Here are a few I have come across the last week or so. Note:
Each link is followed by a title and a few paragraphs. For the full article
click on the link above title of the article. Note also that full access to
some links may require site registration or subscription payment.
General Comment
A
pretty quiet week last week with a very significant highlight for me being the
first article.
Enjoy
the browse…
-----
My Health fears on genomics
- The Australian
- 12:00AM June 12, 2018
Supratim Adhikari
The federal government’s digital health record system, My Health
Record, has been a magnet for security and privacy-related criticisms and
there are growing concerns the platform may at some point host genetic profiles
of Australian citizens.
Elizabeth Sigston, one of Australia’s leading head and neck
surgeons, told The Australian the idea of adding genetic information to the My
Health system continues to gain currency locally, especially on the back of
the work being carried out in the US and China.
The $1.45 billion All of Us project, formerly known as the
Precision Medicine Initiative, which aims to collect genetic and health data
from one million US citizens by 2022, is continuing to grow from strength to
strength. Meanwhile, similar work is under way in China, with the authorities
in the city of Nanjing, the capital of Jiangsu province, working on a genetic
database of residents.
-----
4:30pm, Jun 15, 2018 Updated:
2:38pm, Jun 13
Deadline for online health information sparks concern
Australians
have just a three-month window to opt out of having personal information
included in the new national My Health Online record.
However,
many Australians know nothing about the looming deadline or the federal
government’s new online system, according to the Australian Medical
Association.
“Though
the Australian Medical Association supports My Health Record and its
benefits, many GPs are concerned there may be a current lack of public
awareness about what it is and how it works,” AMA president Dr Tony
Bartone said.
-----
Bringing healthcare into the 21st century
For too long health has been lagging behind other sectors, says consumer advocate
In
March this year, The George Institute for Global Health and the Consumers
Health Forum of Australia, with the support of the Australian Digital Health
Agency, convened a policy roundtable with 40 key stakeholders including
consumer advocates, healthcare providers, clinicians, academics, industry,
government and policy experts from across Australia.
The
purpose of the roundtable was to formulate independent recommendations on the
implementation of Australia’s National Digital Health Strategy.
During
their discussion, roundtable attendees considered chronic care, residential
aged care, emergency care and end-of-life care in the context of digital
health, with the results placed in a report that was published this week.
-----
HealthEngine chief 'unreservedly apologises' for editing patient reviews
By Esther Han
11
June 2018 — 12:42pm
In numbers
·
"Positive customer feedback" of GPs on HealthEngine's
website. 47,900
·
Reviews that have been edited. 53%
·
Medical practices listed on the website that have reviews. 1840
The
chief executive of HealthEngine, the online GP booking business at the centre
of a review-tampering controversy, has apologised for the company's actions and
announced a sweeping review of its "aspirational review system".
Fairfax
Media revealed exclusively on Sunday that 53 per cent
of the 47,900 "positive" patient reviews
on HealthEngine had been edited in some way, with many turned from tepid or
negative to "positive customer feedback".
Initially,
HealthEngine's head, Marcus Tan, defended the company's review policies, saying
it published only positive reviews because it wanted to celebrate
high-performing GP practices.
-----
AHPRA weighs in on 'potentially unlawful' editing of negative online patient reviews
Legal warning
over claims HealthEngine tampered with thousands of comments
14th June 2018
AHPRA
is warning GP clinic booking sites that editing negative patient
reviews to sound more positive could fall foul of the law.
The
warning follows revelations earlier this week that HealthEngine, the biggest GP
booking system in the country covering more than 1800 medical practices,
allegedly tampered with more than half of the 47,900 reviews left by patients
(see box below for examples).
“Selectively
editing reviews or testimonials has the potential to be false, misleading or
deceptive and, therefore, be unlawful," AHPRA said in a statement.
-----
Data sharing OK say older Australians, as MyHealth Record extends to all
Two
thirds of older Australians say they are comfortable having their
de-personalised medical data used for research purposes, according to a new
survey.
The
survey, published in the Australian
and New Zealand Journal of Public Health,
asked 2000 Australians aged 55 and over if they found it acceptable to have
data that had been collected during their aged care assessment de-identified,
collected and used for health research.
A
total of 66.7% of participants replied ‘yes’ with a third of this group
indicating they would be comfortable for data sharing to occur without their
consent.
