Point-of-Care Diagnostics World Congress Agenda

Conference Registration and Continental Breakfast in the Exhibit Hall

Paper Test Cards for Rapid Field Screening of Medications
Marya Lieberman, Professor, University of Notre Dame, United States of America

Serious problems with the quality of both human and animal medications have been found in most of the developing world.  Although there is general agreement that removing low quality pharmaceuticals from the supply chain would be a good idea, there is no global program in place to monitor the quality of pharmaceuticals.  Existing analytical methods for pharmaceuticals lack the combination of low cost, reliability, rapid turn-around, and scalability needed in low-resource settings.  My research group has been trying to crack this problem by developing paper test cards to assay pharmaceutical dosage forms.  The prototype test card incorporates a library of chemical tests that generates a chemical profile of active ingredients and excipients present in a pharmaceutical.  We are now using the test cards at a project site in Kenya where we are attempting to find fake drugs using a random sampling process across 350 pharmacies in Western Kenya.  In this talk, I will demo the test card, show how it performs with different types of substandard and falsified drugs, and discuss the manufacturing and image processing challenges of scaling up the test cards.

Point-of-Care Optical Technologies for Women’s Health
Nimmi Ramanujam, Robert W. Carr Jr., Professor of Biomedical Engineering, Professor of Global Health, Director, Global Women's Health Technologies, Duke University, United States of America

Optical technologies have been exploited widely in the analytical chemical analysis of biological samples. While the benefits of optical spectroscopy and microscopy have long been known in the laboratory, over the past quarter century there has been increasing interest in the application of these techniques to intact human tissues. One of the distinct attributes of light is that is provides exquisite chemical specificity by interacting with a number of molecules that are already present in the tissue and thus has the capability to provide insight into functional, morphological and molecular contrast. Our objective is to exploit the wealth of physiological, metabolic, morphological and molecular sources of optical contrast to develop novel strategies that focus on cervical cancer screening and breast cancer diagnostics.

Coffee Break, Networking in the Exhibit Hall, and Meet the Exhibitors

Information Communication, Telemedicine Technologies & Physician Extenders: The Nucleus for our Nations Home Care
Craig Lehmann, Dean/Professor, Stony Brook University, United States of America

The objectives of this presentation are to address challenges and opportunities of the many needs of the countries priorities to deliver high impact interventions that will improve health outcomes for their aged citizens while strengthening health systems. Under this concept I will focus on the entire continuum of aging through the use of technologies, information communication and physician extenders while aging in place (home). This presentation will address the economics, education, social and health needs of citizens while residing in their home. Topics include electronic health record, chronic disease, home care, rural health care as well as present and future technologies. The presentation will address the major role for ICT in the public health arena (e.g., mobile technology) and its ability to offer health interventions, education and preventive strategies that can address the challenges of the those who have and those who do not now and in the future.

Networking Lunch in the Exhibit Hall, Meet the Exhibitors, View Posters

Technology Spotlight:
Current Requirements in POC´s World: A Short Overview
Roberto Spricigo, OEM Manager, Point-of-Need, QIAGEN Lake Constance

Rapid point-of-care (POC) tests are emerging as tools for more efficient diagnosis and faster patient evaluation. They are becoming more meaningful to healthcare professionals since they provide reports and quantitative results. Here we explain the current requirements for POC devices for lateral flow tests and isothermal amplification methods.

E-DNA: A Versatile Electrochemical Platform for Point-of-Care Molecular Measurement
Kevin Plaxco, Professor, University of California-Santa Barbara, United States of America

The ideal sensor will be sensitive, specific, versatile, small enough to hold in your hand, and selective enough to work even when faced with complex, contaminant-ridden samples. Given the affinity, specificity and generalizability of biomolecular recognition, biosensors have been widely touted for their potential to meet these challenging goals. To date, however, the translation of protein- and nucleic acid-binding events into convenient, highly selective sensing platforms has proven problematic. We have solved this problem by employing the ligand-induced folding of biopolymers as a robust means of transducing binding events into specific, easily detected outputs. Our electronic, folding-based sensors are rapid (minutes to seconds), sensitive (micromolar to femtomolar), and generalizable to an enormous range of protein, nucleic acid and small molecule targets. The sensors are also reagentless, reusable, and selective enough to be employed in blood serum, soil and other grossly contaminated samples. Because of their sensitivity, background suppression, operational convenience and impressive scalability folding-based biosensors appear ideally suited for diagnostics at the point of care and in the developing world.

