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Institute for Health Technology Transformation Announces Health IT Summit in Denver July 24-25

The iHT2 Health IT Summit in Denver, will bring together C-level, physician, practice management, and IT decision-makers from North America’s leading provider organizations and physician practices. For two full days, executives interact with a national audience of peers, national leaders and solutions providers featuring the latest solutions for practice management, mobility, telemedicine, outsourcing, IT infrastructure, next-generation electronic medical records, disease management, and more.

The Summit will feature keynote presentations from Peter Fine, FACHE, President & CEO, Banner Health, and Bernard Harris, Jr., MD, MBA, President & CEO, Vesalius Ventures, and President, American Telemedicine Association.

Featured Speakers include: Dana Moore, SVP & CIO, Centura Health; Gregory Veltri, CIO, Denver Health; Russell Leftwich, MD, CMIO, Tennessee Office of eHealth Initiatives; Neal Ganguly, VP & CIO, CentraState Healthcare System; Andrew Steele, MD, MPH, Director, Medical Informatics, Denver Health; Jonathan Gold, MD, MHA, MSc, Regional CMIO, Catholic Health Initiatives; Charles Doarn, MBA, Research Professor and Director, Telemedicine & e-Health Program, University of Cincinnati; Mark Caron, SVP & CIO, Capital BlueCross, and many more.

Panel Discussions for the Health IT Summit in Denver include: Accountable Care Organizations: Taking on Risk & Identifying Critical Tools, Leveraging Data to Improve Outcomes & Safety, Preparing for 2013: Organizational Strategies for the Transition to ICD-10, Breach Avoidance: Strategies to Protect Patient Data, HIE Performance: Defining Your Objectives & Measuring Progress, Meaningful Use Stage 2: Reaching the Next Stages of Quality & Care, and Mobile Health: Leveraging Data at the Point of Care.

The full agenda can be viewed by visiting: http://ihealthtran.com/2012denveragenda.html

Sponsors and Partners include: ICA, Quantix, Extract Systems, SLI Global Solutions, Nuance, Comcast, Altus, Rubbermaid Healthcare, VMware, Healthcare IT News, CMIO, FierceHealthIT, ADVANCE, NASCIO, AMDIS, eHealth SmartBrief, Frost & Sullivan, IDC Health Insights, Mobile Healthcare Today, SearchHealthIT.com, and more.

 

Institute for Health Technology Transformation Appoints New Health IT Leaders to Advisory Board

The Institute for Health Technology Transformation (iHT²) announced ten new members to their Advisory Board this week. These members represent some of the brightest minds in healthcare information technology, and they will work to provide thought leadership and valuable industry connections to expand and improve the quality of the Institute’s initiatives throughout the year.

The Institute’s Advisory Board is a group of health care thought leaders representing the diverse stakeholders involved in the integration of health information technology. This esteemed group provides iHT² with insight and guidance throughout the year on how it can better serve the health care industry in their goal of fostering the adoption and implementation of health IT.

“Members of the iHT² Advisory Board greatly enhance our ability to offer health IT leaders superior educational and collaborative opportunities,” said Barry P. Chaiken, MD, MPH, Senior Fellow & Health IT Chair, Institute for Health Technology Transformation, CMO, DocsNetwork & former HIMSS Chair. “The insight provided by these distinguished professionals allows iHT² to keep pace with developing trends in healthcare, and offer conferences, webinars and publications that satisfy the needs of a wide range of industry professionals.”

The new members join a board of over twenty health IT leaders representing organizations throughout the country including: Kaiser Permanente, Catholic Health Initiatives, Capital BlueCross, Visiting Nurse Service of New York, Delaware Health Information Network, and more.

The newly appointed members are:

  •     Samantha Burch, VP, Quality & Health IT, Federation of American Hospitals
  •     Mary Carroll Ford, MBA, VP & CIO, Lakeland Regional Medical Center
  •     Dick Gibson, MD, Chief Health Intelligence Officer, Providence Health & Services
  •     Fred Galusha. CIO & COO, Inland Northwest Health Services
  •     Chris Jaeger, MD, VP, Medical Informatics, Sutter Health
  •     Elizabeth Johnson, SVP, Applied Clinical Informatics, Tenet Healthcare
  •     Bill Phillips, CIO, University Healthcare System
  •     Justin Graham, CMIO, NorthBay Healthcare
  •     Andy Steele, MD, Medical Director, Informatics, Denver Health
  •     Doris Crain, CIO, Broward Health
  •     John Santangelo, Director of IT, Cleveland Clinic Florida

“The Advisory Board contributes invaluable industry insight that results in some of the most comprehensive, intimate, and informative programs taking place year after year,” said Waco Hoover, CEO, Institute for Health Technology Transformation. “The accomplishments and dedication of the Advisory Board is what truly separates the Institute apart from other organizations.”