-----
Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use
Published: 08
June 2018
Abstract
Objective
The
aim of this study was to use routinely collected electronic medicines
administration (eMAR) data in residential aged care (RAC) to investigate the
quality use of medicines.
Design
A
cross-sectional analysis of eMAR data.
Setting
71
RAC facilities in New South Wales and the Australian Capital Territory,
Australia.
Participants
Permanent
residents living in a participating facility on 1 October 2015.
Intervention
None.
Main Outcome
Measures
Variation
in polypharmacy (≥5 medications), hyper-polypharmacy (≥10 medications) and
antipsychotic use across facilities was examined using funnel plot analysis.
Results
The
study dataset included 4775 long-term residents. The mean resident age was 85.3
years and 70.6% of residents were female. The median facility size was 60
residents and 74.3% were in metropolitan locations. 84.3% of residents had
polypharmacy, 41.2% hyper-polypharmacy and 21.0% were using an antipsychotic.
The extent of polypharmacy (69.75–100% of residents), hyper-polypharmacy
(38.81–76.19%) and use of antipsychotic medicines (0–75.6%) varied considerably
across the 71 facilities.
Conclusions
Using
eMAR data we found substantial variation in polypharmacy, hyper-polypharmacy
and antipsychotic medicine use across 71 RAC facilities. Further investigation
into the policies and practices of facilities performing above or below
expected levels is warranted to understand variation and drive quality
improvement.
-----
AMA cautiously supports proposed specialist fee website
President Dr Tony
Bartone says it should tell patients what the freeze has done
15th June 2018
The
AMA is cautiously backing the idea of a government-funded website listing
specialists’ fees, saying patients have a “strong desire” for more
transparency.
A
Senate committee has recommended the approach as a way of helping patients
avoid unexpected out-of-pocket costs.
AMA
president Dr Tony Bartone says any government website should tell patients that
the Medicare freeze and a lack of indexation have been driving up fees.
-----
Australian Institute makes home in Vizag
Kalam
Institute of Health Technology (KIHT) a regional hub for conducting Health
Technology Assessment recognised by Department of Health Research, Ministry of
Health and Family Welfare, has got another feather in cap by getting associated
with Joanna Briggs Institute, University of Adelaide as the affiliated group.
The
Joanna Briggs Collaboration (JBC) is a key body that contributes to the global
success of the Joanna Briggs Institute (JBI), with respect to scholarly outputs
and geographic footprint. The JBC has grown exponentially over the course of
the 20-year history of the Institute and now incorporates more than 80 entities
internationally across five regions of the world.
KIHT
would focus on medical devices and diagnostic and associate with other JBI centres
in this domain of research. All the studies done in this space would be
submitted to JBI and KIHT would like to involve in supporting and leading JBI
in medical devices and diagnostic space globally.
-----
New healthcare robot 'easier to talk to' than a doctor, say patients
12 June 2018
TECH
TALK with Antony Scholefield
“IT JUST felt like talking to a fun medical
person ... without the disinterested look of your average GP.” That’s one
patient’s verdict on a motivational speaking robot designed to ensure people
follow lifestyle advice.
If
you thought this aspect of your job was safe from the rise of the robots
because they could never replicate the human connection underpinning the art of
medicine, then think again.
Australian
and UK researchers decided to see if a “brightly coloured, 58cm tall [robot]
with large eyes and humanoid appearance” could encourage patients to make
healthy lifestyle changes.
Rather
than simply instructing patients what to do, the robot was programmed to hold a
conversation with them that would help them self-reflect on their lifestyle.
Initial results from 20 patients who wanted to increase their physical activity
were positive, showing they found the robots more convincing than a human.
-----
Health claims of sex robots are all talk, no trousers
15 June 2018
It's
less than a decade old, but the sex technology industry is already worth an
estimated $39 billion, and it appears demand for robots for sexual
gratification, so-called sexbots, is driving rapid growth.
This
has given rise to an unlikely debate in the health sector.
Players
in the sextech market — encompassing innovations designed to enhance human
sexual experiences — are portraying their wares as harm-reduction tools to
tackle issues ranging from loneliness and sex tourism to rape and paedophilia.
But
are any of these claims supported by empirical evidence? The answer is no,
according to an editorial in BMJ Sexual & Reproductive Health.
