Reference: World Economic Forum

Reference: Linkedin

Attacking the Opioid Crisis on a Budget: 8 Innovative Ideas

• Published on Published onOctober 26, 2017

Political talk is cheap, substance abuse programs are expensive, and the nature of the crisis demands fast action. Sadly, while an official ‘public health emergency’ declaration helps, it doesn’t give a quick infusion of cash to help embattled front line substance abuse workers. To allocate funds, the Health and Human Services (HHS) budget (that currently cuts $4B in funding) must be revised so that Congress has funds to allocate. As it looks like the crisis will continue to be fought on a shoestring, in addition to immediate definitional changes to access existing funds, it’s time to get the biggest bang for addiction intervention bucks: prevention innovation.

Addiction is heartbreakingly difficult to combat, with high failure rates and costs to society. The substance abuse programs that need money are obvious: the acting HHS secretary can allow Medicaid to reimburse opioid abuse treatment at mental health centers, negotiate reduced costs for naloxone, and mandate Medicaid reimbursement of proven addiction medications. (This actually saves systems money - mean health care costs with addiction medication treatment = $13,578; vs. with no addiction treatment = $31,055) . Waiving the requirement for naloxone prescriptions will save lives. But since resources are scarce, focus on increasing community health access for addicted pregnant mothers. Addressing addiction before birth saves $55,000 in treatment costs for neonatal dependence, with lifelong savings in education and law enforcement costs.

Since the era of “Oxycontin doesn’t cause addiction”, between 40 and 80% of opioid abuse has been attributed to initial medical use for pain. These studies underestimate the medicine cabinet availability for experimental teens - they weren't in pain, but someone was. As part of an opioid legislative package in Georgia, pharmacist Rep. Buddy Carter sought help from pharmaceutical companies, noting “Once you get past Tramadol and a couple of others, there is nothing else for us to use [for pain], there is nothing else for us to prescribe.” This perspective is exactly why we have an opioid problem – we’re focusing on drugs, not the problem of pain that got us there. Want fewer addictions? Put fewer pills in circulation. Here are some obvious and some less-intuitive ideas:

• Lower the quantity of pain medications per prescription

Pain is personal, but there is some generalizability of duration of pain for normal recovery. Tier pain management clinical scenarios, and limit scrips for 24, 72 hour, and (rarely) 7 day home recovery.

• Redefine chronic pain

"Chronic" has been defined as pain lasting 3-6 months. Opioids are poor choices for most patients with chronic pain, but by three months of treatment, addiction already exists. We need a new treatment category for pain lasting over 7 days, and must change our focus from treating chronic pain to promoting movement and function.

• Cover initial visits for pain to physical therapists

Pain is usually physical – physical problems require physical solutions. We need to cover visits to physical therapists prior to physician authorization, paying for longer treatments to rehabilitate misused muscles, strengthen, and change movement habits. PTs won't prescribe Percocet.

• Require non-pharmacologic recommendations with every prescription

Prescribing medications is a physician’s super power – we study long and hard for the ability to help people in pain with a prescription. To change addiction, we have to change physician behavior by teaching alternate evidence-based options for pain. This will take a while, so for now, teach pain patients they have options. When patients have a list of nonpharmacologic interventions, the ability to choose gives control, reduces fear, and helps diminish the incorrect perception that drugs are first line pain relievers.

• Cover pain relief devices and office education

The Centers for Medicaid and Medicare pays for pills, but won’t pay for low cost home devices, even when used to reduce opioid intake. BakBalls, VibraCool, NeckRest, Posture Pals, soft tissue rollers, all are over the counter and used by clinicians for patients' pain. To avoid covering a device that a patient finds too cold, or an electrostim unit when a patient hates the feel of electricity, reimburse therapists for office trials.

• Create non-pill pain management lists

Doctors don’t have time to cover exhaustive options, but there are evidence-based nonpharmacologic treatments NOW to address chronic and post-surgical pain. University of Michigan offers a “Poke Plan” for needle pain, University of Iowa has a laminated list from creams to Buzzy – offering treatment option menus to patients is not just good service, it’s good science. Menu-selected treatments benefit from belief bias, choice-supportive bias, confirmation bias, selective perception, and even the “IKEA effect”– you like a pain plan more if you made it yourself. 

• Give injury, chronic pain and post-surgical patients a $200 budget for pain services and products

Pain relief options aren’t useful if they’re unaffordable while opioids are free. If a patient hates stretching but loves massage, don’t waste time and money prescribing a yoga class. Massage, thermal treatments, yoga classes and chiropractor visits topped Consumer reports lists of effective pain management treatments. Pay for them.

• Use available pharmacogenomics testing to predict de novo abuse

Opioids in particular have variable metabolism. Caucasians with variations of the CYP2D6 enzyme metabolize opioids poorly – they may get poor relief from opioids, but more importantly are less likely to become addicted. In contrast, ultra-rapid metabolizers have greater risk of overdosing, and likely addiction. The genetic test is currently available, and the cost and clinical benefits are being tested by Indiana University. Funding to make a rapid bedside test available could help both pain treatment and prevent susceptible patients from getting opioids at all.

