Indiana study profiles local pandemic planning problems

first_img “This is aggravated by federal communication efforts that confuse the two,” the researchers write. Rivalry between hospital systems that impaired coordination (though it was found that a mediator could reduce this problem) Vagueness regarding the roles and responsibilities of local public health, emergency management, and healthcare officials In addition, “Several counties with nursing schools operating within their borders have explored the idea of utilizing nursing students as care extenders, but the efficacy of this will depend in part on school decisions on how to respond to a pandemic event and whether to continue operations,” the report says. Also, it was not known whether any of the counties had checked whether students were willing to serve. The study was part of an effort by researchers at Purdue University to develop a planning template for ways to provide surge capacity to care for a flood of patients during a pandemic. The researchers interviewed public health, emergency preparedness, and hospital officials in 11 representative Indiana counties between November 2006 and August 2007; questionnaires were tested in two other counties. Interviews were conducted by telephone and on-site. In line with these plans, nearly all counties had a basic communication plan to inform the public about the disease and the local response and to direct patients to the most appropriate source of care. However, many county planners focused only on media services located within the county, rather than the sources most used by the local citizenry. For example, one surburban county planned to use the only radio station based in the county, a college station with a weak signal, instead of higher-rated TV and radio stations in the next county. In the face of this reality, “Almost all counties were giving consideration to altered standards of care to stretch resources, but were wary of this option due to liability concerns and lack of statutory protection from malpractice claims, a concern heightened by lack of guidance from state and federal governments,” the report states. Unrealistic expectations for outside help, such as material support from the National Guard or the governor’s office—a misperception grounded in experience with localized disasters such as floods In addition, planning and coordination were hindered by blurry agency roles and mismatches between political boundaries and local healthcare market boundaries. The study also showed that most hospitals were hoping to deal with the influx of pandemic flu patients largely by reducing demand for services, mainly through triage systems. Hospital officials expressed concern about making ends meet during the pressures of a pandemic, the study says. One hospital thought it would have to shut down, while others suggested they would have to rely on federal and state disaster assistance funds to get by. “Few considered the fact that most patients would be insured and that they could use usual mechanism to seek reimbursement for care which might provide a revenue stream,” the authors write. “With few exceptions, planners failed to look beyond their borders, whether to identify resources to support their population or to identify additional demand for resources in their jurisdiction,” the researchers write. “Because planning responsibilities are defined by local political jurisdictions, most focused only on those jurisdictions, with efforts to initiate intercounty cooperation rarely noted.” Managing demandMost of the counties chose to deal with hospital capacity problems during a pandemic at least partly by reducing the demand for hospital services, usually by means of a triage system to save hospital beds for those in greatest medical need, the researchers found. Because of concern about spreading flu, officials were discussing plans to separate flu patients from other patients or to locate triage functions outside the hospital, such as in tent clinics or school gyms. Interviews with health officials in 11 Indiana counties showed recent progress in pandemic planning, but also pointed up many difficulties, according to the report in the Journal of Homeland Security and Emergency Management. On the logistical and financial front, the leading concern was possible shortages of medical supplies, especially drugs and personal protective equipment, the researchers found. The economic pressure to run lean operations was cited as an obstacle to the stockpiling of supplies for emergency use. The authors suggest that, given the differences between political units and healthcare service areas, planning for providing surge capacity would be better done at the regional level than the local level. Among misunderstandings, some planners thought a pandemic would involve such high rates of illness and death that planning would be useless, and many officials had unrealistic expectations about getting help from outside sources such as the National Guard or the state governor. Jul 9, 2008 (CIDRAP News) – A study from Indiana reveals a long list of problems hampering county-level planning for pandemic influenza, ranging from misunderstanding of the threat and lack of coordination and resources to rivalry between hospital systems.center_img The researchers, with George H. Avery as first author, found that planners generally had made progress but had a long way to go. Misperception of the threatIn