-----
The Importance of Health Record Keeping
Jane
Fiske, Partner in the Lander & Rogers’ Health & Ageing team, discusses
what should and should not be included in patient records and explains why good
record keeping is essential.
-----
Digital Health Stocks Win From Technology and Health Care Boom
By
Bob Kohut | 11.06.2018
Many Investors
with the time and temperament to manage their own portfolios of individual
stocks gravitate towards high growth opportunities. After all, given the
effort required to research individual stocks, why not look for outstanding
rewards? For the risk averse with little inclination for individual stock
research there are mutual and exchange traded funds.
Business sectors
with the proverbial “tailwinds” at their backs and newcomers with business
models set to disrupt traditional ways of doing business are prime
targets.
Right now,
healthcare and technology are two of the hottest sectors on the ASX, and likely
to remain so. Both sectors were up 26% for calendar year
2017.
-----
Does AI have to be a privacy nightmare?
AI is a privacy minefield but there could be privacy-enhancing
aspects to the technology, argues an issues paper released by Victoria’s
privacy watchdog
Although
artificial intelligence (AI) presents challenges to many of the key principles
that underpin privacy legislation, it’s not a forgone conclusion that AI has to
usher in a data-driven Orwellian nightmare.
An
issues paper
(PDF) on AI and privacy issued by Victoria’s privacy watchdog — the Office of
the Victorian Information Commissioner (OVIC) — argues that the increased use
of AI technologies does not mean privacy will suddenly become irrelevant.
In
fact, it is possible to imagine scenarios in which AI can be a privacy enabler,
OVIC argues: “For instance, it is likely to mean that less people will actually
need access to raw data in order to work with it, which could in turn minimise
the risk of privacy breaches due to human error,” the paper argues.
-----
Media release - Men encouraged to connect with their health
13 June 2018
Creating
a My Health Record is one way men can be proactive about their health and make
it a priority this Men’s Health Week, running between June 11 – 17.
My
Health Record is a secure online summary of a person’s health information that
can be accessed at any time by the individual and their healthcare
providers.
Australian
Men’s Shed Association Executive Officer David Helmers said My Health Record
will make it easier for men who may find visiting healthcare professionals
difficult or uncomfortable.
-----
Guiding end of life directions for aged care
Providing Australians in all parts of the nation with support and
the right advice on palliative care and advance care planning will be easier,
thanks to the results of a $15 million investment by the Australian Government.
15
June 2018
Providing
Australians in all parts of the nation with support and the right advice on
palliative care and advance care planning will be easier, thanks to the results
of a $15 million investment by the Turnbull Government.
Aged
Care Minister Ken Wyatt AM officially launched the End of Life Directions for
Aged Care project today including a website that provides valuable palliative
care and advance care planning resources.
The
End of Life Directions for Aged Care website was developed by a consortium of
eight partners comprising three of Australia’s leading universities and five
peak industry bodies.
-----
Technology the Key to Caring for Regional Dementia Carers
The call is out for country carers of people living with dementia
to join in a ground-breaking research project using technology to improve their
lives and continue caring.
11
June 2018
The
call is out for country carers of people living with dementia to join in a
ground-breaking research project using technology to improve their lives and
continue caring.
Launched
in Brisbane today by Aged Care Minister Ken Wyatt AM, Caring for Carers of
People with Dementia is appealing to carers from rural, regional and remote
areas around Australia.
“By
joining these research trials, they will help in mapping out a new network of
support for dementia care across the nation,” said Minister Wyatt.
-----
“The art of what's possible”: Queensland Government and vendors collaborate in industry-first showcase
Lynne Minion | 14
Jun 2018
Placing
aside their competitive instincts for what has been described as an
industry-first collaboration, a collection of vendors partnered with Queensland
Health and the CSIRO to demonstrate “the art of what's possible” for health
delivery through integrated technology.
More
than 25 industry partners, including Intel, AWS, VMWare and SAP, joined in
working together to create the Customer Experience Centre at the Queensland
Health eHealth Expo, showcasing the possibilities for cooperative digital
health.
The
installation simulated end-to-end care for hospitalised patients by
demonstrating the technology intersecting throughout the care journey from
hospital admission to critical care, diagnosis, treatment, discharge and in the
home.
“To
me, it's an industry first,” chief customer experience officer at eHealth
Queensland Michael Berndt said.
