You, your health, and the cloud get closer

Box Sends Health Data Right to the Cloud - Technology Review
technologyreview.com

More than half of patients suffering from chronic diseases could benefit from wireless connectivity of their monitoring devices, Valencia says. Yet for every one device that beams out information to health-care providers, four do not—and this is partly because of technical difficulties. The situation is such that some people with sleep-apnea monitors must write down readings and fax them to insurance providers to get reimbursed, he says.

Halamka says such devices are likely to get used much more as the population ages and because of health-care reform, which in part aims to reimburse doctors for keeping patients healthy. This will likely mean more home telemonitoring between visits to the doctor, says Halamka, who blogged on the topic earlier this year.

Many companies are working on wireless solutions for health monitoring, including ones that work as smart-phone apps. In theory, a smart phone could serve the same Swiss-army-knife role as the Qualcomm technology. But Castonguay says current phones do not include the kinds of wireless radio receivers used by many medical devices, which typically use the low-energy protocols Zigbee and Bluetooth. And they generally don’t meet the various security and reliability standards for medical devices.

“There are plenty of apps that will monitor your heart rate or glucose, but if it’s involved in any clinical decision making, that will need to be sent over secure channels and have backup capabilities,” he says.


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Location:Georgetown TX,United States

A Wireless pacemaker is on the horizon

New Pacemaker Needs No Wires - From Technology Review
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A pacemaker that regulates the heart by wirelessly zapping it with pulses of ultrasound from outside the organ is currently undergoing human trials in Europe.

Conventional pacemakers stimulate the heart tissue via electrical leads that are fed into the heart through a vein. But leads can fail, requiring additional surgery to remove and replace them. The conventional approach also restricts where the therapeutic shock can be delivered.

The new device uses focused acoustic waves that are picked up by a small receiver implanted permanently inside the heart, converting the energy into electricity. Unlike radio waves, ultrasound can pass through tissue at high-enough energy levels without causing any heating.

“This represents a significant breakthrough, eliminating the lead in the heart,” says Paul Skjefte, marketing strategist for EBR Systems, the company that created the pacemaker. The startup, based in Sunnyvale, California, was spun out of research by founder Debra Echt, a former professor of medicine and a cardiologist at Vanderbilt University.


The new device, called the wireless cardiac stimulation (WiCS) system, works like an RFID tag in that the receiver has no power supply of its own, and instead gets all its power and signal wirelessly, but with ultrasound instead of radio waves, says Andy Diston, head of global medical technology practice at U.K.-based Cambridge Consultants, which has partnered with EBR Systems to help commercialize the technology. “The receiver is tiny, about 10 millimeters long and one millimeter in diameter. It’s like a grain of rice and entirely passive. It gets its energy from the transmitter,” he says.

The ultrasonic signal comes from a pacemaker-like box implanted in the chest above the ribs. The box contains an array of ultrasonic transducers that steer and focus the beam toward the receiver. The receiver picks up the signal and converts it into an electrical signal that regulates the heart.


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Location:Georgetown TX,United States

Now your car is looking out for you.

Car Warns When Your Blood Sugar Is Low
Technology Review - technologyreview.com

Your car may soon be able to warn you if your blood sugar dips, alert you to high pollen counts, and remind you to take your medication. Ford demonstrated the new in-car technology—currently a research project—this week at the Wireless Health 2011 conference in La Jolla, California.

Many carmakers see a big opportunity in adding new functionality to the computers built into many models. Some cars already use Internet connectivity to alert drivers to traffic tie-ups. Ford has developed three sample apps that combine this connectivity with the growing number of wireless medical devices and health-monitoring apps for people with chronic conditions. Its initial efforts are focused on people with diabetes and asthma; the car can connect to a wireless glucose monitoring device from Medtronic, get allergy alerts through pollen.com, and sync with WellDoc, a mobile health-monitoring platform.

“People already use voice activation for their cell phones and to select music,” says K. Venkatesh Prasad, Ford’s senior technical leader. “What we are trying to do is extend that platform capability to include health and wellness features.”

The car might seem like an odd place to keep track of your health, but Anand Iyer, chief operating officer of WellDoc, which worked with Ford on the project, points out that it makes a lot of sense. “Americans spend about 230 million hours a week in their vehicles,” says Iyer. “It’s a unique environment because it’s kind of private.”

