International CES’ Silvers Summit now Lifelong Tech. An indicator that the focus in ‘aging tech’ is now less on imposing monitoring systems on older people and more on enabling people of all ages to live better is the name change of one of the ur-events of digital health. The focus is now on the 50+ (78 million strong in the US). With the drop in age is a substantial broadening of interest in technology from smartphones to longevity and social connectedness as well as the traditional safety and improved quality of life. Lifelong Tech will debut at 2015 International CES 6-9 January 2015, though the change isn’t on their materials or website yet. Organizers (Living in Digital Times) remain the same. This Editor will be seeing their short and sweet wearable tech presentation (no windy panels of corporate execs) next Wednesday. Release
Is consumer digital device engagement sticky? Or just the hype?
A wonderfully cranky essay by Laurie Orlov on her new blog Boomer Health Tech Watch might make you think The Gimlet Eye was her guest writer (see below). Ms Orlov observes the ratched-up noise level around wearables, fitness bands, smartwatches (in which your Editor will be drenched quadrophonically next Wednesday at CEWeek NYC, glutton for punishment as she is). Yes, we’re swooning around Apple Health [TTA 3 June] and having a minor swivet around Samsung’s Simband and SAMI [TTA 2 June]. The bucket of cold water in Ms Orlov’s grip is the high dropout rate among fitness band users (33-50 percent, cited from Endeavour Partners and NPD Group); this Editor will also add the devices’ relative inaccuracy, fragility and glitches [TTA 10 May]. But ‘the investor community (via the media) clearly IS being transformed, at least temporarily’ as well as outside the health industry, by a belief that these devices will push the world into Quantified Selfing for the Masses. Will wearables herald our arrival at the New Jerusalem of Health? Certainly it’s been trumpeted and tromboned by the D3H (Digital Health Hypester Horde) badly needing a fresh fave rave. But can digital health survive another Hype Curve dive? Can we? The Consumerization of Health Care — is it working?
Further in this jugular vein, Business Investor, in a superficial swipe, dubs smartwatches uncool just because they trail fitness bands by six points. They did a better job in March delving into the real challenges that wearables face: smartwatches look and feel like a brick on your wrist (Ed. D’s term), Google Glass is socially unacceptable in many quarters (banned in Silicon Valley!) and wearables are still in Early Adopter-Ville.
Update: Ms Orlov just sent to this Editor a brief comment with a link to a thoughtful NY Times article not only on The Trouble with Apple’s Health App, but also how the barriers are more subtle–and more common-sensical–than the hype around how consumers are eager to register every burp on a PHR (they’re not), they don’t want to be nagged by technology (easier than your mom to be rid of) and the group that needs it most (the old, poor) has the least, for now, access to it. But largely ignored by the D3H.
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”75″ /]On assignment off Cape May, New Jersey inventorying readiness of coastal defense fortifications. Just between us. Shhhh!VA reduced bed days by 59%, hospital admissions by 35% in 2013
Not all is gloom ‘n’ doom at the US Department of Veterans Affairs (VA), rightly excoriated for cooking the books on wait times for admissions, allowing an estimated 40 veterans to die waiting for care at the epicenter of the coverup, a Phoenix VA hospital, its secretary resigning. A consistent bright spot has been its use of telehealth and telemedicine, along with the Department of Defense (DOD), making them the largest US telehealth contractors. Neurosurgeon Adam Darkins, MD, who is their chief consultant for telehealth services, kept a speaking date at Tuesday’s Government Health IT Conference in Washington, DC to present encouraging results.