-----
Blockchain technology
5 Jun 2018
Description
This
paper discusses the new technology known as the 'blockchain'. It aims to
demystify the blockchain by explaining how it works, outlining current
and potential uses, as well as noting the potential risks and challenges
this technology may pose to policymakers.
Publication
Details
Identifiers: ISSN: 1838-0204
Copyright: State
of New South Wales through the Parliament of New South Wales 2018
Language: English
Published year
only: 2018
-----
Looking online for info on your child’s health? Here are some tips
June 11, 2018
6.05am AEST
Most parents look
online for information about their child’s health. from shutterstock.com
Authors
- Karen Scott
- Patrina Ha Yuen Caldwell
Many
parents can be anxious when their child is sick. So looking online for health
information can help them understand their child’s medical condition and take
an active role in treatment. Seeking health information can also be a coping
strategy for parents coming to terms with their child’s illness.
But
parents have reported
being worried about whether the online health information they find is reliable
and relevant, and are concerned about the possibility of misdiagnosis. They can
also feel overwhelmed by the amount of information online, which can be
difficult to understand.
Just
more than half of the parents we surveyed for a recent study
were hesitant to act on, or present the information they found online, to the
treating doctor. This was despite the fact 73% believed the information
influenced the questions they asked the doctor.
-----
Govt digital blueprint nears completion
To become digital world leader by 2025.
The
Digital Transformation Agency is just months away from delivering a new
government-wide strategy that will underpin efforts by Australia to become one
of the world’s top digital governments.
An
alpha draft of the strategy is currently being “circulated for comments across
the public sector”, assistant minister for digital transformation Michael
Keenan will tell a AIIA luncheon in Canberra later today.
It
will focus on making government interaction with citizens and business easier
and is intended to help Australia become “one of the top three digital
governments in the world [by 2025]”.
-----
One log-in for government services access
Matt CoughlanAAP Tuesday, 12 June 2018 12:50PM
Australians will be able to access government services with a single
log-in under a government plan.
Australians will be able to access government services with a
single log-in under a plan to create a "single digital identity" by
2025.
Michael Keenan, the federal minister in charge of digital
services, said face-to-face interactions with government services would be
greatly reduced.
"Think of it as a 100-point digital ID check that will unlock
access to almost any government agency through a single portal such as a myGov
account," Mr Keenan said.
The minister wants Australia to be a world leader in digital
government, with almost all services to be available online by 2025.
-----
Australians to soon get myGovID single government identity
The first of several pilot programs using a beta version of a
myGovID will begin in October, the federal government confirmed on Tuesday.
Minister
for Human Services and Minister Assisting the Prime Minister for Digital
Transformation Michael Keenan has offered further detail on Australia's digital
identity, announcing the myGovID at the National Press Club on Tuesday.
In
a statement, Keenan said having 30 different log-ins for government services is
"not good enough", and it is anticipated the single log-in will allow
Australians to access almost all government services by 2025.
"Think
of it as a 100-point digital ID check that will unlock access to almost any
government agency through a single portal such as a myGov account," he
said. "The old ways of doing things, like forcing our customers to do
business with us over the counter, must be re-imagined and refined."
-----
Digital assets not included in wills, estate planners warn
- The Australian
- 12:00AM June 13, 2018
Rhian Deutrom
Australians are placing their estates at risk by failing to
secure their digital information in the event of their death or incapacity,
estate planners warn.
A Society of Trust and Estate Practitioners conference in Sydney
yesterday was told many Australians had not considered who would be handed
control of their digital assets after their death.
Digital assets could include email, intellectual property, social
media accounts, music or book libraries, or confidential business data.
A STEP estate-planning survey last year found more than 71 per
cent of Australians with digital assets had no idea what would happen to their
information when they died.
-----
12 June 2018
ASX announcement
MKM Health signs major contract with eHealth NSW
MKM Health signs
three-year Integration Services contract with eHealth NSW
MKM Health is
subject to binding acquisition agreement with Alcidion (announced to ASX on 24
April 2018)
Adelaide,
South Australia, 12 June 2018 – MKM Health has signed a three-year Development
& Support contract with eHealth NSW, to supply development and support of
integration services on the Enterprise Service Bus (ESB) and Enterprise Patient
Repository (EPR) platforms for up to $3.8M.