WellDoc has developed programs to help people with diabetes and other chronic diseases track their conditions. The programs provide feedback based on guidelines from the American Diabetes Association and other medical organizations, and keep caregivers up-to-date on the patient’s health history.

Iyer, who suffers from type 2 diabetes, says that bringing the platform into the car creates a seamless experience for the patient. For example, a user wakes up, tests his blood sugar and goes to his Welldoc profile on his computer or smart phone. It tells him his blood sugar is low and suggests eating breakfast, which he ignores. When he gets in the car, it reminds him of the low reading and asks whether he had some carbs. “The car acts as another device, nothing more, nothing less, at 70 mph,” says Iyer.

For diabetes patients who use Medtronic’s wireless glucose monitor, the car could go even further, issuing an alert if blood sugar is trending low. That could be especially useful for a parent driving with a diabetic child in the backseat, says Prasad.


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Location:Georgetown TX,United States

Maybe that gut feeling really means something

A Gut Check for Many Ailments - Shirley S. Wang - online.wsj.com

What you think is going on in your head may be caused in part by what’s happening in your gut.

A growing body of research shows the gut affects bodily functions far beyond digestion. Studies have shown intriguing links from the gut’s health to bone formation, learning and memory and even conditions including Parkinson’s disease. Recent research found disruptions to the stomach or intestinal bacteria can prompt depression and anxiety—at least in lab rats.

Better understanding the communication between the gut and the brain could help reveal the causes of and treatments for a range of ailments, and provide diagnostic clues for doctors.

New research indicates problems in the gut may cause problems in the brain, just as a mental ailment, such as anxiety, can upset the stomach.

“The gut is important in medical research, not just for problems pertaining to the digestive system but also problems pertaining to the rest of the body,” says Pankaj J. Pasricha, chief of the division of gastroenterology and hepatology at Stanford University School of Medicine.

The gut—considered as a single digestive organ that includes the esophagus, stomach and intestines—has its own nervous system that allows it to operate independently from the brain.

This enteric nervous system is known among researchers as the “gut brain.” It controls organs including the pancreas and gall bladder via nerve connections. Hormones and neurotransmitters generated in the gut interact with organs such as the lungs and heart.

The enteric nervous system, or ‘gut brain,’ can operate independently of the brain.

Neurons in the gut produce neurotransmitters also found in the brain, such as serotonin.

Disruptions to beneficial gut bacteria may affect mood.
Neurotransmitters made in the gut help control the formation of bone.
Stimulating gut neurons may help treat obesity and diabetes.

Like the brain and spinal cord, the gut is filled with nerve cells. The small intestine alone has 100 million neurons, roughly equal to the amount found in the spinal cord, says Michael Gershon, a professor at Columbia University.

The vagus nerve, which stretches down from the brainstem, is the main conduit between the brain and gut. But the gut doesn’t just take orders from the brain.

“The brain is a CEO that doesn’t like to micromanage,” says Dr. Gershon. The brain receives much more information from the gut than it sends down, he adds.

Many people with psychiatric and brain conditions also report gastrointestinal issues. New research indicates problems in the gut may cause problems in the brain, just as a mental ailment, such as anxiety, can upset the stomach.

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Stanford’s Dr. Pasricha and colleagues examined this question in the lab by irritating the stomachs of newborn rats. By the time the animals were eight to 10 weeks old, the physical disturbance had healed, but these animals displayed more depressed and anxious behaviors, such as giving up more quickly in a swimming task, than rats whose stomachs weren’t irritated.

Compared to controls, the rats also showed increased sensitivity to stress and produced more of a stress hormone, in a study published in May in a Public Library of Science journal, PLoS One.

Other work, such as that of researchers from McMaster University in Hamilton, Ontario, demonstrated that bacteria in the gut—known as gut flora—play a role in how the body responds to stress. The exact mechanism is unknown, but certain bacteria are thought to facilitate important interactions between the gut and the brain.

Electrically stimulating the vagus nerve has been shown to reduce the symptoms of epilepsy and depression. (One treatment approved by the Food and Drug Administration, made by Cyberonics Inc., is already on the market.)

Exactly why such stimulation works isn’t known, experts say, but a similar procedure has been shown in animal studies to help improve learning and memory.

Earlier this month, researchers made a small step toward understanding a gastrointestinal ailment that typically affects children with autism.

