Monterey County Fair and Event Center Offering Discounted Rate For Tuesday Site Rental

Tuesdays get even brighter at the Monterey County Fair and Event Center when event site rentals are all 10% off through Dec. 31, 2018.

Monterey, CA, Nov 29, 2017 — Tuesdays get even brighter at the  when event site rentals are all 10% off through Dec. 31, 2018.

Book any site at the fairgrounds, including the Payton Garden Stage and four meeting rooms — Monterey, Salinas, King City and Seaside rooms — for a Tuesday event and get the reduced rate.

The following rooms are available under this special Tuesday rate at the event center at 2004 Fairground Road in Monterey. Kitchen use is a separate fee.

Monterey Room

7,000 square feet

Max seated occupancy: 400

Max occupancy: 1,000

Carpeted

Permanent dance floor

P/A system

Built-in Bar

Kitchen

Salinas Room:

7,000 square feet

Max seated occupancy: 400

Max occupancy: 1,000

Non-carpeted

Tall vaulted ceilings

P/A system

Electrical drop boxes

King City Room:

7,000 square feet

Max seated occupancy: 400

Max occupancy: 1,000

Non-carpeted

Tall vaulted ceilings

P/A system

Electrical drop boxes

Seaside Room:

7,000 square feet

Max occupancy: 300

Carpeted

P/A system

Built-in bar

Large commercial kitchen

Floor plans and event request forms are available at . For more information or to book a site, contact the Event Coordinator at (831) 372-5863.

About the Monterey County Fair & Event Center

The  is a premier event center set on 22 oak-studded acres with ample parking. It is a state-owned multi-use facility that features four large banquet rooms, two outdoor concert venues, and a variety of outdoor and indoor cost-effective sites ideal for all types of events. It is 盛兴彩票网 of the annual award-winning Monterey County Fair, host to many major and private events on the Central Coast, and the site of the Monterey Bay Race Place, a Satellite Wagering Facility.

For more information, contact the Fair Administration Office, at 2004 Fairground Road in Monterey, by calling (831) 372-5863 or go to  for more information.

Contact:

Marci Bracco Cain

Chatterbox PR

Salinas, CA 93901

(831) 747-7455

Monterey Law Firm L+G, LLP Becomes JRG Attorneys at Law

Managing Partner Jeff Gilles announced today that L+G, LLP, Attorneys at Law, will change the name of the law firm to Johnson, Rovella, Retterer, Rosenthal & Gilles, LLP and will be doing business as JRG Attorneys At Law, as of Dec. 1, 2017.

Monterey, CA, Nov. 30, 2017 — Managing Partner Jeff Gilles announced today that L+G, LLP, Attorneys at Law, will change the name of the law firm to Johnson, Rovella, Retterer, Rosenthal & Gilles, LLP and will be doing business as  At Law, as of Dec. 1, 2017.

“JRG are my initials, and, they are also the initials of all of my partners,” said Gilles in a letter to staff and clients. “I have worked for over 38 years building a practice and relationships that allow for us to be leaders in our community and in our profession. I have also partnered with those that I truly feel will continue to build upon our legacy of teamwork, commitment and excellence.”

Gilles said the formal name for the Limited Liability Partnership will change to Johnson, Rovella, Retterer, Rosenthal & Gilles, LLP, but is asking that friends and colleagues call the firm simply, “JRG Attorneys at Law.”

“My partners Aaron Johnson, Paul Rovella, Jason Retterer, Bob Rosenthal and I are committed to ensuring that our team provides you the very best in legal services and we will always be Experts in Your Field,” Gilles writes in a letter to clients. “I am positive we have the staff, attorneys and experience to provide you the professional advice and consultation you require, now and for many years to come.”

The firm’s website will also be changed, to .

About 

Jeff Gilles, Managing Partner of JRG Attorneys at Law, started his practice in the 1970s. Since then, he has assembled a team of attorneys and paralegals with offices in downtown Salinas, downtown Hollister, Monterey, as well as services to the South County and Paso Robles areas.

