Featured Post

Hacking Health in Hamilton Ontario - Let's hear that pitch!

What compelled me to register for a weekend Health Hackathon? Anyway, I could soon be up to my ears in it. A pubmed search on Health Hack...

Friday, December 28, 2012

Putting the Tricorder Together

I have been following the Qualcomm Tricorder Xprize and would now like to try to put on one page, some of the features that could come together. To begin, the Qualcomm Tricorder rules for the form and function. It should:

  • capture key health metrics (i.e. blood pressure, respiratory rate, and temperature) and diagnosing a set of 15 diseases
  • be able to collect large volumes of data from ongoing measurement of health states through a combination of wireless sensors, imaging technologies, and portable, non-invasive laboratory replacements
  • be no greater than 5 pounds (can have any design shape or physical appearance, i.e.teams may use sensors that are attached to a phone-like control unit, fastened individually to the consumer, or kept apart and reserved for occasional use or home monitoring. Similarly, teams may create a tool that has a large screen, a small screen, or perhaps even no screen (audio only).
  • systems should store and share consumer information, which must be accessible remotely via the Internet
  • be safe from electrical energy, thermal energy, chemical exposures, needles, lancets, and infection.
So what this suggests to me is that it doesn't have to be or even look like a smartphone. As we know, many applications currently available can fit the smartphone. It might be better to start imagining something like the first McIntosh computer. Steve Wozniak was influenced by the Home Brew Computer club in San Francisco in those days. He wanted the McIntosh to have up to 11 ports in order to be compatible with the other devices created by computer enthusiasts. I think the Tricorder should also be able to port out to many devices. The model I have in mind is the backpack carried by the Emergency First Response Team at our university. This is a kit equipped to take one to the top of the Himalayas! Bringing that down to 5 pounds will be a chore. That is where  some of the ideas of the "wearable computer" experts like Steve Mann might be helpful.

Smartphone Devices
Smartphone Internet Applications
  • clinical decision support (Dr. Watson) internet AI - Virtual Nurse (Senstore)
  • integrated digital pathology internet connection
  • connection to PHR/EMR/EHR of patient
  • telemedicine and video consultation
Several of the smartphone application developers will enter the Qualcomm Tricorder prize (Scanadu and Senstore are two it would appear). You'd really have to look at what the 15 diseases that need to be diagnosed are. A lot of them might be diagnosable just from a video telemedicine consult, but I think the contest is going to be tougher than that.

What I am now interested in is a non-smartphone form and function - possibly a wearable computer that either the care provider and/or the patient both wear or share. This device in turn would be able to port out to as many mobile medical devices as possible.

Suddenly, this Tricorder competition looks doable! The real problem is going to be, as the Qualcomm Tricorder Prize website says: "Teams will have to consider tradeoffs amongst weight, functionality, power requirements, battery life, screen resolution, AI engine location, diagnosis capability, end consumer cost, and so on." Some team is going to be able to create a device that will cost less than an iPad Mini, or even more like a kindle.

I am going to add to and revise this from time to time.


Friday, December 21, 2012

Smartphone - brain scanner - Emotiv


Emotiv is a revolutionary EEG system (and it's wireless):

 
A revolutionary personal interface for human computer interaction.The Emotiv EPOC uses sensors to tune into electrical signals produced by the brain to detect user thoughts, feelings, and expressions. To devlope your own applications for the EPOC, license an SDK to obtain our proprietary software toolkit
.


Another piece of the Tricorder puzzle? - smartphone brain scanner.


Uploaded on 8 Sep 2011
"Holding your brain in the palm of your hand..."

We demonstrate a fully functional smartphone brain scanner consisting of a low-cost 14-channel EEG headset with a wireless connection to a smartphone (Nokia N900), enabling minimally invasive EEG monitoring in naturalistic settings. The smartphone provides a touch-based interface with real-time brain state decoding and 3D reconstruction.

The Smartphone Brain Scanner is developed by Arkadiusz Stopczynski, Carsten Stahlhut, Michael Kai Petersen, Jakob Eg Larsen, and Lars Kai Hansen, DTU Informatics, Cognitive Systems Section.

