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This article in the NYT cites research published in JAMA that shows higher rates of depression among women who complete medical residency training, because of the larger share of child care and household duties. This places a bigger burden on women than their male counterparts, even though the long hours and strenuous duties create a high rate of depression for doctors.

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Investigations underway into the Red Fort Metro station bomb blast in New Delhi by a car stopped at a red light. It involves three young medical personnel from Kashmir at Al-Falah University in Faridabad near the capital, according to the probe, with connections going back to training in Turkey.

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Remote learning during the pandemic left students with a lack of basic skills. Companies are now working to address these skill issues and training is provided on the job. The scores on tests for students in all professions from nursing and medical to engineering have fallen with remote learning.

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Lufthansa's CEO announced in the early days following the crash that pilot Lubitz was "100 percent" fit to fly. Kulish and Clark point to the denial at Lufthansa and some other airlines about the need for airlines to have a clear understanding about the psychological condition of pilots. This exceptional report with contributions by a team of NYT reporters tells the story of Lubitz and the airline industry's lack of effective screening. The lack of systematic screening of pilots for psychological issues was raised by the UN's Civil Aviation Organization in 2012, and by the European Commission's Aviation Safety Agency focussing on strict data protection rules with Germany in November 2014. A culture of privacy in Germany following the experience of pervasive intrusions into privacy by the Nazis and the Soviet backed GDR government in East Germany, and strict data protection rules, create a special situation in Germany of being reluctant to pass on information or delve into personal records. The head of Lufthansa's department of aviation psychology, says he would not have accepted the pilot Lubitz if he had known about his medical problems of depression before or during the training period....

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Reduce risk of dementia later in life by taking up exercise seriously says this report in The Times. Habits of exercise are learned early and help later in life is proven. As people grow older the following forms of exercise and activities can reduce risk of dementia is proven in medical journals. Exercise such as walking, cycling, running. Strength training with weights and exercise balls.Yoga and Tai-Chi, standing on one leg for balance, and meditation. Household chores such as ironing, washing, and cleaning. Gardening and outdoor activities. Running barefoot on grass also help the mental process and brain.

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Democratic states face a sobering reality- can California, Minnesota, Illinois afford it? It turns out that they cannot and are diverting important funds away from the Nation's priorities in transportation, housing, education, rural healthcare. Here is what happened-- When California Gov. Newsom used state's Medicaid budget for poor citizens and disabled for illegal migrants to give free coverage, Medi-Cal went $6.2 billion over budget in 2025. In Illinois the program for Medicaid coverge to illegal migrants estimated at $112 million annually now costs $800 million and parts of it are now suspended. California had not thought this thing through, with free medical coverage not available to even citizens of the US, why would unrestricted borders not overwhelm a border state's Medicaid system signed into law by a Texan president Lyndon Johnson for the people of this Nation. Democratic States are running into a logical fallacy that the European Union and Germany are already experiencing, stretching straining public services, which has nothing to do with one's sentiments. Gov. Newsom now wants to give this benefit for $100 monthly premiums in 2027. ...

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Sony is setting aggressive goals for its medical business by targeting sales of 200 billion yen ($2.6 billion) by 2020. The Olympus joint venture with Sony is expected to make up about one third of the sales. Olympus has a 70% share of the endoscopes market. Sony is planning on sales of 50 billion yen for its medical monitors, printers and other equipment by March 2015. With its recent investment of 50 billion yen in the joint venture Sony now has a 11% stake in Olympus, making it the largest shareholder. Olympus will use half of the capital injection to develop better medical devices and the rest to setup training centers in emerging markets and cover costs.