Gilles and his partners, associates, and staff offer legal services ranging from agriculture, business formations and transactions, civil litigation, estate planning, labor and employment, land use, municipal law, planning and zoning, cannabis business, and real estate.

The firm has more than 30 years of experience and more than 30 employees in its offices. For more information about JRG Attorneys at Law, please call (831) 754-2444 or visit JRGattorneys.com.

Contact:

Marci Bracco Cain

Chatterbox PR

Salinas, CA 93901

(831) 747-7455

Coming Soon! Big Sur Foragers Festival January 12-14, 2018

Big Sur Foragers Festival is excited to announce the return of their feature venue, the Fungus Face Off, to longtime partner, Ventana Big Sur, for 2018.

Salinas, CA, November 21, 2017 –  is excited to announce the return of their feature venue, the Fungus Face Off, to longtime partner, Ventana Big Sur, for 2018. The community’s non-profit, , will receive the proceeds from all of the festival events to help support the continued presence of local healthcare services in the Big Sur area.

2018 Includes:

Friday night dinner series with local restaurants giving a percentage of the proceeds to the .

Several local restaurants will host winemaker’s dinners.

The sixth annual Fungus Face Off will take place at Ventana Big Sur Ocean Meadow Lawn. The Big Sur Health Center is looking forward to returning to Ventana Big Sur for 2018.

Tickets On Sale Now

Participants Include:

Chefs/Restaurants

Roy’s

Carmel Valley Ranch

The Sur House at Ventana Big Sur

Alvarado Street Brewery

A Taste of Elegance

Wineries and Breweries

Mesa del Sol

Morgan Winery

Bernardus Winery

Comanche Cellars

Mad Otter Ale

Boony Doon Vineyards

Blair Wines

Baker and Brain

Paul Lato Wines

Fillipponi Winery

Alvarado Street Brewery

Fly Wheel Wine

Chappellet Vineyards

Marketplace Vendors and Tastings:

Carmel Honey 盛兴彩票网

Quail and Olive

Percy Pies

Wild Mushroom Walk and Talk

Details To Be Announced

Contact:

Marci Bracco Cain

Chatterbox PR

Salinas, CA 93901

(831) 747-7455

InPreflight for Adobe InDesign Now Supports Creative Cloud 2018

Zevrix Solutions announces InPreflight Pro 2.11.28, a compatibility update to its document preparation solution for Adobe InDesign. Described as “delightfully simple to use” by Macworld magazine, InPreflight is an all-in-one solution to check InDesign documents for errors, automatically collect multiple files for output and ship them to final destination. The new version makes InPreflight compatible with the 2018 release of InDesign CC featured as part of Adobe Creative Cloud.

Toronto (ON), Canada — Zevrix Solutions today announces the release of InPreflight Pro 2.11.28, a compatibility update to its . InPreflight is a powerful all-in-one solution to check InDesign documents for errors, collect them for output and ship to final destination. InPreflight helps graphics and print professionals prevent costly mistakes by uncovering hidden problems, save disk space through smart batch-packaging and reduce production time and costs.

The new version makes InPreflight compatible with the recently announced 2018 release of InDesign CC, featured as part of Adobe Creative Cloud. The update is offered free of charge to InPreflight users. The same version of InPreflight can be used with any version of InDesign from CS3 and later.

“InPreflight is very simple, it provides excellent display of document’s elements with full control over preflighting and file collection,” says Michael Anikst of Anikst Design in London, UK. “I am designing very big books on art, and InPreflight lets me keep all my documents in perfect order.”

InPreflight Pro provides a robust, affordable, reliable and easy-to-use . It offers the following key features:

Batch-packaging:
– automatically.
-Collect all shared links into one folder, saving gigabytes of disk space and hours of production time.

Quality control:
-Quickly check InDesign fonts, colors and links for common errors.
-Create preflight presets for different projects.
-Uncover hidden issues such as image compression, embedded fonts and illegal link locations.