- The VA’s FY2013 telehealth program totaled 608,900 patients and 1.8 million telehealth episodes of care. 45 percent of the patient population live in rural areas, receiving care from 151 VA Medical Centers (VAMC) and over 705 Community Based Outpatient Clinics (CBOCs)
- 2009 to 2012 data show showed a 4 percent cost reduction after a year in a telehealth program, versus a one-year spike of 48 percent in costs for those veterans outside telehealth
- Cost savings are estimated at just under $2,000 per year per patient
- Over 41,000 patients were enabled to live independently in their homes using telehealth
- VA also leads in telemental health, with its National Center providing 2,893 video consults to 1,033 patients at 53 sites in 24 states
- The program is expanding at a rate of 22 percent per year
VA’s telehealth covers six areas: clinical video telehealth, home telehealth, (more…)
IBM Watson, get me consumer engagement
A pointer to the future for healthcare? What’s made health tech headlines is IBM Watson’s big data modeling for decision support tools in oncology and taking the US Medical Licensing Examination [TTA 10 Mar and prior] , but Watson’s capabilities are being tested in other verticals such as retail and customer service. This latest item from Direct Marketing News (!) does a once-over-lightly-from-the-press-release on their partnership with contact (call) center Genesys ‘customer experience platform’. It will further automate both telephonic and online service using Watson methodology by end of this year. Not mentioned of course is all the back end information on customer behavior. What can this mean in healthcare? Off the top of this Editor’s head, it’s proactive consumer engagement, a concept much discussed but rarely achieved without a fair degree of obtrusiveness. Trending data on fitness monitoring being sent on your smartwatch or band, interactive suggestions/reminders in diabetes management at those mid-afternoon times when you’re reaching for candy or coffee, a phone call from a real or virtual ‘case manager’ using behavioral data off your smartphone (locating you at the ice cream stand), better call center support for clinical trial research done by contract research organizations (CROs) using behavioral data….. Article
A healthcare/smartphone survey not from usual suspects
From FICO, an analytics software company best known in the US for your creditworthiness score (FICO Score), are some results on the healthcare portion of a just released cross-industry survey (with mobile banking, insurance) on smartphone usage:
- 80 percent would like to be able to interact with healthcare providers on their smartphones
- 76 percent would like to be reminded of medical appointments
- 69 percent would like to receive reminders to rearrange appointments, or be prompted to take their medication
- Texting as a push communication is preferred for all three above except for medication reminders
- 56 percent trust healthcare organisations with personal data (lower than it should be at this stage–Ed.)
- 2 in 3 want to receive medical advice through digital channels instead of visiting a doctor (cheering news for Better and online providers such as Everyday Health and WebMD)
- But presently, users do most of their research the ‘old-fashioned’ online-on-your-PC way
To get full results on the healthcare preferences of smartphone users in the US, Australia, Brazil, China and the UK, you’ll have to visit their webpage and answer five questions. Release.
Medtronic, Covidien and what it might mean for digital health
“This acquisition will allow Medtronic to reach more patients, in more ways and in more places,” Medtronic Chairman and CEO Omar Ishrak
Cover the Earth? While the healthy Medtronic offer ($42.9 billion in cash and stock) for Ireland-headquartered Covidien plc is not a ‘digital health deal’, it does point to Medtronic’s strategy which includes digital health. There is of course the obvious: growth by acquisition and integration. Acquisitions require cash, and the highly controversial change of domicile to Ireland via ‘tax inversion’ will fatten the exchequer in two ways. First is through the lower overall Irish corporate tax versus the 35 percent US tax, one of the highest in the world. Second is much more flexibility in repatriating plentiful foreign earnings at lower Irish corporate rates rather than the high US rates which Medtronic has avoided. Third is increasing dividends, which can drive up stock price and investor interest. Of interest to the latter is also that Covidien adds horizontal (and global) competitive strength to Medtronic in the clinical area–surgical, vascular, respiratory and wound care.
More Ways-More Places. Not just staples and sutures, Covidien has developed its own advanced in-hospital mobile patient monitoring in Vital Sync as well as several hospital monitoring devices in their Nellcor line. In addition to technology collaboration, the next point of integration could then be with Medtronic’s post-acute telehealth devices from Cardiocom, purchased less than one year ago. We noted at the time that it gave Medtronic entreé into the “chronic condition management continuum– not only into telehealth via Cardiocom’s devices and hubs, but also their clinical and care management systems.”
Approval will take time. Both the US and UK, through various regulatory agencies, scuppered the Pfizer-AstraZeneca deal on similar tax domiciling and competitive grounds. If it does go through, there will be a lot of reorganization. But while it digests, this Editor will be watching Medtronic for its usual pattern of making smaller ‘more ways/more places’ deals in the interim with an eye to diversifying past US-taxable medical devices. One pointer is their just-announced partnering with Sanofi to develop drug delivery-medical device combinations and care management services for diabetes patients (MedCityNews).