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The inspiring story of Joan Poh, only the second rower to compete for Singapore in an Olympics. She rises at 5 am to workout as she also works as a nurse in a 10 hour shift at Tan Tock Seng Hospital. She has missed meals as she does her training in the midst of work as a nurse. She returned to working in nursing after a call from Singapore government for frontline medical workers in April of 2020. She sees sport as a dream, a luxury that one has to work for. Puts in 100% as a nurse and when rowing 100% as a rower.  At 5 foot 5 inches, 30 years old,  she is much smaller than other rowers, and uses her technique and training to compete. She is the oldest of 3 children who grew up in a 1 room apartment in Singapore. Without resources she learned to row on a long boat by joining a dragon boat rowing team when she was 17, then learned to scull in 2015 at age 25. In 2019 she took extended leave from her hospital to train for the Olympics in Australia. A Canadian who won Olympic Bronze in 1996 and 2000 coaches her free from Vancouver Island in Canada, using videos and workout programs, and went to Singapore when Poh qualified for the Olympics to train her in person. She looks at competing not just as medal winning, and sees this as one step in building a team in the right direction. She sees creating opportunities for others, and overcoming her childhood situation growing up struggling for resources. She says early on it was for her not wanting her lack of resources to decide what she could do. As she puts it - to always aim for a strong start even though one started with not such a good start. ...

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Preserving muscle mass, function and strength is important as people age, especially after 50 years of age. One solution is resistance training, and nutrition also plays a part- with protein intake supplements helping preserve muscle as one ages. Preserving muscle is as important as preserving bone mass- with medical practitioners describing the condition as sarcopenia, similiar to osteoporosis. Nestle and Danone are developing nutritional products for this.

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Epic Systems of Verona, Wisconsin, is one of the companies engaged in digitizing health records. It has helped develop records for 40 million patients in hospital systems such as Cedars-Sinai Medical Center in Los Angeles, Kaiser Permanente, the Cleveland Clinic, and John Hopkins Medicine in Baltimore and the Weill Cornell Physicians Organization of New York. Epic provides the software, the IT systems, the training and support. Epic is one of the pioneers in this, having been in the business for 30 years. About 40% of primary care doctors in the U.S. and 25% of hospitals use electronic patient records. The Federal government has provided $2.7 billion in funding from $27 billion of Stimulus funds assigned for the purpose of conversion to electronic medical records. This is likely to speed up the conversion. Other providers are Cerner, Allscripts, Meditech, Siemens Healthcare, G.E. Healthcare, and IBM. Epic Systems is considered the defacto standard in the industry for medical schools and some of the major hospital systems in the country. New contracts are leading to a major expansion of Epic Systems which employs 5100 people. Epic plans to hire an additional 1000 people. Revenue for the privately owned company are estimated at $1.2 billion, a 45% increase over the prior year. Epic is expected to have 127 million patients under medical records by mid 2013. To get the feedback essential for such a large conversion, CEO Faulkner relies on feedback from 250,000 doctors who use the Epic systems software, and on nurses and doctors from Epic who visit customer's sites to see first hand how it works and what needs improvement. Judith Faulkner started Epic more than 30 years ago. A project for the Psychiatry department led to other projects after she graduated in computer science from the University of Wisconsin. Epic continues to attract programmers to Wisconsin by making the Epic campus a fun environment and a great place to work. ...

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Ingram says Obama's 2015 budget is more of a wish list for Democrats, because 2015 spending levels are already set and House Republicans will put together their own budget putting forward the Republican views. Obama's budget includes new taxes on busiess and the wealthy to reduce the deficit. Other ideas- raise tobacco taxes to pay for universal pre-K education, a "Fianncial Crisis Responsibility Fee" on big banks, overhaul immigraion laws to increase tax revenues, limit itemized deductions for the rich, force drug companies to give large rebates on Medicare prescriptions. Another proposal is a $56 billion "Opportunity, Growth and Security" Initiative, for spending on early childhood education, job training, and medical research. To pay for this he would cut the amount wealthy people can save tax free for retirement, cut crop insurance and raise airline security fees.