Graphic preflight reports:
–.
-Detailed paragraph styles report for typography professionals.

Pricing and Availability:
InPreflight Pro can be purchased from Zevrix website for US$99.95 (Studio version: $39.95), as well as from authorized resellers. Trial version is available for download. Update is free for licensed users of version 2, and $50 from earlier versions. InPreflight requires macOS 10.7-10.13 and Adobe InDesign CS3-CC 2018.

About Zevrix Solutions
Located in Toronto, Canada, Zevrix Solutions provides productivity solutions for Adobe Creative Suite software, PDF and graphic file diagnostics and Microsoft Office on Mac OS. Zevrix Solutions is dedicated to helping professionals achieve more while doing less through automating their everyday tasks, producing error-free documents, saving disk space and cutting production costs. For more information, visit http://www.zevrix.com.

Contact:
Leo Revzin
Owner
Zevrix Solutions
105 McCAUL St, Suite 301
Toronto Ontario M5T 2X4 Canada
858-206-0607
media@盛兴彩票网zevrix.com
http://www.zevrix.com

GLDNAcademy.com Kicks off The Cybersecurity Workshop for Today’s Strategic Leaders in Stockholm

How executives in Stockholm, Brussels, Sao Paulo, Mexico City, Kuala Lumpur, Abu Dhabi, Seoul and Hong Kong can build the proper foundation to address today’s information cybersecurity and risk management challenges.

New York City, NY, USA — The Cybersecurity Workshop for Today’s Strategic Leaders will bring the most comprehensive review of what proactive organizations around the world are doing to protect their intellectual property, customers and employee’s information from hackers, competitors and foreign governments. Attendees to these 2-day workshops organized by in Stockholm, Brussels, Sao Paulo, Mexico City, Kuala Lumpur, Abu Dhabi, Seoul and Hong Kong will:

• Gain a comprehensive understanding of cybersecurity and its key aspects
• Get to grips with various cybersecurity testing methods
• Master the cybersecurity framework and its five core functions
• Discover how to establish or improve your cybersecurity program
• Gain an overview of cyber network defense
• Transform the “weak human link” into the organization’s greatest strength
• Look at the four components of the cyber preparedness continuum

will provide insights into the current and future state of affairs for cybersecurity, with particular emphasis on what organizations can do today to prevent cyberattacks from compromising their information and reputation.

ABOUT THE CYBERSECURITY WORKSHOP FOR TODAY’S STRATEGIC LEADERS
Despite the ongoing cyber threat that is witnessed through news reports almost on a daily basis, firms are still neglecting proper cybersecurity planning. As information technology becomes ever more complex and Internet of Things applications progressively widespread, cybersecurity is becoming an increasingly important and business-critical field. Unfortunately, a recent study from security solutions provider Resilient Systems and market research firm Ponemon broke down key areas of continued failure for organizations.

The study found that 66% of IT and security professionals surveyed said their firms were unprepared to recover from a cyber attack, and 75% lacked a formal incident response plan. A key example of this unpreparedness is that fact that many of the companies impacted by the WannaCry ransomware attack had not installed patches in their Windows infrastructure that were released by Microsoft months before. Vulnerabilities in commercial software are common; the only solution is to stay abreast of manufacturer’s releases.

In order to help businesses in their cybersecurity planning, the Cybersecurity Framework released in February 2014 following a collaborative process involving industry, academia and government has been widely adopted by many types of organizations around the world, quickly becoming the de facto standard by which cyber security is going to be measured.

GLDNAcademy.com’s The Cybersecurity Workshop for Today’s Strategic Leaders will bring leaders up to speed on the most recent and battle-tested approaches to protect their companies’ valuable information and intellectual property from prying eyes of hackers and competitors. Attendees to the program will learn how to apply the Cybersecurity Framework in their organizations and erect strong defenses for their valuable customer and employee data and intellectual property.