Related reading: Medtronic hints at more acquisitions following $43 billion Covidien deal (MedCityNews); The Medtronic, Covidien Inversion Deal Is More About Dividends Than Tax (Forbes); Medtronic agrees to buy Covidien for $42.9b in cash, stock (Boston Globe); Medtronic’s $43B Covidien deal—and Irish tax move (CNBC)
Enterprise wearables for clinical health–and more
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/06/Evena-veins-620×454.jpg” thumb_width=”150″ /]This ZDNet story technically has only one wearable in health–the Evena Medical Eyes-On Glasses which help medical staff find that vein (left) and is being trialled at Stanford University Medical Center. The other four profiled are being used in businesses as wide-ranging as engineering, restaurants, retail stores and manufacturing, but they are being used in the ‘here and now’: Abeseilon work-stream video; Google Glass for reviewing/recording work, training and coaching; the Theatro Wearable Computer ‘targeted’ messager; and, somewhat Big Brother-ish, the Hitachi Business Microscope, an RFID-like device the size of an ID card that captures employee interactions and collaborations. A savvy HIT developer or implementer could, as has been done with Glass, find different uses for the other three in hospitals, home care or practices.
And you’ll be surprised what made TechRepublic’s list of wearables’ 10 biggest flops. (Already!)
Apple Health, minus the ‘book’, announced
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/06/healthkit-apple-wwdc-2014-87_verge_medium_landscape.jpg” thumb_width=”170″ /]Breaking and developing… Apple announced their long-rumored health tracking app [TTA 22 Mar] this morning at their WWDC (World Wide Developers Conference) in San Francisco. The consumer app is called Health (not Healthbook) and the developer platform HealthKit which are both part of iOS8 for iPhones and iPads in the fall. HealthKit facilitates pulling in of health data from third-party developers so that all health-related information for the consumer user is in one ‘hub’, similar to what Apple’s Passbook app does now as a ‘virtual pocket’ for airline boarding passes, movie tickets and coupons. Apple’s Craig Federighi, senior VP of software (pictured, courtesy of The Verge), made the announcement of the app and platform as part of the broader debut of iOS8 this morning.
Already on board is Mayo Clinic with an app that logs information like blood pressure, tracking normal range and it appears from reports that a severe enough deviation will initiate a contact with medical professionals. Nike was prominently featured as an app provider, further confirming that it’s leaving the hardware to their close corporate partner now that it’s out of the FuelBand business [TTA 22 April]. Epic Systems, a leading large system (hospitals/practices) EHR, appears to be integrating integrating its personal health record (PHR) with HealthKit, “suggesting a framework for getting information collected via HealthKit into patients’ MyChart (Epic PHR–Ed.) app.”
Editor Donna wonders if the still-in-early-days Better iPhone health personal assistant app (PHA), developed in conjunction with and backed by the aforementioned Mayo Clinic [TTA 23 Apr], will prominently integrate into Health. (We’ll cover when this develops, as we think it will–but mum’s their word for right now.)
In Mashable, the news was applauded by the CEO of leading app MyFitnessPal as a big validation. In his opinion, Apple would work with the existing field of apps and devices. Leading fitness bands Jawbone and Fitbit had no comment. Fitbit was shown during the presentation: CNET (one of six pictures here) and The Verge (article below). The latter makes the excellent point that Jawbone, Fitbit and the Nike FuelBand have all been sold in Apple’s stores.
The speculation is that Health will be a key part of the features of the iWatch to come, but Mashable in quoting Skip Snow of Forrester Research does bring up a significant wrinkle. Bluetooth LE as a network protocol chews up a lot of battery power, and bigger batteries make for clunky devices. Not exactly the Apple design ethic. Could it be that what’s delaying the iWatch is development of a new, more power-efficient network standard?
Update 3 June: With iOS8 having apps communicating with each other, have the Apple-oids opened the door for a Happy Hacking Holiday? Stilgherrian in ZDNet points out that the ‘attack surface’ in info security-ese just got a whole lot larger. A future ‘oopsie’?