 

Intermountain Healthcare, Partners Healthcare System, and Kaiser Permanente to Deliver Keynote Presentations at the Health IT Summit in San Francisco

The Institute for Health Technology Transformation announced the keynote presenters for the Health IT Summit in San Francisco, which will take place March 27-28th at the Hyatt Regency San Francisco Airport. The keynote presenters at the annual program will be Mark Probst, CIO, Intermountain Healthcare, Blackford Middleton, MD, Corporate Director of Clinical Informatics Research & Development, Partners Healthcare System, and Hal Wolf, SVP & COO, The Permanente Federation, Kaiser Permanente.

The iHT2 Health IT Summit, will bring together C-level, physician, practice management, and IT decision-makers from North America’s leading provider organizations and physician practices. For two full days, executives interact with a national audience of peers, national leaders and solutions providers featuring the latest solutions for practice management, mobility, telemedicine, outsourcing, IT infrastructure, next-generation electronic medical records, disease management, and more.

“We are dedicated to continuous improvement that enhances patient care. I look forward to learning from health care leaders and sharing our experience in improving outcomes by putting advanced health IT in the hands of clinicians, care teams, and patients,” said Hal Wolf, Senior Vice President and Chief Operating Officer of The Permanente Federation, Kaiser Permanente.

Panel discussions for the Health IT Summit in San Francisco include: Accounting for Assumptions: Taking a deeper look at reforming our healthcare delivery system, HIE & HIX: The convergence of healthcare information, Securing Electronic Personal Health Information (ePHI): From the Data Warehouse to the Point of Care, Analytics in Healthcare: Improving Outcomes Through Data Management, The Cloud in Healthcare, Stage 2 Meaningful Use: Leveraging Technology to Improve Outcomes & Efficiency, Patient Management Without Walls: Enabling mHealth and Telemedicine, and more.

“Healthcare I.S. leadership is consumed with the demands of ARRA HITECH (meaningful use), ICD-10 (maybe we are going to get some relief) and a barrage of requests to meet the demands of a changing healthcare landscape,” said Mark Probst. “I believe that even though the demands are great – as I.S. leaders, we must not simply follow and adopt aging solutions, rather we have the responsibility to innovate.”

Sponsors and Partners include: ICA, InnerWireless, CloudPrime, Accellion, ICW, SLI Global Solutions, VMware, athenahealth, Comcast, InterSystems, LANDesk Software, Pano Logic, Aventura, Key Info, AUXILIO, Somansa Technologies, Inc., Salesforce.com, EMC2, AMDIS, The California Association of Healthcare Leaders (CAHL), California Association of Public Hospitals and Health Systems (CAPH), CMIO, DOTmed, eHealth SmartBrief, Executive Insight, Frost & Sullivan, Healthcare IT News, IDC Health Insights, MarketsandMarkets, NASCIO, ReportsandReports, SearchHealthIT.com, and more.

 

Health Care Thought Leaders Release Research Report Finding Automation Is Key to Population Health Management

The Institute for Health Technology Transformationtoday released findings from an Automating Population Health Research Project, which seeks to educate the healthcare industry on how best to apply technology in meeting the challenges of population health management.

Prepared in consultation with a broad range of industry experts, the Population Health Management: A Roadmap for Provider-Based Automation in a New Era of Healthcare report finds that population health management requires healthcare providers to develop new skill sets and new infrastructures for delivering care. To make the transition from fee-for-service reimbursement to accountable care, which depends on the ability to improve population health, providers will need to automate many routine tasks, ranging from identification of care gaps and risk stratification to patient engagement, care management, and outcomes measurement.