The History of Point-of-Care Diagnostics: From the Ant to the Smartphone
Joel Ehrenkranz, Chief Medical Officer, i-calQ, United States of America

Indian physicians in 1500 BC described the first point-of-care diagnostic test and diagnostic testing took place at the bedside up to the 1970’s.  Centralized clinical laboratories did not appear until the 1950’s and, until recently, aggressive business tactics and commercial interests enabled large corporations to dominate diagnostics. Recent advances in electronics and computer science are making centralized labs obsolete and smartphones are changing the practice of medicine.  Point-of-care diagnostics is leading this medical technology revolution. This talk will provide a clinical perspective on point-of-care diagnostics and explain why many bioengineering innovations are doomed to fail.

Coffee Break and Networking with Exhibitors in the Exhibit Hall

Smartphone Biosensors for Health, Environment, and Food Safety
Brian Cunningham, Professor and Intel Alumni Endowed Chair, University of Illinois at Urbana-Champaign, United States of America

Since their introduction in 1997, “smart” mobile phones with internet connectivity, high resolution cameras, touch-screen displays, and powerful CPUs have gained rapid market acceptance driven by a combination of falling prices and increasingly sophisticated features. In addition, there is a growing ecosystem of applications that take advantage of the phone’s sensors, display, and connection to powerful computing and data storage capabilities that are available in the “cloud.” The built-in capabilities of smartphones can be further extended through the addition of accessories that enable the phone to sense different types of information. Incorporation of biosensing into mobile platforms is a potentially powerful development, as biological assay capabilities that have previously only been available through expensive laboratory-based instruments may be utilized by anyone.  Such developments may help to facilitate the goal of “personalized medicine” in which home-based tests may be used to diagnose a medical condition, but with a system that automatically communicates results to a cloud-based monitoring system that alerts the physician when warranted. Low-cost portable biosensor systems integrated with mobile devices may also enable diagnostic technology that can be translated to resource-poor regions of the world for pathogen detection, disease diagnosis, and monitoring of nutritional status.  Such systems, deployed widely, would be capable of rapidly monitoring for the presence of environmental contaminants over large areas, or tracking the development of a medical condition throughout a large population.  This talk will summarize recent developments in the Cunningham Group at Illinois in the utilization of integrated smartphone cameras as a high resolution spectrophotometer that is capable of measuring ELISA assays, label-free photonic crystal biosensor assays, thin film chromatography, and fluorescence spectroscopy.  Utilizing special purpose, l

How Computation can Create New Imaging and Sensing Tools for Point-of-Care Medicine
Euan McLeod, Research Scholar, University of California Los Angeles, United States of America

With the aid of computational techniques based on the physics of light, biomedical microscopy and imaging can be significantly enhanced relative to conventional microscopic methods. We discuss here several approaches that we have used to convert conventional cell phones and cell phone image sensors into high-performance microscopic imaging tools where images are computationally reconstructed from raw data. Like conventional microscopes, these new tools provide sub-micron resolution that can be used to differentiate normal from abnormal cells in tissue and blood samples, and have high enough sensitivity to detect single viruses and nanoparticles. Beyond the capabilities of conventional microscopes, these computational approaches also provide the additional advantages of an ultra-large field of view, low cost, ease of portability, and the potential for easy connectivity for telemedicine. One particular set of results we will highlight is the detection and imaging of single viruses and nanoparticles smaller than 50 nm over a field of view of 4 mm x 5 mm using self-assembled liquid nanolenses.

A Novel Point-of-Care Diagnostic Assay to Determine the Correct Placement of Nasogastric Feeding Tubes
Ian Fotheringham, Managing Director, Ingenza Ltd, United Kingdom

Nasogastric feeding tube misplacements can and do have disastrous consequences, including patient death. Existing methods to verify tube placements, including standard pH testing and the gold-standard chest X-rays, have major drawbacks in cost, usability or safety. We have a new enzymatic bedside point-of-care test to verify correct tube placement. The test detects human gastric lipase (HGL) which is stable in gastric juice, resistant towards antacid medications, as well as unlikely to migrate. Our pilot study showed this test to be reliable and accurate, while low cost, simple and requiring no extra user training. The new test significantly outperformed the current pH test and we believe has great potential to translate into clinical practice. There is also potential for deployment of this new assay in under-resourced regions of the world, providing greater reliability for NG tube placement where more sophisticated placement confirmation methods are unavailable.