In a study of 23 autistic children and nine typically developing kids, a bacterium unique to the intestines of those with autism called Sutterella was discovered.

The results, published online in the journal mBio by researchers at Columbia’s school of public health, need to be studied further, but suggest Sutterella may be important in understanding the link between autism and digestive ailments, the authors wrote.

Dr. Gershon, professor of pathology and cell biology at Columbia, has been studying how the gut controls its behavior and that of other organs by investigating the neurotransmitter serotonin.

Low serotonin levels in the brain are known to affect mood and sleep. Several common antidepressants work by raising levels of serotonin in the brain.

Yet about 95% of the serotonin in the body is made in the gut, not in the brain, says Dr. Gershon. Serotonin and other neurotransmitters produced by gut neurons help the digestive track push food through the gut.

Work by Dr. Gershon and others has shown that serotonin is necessary for the repair of cells in the liver and lungs, and plays a role in normal heart development and bone-mass accumulation.

Studying the neurons in the gut also may also help shed light on Parkinson’s disease. Some of the damage the disease causes to brain neurons that make the neurotransmitter dopamine also occur in the gut neurons, researchers say.

Researchers are now studying whether gut neurons, which can be sampled through a routine colonoscopy, may help clinicians diagnose and track the disease without invasive brain biopsies, says Pascal Derkinderen, a professor of neurology at Inserm, France’s national institute of health.



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NeuVax E-75 cancer vaccine halves recurrence rate says US army

NeuVax E-75 cancer vaccine halves recurrence rate says US army - SlashGear slashgear.com | by Chris Davies US Army researchers may have found a vaccine that significantly reduces the recurrence of cancer and could, with more work, eventually help prevent colon, prostate and lung cancer altogether. The drug, currently known as E-75 or NeuVax, has been found to cut in half the recurrence rate in women who have recovered from breast cancer, The Daily reports, as well as seemingly proving effective across a far greater number of patients than existing cancer medication. The scientists, based at the San Antonio Military Medical Center in Texas, opted for women who had previously experienced breast cancer as using groups of women merely believed to have some likelihood of developing the disease would have prolonged the study across several years. Testing is still pre-third stage – that is, broad clinical trials – and the experts are cautious of over-blowing the potential, but early signs are impressive. E-75 works by using the patient’s own immune system to battle cancer, training it to be familiar with a common protein found on cancerous cells. The immune system, when tutored in that way, can identify and destroy the cells. Whereas 20-percent of women in the control group – given no medication – subsequently developed cancer again, only 10-percent of those taking E-75 suffered a recurrence. In comparison to existing breast cancer drug Herceptin - an expensive medication prescribed to late-stage patients – E-75 apparently worked for far more women in the trial. Herceptin is effective in roughly 20-percent of cases, E-75 project chief Col. George Peoples says, whereas the new drug was compatible with roughly 60-percent. Third-stage trials will begin early this year, with the army team partnering with Galena Biopharma on a 300 patient project conducted across twenty sites worldwide. The belief is that NeuVax will prove even more effective if administered in combination with Herceptin. - Posted from my iPad2