At
the customer’s request we cannot provide any further information in the ASX
release.
-----
https://www.itwire.com/data/83170-macaquarie-cloud-launches-healthcare-data-protection-solution.html
Macaquarie Cloud launches healthcare data protection solution
- 12 June 2018
- Written by Peter Dinham
Macquarie
Cloud Services, a division of Macquarie Telecom Group, has developed
LaunchHealth Cloud, a purpose-built solution to enhance data protection for the
healthcare sector.
Macquarie
says the solution has been developed in response to a policy decision by the
Department of Human Services (DHS) designed to protect the integrity of
people’s data entrusted to the Department.
The
DHS policy applies to third-party software connecting with the Department to
deliver online services, such as electronic claims payments for Medicare.
-----
Macquarie stands up Australian health cloud
The Macquarie Launch Health Cloud is a private cloud developed by
the Australian heavyweight specifically for the healthcare sector.
Macquarie Cloud Services, part of the
Macquarie Telecom Group, has launched a new cloud service, purely for storing
health information.
The
company said its Macquarie Launch Health Cloud was developed in response to a
policy decision by the Department of Human Services (DHS) aimed at protecting
the integrity of the data it holds.
The
DHS policy applies to third-party software connecting with the department to
deliver online services, such as electronic claims payments for Medicare.
-----
PageUp says 'advanced methods' used to hack into system
- 12 June 2018
- Written by Sam Varghese
The
data breach at human resources outfit PageUp People has resulted in the leaking
of names, street addresses, email addresses and telephone numbers among others,
the company has said in an update on Tuesday.
Additionally,
some employee usernames and passwords may have been accessed, PageUp People
chief executive Karen Cariss said,
adding that it had used hashing and salting to protect these credentials.
While
the company said in its initial announcement that the breach was due to a
malware infection, a statement on Tuesday said: "Advanced methods were
used to gain unauthorised access to PageUp’s IT systems in Australia, Singapore
and the UK."
-----
Internet users regret move to NBN from previous service: survey
- 12 June 2018
- Written by Peter Dinham
Many
Australians wish they could switch back to their previous Internet service
rather than having to use the country's national broadband network, the NBN,
according to newly published research from comparison website, finder.com.au.
Finder
says the research reveals that the leading reasons for this desire is that
respondents believe their previous connection was more reliable or faster.
And,
finder tech editor Angus Kidman, says that despite that lack of enthusiasm,
there's no option to revert back.
“The
reality is that everyone will need to switch over to the NBN. Aussies generally
have 18 months to migrate to the NBN before all copper and cable networks will
be disconnected.”
-----
Don't like the current NBN policy? Then you're a Labor stooge
- 15 June 2018
- Written by Sam Varghese
At
last week's hearing of the joint standing committee on Australia's national
broadband network, the NBN, Associate Professor Mark Gregory of RMIT University
was repeatedly questioned about his political affiliations, after he had made a
fairly robust opening statement.
The
bid to cast slurs on a technically competent person, who has been forthright in
his views on what is turning out to be one of the great clusterf***s of all
time, came from the chairperson of the panel, Sussan Ley, a former minister in
the Turnbull cabinet who was
forced to resign last year after questions were raised over trips she had made
using taxpayer funds.
These
comments, indeed this whole exchange, has not been reported. If anything, it
illustrates the extent to which the issue of the broadband rollout has become a
political issue.
-----
Enjoy!
David.
16 comments:
BRINGING HEALTHCARE INTO THE 21ST CENTURY
It is headings and statements like this that show how shallow a view some have of technology in healthcare. They seemingly see healthcare as a bunch of scribbles. Technology breakthroughs in health make anything in other industries look like child’s play.
6:56 AM, you will be enthused then to read this - https://ajp.com.au/news/antiquated-and-unreliable-tech-much-go/
I agree with your sentiments, these slogans and other assorted attempts to paint our professions as modern day quacks is tiresome at best. I am not sure what planet these people are from but they should move aside for others who know what a problem is and how to solve it.
"... how shallow a view some have of technology .."