Electrical Lab On Chip For Point Of Care Diagnostic
Rashid Bashir, Professor And Head, University Of Illinois, United States of America

Micro and Nanofluidics and Lab-on-Chip can be very beneficial to realize practical applications in detection of disease markers, counting of specific cells from whole blood, and for identification of pathogens, at point-of-care. The use of small sample size and electrical methods for sensitive analysis of target entities can result in easy to use, one-time-use assays that can be used at point-of-care. In this talk, we will present our work on detection of T cells for diagnostics of HIV AIDs for global health, development of a CBC (Complete Blood Cell) analysis on a chip, electrical detection of multiplexed nucleic acid amplification reactions, and detection of epigenetic markers on DNA at the single molecule level. These technologies are all electrically based and use silicon and polymer based micro and nano-fluidics devices.

Micro- and Nano-scale Technologies for Applications in Medicine at the POC
Utkan Demirci, Professor, Stanford University School of Medicine, United States of America

Micro/nano-scale technologies can have a significant impact on medicine and biology in the areas of cell manipulation, diagnostics and monitoring. At the convergence of these new technologies and biology, we research for enabling solutions to the real world problems at the clinic. Emerging nano-scale and microfluidic technologies integrated with biology offer innovative possibilities for creating intelligent, mobile medical lab-chip devices that could transform diagnostics and monitoring, tissue engineering and regenerative medicine. In this talk, we will present an overview of our laboratory's work in these areas focussed on applications in point-of-care and primary care settings including applications for ovarian cancer detection from urine, rapid CD4 counts for global health, multiple pathogen detection with a focus on viral load from unprocessed whole blood and bedside peritonitis detection for end-stage kidney disease patients going through peritoneal dialysis therapy. We will also review our work on 3-D biofabrication/bioprinting, and dynamic acoustic and magnetic systems for bottom-up tissue-construct assembly using cell encapsulating microscale hydrogels to engineer the 3-D cellular microenvironment. As an example, we will present a microfluidic platform, where flow induces a motile and aggressive phenotype in ovarian cancer nodules via increased epithelial-to-mesenchymal transition (EMT). These emerging technologies could shape our future creating broadly applicable platforms for scientific discovery, providing clinical solutions for resource-constrained settings in the developing world as well as for primary care settings in the developed world.

Cocktail Reception in the Exhibit Hall: Visit the Exhibitors and Network with your Peers

Technology Spotlight:
Scope of Workshop: Manufacturing of Microstructure-based Point-of-Care (POC) Disposable Devices
Markku Känsäkoski, Vice President, Ginolis Ltd, Finland
Per Oskar Lithell, Vice President, Ginolis Oy, Sweden

Topics Addressed:

    Manufacturing of Disposable POC Devices
    Precision Dispensing in Nanolitre to Microlitre scale
    R&D and Technology Transfer Services

Presentations:

Markku Känsäkoski, Vice President Technology Innovations
Controlled Liquid Flow in a Microfluidic Channel

Per Oskar Lithell, Vice President, Precision Solutions
Precision Dispensing with Bellows Pumps

Close of Day 1 of the Conference

Continental Breakfast in the Exhibit Hall and Networking

Impact of Decentralized Molecular Testing for Tuberculosis: a Global Perspective
Robert Kwiatkowski, Vice President, Infectious Disease R&D, Cepheid, United States of America

The GeneXpert MTB/Rif cartridge project was initiated in 2005 in collaboration with UMDNJ investigators, with support from NIAID and FIND.  The goal of the project was to develop a rapid, easy to use cartridge for simultaneous detection of M. tuberculosis and rifampin resistance.  This presentation will summarize the development of the cartridge, its launch in 2010, and its global impact to date.

CLIA Waiver Reform
James Boiani, Partner, Epstein Becker & Green, P.C., United States of America

FDA’s CLIA waiver process is creating problems for patients, health-care providers, and manufacturers by limiting access to important point-of-care diagnostic tests.  In this session we explore the problems with the process from legal, scientific, and public health perspectives, and propose rational reforms that would improve access to important diagnostics.