Location:Houston TX,United States

New material halts bleeding nearly instantaneously

Nanoscale biological coating halts bleeding nearly instantaneously could prevent battlefield deaths nextbigfuture.com Uncontrolled bleeding is the leading cause of trauma death on the battlefield. Traditional methods to halt bleeding, such as tourniquets, are not suitable for the neck and many other parts of the body. In recent years, researchers have tried alternative approaches, all of which have some disadvantages. Fibrin dressings and glues have a short shelf life and can cause an adverse immune response, and zeolite powders are difficult to apply under windy conditions and can cause severe burns. Another option is bandages made of chitosan, a derivative of the primary structural material of shellfish exoskeletons. Those bandages have had some success but can be difficult to mold to fit complex wounds. Many civilian hospitals use a highly absorbent gelatin sponge produced by Ferrosan to stop bleeding. However, those sponges need to be soaked in liquid thrombin just before application to the wound, making them impractical for battlefield use. Hammond’s team came up with the idea to coat the sponges with a blood-clotting agent in advance, so they would be ready when needed, for either military or civilian use. To do that, the researchers developed a nanoscale biological coating that consists of two alternating layers sprayed onto a material, such as the sponges used in this study. The researchers discovered that layers of thrombin, a natural clotting protein, and tannic acid, a small molecule found naturally in tea, yield a film containing large amounts of functional thrombin. Both materials are already approved by the U.S. Food and Drug Administration, which could help with the approval process for a commercialized version of the sponges, Shukla says. A key advantage of the spray method is that it allows a large amount of thrombin to be packed into the sponges, coating even the interior fibers, says David King, a trauma surgeon and instructor in surgery at Massachusetts General Hospital who was not involved in this research. “All of the existing hemostatic materials suffer from the same limitation, which is being able to deliver a dense enough package of hemostatic material to the bleeding site. That’s why this new material is exciting,” says King, also an Army reservist who has served in Afghanistan as chief of trauma surgery. Once sprayed, the sponges can be stored for months before use. The sponges can also be molded to fit the shape of any wound. “Now we have an alternative that could be used without applying a large amount of pressure and can conform to a variety of wounds, because the sponges are so malleable,” Shukla says. In tests with animals at Ferrosan, the coated sponges were applied to wounds, with light pressure (from a human thumb), for 60 seconds — and stopped the bleeding within that time. Sponges lacking thrombin required at least 150 seconds to stop the bleeding. A simple gauze patch, applied for 12 minutes (the length of the experiment), did not stop the bleeding. The researchers have filed a patent application on this technology and on similar sponges coated with the antibiotic vancomycin. Hammond’s lab is now working on combining the blood-clotting and antibiotic activities in a single sponge - Posted from my iPad2

Location:Houston,TX,United States

Distance medicine will change the delivery of healthcare

Stephen C. Schimpff is an internist, professor of medicine and public policy and wrote this entry. --------------------------- Distance medicine technologies can be disruptive in the way physicians and other care givers interact with patients and with each other and can fundamentally change how patients are able to interact with the entire health care system. This is of increasing relevance as medicine gravitates toward chronic illnesses where diagnosis and treatment are complex and require multi-specialist teams. It also has potential to alleviate some of the effects of the growing shortage of professionals. There are certain needs that the health care system in the United States must begin to respond to. Among them are the rising costs of medical care; the challenge to reduce costs; the desire (soon to be a demand) of patients and their families to have greater responsiveness from their health care providers; the rapid emergence to chronic illnesses that are life long and very complex to diagnose and treat; and the current and developing shortage of health care professionals who are in need of time saving and safety enhancement assistance in their daily activities. Distance medicine is one of the key technologies that can indeed address each of these critical medical care needs into the future. There are many opportunities for the use of distance medicine technologies; here is just a sampler. First is a need to receive information from others in a way that is flawless, accurate and prompt. Consider this all too true story. A patient saw his primary care physician for a persistent cough at office site #1. He had a CT scan at hospital site #2 which was 45 miles away. He then had a biopsy at site #3. The pathology report of lung cancer was completed at another institution or site #4. He was then sent to visit a thoracic surgeon two hours away at site #5 who sent him for a PET scan, also at site #5. When the surgeon was then not available for a prompt follow-up visit, the patient arranged to go to a major cancer center four hours away at site #6. But for this visit he was told that he needed to bring all of the information from the previous five sites of care. He had to visit each again and obtain the files. As such he was thus required to serve as his own “Federal Express.” But this should not have been necessary since all of the data from his scans and pathology were already in a digital form and could potentially have been sent, with appropriate security, over the internet with commercially available technology which is available today. The issue of course is to have this happen today using today’s technology. Hospitals especially and imaging centers (and caregivers to a somewhat lesser degree) frankly should not be able to avoid this any longer. The second is the need to transmit information about a patient and the patient’s condition so that it can be monitored and acted upon from a distance. For example, VISICU, and similar technologies, allows an ICU specialist physician at a distant site to observe in real time multiple patients in multiple ICUs. The physician can observe physiologic parameters, review laboratory data in addition to seeing and talking to the patient via tele-technology, examining the patient via electronic stethoscope, etc and interacting with the nursing or resident staff. The result is better medicine with fewer errors, shorter hospital stays and improved patient and staff satisfaction. VISICU is commercially available. Third is a need to submit prescriptions to a local or hospital pharmacy in electronic form to accomplish at least these three goals: increased efficiency, increased accuracy and improved safety. At the same time it can assist in educating and training by alerting the physician to drug-drug interactions and suggesting specific reasons why one drug versus another might be better, say, for a community acquired pneumonia. The needed technology to accomplish these goals is currently available commercially and frequently utilized in hospitals and increasingly in the out patient setting provided the physician has some form of electronic medical record system. Forth is a need to obtain patient information that is of critical or urgent importance and transmit it to the care giver(s) for rapid action. For example, home blood glucose monitoring connected to the provider’s office via the internet can alert the physician or nurse that glucose control is less than satisfactory and thus prompt a call to the patient. Or, a home scale connected via the internet to the provider’s office for a patient with heart failure. If the patient’s weight begins to increase, the physician might alter the diuretic dosage and thereby save not only an office visit but even a trip to the ER or a hospital admission. Or, a portable home heart rhythm monitoring for the patient with an unstable cardiac arrhythmia. This is often built into newer pacemakers and all intra-cardiac defibrillators but is infrequently utilized to anywhere near its potential. In a similar manner, a “pacemaker” equivalent can monitor the patient’s internal EKG and reports via wireless technology at the first evidence of a developing infarct, even before the patient feels pain developing. A fifth need is a methodology to create “distributed patient care,” that is, immediate access to consultative services when time is critical. Imagine this also true story. A surgeon found himself in a difficult situation during emergency nighttime surgery and could not stop the patient’s bleeding. A call goes out to a senior surgical colleague at home some 65 miles away for advice. The at home surgeon listens to the situation over the telephone but cannot truly appreciate the problem via the spoken word – he needs visualization in order to give useful advice. So he drives to the distant hospital to assist where he is now able to visualize the problem and give a useful consultation. Rather than that scenario, a video in the OR light source, the room wall and/ or the laparoscopic instruments could be transmitted to the senior surgeon’s home computer thereby eliminating the need for a lengthy drive and the time related. This will allow for expert consultation at short notice. This scenario could be solved with currently available commercial technology. In the future the senior surgeon could not only advise on next steps in a procedure but assist via telesurgery devices and even demonstrate via telesurgery devices. My last example is the need for a methodology to create “distributed learning.” Rather than expect every smaller hospital to have its own broad-based continuing educationl programs, arrange for expert training and education via telementoring methodologies. It is better to build an excellent central source with expert educators and trainers and distribute their expertise via various telementoring devices including the internet, DVDs, CDs, cell phones, ipods, PCs, etc. Many aspects of distance medicine are not paid for today given our current reimbursement methodology. But if some medical leaders, by advancing the use of distance medicine techniques, can demonstrate the cost saving opportunities along with the improvements of patient care, patient safety and responsiveness possible, it will encourage the needed financial actions. This will be a disruptive and transformational change that will have a major impact on how medicine is practiced into the future – a medical megatrend in the making. - Posted from my iPad2