ABOUT GLDNACADEMY.COM
GLDNAcademy.com invites CEOs, board members, managers, leaders and professionals to expand their horizons:

• To engage with an experienced faculty that exhibits the deepest knowledge across the most practical and challenging matters that really matter for businesses today
• To meet fellow leaders, entrepreneurs, executives, managers, investors and regulators looking for the industry insights that will move the needle in their organizations
• To become part of the most engaging professional network of leaders in the world

GLDNAcademy.com offers seminars in dozens of industries and functional areas. Each and all of these programs incorporate the following:

• State-of-the-art workshops that incorporate hundreds of hours delivering the best
• Relevant programs offered in the top business capitals of the world
• Pre-program questionnaires that provide key information that permeates our offerings
• World-class faculty with access to the top echelons of the world’s most innovative organizations
• Thousands of satisfied attendees from all over the world

Media Contact:
Melania Pulitzer
Managing Director
GLDNAcademy.com
+1-414-FORUMS0
mjp@盛兴彩票网gldnacademy.com
http://www.gldnacademy.com

Output Factory for Adobe InDesign Now Supports Creative Cloud 2018

Zevrix Solutions announces Output Factory 2.2.1, a compatibility update to company’s output automation solution for Adobe InDesign. Output Factory automates printing, exporting and post-processing from InDesign and offers batch processing, export as single pages, variable file names, layer versioning, preflighting, detailed history and more. The new version makes Output Factory compatible with the recently released InDesign CC 2018 and improves the reliability of multi-format workflow output.

Toronto (ON), Canada — Zevrix Solutions today announces the release of Output Factory 2.2.1, a compatibility update to company’s solution to . Output Factory automates and simplifies workflows of printers, prepress bureaus, ad agencies and publishing houses worldwide by offering batch processing with powerful and time-saving output options.

The new version makes Output Factory compatible with the recently released InDesign CC 2018 and is offered free of charge to licensed users. The same version of Output Factory can be used with any version of InDesign from CS5 and later. The update also addresses an issue in which Output Factory could stall when running sequences of multi-format output workflows.

“When every second counts Output Factory is a life saver!” says Glen Saville of Glen Saville Design studio, Hornchurch, UK. “It’s a sublime beast that saves a lot of time. I just drag my files into the job list, set them up as I want and then sit back and watch the computer do its stuff.”

Output Factory supports printing as well as exporting to PDF, PostScript, EPS, Flash, IDML, EPUB and several image formats. It offers the following key features:


-Output as single pages
-Create custom workflows for different job targets
-Output files to multiple formats with one click

-Layer versioning: output layer combinations as single files
-Preflight InDesign documents and skip the ones with errors
-Split InDesign files into single pages

-Keep track of jobs, output files and errors

Pricing and Availability:
Output Factory can be purchased from Zevrix website for US$169.95 (Lite version $119.95), as well as from authorized resellers and Adobe Exchange. Trial is also available for download. The update is free for the users of Output Factory 2.x, and $84.97 to upgrade from BatchOutput and Output Factory 1.x. Output Factory requires macOS 10.7-10.13 and Adobe InDesign CS3-CC 2018.

About Zevrix Solutions
Located in Toronto, Canada, Zevrix Solutions provides productivity solutions for Adobe Creative Suite software, PDF workflows, graphic file diagnostics, file delivery and Microsoft Office on Mac OS. Zevrix is dedicated to help professionals increase their profits through automating everyday tasks, producing error-free documents, saving disk space and cutting production costs. For more information, visit http://www.zevrix.com.

Contact:
Leo Revzin
Owner
Zevrix Solutions
105 McCAUL St, Suite 301
Toronto Ontario M5T 2X4 Canada
858-206-0607
media@盛兴彩票网zevrix.com
http://www.zevrix.com

FED Publishing Releases New Book, “My Journey, A Victory Over Cancer Through Alternative Methods” by Valarie Hendriks

My Journey, A Victory Over Cancer Through Alternative Methods, by Valarie Hendriks, is a story about one courageous woman’s journey and victory over cancer through alternative methods.