More information available at: http://milab.imm.dtu.dk/eeg
The project is open source and available at: http://code.google.com/p/smartphonebrainscanner2/

Wednesday, December 19, 2012

p value less than 0.05



I received an email about a Research Integrity conference and checked out the keynote speakers. One of them was Dr. John Ioannidis. This lead to me to what I discovered was one of the most cited research papers out there "Why Most Published Research Findings are False". This article touched off a nerve or two in me, and eventually I will try and read it to at least a level of comprehension, because it is very mathematical. What struck me was the hypothesis that:

Several methodologists have pointed out [9–11] that the high rate of nonreplication (lack of confirmation) of research discoveries is a consequence of the convenient, yet ill-founded strategy of claiming conclusive research findings solely on the basis of a single study assessed by formal statistical significance, typically for a p-value less than 0.05.

I took courses in health research methodology and was taught how to read medical literature and the p value inherent in most of the journal articles always confused me.  I still don't know the significance of the p value, but this I know: it is not good if family doctors, relying on evidence- based medicine to prescribe innovative therapeutic drugs, are relying on these articles' conclusions and p values for their predictive value to help me. They should be relying on the gold standards of medical evidence: systematic reviews and meta-analysis - the highest forms of "unbiased" research. Atlantic magazine has a great article "Lies, Damn Lies, and Medical Science" (in plain English) about Ioannidis and this medical dilemma.

If you want to check out why I might be confused by what a p value is, check out this definition in wikipedia:


In statistical hypothesis testing, the p-value is the probability of obtaining a test statistic at least as extreme as the one that was actually observed, assuming that the null hypothesis is true.[1] One often "rejects the null hypothesis" when the p-value is less than the significance level α (Greek alpha), which is often 0.05 or 0.01.
Although there is often confusion, the p-value is not the probability of the null hypothesis being true, nor is the p-value the same as the Type I error rate.[2] A Type I error in statistics is the incorrect rejection of the null hypothesis. In this case the hypothesis was correct but wrongly rejected. In a Type II error, however, the null hypothesis was not rejected despite being incorrect. This results in the failure of rejection of incorrect assumptions.


The best place to learn about all of this is in one of the classics of evidence-based medicine by one of the authors who coined the term "evidence-based medicine", Dr. Gordon Guyatt, who teaches and does research at McMaster University:

Users' Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice, Second Edition (Jama & Archives Journals) by Gordon Guyatt, Drummond Rennie, Maureen Meade and Deborah Cook (May 21, 2008)



Thursday, December 13, 2012

Another McMaster Study about Health IT: The Renaissance Version!

So, I enjoy reading posts on the Kevin Pho MD newsletter, and I am not even an MD. The ehealth stories are often very interesting, like the one I am posting here. Now this article has 3 main characters:

1. The article by James Salwitz entitled "Why IT is the core of the healthcare renaissance".
2. An article mentioned by Dr. Salwitz by Stephen Soumeri and Ross Koppel on the online Wall Street Journal called "A Major Glitch for Digitized Health-care Reform".
3. A paper by McMaster University researchers entitled "The economics of health information technology in medication management: a systematic review of economic evaluations".

Please draw your own conclusions! My conclusion would be that the McMaster researchers uncovered a need for better economic assessments of healthcare technology, in order to really make a realistic appraisal. And I agree with Dr. Salwitz that looking back 5 decades is too long.

And this isn't the only research that has cast aspersions on the benefits of eHealth technology. A study on PLOS last year, that was almost polemical in tone, blew the doors off of that "The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview"
"http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000387