Coffee Break and Networking with Exhibitors in the Exhibit Hall

The Three R’s of Devices and Diagnostics: Realities of a Reformed Health System
Ken Yale, Vice President of Clinical Solutions, ActiveHealth Management-An Aetna Company, United States of America

Healthcare reform, spawned by the Affordable Care Act, has fundamentally changed the way payers do business and practitioners get paid. This talk reviews the current environment for reimbursement of medical devices and diagnostics, and the “Three Rs” of new devices and diagnostic adoption: regulation, reimbursement, and recordkeeping. Also chronicled is how one major payer is changing the way they do business in response to a radically changed healthcare environment.

How to Develop Point-of-Care Medical Devices: An Engineering Primer for Scientists
Espir Kahatt, Director of Engineering, Symbient Product Development, United States of America

You have proven the feasibility of your assay in the lab and are ready to start the engineering phase to develop the physical product that will embody your solution and package it for the marketplace. This presentation will outline both the common next steps that you will need to follow during the engineering process and a key, often-overlooked development process: High Risk Function Development (HRFD). The HRFD process is a product development technique that focuses on the functions of your device that are most likely to require multiple iterations to achieve, and therefore present a relatively greater risk to the project schedule and budget. The common development steps that will be discussed include defining requirements, key metrics, materials, manufacturing processes, target unit costs and achievable project timelines. These and other key steps will be presented that substantially mitigate the risks of schedule delays and cost overruns when thoroughly executed early in the development process.

Networking Lunch in the Exhibit Hall and Poster Viewing

Technology Spotlight:
Restriction Cascade Exponential Amplification (RCEA): A Novel Bio-detection Technology with Sensitivity Similar to PCR and Near-Absolute Specificity
Kenneth Smith, Chief Executive Officer, Cascade Biosystems Inc

This novel technology achieves selective and sensitive detection of nucleic acid targets by using signal amplification, rather than by amplifying DNA targets as in standard PCR. The RCEA assay is based on the specific cleavage per-formed by restriction endonuclease enzymes and provides for near absolute specificity since two bio-recognition events must occur independently to generate a signal first by hybridization of target DNA to oligonucleotide probes and then restrictase recognition and cleavage of a se-quence-specific locus within the formed double-stranded hybrid. The assay has been demonstrated with the detection of the methicillin-resistant Stapphylococus aureus (MRSA) pathogen, using the mecA gene as the target. The RCEA based assay can be integrated into a variety of user friendly POC formats ranging from instrument-free colorimetric kits to hand-held electrochemical detectors. The assay can be easily adapted to detect any DNA target of interest for POC diagnostics applications.

Transforming Cancer Risk Screening in Primary Care Setting
Vadim Backman, Walter Dill Scott Professor of Biomedical Engineering, Northwestern University, United States of America

NanoCytomics is developing a new optical technology platform termed nanocytology for highly sensitive, cost-effective and non-invasive cancer screening of populations in a primary care setting by means of the measurement of the nanoscale architecture of biological cells. Nanocytology-detectable alterations in chromatin nanoarchitecture are a highly robust and accurate marker of field carcinogenesis in clinical trials in lung, colon, prostate, pancreatic, esophageal, ovarian and thyroid cancers. A significant application of nanocytology is in cancer screening enabled by the detection of field carcinogenesis via the analysis of the nanoarchitecture of cells obtained from easily accessible surrogate tissue sites, with the objective to increase the detection rate of significant pre-neoplastic or neoplastic lesions while reducing overdiagnosis. Examples include the analysis of rectal cells for colon neoplasia and buccal (cheek) cells for lung cancer identification. Data from multi-institutional clinical trials has demonstrated that nanocytology has the potential to become a new platform for cancer screening broadly applicable to a number of organ sites from which cellular specimens can be obtained.