Hat tip to Editor Toni Bunting
More information: Mashable can’t stop mashing stories: Apple Reveals iOS 8: Interactive Notifications, Health App and More, Apple Gets Into Fitness Tracking With Health App and HealthKit for iOS 8, Apple’s First Step Into Health Tracking Is Small But Powerful. Mobihealthnews gets into the act noting Epic’s involvement: Apple reveals tracking app HealthKit and partners with Mayo Clinic, Epic. The Verge positively is on said verge with Apple HealthKit announced: a hub for all your iOS fitness tracking needs.
Monday’s ‘in the news’ briefs
Proteus raises $120 million from “major new institutional investors based in the United States, Europe and Asia” for further development of its ‘smart pills’. Mobihealthnews. Previously in TTA here (starting in 2009!) It’s a long way from ‘tattletale pills’…..InTouch Health now has an FDA-cleared iPad app, CS for iPad, to support a digital stethoscope component on the mobile devices. The app is designed to assess heart and lung sounds in real time in acute-care settings particularly tele-ICU. MedCityNews…..In the mood to read your brainwaves? The Muse is here to help with neurofeedback. MedCityNews takes it on a test drive and if you don’t mind wiping your head down to get a good connection, it definitely points to the future of controlling computers with brain waves and in the meantime, pairing up health apps to get a correlation with those waves….And finally a ‘think piece’ in HeartSisters by Carolyn Thomas, “To just be a person, and not a patient anymore” is largely an impossible dream for those with chronic disease. It’s part of the basis behind non-compliance and other patient behavior that doctors have difficulty understanding. The experience of the patient–the frustration (the ‘perpetual battle of Stalingrad’) and the burden that person carries is the argument behind ‘Minimally Disruptive Medicine’. Must reading as those same patients will be pressed now even more to Quantify Themselves and also to keep track of every fluctuation in vital signs on their iPhone.
More Samsung ‘we try harder’ telehealth moves
Is Samsung playing Avis “We try harder®” to Apple’s Hertz?
Samsung’s other, less noticed end-run in addition to the Simband reference hardware and SAMI ‘open ecosystem’ is an initiative creating a joint research center with the University of California, San Francisco (UCSF) called the Center for Digital Health Innovation (CDHI). It is being headed by Michael Blum, a medical doctor who is the UCSF assistant vice chancellor of informatics. From the statements made to The Atlantic, Dr Blum’s intent is to clinically validate the sensors and algorithms produced within the Samsung ecosystem. Already featured are four initial projects: CareWeb (a collaborative care platform built on Salesforce.com), Tidepool (infrastructure for diabetes apps), Health eHeart (clinical trial app on heart disease) and Trinity (‘precision team care’). On the frontier: ‘novel vital signs’ which he predicts will come out of the analysis of standard vital signs, “…new markers of health and wellness that come out of these large datasets.” Is Samsung, rather than going head-to-head with Apple on Healthbook [TTA 22 Mar] is leapfrogging into something akin to Telehealth 2.0 or 3.0? Yet this Editor notes that we haven’t figured out, for the most part, the FBQs (Five Big Questions)* of 1.0….
* The Five Big Questions (FBQs)–who pays, how much, who’s looking at the data, who’s actioning it, how data is integrated into patient records.
Another Khosla pronunciamento: self-promoting but myopically correct?
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /] The Gimlet Eye returns and delivers some hefty weekend reading…. Like General Douglas MacArthur, The Eye had to return from my Remote Pacific Island sometime. What better reason than to deliver to our readers Mr Vinod Khosla’s, tech investor and now Health Futurist, latest pronunciamento via VentureBeat.
It is, as they said in 1950, a beaut. It’s apparent Mr Khosla need not even speak at conferences anymore, because he can publish on his investment company’s website a ‘Draft’ entitled ’20 percent doctor included: Speculations and musings of a technology optimist’. It is being treated in certain quarters like Moses toting The Big Tablets down Mount Sinai; at the bottom the DH3 (Digital Health Hypester Horde) swoon in the usual places.