Why IT is the core of the healthcare renaissance


Why IT is the core of the healthcare renaissance
Warning!  I am a practicing doctor who sees real patients using an electronic medical record (EMR).  My sole agenda is to provide the best patient care.  I have no financial stake in information technology (IT).  However, unlike the editorial board at the Wall Street Journal, Mr. Stephen Soumerai of Harvard or Mr. Ross Koppel of the University of Pennsylvania, I have actually used digital patient records for over a decade and I have news for them;  EMRs work.
In a reactionary opinion in the WSJ entitled “A Major Glitch for Digitized Health-Care Records,” the authors expanded to the point of silliness the conclusions of a review of healthcare IT by McMaster University.  The McMaster analysis abstracts data from 36000 studies over five decades of healthcare IT and concludes that computerization has yet to save dollars nor improve health care.  WSJ editorialists proposed that the concept of a common medical database has “already failed” as is “common knowledge.”  While they portend to “fully share the hope” in the success of a computerized healthcare system they express doubt as to “why are we pushing ahead to digitalize.”
The question is so ridiculous as to barely require an answer.  We are pushing ahead to digitalize because the healthcare industry, which is 18% of our GDP, is the last major industry to go electronic.  Despite how critical medicine is to our citizen and nation’s vitality, health care is most often documented with paper and ink.  Can you imagine any other industry where this would be acceptable?  Would you go to a bank where they use a hand-written ledger?  Travel on an airplane without GPS, fly by wire technology or a minimum of three computers?  Do you yearn for rotary phones?  Credit cards left paper money behind decades ago and will soon move on to the next phase, pay by smart-phone. The world is digital and one of the core problems with medical care is its failure to follow.
The average doctor writes his notes on parchment and scribbles orders on contact paper.  He wastes time writing prescriptions by hand that cannot be read and will produce unneeded drug interactions and side effects.  The data on billions of health care events cannot be mined, monitored, analyzed or improved, because it is not digital.   Millions of hours are wasted, billions of dollars vanish and tens of thousands die because of preventable medical complications, the result of massive variation in quality and safety.  We are doomed because we cannot access or evaluate most medical care data; “If you can not measure it, you can not manage it.”
Taking health digital is key to fixing and affording care.  Standard, unified medical records will significantly decrease the risk of providing unneeded or dangerous medical care.  Massive efficiencies will result by reducing duplication, speeding communication and reduction in waste (and fraud).  Critical improvements will follow the use of guidelines to study clinical databases and drive quality. This means that whether one lives in Manhattan, in the mountains of Tennessee or potentially deep in Africa, the finest care will be possible.
How do I know this to be true?  Our practice of seven doctors and three nurse practitioners was an early EMR adapter.  We put in our first basic system in 2000, upgraded three times and have been fully electronic for four years.  This has resulted in marked efficiencies and obvious quality improvement. Encrypted electronic records cannot be lost, are unlikely to be stolen and are always available from anywhere.  Ordering tests is instantaneous, as is reviewing results, organizing treatments, scheduling appointments or communication with outside health providers. On the cost side we reduced non-clinical staff by more than 50% and in an account receivable analysis our billing cycle dropped more than 60% and bad debt fell to low single digits.
Today in the office, I saw four new patients.  Without assistance of clerical staff and without leaving my desk I reviewed their entire surgical, laboratory, pathological, and radiologic records.  By the time, I entered the room to meet each of them a significant part of their medical history was entered into our EMR, based on outside records, so that the care and observations of previous doctors was not forgotten. Half way through each visit documentation of their history and physical exam was complete, leaving more time to talk with each patient.  Tests were ordered, treatments scheduled, disability letters printed, medications e-scripted, instructions created and follow-up appointments setup.  The patients were given codes to electronically access their records from home.  Letters were sent online to referring doctors, as well as any clinicians we were consulting in that patient’s care.  Billing was complete before each patient got to the parking lot.  Such is the power, efficiency and quality of electronic medical records.
This is just the beginning.  Although EMRs now provide assistance with basic medical care, such as scheduling flu shots, identifying drug interactions, and health screening reminders, future systems will use academic information to assist the doctor in making diagnoses and planning treatments.   Seamless with the EMR will be computer augmentation to create differential diagnoses and recommend treatment alternatives.  In oncology alone there are almost 50,000 articles published each year; Artificial intelligence integration with the clinical EMR will help every doctor penetrate that massive database on a continuous basis as it applies to individual patients.
So, why does the McMaster study not show this obvious benefit? It comes to four factors. The first is the “five decades” of study reviewed by the Canadian authors.  Since most doctors did not start adapting EMRs until 3 years ago, that leaves 57 months of irrelevant data.  Second, we have not reached the critical mass to achieve broad system efficiencies, as hospitals and doctors are still figuring out how to incorporate the technology into their daily practice, and less than 50% of health care providers have converted to EMRs.   Third, we do not yet have a universal common database for medical records. This is a complex technological step, which has been achieved in major industries such as banking, but still must be assembled in medicine.  Finally, as was correctly stated in the WSJ op-ed piece, present EMRs are cumbersome, immature, and several generations short of perfection.  However, these are expected problems when implementing disruptive evolving technology in the complex changing health market. Challenge is a weak argument for giving up and bringing back the fountain pen.
I am not certain what the goal of Sommeri and Koppel was in writing this piece, they offer nothing but “hope.”  The WSJ has been a strong supporter of business technology leading the drive towards quality, and has long recognized the positive contribution of IT to industry.   Those of us in the trenches, putting EMRs in place, ironing out the kinks, know that electronic medical records are now and they are the future.  With IT at the core of the healthcare renaissance we can make medicine cost efficient, producing quality second to none.
James C. Salwitz is an oncologist who blogs at Sunrise Rounds.
Image credit: Shutterstock.com