Silicon Photonic Point-of-Care Sensors for Multiplexed Diagnostics
Ryan Bailey, Associate Professor, University of Illinois at Urbana-Champaign, United States of America

The concept of personalized medicine is predicated on an ability to comprehend a patient’s disease state in a highly informed manner that ideally illuminates an effective, molecularly-targeted treatment strategy. A growing body of evidence suggests that the simultaneous measurement of many unique biomolecular signatures from a single clinically relevant sample would be incredibly enabling in achieving such an informative diagnosis. Unfortunately, this is an analytical feat that currently not possible using established methods, thereby limiting the implementation of informative molecular diagnostic and theragnostic strategies in the clinical treatment of disease. In response to this and other bioanalytical challenges that simultaneously require high sensitivity, high level multiplexing capability, and scalable and cost effective sensor fabrication, our group has developed a new biomolecular analysis platform based upon silicon photonic microring resonators. This detection strategy leverages well validated semiconductor fabrication, laser sources from optic telecommunications, and conventional microarraying tools to create highly multiplexed and robust biosensor arrays that are extraordinarily sensitive to biomolecular binding events at the sensor surface. In this talk I will describe our efforts to develop this emerging platform in the context of creating multiplexed detection solutions for point-of-care diagnostics.

Coffee Break and Networking with Exhibitors in the Exhibit Hall

Cell Diagnostics based on Rapid Phase Imaging
Adam Wax, Theodore Kennedy Professor, Duke University, United States of America

Current blood cell analysis techniques require manual examination by expert technicians, resulting in a costly and time-consuming test. Our group has been developing new methods for automated screening of blood cell imaging using a compact, portable, inexpensive, and easy-to-use wide field digital holographic  microscope. This instrument will permit more cost effective diagnosis of pathological conditions by avoiding the need for the time of a trained microscopist. In our unique microscope design, optical fidelity and alignment are achieved through the use of our interferometric sample chamber (InCh), which produces holographic images of cell samples with simple laser illumination.

A Simple Sensitive Molecular Platform for Malaria Diagnosis: The Direct on Blood PCR-NALFIA System
Henk Schallig, Research Coordinator, Koninklijk Instituut Voor de Tropen, Netherlands

Molecular tools allow for specific/sensitive malaria diagnosis, but current formats, like PCR with gel-electrophoresis, are difficult to implement in resource poor settings. Therefore, a simple, fast, sensitive/specific molecular diagnostic platform, the direct on blood PCR combined with nucleic acid lateral flow immunoassay (NALFIA) to detect amplified PCR products of Pan-Plasmodium and human GAPDH (internal control) was developed and evaluated under laboratory conditions, a multi country ring trial and two malaria endemic countries. Analytical sensitivity/specificity of PCR-NALFIA in a single laboratory evaluation was >95% and able to detect 1 parasite/µl blood [1]. All laboratories in the ring trial reported ease of use of the system and could successfully perform the protocol. Overall laboratory inter variability was low and the agreement of reported results was high. Overall test sensitivity and specificity was >95% [2]. Field evaluations in disease endemic countries, Thailand and Burkina Faso, were performed. In Burkina Faso sensitivity was 94,8% and specificity 82,4% compared to microscopy and 93,3% and 91.4% compared to RDT. In Thailand the sensitivity and specificity was 93,4% and 90,9 respectively compared to microscopy and 95,6% and 87.1 % compared to RDT. These numbers are under estimation of test performance as the results are not PCR corrected.

Vacuum Battery Pumping Integrated with Digital Plasma Separation for Quantitative Diagnostics
Charlie Yeh, , University Of California-Berkeley, United States of America

Current blood-based quantitative nucleic acid (NA) detection requires many sample preparation steps or bulky and costly bench top equipment such as PCR machines. Here a portable, power-free, and significantly lower cost portable microfluidic platform for one-step quantitative NA detection is presented. This platform uses a next generation microfluidic pumping method, termed the “Vacuum Battery System”. Vacuum potential is pre-stored in a “vacuum battery” void, and discharged over gas permeable lung-like structures to drive flow. It enables dead-end and deep well loading, has excellent optical properties, and is not dependent on surface tension, all of which are common limitations of capillary pumping. Highly controlled pumping was possible for up to 2 hours (up to140 µl, range of 2~17 µl/min), without any external equipment, power sources, or pumps. Furthermore, it was possible to integrate plasma separation and sample compartmentalization (224 wells, 100 nl each) into one-step with the “Digital Plasma Separation” design in 12 minutes using inertial microfluidics. Lastly, this chip is able to perform on-chip end-point quantitative digital MRSA DNA detection directly from human whole blood within 30 mins, with a dynamic ranged of 10~105 copies DNA/ µl, using isothermal amplification (Recombinase Polymerase Amplification).