Mr Khosla reiterates some of his bomb-thrower memes from a couple of years ago: 80 percent of doctors could be replaced by machines, doctors were clinging to ‘voodoo-like practices’ and eventually we will not need doctors because we’ll be weller through technology and Big Data anyway. But the Eye’s Review of the ‘Draft’–which Eye was prepared to give the Gimlety Treatment–is that his prior attention-getting statements are not only more qualified (or stated more gently), but also backed up with real data, examples and mostly memorably, legitimately forward thinking whch largely avoids blaming doctors and shifts it onto the laggard Medical Establishment. “In fifteen years, data will transform diagnostics, to the point where automated systems may displace up to 80-percent of physicians’ standard work. Technological developments will AMPLIFY physicians’ abilities (more…)
More on DARPA’s ‘brain chips’ for PTSD, TBI
DARPA’s continued research on deep brain stimulation (DBS) implants to treat PTSD and TBI, as well as other neuropsychological conditions, is given the once-over in this Defense One article. New information from the time this Editor last wrote about it in December is that the SUBNETS program (Systems-Based Neurotechnology for Emerging Therapies), funded with $12 to 26 million, will work with the University of California at San Francisco, Lawrence Livermore National Lab and Medtronic to create an implant with electrodes reaching into the brain and which does not require staying still under a machine in a lab. The prototype development is expected to take five years. The article also points out the US Air Force initiative studying the effects of low amounts of electricity on the brain to boost alertness delivered by an external cap.
Samsung’s ‘shot over bow’ in health
Watched closely as part of Samsung’s various moves in health (here in the US heavily promoting the S5’s heart monitoring capabilities) is their unveiling of a reference hardware called the Simband, a wristband designed for interchangeable body sensor modules yet in fact to be developed. Its platform is dubbed Samsung Architecture for Multimodal Interactions (SAMI) and is part of an open ecosystem which invites developers “to design and integrate their own sensor technology and, through the SAMI platform, develop applications and algorithms for wearables.” The design was in partnership with the biosensing institution Imec and will be available before end of 2014.(Gizmag) Coming before Apple’s Worldwide Developers Conference (WWDC) and the rumored announcement of the Healthbook iOS app [TTA 22 Mar]…the Samsung-Apple wars continue, and not in court. Also Gizmodo
‘Fashionable safety’ alert device for women
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/05/Guardian-Angel-necklace.jpg” thumb_width=”150″ /]Out of Singapore is a pretty silver necklace or bracelet that does more than adorn: with the press of its small silver button, it can help the wearer get away from an uncomfortable or harassing situation in a public setting (like the workplace, a bar or party) by sending that ‘nick of time’ fake call to your iPhone by Bluetooth LE. Or if held down for over 3 seconds in an emergency, it sends an SOS text, coordinates and a Google Map link via the phone to designated recipients (not law enforcement.) The Guardian Angel pendant was developed by ad agency JWT Singapore to support AWARE (Association of Women for Action and Research) in Singapore through a 10 percent per unit donation, and is available at local retailer My Room Retail or internationally via their website for US$120 (UK£71) plus shipping, handling and optional bracelets. What isn’t clear is if a smartphone is needed–the website indicates that an app must be downloaded from the Apple AppStore but the Daily Mail article says it works with any phone. Also PSFK review, ABC (US) News. What’s a little disappointing is that the first function (‘get me away from this creep’ self-call) is being more widely touted than the second (‘the creep is coming after me with handcuffs, and he’s not a cop’ SOS). This Editor also wonders how reachable the necklace in particular would be in a truly dangerous situation. But it is certainly better than the alternative. Hat tip to Editor Toni Bunting.
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/03/first_sign_clip-1.jpg” thumb_width=”120″ /]In TTA 6 March we covered another ‘fashionable safety’ item, the First Sign hair clip, which is more violent crime deterrence and recording-oriented. It senses impact and sends audio/video/GPS location to monitors plus designated recipients along with a pre-recorded announcement that it is gathering evidence. It succeeded in its Indiegogo financing round and is available for pre-order here for estimated November delivery at $50-75 plus monitoring. But so far, fashion hasn’t made its way into the maddeningly institutional PERS design (though Chubb has given it a whirl with its Glasgow competition recently.)
A random walk through ATA 2014
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/05/ATA_Button_color_filled.jpg” thumb_width=”150″ /] Editor Donna attended ATA 2014 on Monday only. This article is a set of impressions (mainly) of the exhibit floor and visits to a number of select booths.
Donna, it’s Baltimore. You’re not in NYC or Las Vegas.