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 South Korea has run about 300,000 coronavirus tests, double that in Italy and ten times that in the U.S., says this report in the WSJ. This report shows how the South Korean testing works and the workday of Lee Hyuk-min, a clinical microbiologist at a testing lab of Yonsei University Health System Severance Hospital in Seoul, who is working from 4.45 am to 11 pm. South Korea's effectiveness in controlling the spread is based on a strategy of efficient testing that enables isolating quickly people and areas. South Korea's testing network is a legacy of the MERS coronavirus outbreak in 2015, and the government failure at that time to control it.  It brings together doctors, medical staff, labs, and political leaders in roles following the protocols established since then. Dr Lee and others are the final checkpoint in the system which coordinates a diagnostic operation that combines together 633 test sites and 100 labs. The protocol includes a uniform setup- same testing equipment, same training, same decision making process. At 8 am each day all labs upload results to a shared database, which allows public and private hospitals to monitor patient results and report them to Korea Centers for Disease Prevention and Control. Hospitals upload testing details to an online directory. This surveillance allows South Korea to predict where to concentrate its efforts for controlling spread, says Dr Lee who advises the South Korean government on lab testing issues. Action plan took 2 years for the new rules to be implemented following MERS in 2015. The plan included accelerated bio testing company approval for tests. The first company got approval on Feb 4, followed by 4 other firms. Dr Lee says testing is only part of the equation as labs are needed to process and confirm results. Another key is innovation. South Korea setup testing in drive thru locations, that limit contact and speed up testing, which the U.S. is adopting. Dr Lee says early identification is key, and identifying the first coronavirus patient which was done in South Korea on January 20. Other countries including the U.S. took too long to identify the first patient, says Dr. Lee. ...

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WSJ looks at the changes in the way medicine should be practiced in the light of what we have learned from the pandemic.  Medicine practiced before the pandemic and still today relies mainly on a visit to the doctor or specialist who is short of time. There is a shortage of doctors. Patients have many illnesses as a result of decades of neglect of proper nutrition, and exercize habits. Obesity is at about 40% in the U.S. about 30% in the UK and 17% in France, and high also in other parts of the world. These high rates were unknown throughout history and result in many illnesses and increase by four times the vulnerability to the coronavirus. One authority in medicine calls obesity pouring gasoline on a fire for effects of the virus.  A doctor's appointment with doctors short of time with no coordination around a whole range of factors related to obesity, illnesses, health checkups, mental health, is now seen as a heavily handicapped way to practice medicine or for patient healthcare and wellbeing. The alternative is discussed here as the way forward. A  team will be responsible for a patient's care not just an individual doctor. The team would care for general health after a patient's checkup, cover individual illnesses, weight issues, mental health, exercize nutritional needs and other good healthcare habits. Instead of relying on doctors at a time of shortages of doctors the team would be led by nurse practitioners.  A nurse practitioner is someone with a bachelors degree and a masters degree or doctoral degree in nursing with 1000 hours of clinical training. Studies have shown that they are effective and even more effective than individual doctors. Today particularly with the problem of doctors with limited time compounded by the built up problems of decades of bad habits in nutrition and exercize and poor "cultural" habits getting entrenched, there has never been a greater need for a better way to practice real healthcare for a person's wellbeing. Particularly in rural areas with an even larger shortage of doctors the health practitioner led team will play a big role. Patients will under this setting receive more care virtually and get more followup care by phone and video messaging. The numbers tell the story- there are shortages of doctors in USA, Europe, Africa, Latin America and Asia. In the U.S. shortage of doctors is 55,000 projected to 2033 by Association of American Medical Colleges. There are 290,000 nurse practitioners licensed in the U.S. and 131,0000 physician assistants. The goal will be to get an adequate number of nurse practitioners licensed in this decade to take care of these teams. The pandemic has made virtual visits to doctors and nurse practitioners popular. Medicine reimbursement should and would be practiced on the basis of how well a patient is doing not on a fee for each micro service that is delivered. For this to happen the teams led by the nurse practitioner have to commit to patient education of the benefits from good practices and good habits for nutrition, exercize, caring for oneself. A doctor short of time is hardly the person to carry on this patient education which is where the major opportunities for a new system arise. The virtual care also provides a new medium for patient education and awareness of the risks of getting illnesses, preventive actions to be taken in advance. One approach being tested in California and Texas is for a monthly fee for patients more payments by health plans to doctors or healthcare teams if the patient is healthier. Additional health professionals are added to the team including health coaches, dietitians and medical assistants to increase its effectiveness in counseling and education and monitoring.  The nurse practitioner team approach is already being practiced in parts of the U.S. including the example of New Hampshire shown here, and is predicted to be the approach for primary care in the next decade. ...