Location:Georgetown TX,United States

A Diabetic Meter That Talks to iPhones and Doctors

Personal Technology: A Diabetic Meter That Talks to iPhones and Doctors - Walt Mossberg online.wsj.com While consumer technology advances by leaps and bounds, the devices patients use to manage diseases often seem stuck in the past. A glaring example is the glucometer, the instrument diabetics use to measure the sugar in their blood—information they use to adjust their diet, exercise and medication. These meters, which analyze drops of blood drawn from fingertips, typically resemble crude PDAs from 10 or 15 years ago. They offer little feedback and can’t connect to the Internet to show results to caregivers. Most diabetics who use them log their readings on paper, which they hand doctors weeks or months later. But that is beginning to change. Next week, a small start-up will introduce a new diabetes meter it says is the first with wireless technology that instantly transmits a patient’s readings to a private online database, which can be accessed by the patient or—with permission—by a doctor, caregiver or family member. This system charts the results to highlight trends and spot problems, and can be accessed via a Web browser or an iPhone app. It automatically transmits relevant feedback—such as whether your readings seem high or low—and allows doctors to respond. I’ve been testing this new meter and service, which is called Telcare and comes from a Bethesda, Md., company of the same name. As a Type 2 diabetic myself, I found the Telcare meter a refreshing change, and a significant step toward bringing consumer medical devices closer to the world of modern technology. Despite some drawbacks, including a high price, I recommend the Telcare be considered by diabetics who want a better substitute for paper logs, or would benefit from real-time sharing of their readings. However, as with any medical decision, I urge people to consult their doctors before switching meters. Also, I evaluated this product as a consumer technology. I am not a physician or diabetes expert. While I found the Telcare meter convenient and accurate for me, your situation might differ. The Telcare device works much like a traditional meter. You insert a test strip into a slot on the meter, then prick your finger with a lancing device to get a drop of blood, touch the strip to the drop, and wait for the reading to appear. The difference is the meter immediately sends results to its online database, where you or your doctor can find it via the password-protected website or iPhone app. This transmission is achieved via a built-in cellular modem, which doesn’t involve any cellphone, carrier contract or fee. That cellular connection is used to send you messages about your readings, if necessary. In this first version, the patient can’t reply to doctors’ messages from the meter, but that’s planned for the future. Telcare typically uses T-Mobile’s network, but, if that’s not available, the meter will automatically shift to whatever compatible connection it finds. If no connection is available, it will save the results and you can transmit them manually when you’re back in range. - Posted from my iPad2