Oakland Township, MI, USA — Valarie Hendriks’ My Journey, A Victory Over Cancer Through Alternative Methods is a book that will make you laugh, make you cry, inspire you and motivate you. However, most of all it will help you in battling one of the most dreaded diseases plaguing mankind, cancer.

Valarie Hendriks grew up in the Midwest part of the United States. After college she got a job in the Optical field and is currently working as a Manager and ABO Certified Optician. Along the way she got married to her spouse of twenty five years. Her hobbies are tennis, horseback riding and Ball Room Dancing. She competed in Ball Room Dancing and won several competitions over her career. Then one day she was diagnosed with cancer. At this point in her life she thought her entire world was falling apart. However, she was determined to defeat this dreaded disease.

Her book My Journey, A Victory Over Cancer Through Alternative Methods is a book that Valarie wrote that outlines how she beat cancer. In her book she provides all of the information that she learned through two years of research so that she could help other people in their battle against cancer without going through the trauma of traditional cancer treatments. Her book is uplifting, inspiring, and motivational. It will make you laugh and it will make you cry but most of all it could help you to defeat one of the most dreaded diseases in the world, the disease that we call cancer.

Genre – Cancer, Cure, Alternative Methods, Alternative Medicine, Cancer Cure, Inspiration, Treatment, Motivational

The ebook version of My Journey, A Victory Over Cancer Through Alternative Methods ISBN 9781506903477, published by First Edition Design Publishing (), is available on-line wherever ebooks are sold. The 194 page print book version, ISBN 9781506903460, and ISBN 9781506903453 hardback, are published by First Edition Design Publishing and distributed worldwide to online booksellers.

Media Contact:
Valarie Hendriks
+1(941)921-2607
monty-nbf@盛兴彩票网att.net

SmartTOP Soft Top Control for Mercedes-Benz C-Class Cabriolet from Mods4cars

The new SmartTOP soft top control for the Mercedes-Benz C-Class Cabriolet (A205) is now available. The retrofitted comfort module from Mods4cars makes it possible to open and close the convertible roof from a distance via the original vehicle key. In addition, the top can be operated within the vehicles interior with One-Touch. The soft top button no longer has to be continuously held down.

Las Vegas, NV (USA), November 9th, 2017 — The retrofit SmartTOP module is now available for the new C-Class Cabriolet (A205) from Mercedes-Benz. With smart functions, it facilitates the everyday life of the convertible user. This ensures, among other things, that the top is opened or closed automatically after just a tip on the top button. It is thereby no longer necessary to keep the button pressed down during the entire top movement.

Furthermore, with the SmartTOP module, the convertible top of the C-Class convertible can be operated from a distance via the existing vehicle key. Pressing a key combination on the remote control activates the convertible top movement. “Our customers can open the top as they approach their vehicle and start their drive open,” explains PR spokesman Sven Tornow. A change to the vehicles remote control is not needed.

The latest also offers, besides these main functions, various additional functions: The windows can be controlled via the remote control. It is adjustable whether the front or all windows should be closed automatically after the top opening. All windows can be closed by One-Touch via the centre console button.

On vehicles with a keyless entry package, the convertible top can be operated by touching the door latch. The function “Tear-Wipe” was developed on customer request and ensures that the windscreen is wiped once or twice more after a short pause once the use of the spray nozzles has been activated. All functions of the SmartTOP roof module can be programmed according to personal wishes.

The SmartTOP module is equipped with an USB port to connect the cabriolet module to the 盛兴彩票网 PC / MAC. In this way the module can be configured and software updates, which are made available by Mods4cars free of charge, can be implemented.

In addition, a plug-and-play cable kit is included in the delivery, which ensures an easy installation. The connection between vehicle electronics and SmartTOP is made by simply plugging together. Plug-in adapter in original equipment quality ensure 100% accuracy. No cables need to be cut through and the module can be removed without a trace.