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Efforts to train China's rural village doctors.How a company Haoyisheng which means Good Doctor has setup 6000 clasrooms across rural China to educate rural doctors who have little medical training. The Chinese Ministry of Health has brought in 120,000 doctors to educate and is paying the company 1200 yuan out of the 3400 yuan fee for 3 years of classes. It is video and internet based and students progress on questions is monitored via intenet and the program is run from Beijing. Tests show students are making significant progress especially since the Chinese system of rural doctors is fallig apart with the intoroduction of privatized medicine and rural doctor training has suffered badly.The company was founded by Mark Engel and Gao Zhan.. Gao studied at the University of Munich for his PHD in Biochemistry and grew up in Shanghai. They own several health related businesses in China.

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Jared Bernstein of the Economic Policy Institute points to trade barriers reducing competition and free trade that should raise an outcry when free trade and competition advocates focus alone on the Trump steel tariffs. He points to estimates that show $90 billion in additional costs to Americans from the barriers that prevent Americans from paying world market prices for surgeries and medical treatment, prices similar to what is paid in advanced countries like Germany, Britain and France. A bigger barrier in pharmaceuticals prices being sheltered from market competition worldwide costs a huge $370 billion in additional costs to Americans. These two costs in healthcare would help Americans by a magnitude compared to tax cuts that do not work for average Americans with the business tax cut going more into share buybacks than into increasing wages or capital investment in 2018.  Bernstein points to Neil Irwin's column in the NYT that flags statements such as Senator Mike Lee, Republican, that the steel tariffs are a huge job killing tax hike, as being misleading. Bernstein says two actions were never taken that would have used benefits of free trade to help affected communities that lost jobs in industries such as steel and textiles, other industries affected by foreign competition.  He lists these steps as sectoral employment training, apprenticeships ,and job creation efforts in the worst affected areas. Basically no one really knows what is good trade policy, the textbook concepts and theories are out of date when countries can subsidize particular industries such as steel and dump products into the American market. At a press conference on CSPAN with the Swedish prime minister Mr. Trump stated that China was exporting more than what is officially shown as there are transshipments from other countries, some of them with no steel mills.  As Mr. Trump stated at that press conference he was elected partly because of the worst affected communities- in places such as Michigan and other states in the midwestern U.S.- that suffered from unfair trade. Bernstein admonishes the economists and politicians, media, for the headlines that are misleading in showing that bad trade policy is being pursued and trade wars are being started. This deserves attention because the Trump administration and advisors such as Lighthizer who served in the Reagan administration seek fair trade, and the Commerce Secretary Wilbur Ross successfully pushed for NAFTA trade deal renegotiation not the outright rejection of NAFTA that was mentioned in the election campaign. Ironically no one is helped by this trade rhetoric and misleading headlines. In fact the strengthening of the U.S. currency as the huge trade surplus of China goes into U.S. assets, and with the election of Mr. Trump, gives foreign competitors a continued advantage. And in fact Japan, South Korea, China, had a mild response to the tariffs as reported, because these countries are aware of global overcapacity created especially by China which produces 50% of the world's steel, and as China shifts to higher technologically value added products closing many older steel mills. ...