some counties, officials’ view of the likely impact of a pandemic amounted to “a synthesis of misinformation, resulting in a perception of impact which exceeds the worst cases historically observed,” the article states. Using retired physicians, student nursesConcerning staffing, the counties generally had tried to follow guidance in the federal pandemic flu plan, but they ran into some problems with it. For example, most counties had begun to develop a reserve list of retired or inactive physicians and nurses who could help in a pandemic. But local officials complained of a lack of state guidance on licensing and credentials, and few had addressed the problem of malpractice insurance for those workers. “While planners, for the most part, were committing a significant effort in trying to develop a pandemic influenza plan, and in fact had made large strides over the previous year, the plans developed were still crude and required much more work,” the report says. They also note other researchers’ observation that the idea of using alternative sites to provide surge capacity in a pandemic is widespread, but it is not clear just how these sites would work or even if they would be feasible. They write, “Significant barriers exist to the use of alternative care sites for building hospital surge capacity, and any attempt to develop such capacity should focus on how alternative care arrangements fit into the overall local emergency management and healthcare systems. More important than the alternative care site is the strategy for an alternative care system.” In the realm of planning and coordination, one major problem was that political boundaries “bear little resemblance to the geography of local healthcare markets, resulting in a mismatch between the way resources are used and the plans formulated for using them to meet the demands of a pandemic.” The researchers also found various other problems in planning and coordination, including: “This confusion resulted in a sense of helplessness among some planning teams, resulting from a belief that any planning would be rendered useless by the magnitude of the problem,” the report states. “This indicates a need for more care in risk communication by federal, state, international, and academic public health experts.” Local officials were also looking at other tools to limit demand for hospital services, including “public information efforts to convince those with the disease to utilize self-care when possible, creation of dedicated outpatient flu and fever clinics, and public education programs to prevent exposure by encouraging social distancing,” the report states. One county hospital that looked into insurance reimbursement during a pandemic learned that care would be covered only if it was provided in the hospital’s own facility, a restriction that would limit options for expanding capacity, the report notes. Other hospital officials assumed that the pressures of a pandemic would drive insurers into bankruptcy. A message the researchers heard from all the counties was that flu patients would not be the only demand on healthcare organizations during a pandemic. Officials said other healthcare needs would continue, such as trauma, childbirth, and medical emergencies. Consequently, not all beds could be allocated to flu patients, and hospitals will need to take steps to prevent flu from spreading to other patients. For example, several counties expected illness attack rates greater than 50% and a case-fatality rate of 50%. The researchers determined that officials derived this view by linking the high case-fatality rate in the (rare) human cases of H5N1 influenza with the high attack rate in the 1918 pandemic. The scientists grouped their findings into six categories: impact perception, planning and coordination, staffing, logistical and financial barriers, demand management, and dealing with other healthcare needs during a pandemic. Among lessons drawn from their findings, the authors say that legal and institutional barriers may limit planning in ways that are not obvious and that planners may not have the authority to address such problems. “Issues such as insurance reimbursement, malpractice and liability insurance, and scope of practice rules constrain the solution set for local planners, and require policy action at a state or federal level to solve,” they state. Avery GH, Lawley M, Garret S, et al. Planning for pandemic influenza: lessons from the experiences of thirteen Indiana counties. J Homeland Secur Emerg Manage 2008;5(1):29 [Abstract]last_img read more

Castro added that StatefulSets gives traditional a

first_imgCastro added that StatefulSets gives traditional applications “a place to go,” so users can reap the benefits of Kubernetes without being forced to rewrite applications.Kubernetes 1.5 sort of marks a passing over the hump of “It’s interesting technology; we should take a look at it,” to, “We’re actively testing our applications on it,” said Castro. In version 1.6, companies should expect to see new opportunities for the community to scale out its Kubernetes expertise and knowledge, which in turn leads to more contributors and participants, he said.Another feature worth highlighting in this release is Federation, which means someone can take an individual Kubernetes environment and pair it or federate it with a second or multiple other Kubernetes environments to make them look like one pool of resources, said Gracely. He said this is important because companies can enable their data centers to use additional public cloud resources, allowing them to have a technology that allows them to think about how to go beyond the walls of their data center, but still have the visibility and control over what those environments look like.Limitations of Kubernetes 1.5StatefulSets, kubeadm and other features are still in beta, but they are seeing quick development, said Castro. The parts that still need work included installation, upgrades and configuration, because they are not where they should be, especially on bare metal, he said.