at each location of care. In Chicago this week, stakeholders are gathering at HIMSS, a major health IT conference, and healthcare connectivity will be a major point of discussion. Through sustained collaboration and ongoing dialogue, industry partnerships are making the safe and secure sharing of health information a reality.

What role can consumers play in moving the ball down the field? As patients and consumers, we play the most important role. We should insist on the same level of connectivity in healthcare that we have come to expect in so many areas of our connected lives. We should refuse to settle for paper forms and incomplete information. Instead, we should demand a seamless, interconnected system that provides access to the right health information regardless of where we receive care.

If you are interested in participating in the dialogue about creating a national system to safely and securely share patient data, I encourage you to share your thoughts with your federal representative. There is a strong interest in Congress to address this issue in the current legislative session.

But you should also talk with your physician about your desire to have online access to your complete medical records. At your next medical appointment, when you’re handed a piece of paper to fill out, ask whether the information will be available for use by other medical professionals who may be involved in your care—specialists, labs, pharmacists, etc. A vocal consumer population is a critical ingredient to make the patient’s needs and wants heard as we build out a truly connected healthcare system.

This article was originally published on LinkedIn and has been republished with permission by the author. 

Link: http://hitconsultant.net

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Watch Surgical Robot Deftly Suture a Grape

by System Administrator - Monday, 18 May 2015, 8:44 PM
 

Watch Surgical Robot Deftly Suture a Grape

By Jason Dorrier

We've covered Intuitive Surgical's da Vinci surgical robot for years. In fact, to some, the system's long history—1.5 million surgeries dating back to 2000—may be one of its most surprising attributes. But this video really drives home the system's dexterity. Using a new tool, the FDA-approved Single-Site Wristed Needle Driver, a surgeon guides the bot to gently stitch the skin back onto a grape. Inside a glass bottle.

If you aren't familiar with the da Vinci surgical robot—it's not a robot in the sense you might imagine. This isn't Prometheus. The da Vinci's robotic arms still require a human operator to perform surgery.

The surgeon sits across the room from the robotic arms and, looking through a viewfinder, manipulates a pair of controls. As the surgeon works, his or her movements are translated to the arms, onto which a range of end effectors (or tools) can be attached. Using a surgical robot requires long training and practice.

The idea is simple though. The robot is said to enable less invasive surgery by way of smaller incisions. This, in turn, means less scarring, shorter recovery times, and a lower probability of complications.

As far back as 2010, surgeons were using the robot to perform some 86% of prostate surgeries and 10% of hysterectomies (up from less than 1% in 2007) in the US. Whether its professed benefits play out in practice, however, has been a matter of debate. At least one study, out of Johns Hopkins, called into question the benefits of robotic surgery as compared to human surgery and noted its greater cost.

In either case, the system's popularity is hard to deny.

Dreams for the future include telesurgery—where we might install a surgical robot in a field hospital thousands of miles away, and operated by a top surgeon, it would (securely) transport his or her skills around the globe to where they're most needed—and maybe, much further on, some degree of autonomy.

But such capabilities are still ahead of us. For now, we can marvel at the dexterity with which this surgeon handles their robotic tools. And no doubt, grapes everywhere can feel more secure such tech exists.

Related topics:

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Wearable App for ALS Patients

by System Administrator - Tuesday, 16 September 2014, 12:44 PM
 

Phillips and Accenture Develop Brain Controlled Wearable App for ALS Patients (Amyotrophic lateral sclerosis)

Phillips and Accenture today announced that they have developed proof of concept software connecting a wearable display to Emotiv Insight Brainware that could ultimately give more independence to patients with amyotrophic lateral sclerosis (ALS) and other neurodegenerative diseases. Affecting more than 400,000 people per year*, ALS, also known as Lou Gehrig’s Disease, impairs brain and spinal cord nerve cells, gradually diminishing voluntary muscle action. Late-stage patients often become totally paralyzed while retaining brain functions.

How It Works

When a wearable display and the Emotiv Insight Brainware, which scans EEG brainwaves, are connected to a tablet, users can issue brain commands to control Philips products including Philips Lifeline Medical Alert Service, Philips SmartTV (with TP Vision), and Philips Hue personal wireless lighting. The tablet also allows control of these products using eye and voice commands. In both cases, a patient could communicate preconfigured messages, request medical assistance, and control TVs and lights. Accenture and Philips developed the software that enables the integration and interaction between these multiple technologies.

The proof of concept application demonstrates how existing technology could be used to transform the quality of life for ALS patients. When patients lose muscle control and eye tracking ability, they can still potentially operate the Philips suite of connected products in their home environment through brain commands. The Emotiv technology uses sensors to tune in to electric signals produced by the wearer’s brain to detect, in real-time, their thoughts, feelings and expressions. The wearable display provides visual feedback that allows the wearer to navigate through the application menu.