Arriving after a long trip to a city you used to visit regularly, but haven’t been to in over 30 years, is disorienting, especially when you are heading on a fair spring day to a section that didn’t exist then. The Inner Harbor and Camden Yards resemble Atlanta, not necessarily a bad thing since the parts of ‘Charm City’ they replaced were largely past ‘gentrification’. The Baltimore Convention Center was unexpectedly huge, the distance to registration made longer by a taxi driver who dropped me off at another entrance two blocks away. Any resolve I had to drop in on the many educational sessions was dissuaded by the sheer length of the halls. The thick Exhibit Guide confirmed that the show floor filled two city blocks–a challenge to cover and spend time with my appointments before the close of the day.
Was it a hardware show, a software show or somewhere in between?
You could make a case for both views. One observer I walked with at the start compared it to a radiology trade show–all hardware. Yet a closer look indicated that the hardware–the PCs, tablets and smartphones–was there to show software that integrated: systems to track patients, distribute information, workflows, store and forward images and reports. It was about enabling secure consults, platforms, interoperability, two-way data flows, mitigating readmissions and putting telehealth, telemedicine and education into provider and patient hands. It was also about making the business case. It was most definitely NOT about gadgets and single purpose peripherals, though the latter were still quite visible. The old picture of telehealth closed systems, of proprietary monitoring devices feeding data onto a proprietary PC platform where it’s seen by a care manager, is so 2011.
Noteworthy: the growth in specialized services like telepsychiatry, teleneurology, teleradiology and teledermatology. Contrast: despite VGo‘s ubiquitous telepresence robots accosting you on the floor, a tablet-faced robot following a nurse down the hospital hall and ‘consulting’ with patients will likely still be a rarity.
Patient engagement on top
Traditional telehealth device makers are connecting their devices and opening up their reporting platforms to be accessible to patients. But there are bumps along the way in this transition. A&D Medical has gone ‘Wellness Connected’ with a mobile app (more…)
Tunstall’s unhappy lenders and the consequences of debt service
A ‘slipped under the radar’ story (in this Editor’s judgement, based on the lack of news references) is Bloomberg News’ exclusive on last week’s (12 May) meetings between Tunstall Group Ltd and its creditors over the company’s recent performance. According to Bloomberg’s sources, the meeting was called “after income plunged and management changed following a refinancing in September.” In a statement from Charterhouse that cleverly tap-danced past the reason for the meeting, “Tunstall continues to be a successful, profitable, cash-generating business and comparable to many other organizations, experiences short-term fluctuations in performance.” and “The group has been impacted by a number of factors including specific market factors and the continued strength of sterling against the major-trading currencies.” The business has also been hurt by delays in awarding major contracts, according to the statement.
From the Bloomberg article:
As Tunstall’s profits have declined, its ratio of debt to earnings before interest, taxes, depreciation and amortization increased to 5.6 times as of March, from 4.7 times in September, the people said. The loan terms in the March test dictated that the leverage ratio shouldn’t exceed 6.3 times, they said.
Lenders are expecting the company to give a new profit forecast today for the 12 months to September 2014, according to the people. The company didn’t comment on earnings targets or leverage in its statement.
AND: Its 350 million pounds ($590 million) of loans dropped to as little as 77 pence on the pound, according to broker quotes, from 99 pence in September. (Ed. note: these loans are publicly traded and a lowered value is highly significant as to the debt quality.)
The outcome of the meeting is not yet known.
As our readers know, private equity firm Charterhouse Capital Partners LLP acquired Tunstall Group in 2008 from Bridgepoint Capital for £514 million (US$ 1 billion), funded in part with over £242 million in debt and with Bridgepoint and management retaining small shares (FT.com). The September 2013 refinancing was for £350 million ($590 million). This paints a picture of a highly leveraged company beholden to many beyond its owners and its contractors in local authorities and housing associations. Tunstall and Charterhouse also received negative publicity when the Guardian did an exposé on their use of the (wholly legal) ‘Quoted Eurobond Exemption’, where they pay loan interest at high rates to their parent companies through a mechanism via the Channel Islands Stock Exchange.
Management changes over the past six months have also rocked the top layers of the company. (more…)
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