#Cmdr_Hadfield - tweets from the space station

As of today, Commander Hadfield is still in quarantine waiting for the Soyuz blast to take him to the International Space Station, where he will stay almost half a year. I am going to try and follow his twitter account.  He had an interesting post today pointing to a medical article that talks about how life in space is not good for life extension - it can be compared to the most sedentary sofa bound earth lifestyle! I would like to learn more about telehealth precautions they might have planned.


Tom Blackwell | Dec 12, 2012 9:24 PM ET | Last Updated: Dec 12, 2012 10:48 PM ET
More from Tom Blackwell | @tomblackwellNP
NASA / Getty Images
NASA / Getty ImagesNASA astronaut Garrett Reisman, STS-132 mission specialist, participates in the mission's first session of extravehicular activity (EVA) as construction and maintenance continue on the International Space Station.
It seems astronauts hovering in weightless environments and earthlings reclining in front of the TV share a surprising trait: both avoid the effects of gravity — and both age rapidly as a result.
Now a unique joint venture between Canada’s health-research and space agencies is investigating the parallels between space flight and terrestrial aging, hoping to find ways to prevent the ill effects of each.
Astronauts and inactive older people suffer similar bone loss, muscle atrophy, blood-vessel changes and even fainting spells, say scientists, and their respective conditions can provide lessons for both domains.
Space flight is the ultimate in sedentary lifestyle
“To me, there really are a lot of overlaps,” said Richard Hughson, a University of Waterloo expert on vascular aging and brain health. “Space flight is the ultimate in sedentary lifestyle. When you’re up in space, you’re floating around, when you want to move a heavy object, you just give it a little push and away it goes.”
Billed as the first formal collaboration of its kind in the world, the project of the Canadian Space Agency and the Canadian Institutes for Health Research hosted a workshop for domestics scientists, doctors and business people in Ottawa earlier this year, and plans a broader international conference in 2013.
Typically in top physical shape, astronauts would seem on the surface to have little in common with seniors, especially those with particularly inactive lifestyles. Yet development of human bodies depends greatly on mechanical forces at play when people walk, lift things and otherwise move the weight of their own bodies or other objects against the ubiquitous pull of gravity.

iPhone EKG Case - Another piece in the Tricorder XPrize?




I thought the iStethoscope was a pretty good missing piece for the Qualcomm TriCorder XPrize.   I blogged about this before < here >. Here is another component which fits nicely.  It won't be long before a powerful point of care diagnostic smart phone finds it way to FDA approval - and an XPrize winner.








This $200 iPhone Case Is An FDA-Approved EKG Machine

HEALTH CARE IS HURTING, AND THE WORLD IS CHANGING. MORE AND MORE, HOSPITALS WILL FIT IN OUR POCKETS.

Most iPhone cases just protect your phone from drops. If you’re getting fancy, it may have a fisheye camera lens or a screen-printed back. But what about diagnosing coronary heart disease, arrhythmia, or congenital heart defects? The AliveCor Heart Monitor is an FDA-approved iPhone case that can be held in your hands (or dramatically pressed against your chest) to produce an EKG/ECG--the infamous green blips pulsing patient-side in hospitals everywhere.
“We think that EKG screening can be as approachable as taking blood pressure,” AliveCor President and CEO Judy Wade tells Co.Design.







There are already apps that take your heartbeat, of course. But there’s a big difference between the fast-paced standards of casual electronics and the strict sanctions of government-approved medical devices. “The heartbeat camera apps are good at wellness,” Wade admits, “but we see ourselves for use by people who want clinical-quality equipment.”