“In the era of healthcare reform, provider organizations must change their traditional approach and embrace new ways of thinking about their mission,” said Waco Hoover, CEO of the Institute for Health Technology Transformation. “They must not only care for the sick, but also strive to keep their patient populations healthy. Information technology is the key to doing this cost efficiently, and automation can enable care teams to identify and work with the patients who truly need their help.”

Report coauthor Paul Grundy, MD, Global Director of Healthcare Transformation for IBM, and President of Patient-Centered Primary Care Collaborative, commented, “Patient-centered medical homes based on primary care are the building blocks of accountable care, and information technology is the key to successful medical homes. With the help of registries, electronic health records, health information exchanges, and other tools for care coordination and automation, healthcare providers can manage their populations effectively and keep their patients as healthy as possible.”

Andy Steele, MD, MPH, Director of Medical Informatics at Denver Health, and another of the report’s contributing authors, said, “Given potential health care reform and efforts to increase quality and efficiency of care in the setting of persistent fiscal limitations, the importance of leveraging information technology and focusing on population health management has become a top priority for many health care institutions. Our goal for the project is to provide resources that health care providers can utilize as they are considering and implementing population health management initiatives.”

Richard Hodach, MD, MPH, PhD, Chief Medical Officer of Phytel and chair of the report’s research committee, commented, “This important new report underscores the message that Phytel has been spreading among physician groups for the past several years. By using technology to identify subpopulations and patients who are at risk, to reach out to those patients, and to automate care management, healthcare providers can provide optimal preventive and chronic care to their patient populations. Providers can also use technology to engage patients in their own care, which is the real key to lowering costs and improving population health. We are proud of our participation in this project, and we hope that the report will be helpful to providers who plan to move in this direction.”

Among the healthcare thought leaders who contributed to the Automating Population Health Research Project are Alide Chase, MS, Senior Vice President for Quality and Service, Kaiser Permanente; Robert Fortini, Vice President and Chief Clinical Officer, Bon Secours Health System; Connie White Delaney, PhD, RN, School of Nursing Professor & Dean, Academic Health Center Director, Associate Director of Biomedical Health Informatics, and Acting Director of the Institute for Health Informatics, University of Minnesota; Richard Hodach, MD, MPH, PhD, Chief Medical Officer, Phytel; Paul Grundy, MD, MPH, Global Director of Healthcare Transformation, IBM; Margaret O’Kane, President, National Committee for Quality Assurance; Andy Steele, MD, MPH, Director of Medical Informatics, Denver Health; and Dan Fetterolf, Principal, Fetterolf Healthcare Consulting.

 

Institute for Health Technology Transformation Appoints Jay Srini Senior Fellow & Innovation Chair

The Institute for Health Technology Transformation announced today that Jay Srini, Chief Strategist at SCS Ventures has been appointed Senior Fellow & Innovation Chair for the Institute’s 2012 series of educational programs and meetings.

Jay Srini is an internationally recognized thought leader on national and international trends that are changing the face of healthcare. In her current role at SCS Ventures, Jay works with startup companies internationally to help them with their business development, technology strategy, and expansion. She also advises established companies on their strategies to enter and grow their healthcare vertical.

“We’re thrilled to work with Jay in a concerted effort to move our health system forward with programs that foster the more innovative use of information technology,” said Waco Hoover, the Institute’s CEO. “Jay has a wealth of industry expertise that will make a meaningful and lasting impact on programs and initiatives developed at the Institute.”

In Jay Srini’s role as Senior Fellow and Innovation Chair she will work with the Institute’s Advisory Board and other industry leaders to program and develop leading educational programs and collaboration opportunities for health care leaders. In tandem with the Institute’s mission to promote the effective use of technology across the U.S. health system, Mrs. Srini will engage leaders from the community to ensure the Institute continually provides timely and relevant resources.

“We are in the midst of tectonic shifts in healthcare on all fronts ranging from new discoveries to new payment models and new stakeholders entering the healthcare sector,” said Jay Srini. “Finding innovative ways to deliver cost effective patient centered health care has never been as important as now. Innovation is virtually impossible without collaboration! I am honored and excited to take on this new role at iHT2 to develop new programs and platforms to drive innovation in healthcare through collaboration knowledge acquisition and knowledge dissemination.”