Location:Georgetown TX,United States

Hospitals adopting Apple's iPad for patient and visitor kiosks

I make no bones about it I am an iPad devotee. I am also one who believes it is a great tool for the tech savvy patient. Hospitals adopting Apple's iPad for patient and visitor kiosks appleinsider.com By Neil Hughes Apple’s iPad is increasingly finding use in hospitals, where some locations have begun using the touchscreen tablet as a kiosk to allow patients and visitors to check in or access information. The iPad has helped some hospitals to streamline their operations by reducing labor costs and improving staff efficiency, according to The Point of Sale News. Hospitals have begun to use specific applications on the iPad to allow easier access to information when used as a kiosk, with the iPad held in place in a secure frame. The report notes a few uses for the iPad from hospitals around the world, including Singapore’s Changi General Hospital. There, visitors, patients and hospital staff can find their way through the facility with an iPad located in a kiosk. At Boston’s Massachusetts General Hospital, doctors access up-to-date information with an iPad before and during a visit with a patient. And New York Methodist Hospital uses kiosk-mounted iPads for EKG and other diagnostic machines. “The new system has been embraced by nurses and technicians as a great time-saver, and has proven a convenient tool for doctors as an access point to all patient data for analysis and diagnosis,” the report said. Professionals in the healthcare industry have shown great interest in Apple’s iPad since the device first launched in 2010. Its use has expanded with new applications, including one that launched last year with FDA approval for mobile diagnoses. Functionality for the iPad among doctors, nurses and others in hospitals could grow even more this year with an anticipated third-generation iPad with a high-resolution Retina Display. More pixels packed into the iPad’s 9.7-inch touchscreen could make it even better for medical imaging among healthcare professionals. - Posted from my iPad2

Location:Georgetown TX,United States

A portable device now available to check on Asthmatics

Medicine / Pediatrics NIOX MINO®, a hand-held device for the measurement of airway inflammation and monitoring of patients with asthma, has just been 510(k) cleared by the FDA. The device will “cost efficiently improve management and care of patients with inflammatory disorders, such as asthma.” The monitor is sensitive enough to detect as low as 5 particles per billion of exhaled nitric oxide. NIOX MINO Airway Inflammation Monitor is an easy-to-use handheld device that provides accurate, reproducible and immediate measurement of fractional exhaled nitric oxide (FENO). This is a proven and sensitive indicator of the inflammation that causes the symptoms of airway inflammatory diseases including asthma. Current management of airway inflammatory diseases, including asthma, is achieved primarily by monitoring symptoms and lung function, with the treatment objective of bringing the disease under control. But the underlying cause of these respiratory symptoms and asthma attacks is airway inflammation, which until now could not be routinely measured. NIOX MINO provides physicians in the U.S., for the first time ever, a powerful, easy-to-use tool that enables them to provide people living with inflammatory airway diseases, such as asthma, personalized inflammation control. By using NIOX MINO, doctors can provide the ideal level of therapy to each patient in order to achieve and maintain control of their symptoms. NIOX MINO answers the need for a simple, accurate tool for assessing asthma control and responsiveness to treatment. NIOX MINO helps physicians achieve asthma treatment and management goals, allowing people with asthma to enjoy greater quality of life. In its effort to increase clinicians’ awareness of fractional exhaled nitric oxide (FENO) monitoring, the company has put out the following white paper. - Posted from my iPad2

Location:Georgetown TX,United States