So unlike most iPhone cases that are squirted by Chinese factories at extremely high margins, AliveCor’s case has been in serious development since 2010. Aside from building the gadget itself, to become approved for medical use by the FDA, AliveCor had to participate in two clinical trials to field test both the hardware and the accompanying app. One study investigated how its single-lead EKG compared to a traditional 12-lead device, the other examined if 54 participants could figure out how to use the case properly, with no previous medical training. The latter study was not only successful but led to the diagnosis of two serious heart problems.

THE COMPLICATIONS OF INNOVATING UNDER THE FDA

AliveCor was lucky. Though it took about six months to get the application ready, the approval arrived well within the 90-day approval window, allowing the company to come to market sooner. It was a necessary hassle; FDA approval opens a lot of doors. Instantly, what could be considered some scam iPhone case was marketable to health care professionals--doctors--who’d most likely pay out of pocket for a $200 stethoscope replacement without blinking. FDA approval also allows doctors to prescribe, and potentially have insurance cover, AliveCor’s device for their patients to take home.
But even with an approval in-hand, AliveCor will continue to juggle complicated regulations to stay competitive in the market. For one, the approved monitor was designed for the iPhone 4 and 4S. Before AliveCor can release an iPhone 5 version with the exact same hardware internals, they will need to seek out additional FDA approval. (With previous approval and clinical trials to cite, the process is mostly a formality, but it’s still paperwork that takes more time and resources.)







The company also intends to release an over-the-counter version of the case. The good news is, this device will be eligible for coverage in most employee spending programs. But because of FDA regulations, this OTC version cannot provide the raw EKG data to a consumer who might not know how to interpret the esoteric waveforms. Instead, AliveCor will redesign the app to provide an infographic-esque interpretation of the EKG. “An EKG means something to a trained physician, but we can provide a lot of insights to an untrained consumer that might help explain what triggered a cardiac event,” Wade explains. “Like caffeine is a trigger. With an app, we see being able to offer more insight to an individual about their heart health.”
From a product design standpoint, this second-level data analysis sounds like an ideal, consumer-oriented decision. But from a consumer rights standpoint, why is any government agency standing in the way of consumer access to our own raw data? I can see how strongly my iPhone’s antenna is reaching the nearest cell tower, but I can’t see how well my own heart is ticking inside my body? How absurd is that? Interestingly enough, AliveCor is using this regulation to their advantage, banking on the health care model as it stands now. Its OTC device will offer services to refer you to a physician for deeper result analysis (and access to your actual waveforms, if you’re so concerned), which will provide a backend revenue stream beyond typical hardware sales. Imagine the potential: In-app purchase for a follow-up appointment.







An eagle at the Edinburgh Zoo that had been shot, but AliveCor’s case measured a heartbeat through its feathers. The eagle was deemed fit enough for surgery, underwent the procedure and lived. Needless to say, the device has veterinary applications as well.

THE FUTURE OF MEDICINE

For the time being, AliveCor is continuing to develop their EKG cases into a full line, including that OTC device, which will also be a universal version working for both iOS and Android. (Since the case actually communicates with the phone wirelessly, once the software programming is done, these product differentiations are largely cosmetic in nature.) No doubt, AliveCor sees the case as a stepping stone to the company’s overall vision, that “everyone should have their health at their fingertips,” Wade says. But the company will have to solve a lot of larger problems that the industry is struggling with to make that future a reality.







While diagnostic devices may be coming to the phone, we still have no standards to get such diagnostic information back to our doctors. AliveCor explained to me that it can send a push notification to my cardiologist every time I check my heart, but does my cardiologist really want push notifications all day from their client list? Or worse, would any doctor want a devastating cardiac episode just sitting under 30 other messages in the iOS Notification Center? Should my phone text or not text emergency information? Should doctors be held accountable for app-based information? Should medical devices be regulated to automatically dial 911 in cases of emergency?
No doubt, AliveCor’s Heart Monitor is another case of affordable consumer technology outpacing our brick-and-mortar hospitals, but to the credit of our hospitals, affordable consumer technology is outpacing most of the world. Still, just as Domino’s has figured out to deliver me a pizza through an app (no doubt, saving a few cents in the process), so, too, will the medical community come around to juggling big data at the individual patient level. The real question is, will FDA regulations leave space for the little guys--the weekend app warriors and the Kickstarters--to innovate responsibly, at a price cheaper than clinical trials and a timeframe faster than paperwork?
[Hat tip: Co.Exist]






Wednesday, December 5, 2012

Father of medical informatics, Utah’s Homer Warner dies


In my eHealth studies I had not heard of Homer Warner, but I did hear about Intermountain Healthcare in Utah, where Warner was working, because they did a lot of advanced EHR informatics using HL7.  This story about how he came to use computers in the study of cardiology was fascinating.  