Jay’s prior experience includes her role as Chief Innovation Officer for UPMC (University of Pittsburgh Medical Center) Insurance Services Division as well as her role as Vice President of Emerging Technologies for UPMC. Jay was Managing Director for e-Health Initiatives at Internet Venture Works where she led technology and industry assessments of opportunities presented by strategic partners, investors and external sources and served in executive management roles for its’ portfolio companies. She has served on several healthcare boards including HIMSS (himss.org), PRHI (prhi.org) and is a frequent speaker on International Healthcare forums. She serves on several HHS (Health and Human Services –hhs.gov) related advisory panels and serves in an advisory capacity to International healthcare Institutions and Venture capitalists.

Jay has a Master’s Degree in Computer Science from New York University and a Master’s Degree in Business Administration from Bucknell University and her executive education from the Kellogg School of Management at Northwestern University. She also serves as one of the commissioners at CCHIT (Certification Commission of HealthCare Information Technology) in addition to her role as adjunct faculty Assistant Professor at the University of Pittsburgh and advisory board of the School of Computer Science at Carnegie Mellon University.

 

About iHT2

The Institute for Health Technology Transformation is the leading organization committed to bringing together private and public sector leaders fostering the growth and effective use of technology across the healthcare industry. Through collaborative efforts the Institute provides programs that drive innovation, educate, and provide a critical understanding of how technology applications, solutions and devices can improve the quality, safety and efficiency of healthcare.

The Institute engages multiple stakeholders:

• Hospitals and other healthcare providers
• Clinical groups
• Academic and research institutions
• Healthcare information technology organizations
• Healthcare technology investors
• Health plans
• Consumer and patient groups
• Employers and purchasers
• Device manufacturers
• Private sector stakeholders
• Public sector stakeholders

Have Researchers Finally Settled The Nature Vs Nurture Debate?

Health and Medicine
Photo credit: Blend Images via Shutterstock

When it comes to the nature vs nurture debate, which camp do you sit in? Well, you're both right because it’s a draw. The study, published in Nature Genetics, reviewed almost every twin study done in the last 50 years and found that 49% of the average variation for human traits and diseases were down to genetics, and the other 51% were due to environmental factors.

"When visiting the nature versus nurture debate, there is overwhelming evidence that both genetic and environmental factors can influence traits and diseases," said lead researcher Dr. Beben Benyamin, from the Queensland Brain Institute (QBI), in a statement. "The findings show that we need to look at ourselves outside of a view of nature versus nurture, and instead look at it as nature and nurture."

Working with researchers at VU University of Amsterdam, Benyamin and his team studied 2,748 classical twin studies—involving 14.5 million pairs of twins—published between 1958 and 2012. These twin studies compared identical twins, which have the same genetic makeup, to non-identical twins, who only share half of their genes. The study...

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Success Against Most Common Form Of Cystic Fibrosis

Health and Medicine
Photo credit: John Teate via Shutterstock. Two drugs working together have been found to be effective against the most common cause of cystic fibrosis

A treatment for the most common cause of cystic fibrosis has exceeded expectations, significantly improving the quality of life of more than a thousand children with the genetic disease. The trial was too short to determine whether the drug combination also extends the life expectancy of children with the disease, but researchers are optimistic.

Cystic fibrosis affects the lungs, liver and pancreas of children born with one of several mutations. Proteins that act as channels for chloride cells fail to fold normally, trapping chloride inside cells. More seriously, lungs fill up with sticky mucus, making it hard to breathe and increasing vulnerability to lung infections.

Tens of thousands of people worldwide are affected, the frequency being highest among those with northern European ancestry. There has been some slow progress in reducing the mortality rates of those with the condition, but life expectancy remains at only around half of that of the general population.

Treatments that work...

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Watch T Cells Hunt Down And Kill Cancer Cells

Health and Medicine
Photo credit: Gillian Griffiths/Jonny Settle

Cytotoxic T cells, which researchers describe as ‘serial killers,’ have a pretty important role to play in keeping your body healthy. They move rapidly around their environment looking for infected and cancerous cells. Once identified, cytotoxic T cells lock on to their target and kill them. This remarkable process has now been captured on film by researchers from the University of Cambridge using state-of-the-art imaging techniques.

There are billions of cytotoxic T cells in our body, which are the orange or green 'blobs’ in the video below, and they are able to recognize a variety of pathogens through the ‘markers’ on the surface of the cells. These markers, known as antigens, tell the cytotoxic T cells whether the cell is carrying foreign or abnormal molecules. Once cytotoxic T cells recognize unwanted intruders, they launch an attack by binding to the cell and injecting it with poisonous molecules called cytotoxins—shown in red in the film.