Since 2001, the company Mods4cars has been manufacturing its for all common convertible models. The following vehicle brands are supported: Alfa, Audi, Bentley, BMW, Chevrolet, Ferrari, Ford, Infiniti, Jaguar, Lamborghini, Mazda, Mercedes-Benz, Mini, Nissan, Opel, Peugeot, Porsche, Renault, Volvo and Volkswagen.

The SmartTOP module for the Mercedes-Benz C-Class Cabriolet (A205) is available for 339,00 Euro + tax.

A product video can be viewed here:

For more Information:

About Mods4cars:
Mods4cars was founded in 2002 from the idea to add a highly demanded feature to the otherwise almost perfect Porsche Boxster: Comfort One-Touch roof operation while driving at slow speeds. The resulting product offered not only that, but also allowed quick and easy installation by just swapping out a relay box, thus leaving no traces and no permanent changes on the vehicle. The first SmartTOP roof controller was born.

The success of their first products in Germany and Europe prompted them in late 2004 to move operations to the USA, to be able to serve the American market as well as all other English speaking countries such as Australia, UK and South Africa from one central location. Their business has grown to a full-fledged international corporation with an office in Las Vegas and a full line of innovative products as well as distributors and installation partners all over the globe.

Being highly specialized in the development and distribution of aftermarket roof- and comfort controllers since 2002 allows them to offer an unsurpassed level of competence and product quality. Their main goal is optimization of each individual product to a maximum in compatibility, usability and intuitive operation. They put greatest effort into development and quality checks of all their products to achieve this goal and meet all expectations of their customers.

The extraordinary success of their products is also based on the great communication with their customers, which usually already starts for each new product during the development and prototyping phase.

Press & Media Contact:
Sven Tornow
Mods4cars LLC
1350 E. Flamingo Rd #3100,
Las Vegas, NV 89119 – USA
+1-310-9109055
tornow@盛兴彩票网mods4cars.com
http://www.mods4cars.com

“Finding the Beautiful You” Guides Readers to Discover Their True Self

We all struggle with our self-confidence at some point and often question our self-worth. In Lisa Cassman’s latest book, “Finding the Beautiful You” she helps readers discover who they are.

San Antonio, TX (USA), November 9th, 2017 — Are you plagued by an inner voice reminding you of your faults and shortcomings? We all struggle with our self-confidence at some point and often question our self-worth. In Lisa Cassman’s latest book, “Finding the Beautiful You” she helps readers discover who they are. With a pen in one hand and the Bible in the other, Cassman guides readers through the process of examining their self-worth to truly find their beautiful self.

“As a licensed minister and motivational speaker, women frequently approach me asking for a book that outlines the content of my workshops on self-confidence,” said Lisa Cassman, author. “I realized that women were hungry for a guide that would help them address past hurts and disappointments so they could focus on the joy the future holds as their true beautiful self.” Thus, the birth of “Finding the Beautiful You.”

In Cassman’s book, she offers a variety of interactive exercises that force readers to truly absorb the information and personalize the content to help with their own self-discovery. Used as a workbook, readers are encouraged to write their thoughts to emotional prompts like “I wish I could change…”

Additionally, throughout the book, readers are directed to read specific scripture passages and write down their feelings. Cassman has selected a variety of Biblical text to support her belief that God loves us and has a special and unique purpose for each of us. “Finding the Beautiful You” was written to help readers discover the positive message that can be found in scripture and our own self-examination.

“It is one thing to read a book, but another to truly be immersed in the content,” said Cassman. “By encouraging readers to examine the hurts and disappointments in their past; take them out, look at them, forgive themselves and then finally put them behind them, I hope readers will finally see their wonderful value.”

“I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well.” Psalm 139:14 ()

“The minute we give God our cares and concerns to carry, He lightens our load,” said Cassman. “However, we also need to forgive ourselves and let go. Through “Finding the Beautiful You” I hope that readers will finally be able to put aside their fears and concerns and focus on the positive message God has for our life.”