• Don’t even think of putting more money toward the drug war. Aggressive law enforcement keeps illicit drug users and pregnant mothers from treatment, and has not been proven to reduce use. A 2012 article in The Lancet argues international drug conventions may have increased availability. No additional funds here.

Treating addiction is astronomically expensive. Drastically curtailing opioids in circulation can save money as well as lives at a fraction of the cost. Declare a national emergency, yes, and PLEASE pay for addiction medications, but let’s use this ‘public health emergency’ opportunity to change how we think about and pay for pain.

해외에서 가장 먼저 숙지하고 있어야 할 것이 응급 상황에 대처하는 방법입니다. 911에 전화를 했을 때의 상황을 머리 속에 그리고 있어야 합니다. 

The first thing that you have to know when you are abroad is to make a phone call to 911 in an emergency. You have to be prepared for those emergencies.

Reference: English The American Way, Sheila MacMechnie Murtha

If you own a television, you've seen them: amazing rescues from the burning buildings, victims rescued from the bad guys and lives saved in hospital ERs. From the comfort of your couch, you've seen the TV versions of real-life drama. The downside of these TV dramas is that they make the emergencies seem very simple. Unlike in real life, TV problems are resolved in just an hour. But the upside of emergency shows is that people see what they have to do to get help. 

  The most important information to know in an emergency is a very simple phone number: 911. Even schools teach this number to small children at an early age. There are plenty of stories of kids as young as three years old making a 911 phone call that has saved a life. 

  The phone number is the same for fire, medical and police emergencies: 911.

  The phone number is the same from both landlines and cell phones: 911.

  When a landline call comes in, the emergency dispatcher may able to see the phone number and the exact location, but not always. Calls from a cell phone may not display the same information. The most critical thing to remember when making an emergency call is to remain calm. It's a matter of life and death. You must be understood when making this call. Because everyone tends to speak very quickly or excitedly when they are nervous or afraid, it can be even more difficult to understand second language speakers in an emergency. For this reason, it's vital to remember the following instructions:

• Stay calm.

• Speak slowly and clearly.

• Know what information the operator needs.

The operator will ask many questions so that she can get a good picture of the problem and send exactly the right kind of help. She will ask for essential information like: Who? What? Where? When? It's important to answer all the questions slowly and clearly. Don't worry; she is not wasting time. Even while you're answering her questions, the operator is contacting the right emergency system. You must stay on the line with the operator until help arrives. Don't hang up! 

  The 911 dispatchers are specially trained to ask very clear questions about the emergency. The dialogues below are examples of the kinds of conversations you may have. Remember, the operator will ask different questions as he or she learns about your emergency.

영어로 책 쓰기에 도전해봅시다.

Let's try to write your own books.

• Video 1: The Common Fears of Aspiring Authors (And How to Conquer Tem Once and For All)
• Video 2: 7 Painful Truths I Wish I Knew Before Writing My First Book
• Video 3: How to Write Your First Book Like a Professional Author

Reference: https://www.rd.com/culture/benefits-of-reading/

Here's a simple question - answer it honestly, because your response could boost the amount of pleasure in your daily life, delay dementia, and even help you live longer: How many hours did you spend reading books last week?

dementia

This question has arrived in thousands of U.S. homes every other year since 1992 as part of the University of Michigan's Health and Retirement Study(HRS). A minor item on a massive survey of more than 20,000 retirees, it had long gone ignored in the analysis of elder brain health. But in 2016, when researchers at the Yale School of Public Health dug into 12 years of HRS data about the reading habits and health of more than 36,000 men and women over the age of 50, a hopeful pattern emerged: People who read books-fiction or nonfiction, poetry or prose-for as little as 30 minutes a day over several years were living an average of two years longer than people who don't read anything at all. Odder still, book readers who reported more than three hours of reading a week were 23 percent less likely to die between 2001 and 2012 than their peers who read only newspapers or magazines.

every other year

retiree

dig into ~

emerge

prose

If you're reading this, it's safe to assume you don't need to be sold on the merits of written words. You may already be familiar with recent findings that suggest children as young as six months who read books with their parents several times a week show stronger literacy skills four years later, score higher on intelligence tests, and land better jobs than nonreaders. But recent research argues that reading may be just as important in adulthood. When practiced over a lifetime, reading and language-acquisition skills can support healthy brain functioning in big ways. Simply put: Word power increases brain power.

on its [a person's] (own) merits

You may be familiar with recent findings that ~

literacy

score higher on intelligent tests

land better job

just as ~ = at the same time as

adulthood

over a lifetime

in a way / in big was

simply put

To understand why and what each of us can do to get the most out of the words, start by asking the same question the Yale team did: What is it about reading books in particular that boosts our brain power whereas reading newspapers or magazines doesn't? For one, the researchers posit, chapter books encourage "deep reading." Unlike, say, skimming a page of headlines, reading a book(of any genre) forces your brain to think critically and make connections from one chapter to another, and to the outside world. When you make connections, so does your brain, literally forging new pathways between regions of all four lobes and both hemispheres. Over time, these neural networks promote quicker thinking and may provide a greater defense against the worst effects of cognitive decay.