"In our bodies, where cells are packed together, it's essential that the T cell focuses the lethal hit on its target, otherwise it will cause collateral...

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23 Unusual Ways To Die In The US In One Handy Map

Health and Medicine
Photo credit: Fer Gregory via shutterstock

“…in this world, nothing can be said to be certain, except death and taxes,” quoted Benjamin Franklin in a letter to Jean-Baptiste Leroy in 1789. The great dispatcher will come for us all in time, but this doesn’t mean you can’t leave in unusual style.

Published by Centers for Disease Control and Prevention, the map shown below illustrates “the most distinctive causes of death” in each of the 50 states. Using data acquired between 2000 and 2010, the paper describes the cause of death in each state that most stands out when compared with how people in the US usually die.

Image Credit: Centers for Disease Control and Prevention

But if you’re a North Dakotan who is now alarmed by the significant amount of influenza deaths– relax, there is no need to panic. The map is meant to be a “colorful and provocative way of starting some conversations and highlighting some unusual things that are going on,” said study co-author Francis Boscoe to Live Science. “If something is almost nonexistent everywhere in the country, but there's a handful of them in one state, then that could show up."

The results, the...

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The Science Of Hangovers

Health and Medicine
Photo credit: XiXinXing on shutterstock

As a bothersome buzz at the base of your neck or an agonizing ache all over, the effects of drinking alcohol on the body are the least amount of fun the morning after. But what if you could harness the power of science to drink smart and feel less like a trembling gremlin the next day?

Help is at hand, thanks to Kayla Matthews, a tech productivity blogger, who made a handy infographic (shown below) to illustrate the science behind that hellish hangover.

Created with Clarity Way, a drug and alcohol rehabilitation center, Matthews’ research promotes healthy living with a responsible consumption of alcohol. 

Read this next: Meet the New Blue and Purple Crayfish from Indonesia

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  • alcohol
  • drinking
  • clarity way
  • hangover
  • kayla matthews

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Doubt Cast On 'Young Blood' Anti-Aging Protein

Health and Medicine
Photo credit: wk1003mike/Shutterstock

It might sound like the plot from a vampire movie, but since the 1950s it’s been observed that young blood seemingly rejuvenates old mice. To great fanfare, last year it was announced that scientists might have finally cracked the riddle following the discovery of the specific protein that could be responsible for the apparent anti-aging properties. However, a new paper has cast doubt on this discovery.

When a team of scientists in 2013 hooked up the circulatory systems of a young mouse to an old one that showed signs of thickening of the heart, a common condition of old age, they found that after four weeks the old mouses’ heart had reverted to almost the same size as the younger ones. The researchers identified a certain protein they thought responsible: GDF11. 

To David Glass, who works at the Novartis Institute for Biomedical Research, this was completely counter-intuitive. He’d been working on an incredibly similar protein, called myostatin, that didn’t restore muscle but damaged it. “You could imagine that when it came out last year that [GDF11] helped muscle, it was quite a surprise,” Glass told...

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Teenage Girl Had To Stay Awake For Four Days After Parasite Started Eating Her Eyeball

Health and Medicine
Photo credit: Jessica Greaney's right eye is swollen from the eye parasite / Jessica Greaney

For the squeamish, the images in this article are not extreme.

The 19-year-old contact lens wearer, Jessica Greaney, thought she only had a minor eye infection: her eye was sore and her eyelid kept drooping. "But, by the end of the week, my eye was bulging, and it looked like a huge red golf ball," Greaney said. "It was swollen, and extremely painful, and they admitted me into hospital."

Little did she know that there was a parasite, Acanthamoeba, living inside her eyeball. Left untreated, this parasite can cause blindness. To diagnose the problem, doctors had to scrape away a small sample of her eye tissue with a scalpel.

For the next four days, Greaney had to stay awake for treatment and put eye drops in her eye every thirty minutes. She commented on her harrowing experience: "Four nights of not being able to sleep sounds like torture and it is. It's really heartbreaking and hard to go through." Jessica recalls being exhausted, losing her appetite and, as a result, her immune system was shot.

"Although it's hard, it is worth it in the end because...