Superficial nonsense indeed. If I had to pick just one statement / claim from among the many made I would opt for patients are ed up with repeating their story. This says to me they don't want to talk to their doctors, they want the doctor to read everything and be fully informed, nuances, body language, tone of voice, eliciting variations in the story, eye contact with the record and not the patient, ... oh dear how little do these amateur exponents of technology understand, all they are doing is creating more drainpipes for rats and mice to run up and down adding more chaos to the health system..
Secure messaging - sharing health data among health providers. Seems a very good idea.
A couple of questions though:
Why didn't NEHTA do this either before or instead of myhr? That they didn't has just wasted over six years of opportunity.
Is ADHA going to nudge the system so that it automatically sends a copy of everything to the government's document database?
Is it intended to only be a push system? If it were a push and pull system, then an A&E department or even another GP/Specialist could pull data from existing clinical systems.
What would myhr then offer? Oh yes. A massive risk to privacy, huge costs and the threat of government snooping of patients and GPs.
Google Is Training Machines to Predict When a Patient Will Die
AI advances by the 'Medical Brain' team could help the internet giant finally break into the health-care business
https://www.bloomberg.com/news/articles/2018-06-18/google-is-training-machines-to-predict-when-a-patient-will-die
Where is most data on a patient held? In hospital and clinics. How much is in myhr? very very little - it's summary or test data with no context.
Which is more likely to be part of healthcare in the 21 Century? A government owned, centralised, summary, document management system with hard to access data?
Or AI/Machine learning utilising large amounts of data collected at zero extra cost and held at the point of care?
Can we all spell White Elephant?
10:03, agree the purpose is suppose to be enhancing human communication, not build walls between us.
AI is going to predict when we die? Oh that sounds wonderful, can’t imagine what could go wrong
https://www.google.com.au/amp/s/www.digitaltrends.com/cool-tech/algorithms-of-oppression-racist/amp/
The book is worth reading
The point is, will the future of medicine be in large amounts of personal data or summary data?
Algorithms have a long way to go, but big data (which includes Randomised Controlled Trials, the bedrock of modern medicine) is the next step. The step after that is understanding individuals and their conditions as unique systems, not just a collection of data.
pdfs and summary data without context have no place in the future of health care. IMHO.
But what do government bureaucrats know of the future? They have hard enough trouble dealing with the past and the present, never mind the future.
Bernard, wrt Secure Messaging, you ask "Why didn't NEHTA do this either before or instead of myhr? That they didn't has just wasted over six years of opportunity."
Well NEHTA continually claimed that they had. NEHTA was established in 2005 with 12 Objects, one of which was Secure Messaging. From about 2009 onwards, there were dozens of presentations given by the CEO and others proclaiming that Secure Messaging had been ticked off. Also, a letter in 2012 to the head of the Australian Commission on Safety and Quality, signed by Peter Fleming and Mukesh Haikerwal stated:
"The PCEHR will build on the range of eHealth products and services already developed by NEHTA, including the Healthcare Identifier Service, Secure Messaging, eReferrals, ePrescriptions, specialist letters, discharge summaries and NASH."
Eventually it became too obvious to too many that NEHTA's Secure Messaging solution was more hype than reality and the "new" Agency was left with having to tackle it afresh.
Time will tell.
In 2012 they made the entire secure messaging team redundant because the PCEHR powers wanted it shut down. Specifications, pilots, test harnesses, conformance and test labs were left to die on the vine. This was a degree by the department of health eHealth branch because nothing but the pcehr mattered. The ADHA I hear killed of any remaining technical will.
Time will tell, but I believe the interoperability and secure messaging projects are simply there to keep peoples attention away from the MyHR scope creep which is coming thick and fast.
The past is the past, what is happening now is secure messaging is happening, standards based, consensus based and Telstra Health and Healthlink proved this. There is no turning back, the tyranny of the fax is over.
No one is suggesting secure messaging shouldn't happen. It should have happened years ago and if done properly (and we have yet to see if it will be done properly) will make myhr even more redundant.
if done properly
Ah the shuttle complexity behind a simple phrase like - if done properly
The team behind brining the players together and making a joint statement should be commended though, I am sure it was a trying journey.
They've been trying for years. It's about time they delivered something medically useful.
Interesting article in pulse today, seems ADHA has lost another executive, this one was the lady leading the clinical and consumer engagement, add that to the lady running innovation and it does not look good.
I am sure there is no shortage of replacements. The job will require encouraging more participation in myhr or loose government incentives. The carrot will become the stick
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