Use "each of us" instead of "we" to stress each person.

in particular

Use "whereas" instead of "but".

posit

encourage

skimming a page of headlines

genre

literally

forge

pathway

lobe

over time

promote

defense against

cognitive decay

Second, reading books, especially fiction, has shown to increase empathy and emotional intelligence. One 2013 study found that participants who just read the first part or chapter of a story showed a noticeable increase in empathy one week later, while newspaper readers showed a decrease. These findings may sound trivial, but they're not; developing social tools such as empathy and emotional intelligence can lead to more (and more positive) human interaction, which in turn can lower stress levels - both of which are proved to help you live longer and healthier.

empathy

emotional intelligence

in turn

That's not to say that magazines, newspapers, and Web articles are without merit. Reading anything that fills your mind and exposes you to new words, phrases and facts seems to carry mental benefits. New research indicates that a large vocabulary may lead to a more resilient mind by fueling what scientists call cognitive reserve. One way to think about this reserve is as your brain's ability to adapt to damage. Just as your blood cells will clot to cover a cut on your knee, cognitive reserve helps your brain cells find new mental pathways around areas damaged by stroke, dementia and other forms of decay. This could explain why, after death, many seemingly healthy elders turn out to harbor advanced signs of Alzheimer's diseases in their brain, despite showing few signs in life. It's their cognitive reserve, researchers suspect, that may allow some seniors to seamlessly compensate for hidden brain damage.

without merit

resilient

clot

Alzheimer's disease

So how does one build up a cognitive reserve? That's more good news for word lovers. Vocabulary is notoriously resistant to aging and having a rich one, according to researchers from Spain's University of Santiago de Compostela, can significantly delay the manifestation of mental decline. When the team analyzed vocabulary test scores of more than 300 volunteers ages 50 or older, they found that participants with the lowest scores were between three and four times more at risk of cognitive decay than participants with the highest scores.

resistant

manifestation sign symptom indication

volunteer

Learning foreign words also offers important cognitive nutrients. In fact, research shows that learning something new, such as how to play an instrument or speak a second language, is one of the best things you can do for your brain at any age. Remember that powerful network of brain connections we get from reading? Successfully learning a second language grows that network even more. As a result, polyglots have been shown to be stronger at multitasking,  superior at memorizing and better at focusing on important information than monolingual speakers. A 2013 study in Neurology discovered that patients who spoke two or more languages developed dementia an average 4.5 years later than monolingual patients. And while a brain that learns a second language earlier in life, will likely see more cognitive advantages than a late-life learner, it is never too late to open the phrase book. You don't need to end up a fluent speaker, either. "Just having the basics of those linguistic connections can delay dementia," Dr. Thomas Back of the Universiy of Edinburgh told the Atlantic. 

nutrient

neurology

discover

develope

dementia

an average 

either

Of course, learning a new language is no quick feat.

Luckily, the payoff of a single lesson can provide instant gratification. Researchers from Germany and Span had 36 participants read two sentences containing the same foreign word: "Every Sunday, the grandmother went to the jedin" and "The man was buried in the jedin." When asked what jedin means, the folks who correctly guessed "graveyard" showed reactions in the same pleasure-sensing parts of the brain you'd expect from food, sex, gambling and other satisfying stimuli. Though when it comes to words, over-indulgence is encouraged. 

feat

instant gratification

the folks

pleasure-sensing

when it comes to ~ 

over-indulgence

encourage

It's in that spirit of brain-building that we bring you a special Genius Issue devoted to all things philological. You'll find a story about the people who write dictionaries, the narrative tricks that "super memorizers" use to recall massive amounts of information, an essay that wonders if our fiction tastes are becoming simpler. There are heartwarming stories, too, such as the tale of how a young girl learned a few words of English from an American soldier during World War II, and a "Drama in Real Life" about a man who lost all ability to communicate - and almost died because of it. Wherever you land, we hope you'll be inspired to turn the page. Because, as science reminds us, it pays to increase your word power-today, tomorrow, and to the rest of your life.

devote

philological

narrative

recall 

heartwarming

soldier

Reference: Amazingly Easy Phrasal Verbs

Run out of - to have no more of something

This morning, I wanted to have some bread toast, however, I'd run out of bread. So, I rushed out of (the) house and got into the car. I turned the key but the car didn't start - I'd run out of petrol! I ran down the road to the shop, but they'd run out of sliced bread. I decided to buy some rolls (instead). Then I realized I'd run out of money. I'm always doing it and the shopkeeper has run out of patience (with me). I came home, looked at the clock, and saw that I'd run out of time for breakfast.

(missing words), not remembered