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Exercise at a relatively low effort for a long time is now called Zone 2. In it someone can carry a slightly strained conversation while exercising. This is becoming popular as the right way to exercise and is the best way to build a sustained and stable way to health. It stimulates our cell's powerhouses say experts and converts into better health and athletic fitness. It is the secret of great elites that helps them faster for longer, says an expert at UT Medical Center in Dallas. As we age we lose mitochondrial function so it is even more important to so this kind of exercise. Mitochrondrial refers to the mitochondria, the battery packs in our cells that convert fat and cars into energy. Zone 2 exercise stimulates mitochondria effectively. About 80% of training can be Zone 2, and 20% at higher intensity to achieve the right balance.

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The stories of Dylan Roberts, 32 years, in Rockford, Illinois and Alfred Butt, 42 years,in Hohenlockenstedt, Germany. Roberts lost his job at aChrysler plant in Belvidere, near Rockford, Illinois, and Butt lost his job a German auto parts maker. Roberts gets a $64,000 severance package, and 59 weeks of unemployment insurance, with apossible additional 13 weeks, with monthly check of $1426 that is 27% of his income of $64,000 a year when employed. attribute 33 weeks of the 59 weeks to the stimulus measures of President Obama. Butt has 4 months as atransfer worker at full pay, which can be as long as 1 year, then he has till May 2010 at 80% of his pay when employed full time of 2700 euros amonth. The transfer company gives job training and job hunting advice. He continues getting his medical insurance benefits which are provided by the state. Roberts loses his health insurance with his job, and hopes to pay his expenses for a2 bedroom apartment with his girlfriend who makes close to $1500 as an elementary school teacher. He will take a2 year electronic engineering course with a local college using $6000 from Obama's Dislocated Worker's Program. But he isn't sure if he can do his studies after one year when his unemployment benefits expire. Butt can afford to take a vacation to Cyprus and his lifestyle is not much affected he says. His wife works as a nurse at a rheumatism clinic. Butt is like the 64% of Germans who say the crisis is not affecting them personally. Roberts is like the 87% of Americans who say this crisis id hurting them in their persdonal lives. To pay for the state funded benefits the total wage tax burdenas a percentage of labor costs for Butt is 52% in Germany. FOr Roberts it is 30% in the USA. France is at 49% Spain at 39% and the UK at 34%. Germany's public expenditures for these labor benefits are 2.97% of GDP in 2006, the USA's are 0.38%. Spain and France are at 2.32% and the UK at 0.61%. This also explains why the impact in countries like Germany and Spain is not felt so badly as in the USA. In SPain there is also the lower mobility and the safety net of family support helping people cope making it possible to cope with 20% unemployment without serious distress and hardships. See the link to Spain's unemployed....

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Legal experts say Lufthansa faces significant liability claims from the 150 persons killed in the crash of Germanwings Flight 9525, beyond the $150,000 per crash victim established by international airline rules. The claims could be much higher in countries such as the U.S. and lower in Germany. Lufthansa's insurer Allianz would pay out the claims, with Lufthansa incurring higher future premium costs. Lufthansa said it was initially paying out 50,000 euros per person to relatives of victims. Airline insurance premiums were about $1.65 billion for the industry in 2014, according to Ascend Worldwide, with premiums down by over 50% since the Sept. 11, 2011, terrorist attacks, and were not affected by the loss of two Malaysia Airline aircraft in accidents recently.

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The 28 year old pilot Andreas Lubitz of Lufthansa Germanwings Flight 9525 was being treated for depression at Dusseldorf University Hospital at the time of the flight. Several torn up doctors notes found in his apartment by investigators, including for the day of the flight by his neuropsychologist, show he did not disclose his condition to his employer. Prosecutors say he had intended to "destroy the aircraft" when he flew the plane into France's southern Alps.