“This is a beautiful book,” said Lisa Umina, founder and president of . “The format is very user-friendly. I found that I had a pencil close at hand to jot down my thoughts and my Bible next to me so that I could immediately read the scripture Lisa mentions. She doesn’t give the answers but encourages the readers to take part in the process and find peace and understanding within the word of God.”

Finding the Beautiful You is now available at Halo Publishing, Amazon and Barnes and Noble, in paperback for $12.95 and $6.99 for the e-book. Visit http://www.lisacassman.com to learn more about her workshop “New You – New Life:  7 Steps to Boosting Self Confidence” and her other services.

*
*
* and now . Through the inspiration of her husband Steve and spending six months riding with him in his semi-truck traveling the west coast, Lisa has taken her pastors degree and her work in Christian counseling to offer many unique and positive ways to a more successful marriage. Growing up and living most of her life in Minnesota, Lisa plans on continuing traveling only now as a couple visiting churches to host marriage seminars based on her book.

Press & Media Contact:
Lisa M. Umina, Publisher
Halo Publishing International
1100 NW Loop 410, Suite 700-176
San Antonio, TX 78213 – USA
+1 877-705-9647
contact@盛兴彩票网halopublishing.com
http://www.halopublishing.com

Significant Cost Reduction in COPD Care With Simple, Drug-free Device

Aerobika® OPEP device proves to be a cost-effective treatment option in the management of post-exacerbation COPD patients.

Plattsburgh, NY, USA — The Aerobika® Oscillating Positive Expiratory Pressure (OPEP) device (Monaghan Medical Corporation) is a cost-effective treatment option in the management of COPD exacerbations, according to a study published October 20th in the International Journal of COPD.[1] This study, which used data from the published literature and national fee schedules to model the cost-effectiveness of the Aerobika® OPEP device, shows that it provides both clinical benefit and direct medical cost savings in a post-exacerbation care COPD population.

COPD is a major (and growing) source of morbidity, mortality and healthcare utilization, with hospitalization for acute exacerbations being the biggest cost driver.[2] Once a patient experiences an exacerbation, the risk of further exacerbation is increased two- to four-fold[3], and many patients experience two or three exacerbations every year.[4] As many as one in five patients discharged from hospital following an exacerbation are re-admitted within 30 days.[5]

The economic burden on the healthcare system associated with COPD is significant; in the US alone, the cost of COPD in 2010 was estimated to be US $50 billion; $30 billion in direct healthcare expenditure, with the remainder accounted for by indirect costs such as productivity losses and costs to families.[6] Approximately half of the direct costs could be accounted for by hospital care for COPD exacerbations,[6] which supports the GOLD guideline treatment goals of minimizing the negative impact of exacerbations and preventing recurrences.[2] Healthcare systems in many countries acknowledge the problem, and policies are now being put in place to try to address it; the US Medicare Hospital Readmission Reduction Program penalizes hospitals for excess 30-day, all-cause readmissions after a hospitalization for an acute exacerbation of COPD.[7]

The Aerobika® OPEP device is a drug-free, handheld mechanical oscillating positive expiratory pressure (OPEP) device that has been designed to address the structural and functional challenges in the airways of patients with COPD. When the patient exhales through the device, it helps to expand the airways, loosen and expel mucus from the lungs and may also enhance drug deposition. It has been shown to improve lung function, exercise capacity and quality of life in COPD patients,[8] and a recent real-word study showed that the device reduced exacerbation rates in patients during the critical 30-day post-exacerbation period.[9] Using data from the latter study to provide real-world input, the authors of this current analysis showed cost savings ($553 per patient) and improved outcomes (equivalent to 6 fewer exacerbations per 100 patients per year) with the Aerobika® OPEP device compared with no OPEP/PEP use, and concluded that the device provides cost-effective treatment for post-exacerbation COPD patients.