Colorimetric Molecular and Cellular Imaging on Nanophotonics Integrated Microfluidic Platform
Logan Liu, Associate Professor, University of Illinois at Urbana-Champaign, United States of America

There were significant research efforts in recent years to develop new molecular sensing and cellular imaging instrumentations with largely improved sensitivity; however the augmented performance usually requires the addition of expensive specialized equipment.  My research group efforts aim at inventing new bioimaging solutions from a very different angle by engineering nanoplasmonic chips to permit colorimetric molecular and cell imaging in microfluidic devices.  In my talk, I will present our work on developing colorimetric plasmon resonance sensor chip integrated with multifunctional microfluidic platforms.  The surface plasmon resonance molecular sensing in microfluidics is transformed to a nearly “equipment free” technology requiring only naked eyes or cell phone cameras, allowing for high-performance point-of-care applications.  Label-free colorimetric  sensing of enzymatic reactions and cell metabolites in microfluidics will be demonstrated.

Waveguide-based Microarray Technology for Rapid, Inexpensive, Multiplex Diagnostics Assays
James Herron, Associate Professor, University Of Utah, United States of America

In-plane parallel scanning (IPPS) is an innovative microarray technology for rapid, inexpensive, multiplex diagnostics assays. It replaces expensive laser scanning with a grid of 100 µm-wide waveguides embedded in the chip’s substrate enabling real-time quantification of molecular complex formation on the chip’s surface.  Compared to conventional microarray technology, IPPS offers advantages of shorter assay time and lower instrument cost and complexity so that the platform can potentially be used in point-of-care (POC) settings. Two different chip formats have been developed: a low-density microarray with 10 sensing wells and a medium-density one with 100 sensing wells. Sub- to low-picomolar performance has been observed in several different clinical immunoassays using this technology.

Use of TeleHealth Solutions for Preventive, Sub-acute and Post-acute Care Coordination in Total Population Health Management
Pramod Gaur, Adjunct Professor, Pace University, United States of America

Recent advances in mobile TeleHealth technology devices and services has opened a possibility to create a truly patient centric 360O view of personal health record that is collected from both professional settings (hospital/clinic, laboratory, doctor’s office, pharmacy and medical claims) and personal setting (self-reported information via TeleHealth technology). Interoperability among the wireless medical devices and data aggregation devices at member’s end and adoption of electronic health records and health data exchanges at healthcare provider’s end would allow a Total Population Health Management (TPHM) model for preventive, acute/sub-acute and post-acute care. The primary goal for TPHM program is to provide preventive TeleHealth solutions to help majority of the members Stay Healthy; provide video based telemedicine solutions for acute/sub-acute care for members to Get Well Soon; and finally, provide remote patient monitoring TeleHealth solutions for post-acute care for the chronically ill members so they can Live with Illness. The measurement matrices include: 1) Access to Healthcare; 2) Quality of Evidence Based Care; 3) Member Satisfaction; 4) Provider Workflow Alignment and 5) Overall Healthcare Cost.

POC Diagnostics for Global Health – Addressing the NCD Epidemic
Bernhard Weigl, Director, Center for In-Vitro Diagnostics, Intellectual Ventures/Global Good-Bill Gates Venture Fund, United States of America

The emergence of point-of-care diagnostics specifically designed for low-resource settings coupled with the rapid increase in need for routine care of patients with chronic diseases should prompt reconsideration of how health care can be delivered most beneficially and cost-effectively in developing countries. Bolstering support for primary care to provide rapid and appropriate integrated acute and chronic care treatment may be a possible solution. Point-of-Care (POC) diagnostics can empower local and primary care providers and enable them to make better clinical decisions. This talk explores the opportunity for point-of-care diagnostics to strengthen primary care and chronic disease diagnosis and management in a low-resource setting (LRS) to deliver appropriate, consistent, and integrated care. We analyze the requirements of resource-appropriate chronic disease care, the characteristics of POC diagnostics in LRS vs the developed world, the many roles of diagnostics in the care continuum in LRS, as well as the process and economics of developing LRS-compatible POC diagnostics. We will also discuss a number of examples of POC diagnostics for low resource settings under development by PATH and its partners including screening and diagnostic devices for gestational and type 2 diabetes, preeclampsia, cardiovascular disease, and breast and cervical cancer.

Close of Day 2 of the Conference.