The Accenture Technology Labs in San Jose, California collaborated with the Philips Digital Accelerator Lab in the Netherlands to create the software to interact with the Emotiv Insight Brainware and the wearable display. Fjord, a design consultancy owned by Accenture Interactive, designed the display’s user interface.

“This proof of concept shows the potential of wearable technology in a powerful new way —helping people with serious diseases and mobility issues take back some control of their lives through digital innovation,” said Paul Daugherty, Accenture’s chief technology officer. “It is another demonstration of how Accenture and Philips, collaborating with other technology innovators, seek to improve the lives of people with healthcare challenges.”

For more information on the proof of concept application for controlling Philips connected technologies with brain commands, see the infographic visualization below: 

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Web-based mHealth tools can drive patient engagement, care satisfaction

by System Administrator - Tuesday, 11 August 2015, 3:15 PM
 

Web-based mHealth tools can drive patient engagement, care satisfaction

By Judy Mottl

Access to online educational content specific to medical issues and Web-based tools that enhance communication between patients and providers can help users gain a deeper understanding of care and boost patient satisfaction, reveals a new Brigham and Women's Hospital study.

The use of an online patient-centered toolkit (PCTK) also facilitates patient involvement and input into the plan of care, states the study published in the Journal of the American Medical Informatics Association.

"Doctors and nurses oversee the plan of care, but the patients' goals, priorities and preferences may not always be effectively conveyed to the clinical care team," lead study author Anuj Dalal, and a hospitalist in Brigham and Women's division of general medicine and primary care, said in an announcement. "Decision-making should be shared among patients, families and healthcare providers."

The study aligns with recent research and efforts investigating how consumers view mHealth tools. For instance, a research team featuring physicians from the departments of emergency medicine at Yale School of Medicine and Beth Israel Deaconess Medical Center recently reported a large number of emergency department patients are embracing smartphones, tablets and apps to assist in their care. Another effort, a wearable monitor pilot launched by the University of Pennsylvania Health System, is aimed at determining how patients and clinicians view mHealth technology.

The Brigham and Women's study provided iPads to patients and caregivers in the intensive and oncology units at the hospital, which enabled them to access online content specific to the patient's condition. The researchers evaluated enrollment strategies, the use and usability of patient tools and the content of patient-generated messages.

The study revealed non-critically ill patients were more inclined to engage with the tools compared to those who were critically ill. The majority of patients who used PCTK features were those helping patients establish goals, access test results and medications and identify care team members.

For more information:
- read the announcement
- here's the abstract

Related Articles:

Link: http://www.fiercemobilehealthcare.com/

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Where do health IT investments and improved outcomes intersect?

by System Administrator - Sunday, 20 September 2015, 7:38 PM
 

Where do health IT investments and improved outcomes intersect?

Love it or hate it, the HITECH Act has reshaped the hospital IT market and encouraged a rapid increase in the use of EMRs. In 2006, HIMSS Analytics EMR Adoption Model Data showed 62% of hospitals had only some EMR functionality. Today that number is north of 90% >> http://ow.ly/Sjhol
Now that you have all this data, what do you do with it? What’s next?

We’d love to hear what you think. HIMSS Analytics sees the following priorities driving hospital purchase activity in the near term:

1. Optimization

2. Improved workflows

3. Better revenue capture

4. Patient & provider engagement

There’s no shortage of technologies out there to help hospitals improve these core operations. But according to HIMSS Analytics the following 18 technologies are poised for the biggest growth >> http://ow.ly/SjhhF

These technologies focus on capturing, understanding and utilizing data to drive improved outcomes and lower costs. Over the last four years we’ve seen adoption of some of these technologies increase by 25% but there are still more than 1,600 hospitals that have yet to adopt.
Examining the technologies we’ve identified (or perhaps some that we haven’t), what areas will or should flourish in a post-EMR world?

Link: https://www.linkedin.com

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WHO'S ON CALL? REACHING THE RIGHT PROVIDER WHEN SECONDS COUNT

by System Administrator - Tuesday, 10 March 2015, 9:49 PM
 

WHO'S ON CALL?

REACHING THE RIGHT PROVIDER WHEN SECONDS COUNT

With the prevalence of smartphones and pagers, reaching the right doctor for consultations and questions ought to be easy.

In fact, ninety-six percent of physicians use smartphones to support patient care. But the reality is that finding the right clinician, especially one on call, is still a challenge. Sixty-one percent of physicians express concerns about having access to colleagues and specialists, and 53 percent of nurses cite difficulties determining which physician is available.

In a two-month study at academic medical centers in Toronto, Canada, Dr. Brian Wong found that 14 percent of pages were sent to a provider who was not on duty. Further investigation revealed that 15 percent of the pages sent to the wrong clinician were for emergencies that required immediate attention—that’s 211 pages in just two months.

Another 32 percent of pages sent to the wrong provider were urgent. Why were so many important messages sent to off-duty doctors?

According to the author, many of these errors resulted from numbers being written incorrectly on paper (so the wrong number was dialed), or information was pulled from a schedule that had not been updated.

Please read the attached whitepaper.


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