The authors also used various scenarios to investigate the likelihood of the benefit continuing over a full year, and predicted further clinical and cost benefits (21 exacerbations per 100 patients per year; cost savings of $1,952 per patient). Author Dominic Coppolo, MBA, RRT, FAARC, Vice President Clinical Strategy and Development noted, “Our model provides evidence of clinical and cost benefits of the Aerobika® OPEP device in that critical 30-day period following an exacerbation. Given the high burden of COPD – in particular, costs relating to exacerbations – in the US population, we would expect that even a small benefit would have a significant impact on the healthcare system”. He went on to say that, although further studies would be needed to validate the long-term effectiveness, these data also give a good indication that the benefits will be sustained with long-term use.

“With the increasing pressure to improve care and reduce hospital admissions, the previously-published real-world study showing exacerbation reductions in the critical 30-day post exacerbation period gave us useful insights into the benefits of integrating the Aerobika® OPEP device into standard clinical practice”, noted Dr Jason Suggett (Group Director of Global Science and Technology, TMI). “This new analysis now gives us clear evidence that such clinical benefits would be translated into cost-effectiveness in this post-exacerbation population. In addition, new data presented at CHEST 2017 demonstrating that the generation of the proprietary pressure/oscillation pattern of the Aerobika* device efficiently generates oscillations throughout a high percentage of each exhaled breath, and with consistently high pressure amplitudes. The Aerobika* device demonstrated efficient and effective performance related to therapeutic effectiveness nearly twice that of other devices tested.”[10]

About Monaghan Medical Corporation (MMC, USA)
MMC offers leading aerosol drug delivery devices and respiratory management products including AeroEclipse® II BAN, AeroChamber Plus® aVHC and the Aerobika® device () exclusively in the United States. MMC’s strength lies in product development around core capabilities in mechanical design complimented by collaboration with a state-of-the-art aerosol research laboratory. MMC focuses on developing cost-efficient, outcome-based solutions for its customers.

About the Aerobika® device
The Aerobika® OPEP device () is a hand-held, robust, easy-to-use, drug-free oscillating positive expiratory pressure (OPEP) device designed to help expel mucus from the lungs, expand airways and enhance drug deposition. When the patient exhales through the device, intermittent resistance creates a unique pressure-oscillation dynamic, which expands the airways, helps expel the mucus to the upper airways where it can be coughed out. The Aerobika® OPEP device is designed to function independent of angle of use or flow rate, and allows for a direct aerosol pathway for patients using a nebulizer for medication delivery. The Aerobika® OPEP device has been shown to significantly improve forced vital capacity (FVC), 6-min walk distance (6MWD), and St. George’s Respiratory Questionnaire (SGRQ) score in COPD patients.[8] The Aerobika® OPEP device is available in the US via Monaghan Medical Corporation (), and in Canada, Mexico, and select European countries including the UK and Germany through Trudell Medical International ().

About the study
A one-year Markov model was used to estimate the cost-effectiveness of the Aerobika® OPEP device in patients who had experienced an exacerbation in the previous month, or a post-exacerbation care population, with input data from the published literature and national fee schedules. Using a base-case assumption that the benefit of the Aerobika® OPEP device would last 30 days, cost-savings ($553 per patient) and improved outcomes (ie, 6 fewer exacerbations per 100 patients per year) were demonstrated when compared with no OPEP/positive expiratory pressure use. Assuming a scenario with effect beyond the conservative 30 day time frame, the Aerobika® OPEP device continued to show benefit (21 exacerbations per 100 patients per year; cost savings of $1,952 per patient). One-way sensitivity analyses were conducted for all input variables, increasing or decreasing the effect by 20%, to determine the impact of change on costs and health effects; the results supported the robustness of the base-case conclusions.

For clinical inquiries, please contact:
Dominic P. Coppolo, MBA, RRT, FAARC
Vice President Clinical Strategy and Development
Monaghan Medical Corporation
1-800-343-9071

Words or phrases accompanied by ® are trademarks and registered trademarks of Monaghan Medical Corporation or an affiliate of Monaghan Medical Corporation. © 2017 Monaghan Medical Corporation.

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