Father of medical informatics, Utah’s Homer Warner dies
Groundbreaking work of cardiologist is still redefining medicine.
First Published Dec 03 2012 04:49 pm • Last Updated Dec 04 2012 08:09 am
Homer Warner, a Utah cardiologist widely recognized as the father of medical informatics, died last week from complications of pancreatitis. He was 90.
Warner’s research is still redefining medicine, colleagues say. Modern intensive care units can be traced back to the electronic systems he built to monitor heart patients in the mid-1950s. And his creation of one of the first electronic medical records in the ‘70s set the stage for a new academic field and multi-billion dollar health IT industry.
     
Photos
At a glance
Funeral services
A public service will be held at noon on Thursday, Dec. 6, at the Foothill Stake Center, 1933 S. 2100 East in Salt Lake City.
In lieu of flowers, the family suggests donations to the Homer R. Warner Scholarship Fund in Medical Informatics at the University of Utah.
Online condolences may be left atwww.larkincares.com.

He had the mind of an intellectual and the soul of an adventurer, captivating University of Utah medical students in a speech just weeks before he died, said his son Homer Warner Jr. "He just had a quiet magnetism about him."
Warner checked into a hospital complaining of stomach pain before Thanksgiving, said his son. He died Nov. 30, about a week later, surrounded by friends and family.
A graduate of East High School, Warner earned his medical degree at the University of Utah in 1949 and then earned a doctorate in physiology from the University of Minnesota. While training in Minnesota, he worked at the Mayo Clinic with cardiologist Earl Wood, who spurred his interest in medical research.
He returned to Utah, where he opened a Cardiovascular Laboratory at LDS Hospital and studied waveforms as a potential path to diagnosing heart patients.
"His real genius was probably in that early work," said Homer Warner Jr. While taking an engineering math course to further his work in 1956, he once stayed up all night to analyze one heart beat using a 3-foot slide ruler.
"I got so excited because it was such an interesting way to look at things," Warner told Peta Owens-Liston, a freelance writer for the U.’s alumni magazine, in 2010. "This was a turning point for me, since it led me to the whole concept of using computers in medicine."
After the U. bought its first digital computer in 1960, Warner worked with graduate students to develop a tool to effectively diagnose congenital heart disease – but doctors were skeptical, he told Owens-Liston.
Two years later he became the chairman of what is now considered the first program to grant degrees in medical informatics. Then called the Department of Biophysics and Bioengineering, it was located in the U.’s engineering school.



In 1968, Warner wrote his first version of a software program to evaluate patient data to guide physicians. He had been inspired by seeing an Intensive Care Unit nurse overwhelmed by information from sensors.
"The venous pressure was rising, the arterial pressure was going down, and the cardiac output was dropping, and she didn’t know what to do," Warner told Owens-Liston.
As the HELP program, for "Health Evaluation through Logical Processing," was further developed, it expanded to include information about drugs, lab tests, pulmonary function testing, patients’ medical history and more. It is now considered one of the nation’s first electronic medical records – and is still operational 40 years later at Intermountain Healthcare hospitals.
"We clearly had a jewel. He gave us a huge advantage," said Intermountain’s Chief Information Officer Marc Probst.
Getting doctors to use computers is still challenging, but Warner chipped away at their resistance by providing them with not just data, but information with the power to improve care, he said.
In a 2011 announcement of the opening of the Homer Warner Center for Informatics Research at Intermountain Medical Center, the hospital chain’s chief quality officer, Brent James said, "Dr. Warner identified the field and then defined that field...It’s hard to describe that contribution, not just to Intermountain, not just to the medical profession, but to the patients that we serve."
Warner’s lab was moved to the U. in 1980 where he continued his research until retiring in 1996. He outlived two of his wives, Katherine Ann Romney and Jeanne Okland, marrying a third, June Okland Cockrell, who survives him.
Next Page >