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Young Blood Speeds Healing Of Old Broken Bones

Health and Medicine
Photo credit: Puwadol Jaturawutthichai/ Shutterstock

Hailed as the long sought-after elixir of youth ever since scientists demonstrated that it could reverse signs of aging in old mice, there has been a lot of interest in young blood as a potential rejuvenation factor. While scientists thought they may have pinpointed the responsible molecule, describing its impressive effects in several high-profile publications, its age-defying abilities have this week been called into question by a new study. But it seems scientists shouldn’t fall at the first hurdle as, interestingly, a new investigation has come out that showed that young blood can help old broken bones heal faster.

As described in Nature Communications, circulating the blood of young mice in older mice with fractures sped up the healing process, an effect that they could replicate by also giving the elderly mice a bone marrow transplant from youthful individuals. Furthermore, they were also able to pinpoint a signaling pathway that is at least partly responsible, although what causes it to go wrong in the elderly remains unknown.

The signaling molecule in question is a protein called...

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Why Does Day Care Protect Children Against Leukemia?

Health and Medicine
Photo credit: Sebastian Kaulitzki/shutterstock

It’s a curious link: Children who start day care earlier in their life are less likely to develop acute lymphoblastic leukemia. The cancer occurs when the body starts over-producing immature white blood cells that then crowd out other cell types from the child's blood. This causes symptoms similar to anemia, as well as an increased chance of excessive bleeding. 

Now, scientists might have figured out what it is that drives this cancer, and why starting day care earlier might help protect against developing it. The new research, published this week in Nature Immunology, suggests that exposing children at an early age to minor infections might 'prime' the body, reducing the likelihood that the immune system will react disproportionately when triggered later in life. Without this exposure, repeated bacterial infections can cause the immune system, specifically the genes that control the production of white blood cells, to overreact and continue unchecked, causing acute lymphoblastic leukemia (ALL).

This is why, the researchers propose, sending children to day care early in life—where contact with...

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Plant biosecurity course combats wheat blast

Wheat blast, an emerging disease that threatens worldwide food security, is the focus of a plant biosecurity course at an American university. The course is designed to help participants learn how to contain and exclude a plant pathogen.

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Best and safest blood pressure treatments in kidney, diabetes patients compiled

The first definitive summary of the best and safest blood pressure lowering treatments for kidney disease and diabetes patients has been compiled by clinicians. Diabetes and high blood pressure are the most common causes of kidney disease around the world, and people often have both. Chronic kidney disease caused by diabetes always affects both kidneys and generally gets worse over time, often leading to kidney failure requiring dialysis treatment or a kidney transplant.

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New mechanism for Alzheimer's disease confirmed

Decreased removal of toxic peptides in the brain causes the onset and first clinical signs of Alzheimer's disease, research suggests, rather than overproduction as has previously been assumed. This information can now be used to target specific genes to enhance their function in the brain of elderly or people at risk.

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This Lens Could Give You Superhuman Vision

Health and Medicine
Photo credit: Darryl Dyck / Canadian Press

Ocumetics Technology Corp claims to have developed a painless eight-minute procedure that would give you vision that is supposedly three times better than 20/20. The "bionic" lenses would give even 100-year-olds better vision than anything currently available. Does this sound too good to be true? Well, we can’t tell, as it has yet to undergo any clinical trials. 

“Freedom from glasses and contact lenses is a goal that is now a reality,” Ocumetics says on its website. The CEO, Dr Gareth Webb, a Canadian optometrist, invented the "button-shaped" lens and has been working on the product for eight years of research, costing $3m.

"This is vision enhancement that the world has never seen before. If you can just barely see the clock at 10 feet, when you get the Bionic Lens you can see the clock at 30 feet away," Webb told CBC.

The procedure is similar to cataract surgery. It involves removing your original lens and replacing it with an Ocumetics' Bionic Lens, which is folded into a syringe in a saline solution and injected directly into your eye. Webb says that the specialized lens would also prevent...

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'Deep web search' may help scientists

When you do a simple Web search on a topic, the results that pop up aren't the whole story. The Internet contains a vast trove of information -- sometimes called the "Deep Web" -- that isn't indexed by search engines: information that would be useful for tracking criminals, terrorist activities, sex trafficking and the spread of diseases. Scientists could also use it to search for images and data from spacecraft.

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