“Every organization is different, especially networking, so it can be challenging to help someone set up a cluster if they don’t have a high level of control of their infrastructure,” said Castro. “We strongly believe that the only way to do this is to stop treating bare metal as a unique snowflake and to model it like a cloud. Users who use metal-as-a-service to model their hardware and network as a cloud have a significantly easier time standing up Kubernetes.”The one big thing Kubernetes will need to tackle is upgrades, because “releasing every three months is brutal for users,” said Castro.“Nailing a reliable and repeatable upgrade process is the thing I’m most excited about in 2017,” he said.Kubernetes community velocityKubernetes 1.5 was also evidence that its ecosystem is growing rapidly, which benefits partners like Canonical and Red Hat, which already provide commercial services for Kubernetes users.Castro said Canonical stands up and operates Kubernetes for customers through a program called BootStack, which is similar to what Canonical has been doing with OpenStack for years. Canonical is also standing up a production Kubernetes cluster for its snap store, which will serve software packages to Arch, Fedora, Gentoo and Ubuntu users, said Castro.Red Hat uses Kubernetes technology as the core of its OpenShift technology, and it delivers that as a software element to customers who want to run their own software. Red Hat also uses Kubernetes for its day-to-day operations for what it calls OpenShift Online or OpenShift Dedicated, said Gracely. This means Red Hat operates the technology for customers who just want to use containers and build new apps.Besides checking out Kubernetes partners for additional resources, Gracely suggested Kubernetes users read about recently added features and updates of Kubernetes 1.5, and to have teams “get their hands dirty” by testing it out. More companies are adopting container technology to achieve things like developer efficiency, and while Docker remains a leader in container technology, Kubernetes is a choice for container orchestration and management, according to a recent ClusterHQ report. The most recent version of the open-source project, Kubernetes 1.5, includes several new features that can be beneficial and help teams optimize container usage in their organization.The current state of containers has hit a tipping point, according to Red Hat’s director of product strategy, Brian Gracely, and businesses are finally saying that they need to be faster and more responsive as to what is going on in the market, he noted.(Related: Kubernetes gets support for Windows Server 2016)As companies try to iterate more quickly, they end up having to rely on individuals to update or make sure the systems are secure and scaling appropriately. Instead of doing these processes manually, companies can utilize Kubernetes so it run things automatically, said Gracely.“[Kubernetes has] become this technology that we were able to leverage out of the big global web-scale cloud providers, and it’s becoming very applicable to lots of vertical businesses and lots of vertical industries,” he said.When Kubernetes first came out, it was designed for the mindset of “Let’s use this technology to build new apps,” whether it be mobile or IoT or any other type of application, said Gracely. Now, the technology has created two paths for companies to take, where they can either apply the technology to new projects or figure out how they can add it to their portfolios, he said.“The latest release of Kubernetes 1.5 is really the beginning of the Kubernetes community saying, ‘We have something really good, we are seeing a lot of adoption, we are seeing a lot of contribution, and we are seeing real customers say help us solve more problems,’ ” said Gracely.Key features of Kubernetes 1.5Kubernetes 1.5 introduced solutions for those looking to run a distributed database on Kubernetes, including solutions on how to guarantee application disruption service-level objectives (SLO) for stateful and stateless apps, according to the Kubernetes team. Kubernetes 1.5 is also special because StatefulSet and PodDisruptionBudget moved into beta. These features “provide an easier way to deploy and scale stateful applications, and make it possible to perform cluster operations like node upgrade without violating application disruption SLOs,” the team wrote.Gracely said that StatefulSet allows companies to bring their applications right into a Kubernetes environment and run them in containers. The system gives teams much of the look and feel they had in their environments, but for customers, this means they have a more consistent platform and they do not lose out on functionality, he said.Jorge Castro, cloud community liaison on the Canonical cloud developer operations team, said StatefulSets are “the most interesting” feature of the 1.5 release, mostly because it “allows traditional workloads to have a place in the new world.”“It can be frustrating to hear about all the great things containers can provide you, and then finish that off with ‘…but you need to rewrite all your applications,’ ” he said. “That’s not an option for a large swath of enterprise applications. If I’m looking at cloud-native infrastructure for all my future applications, and I have still have to maintain infrastructure for traditional applications, now I have two problems.”last_img read more

Employees unique skills and expertise determine w

first_imgEmployees’ unique skills and expertise determine what software they will deliver, how profitable it will be for the company and what benefits it will bring to the customer.Employees create a collaborative culture in software development. Dynamic collaboration is the basis of the popular DevOps strategy that puts together software development and software operations. And although tools can support DevOps, only people can make it alive by spreading the collaborative culture.Employees build up customer relationships. Collaboration in software development supposes active interaction with customers. And only employees can ensure an individual approach to each customer, thus forging long-term partnerships.When tools outdo peopleHuman collaboration can exist without tools. However, collaboration tools offer teams and an entire software development company several advantages.Connecting people remotely. Team members differ by character, position, communication habits, interests, so it can be hard for them to collaborate in person. Fortunately, with a tool on their hands, employees can collaborate even without meeting each other.Keeping collaboration records. Once people stop their communication, it’s only saved in their minds. So even two days later, it’s hard to remember in detail what was discussed. Tools allow recording all the collaboration so that employees review and reuse it or its components at any moment.Support teams’ unity. Using tools, newcomers can assimilate with other team members and get involved in a software development project quicker.Enable continuous collaboration between a software development company and their customers. Tools support collaboration regardless of physical location of the involved parties. Five critical requirements to collaboration tools in software developmentAs you can see, the role of collaboration tools in the software development process is essential. But there is a certain risk too. For example, if a team member doesn’t fit the project requirements, he or she can be replaced quickly with no impact on the project. But if a collaboration tool is ineffective, it can take some time to identify the problem and to replace the tool.So choosing tools, make sure they meet the following requirements:Cover different collaboration scenarios. To ensure quality software development services, the company should enable quality collaboration between all the stakeholders. So collaboration tools should support BAs-to-developers, PMs-to-BAs, PMs-to-customers and other collaboration scenarios equally well.Structure collaboration. When collaboration becomes massive, it’s critical to structure it and make it suitable for further reuse. For example, threads in such collaboration tools as Microsoft Teams or Slack allow finding relevant pieces of information by subtopics.Meet collaboration habits of different users. Software developers are usually introverts and aren’t interested in communication, while business analysts can be quite chatty. So consider implementing a tool that will support collaboration adepts and won’t annoy closed-off employees, along with keeping them tuned into the project.Enable external users to participate. When customers participate in the software development process actively, collaboration tools should be available for them too.Integrate with other solutions. If a collaboration tool is integrated with other enterprise systems (a CRM, ERP or a project management system), you can manage a project taking into consideration all the information about the customer and previous communication experience.Support the synergy of people and toolsAs you can see, collaboration tools are often indispensable to lead the software development project to success. They can structure collaboration, make it manageable and reusable. At the same time, the human factor is crucial. If a team is disintegrated even effective tools can’t guarantee success. That’s why organizations should support the synergy of employees and collaboration tools and to foster a collaborative culture to reach positive results. The success of a software development project depends on individual skills of the dedicated specialists, as well as on how effectively they complement each other and collaborate. At the same time, collaboration itself often rolls within collaboration tools. The latter not only determine how collaboration flows but also can turn it into a flexible business process.So what is more important in software development collaboration: employees’ expertise and communication skills or a correctly selected collaboration tool that powers team members and leads them to success?When people outdo toolsEmployees are the most valuable asset in a software development company, which can be proved by several facts.last_img read more