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

Investment professionals must focus on clients over profits – CFA Institute

first_imgInvestment management professionals should be less focused on their employers’ profits and more on solving their clients’ problems, the head of the CFA Institute has said.Chief executive and president Paul Smith said both investment and asset managers should focus on providing client services rather than the overall success of the company.Smith, who has led the institute since January, said the investment industry also suffered from a lack of trust from the public, as “there is not enough focus on properly pricing products”, or on investor protection.“In the same way the main focus for doctors is their patient’s health, the goal of investment management professionals should be solving their clients’ problems, rather than maximising profits for their firms,” he said. The CFA Institute provides education for investment/asset managers and has drafted a code of ethics charter holders are told to adhere to when managing money for clients.“We need better-structured products and better incentives,” Smith said, adding that fee structures are skewed towards the interests of managers.He also believes the industry has failed to present itself correctly to regulators, and that this will drive more regulation for asset managers.“We have not set the bar high enough,” he said. “As a result, the drift of regulation is such that making money will become more difficult.”Smith did concede that if profit-making became harder for asset managers and the broader financial services industry, the pace of global economic growth may slow down.He also raised concerns about the image of the industry to graduates, as well as gender balance and diversity within the industry.The institute said it wanted to focus on bringing greater gender diversity into the industry in the long term, citing increasing evidence that diversity within asset management firms may be beneficial to end investors.The investment management industry, Smith added, is resisting modernisation and the introduction of technology overall. “Regulators should enable the adoption of technology,” he said.last_img read more

Lakers’ Kobe Bryant offers vintage performance in career finale

first_img“I can’t believe this actually happened,” Bryant said in his jersey still drenched in sweat. “This is kind of crazy. It’s hard for me to believe it happened this way. I’m in shock about it.”• PHOTOS: This is what Kobe’s final game looked like through our photo lensEven if Bryant averaged 17.6 points per game on a career-low 35.8 percent shooting, Lakers coach Byron Scott turned to head athletic trainer Gary Vitti.“I’m not surprised,” Scott said. It hardly seems shocking Bryant that he took so many shots, too. Newsroom GuidelinesNews TipsContact UsReport an Error For 20 years, the man sank clutch shots that lifted his team out of a deficit, delivered a victory and sent fans into a frenzy. For 20 years, the man missed wild shots through suffocating double teams, insurmountable distances and even open airballs. On a night everyone from Magic Johnson to the Lakers fan in the nosebleed sections extolled his greatness, Kobe Bryant’s final game featured everything that made him so captivating both for better and for worse. The Lakers’ 101-96 victory over the Utah Jazz on Wednesday at Staples Center featured Bryant setting his season-high in points (60), a career-high in shot attempts (50) and a season-high in minutes (42). He tied his fifth-highest scoring output of his 20-year NBA career. Bryant also eclipsed his previous record of 47 shot attempts against Boston on Nov. 7, 2002. center_img Bryant shot 22 of 50 from the field. He finished 6 of 21 from 3-point range, which eclipsed the combined shot totals from D’Angelo Russell and Jordan Clarkson (20). Bryant missed his first five shots. He fumbled the ball out of bounds. He even airballed two shots, which brought back reminders of when he did in a closeout postseason loss in his rookie season in Utah.“My teammates were just continuing to encourage me to shoot, shoot,” Bryant said. “It’s like reverse. It’s so weird to hear. You go through being a villain to some time of (being) a hero. You go from pass the ball to shoot the ball.”Amid all the imperfections, this all represented a perfect image of Bryant. He won five NBA championships by climbing to third place on the NBA’s all-time scoring list (33,643 points). Bryant won his final game by scoring 15 of the Lakers’ last 17 points, He also missed the most shots in league history (14,453). “I loved the way he was able to go out,” Scott said. “To me, this is the perfect finish.”• Read our coverage: Kobe Bryant gets Hollywood endingBryant respectfully disagreed.His young teammates drenched Bryant with a champagne bath once he entered the locker room. Out of instincts, Bryant quickly remarked, “‘That’s only for championships, but all right.” Bryant later added, “The perfect ending would’ve been a championship.”Instead, the Lakers (17-65) ended the 2015-16 season with their worst record in franchise history and a missed playoff appearance for the third consecutive season. That did not stop the Lakers from presenting an elaborate display of pageantry that mirrored an NBA Finals game. The Team LA store at Staples Center sold so much exclusive Bryant merchandise from Wednesday morning to night that they ran out of supplies. The Lakers hosted Fan Fest at LA Live from 4 to 7 p.m that entailed ticket giveaways and photo opportunities with the Laker Girls. Fans adored the Bryant banners on the Staples Center building. They wrote out messages on a large mural expressing thanks.Leading up to the game, Bryant resisted watching any news or reading any clippings. All those sights, however, spoiled his hope to have a normal day. “Seeing everything that was taking place before, I was enjoying it, and I was appreciative of it,” Bryant said. “Then I quickly got right back to thinking, ‘Okay, you have to go out there and perform.’ ”Before that happened, more pageantry awaited Bryant shortly after he strolled into Staples Center nearly two hours before tipoff and hugged Scott. Courtside fans received a gift bag of a Bryant hat, T-shirt, an action figure featuring him and a mini-helicopter. His teammates wore his Nike shoes and Bryant-themed socks. They also received commemorative Bryant jerseys worth $800. “It’s nuts; it doesn’t even feel like a game,” Lakers rookie forward Larry Nance Jr. said. “It feels like a concert.”This concert featured many acts.Magic Johnson first spoke before tipoff and explained why he considered Bryant “the greatest to wear the purple and gold.” “Kobe Bryant has never cheated the game, he has never cheated us as the fans. He’s played through injuries,” Johnson said. “We have five championship banners to show for it.”The Lakers then played endless tribute videos that featured nearly every athlete and celebrity imaginable. Former teammates, such as Shaquille O’Neal, Derek Fisher, Pau Gasol and Lamar Odom, praised Bryant’s play. Different opponents, such as Kevin Durant, Dwyane Wade, Dirk Nowitzki, Spurs coach Gregg Popovich, Kevin Garnett, Carmelo Anthony and Stephen Curry, complimented Bryant’s competitiveness. • Commemorative book: Kobe Bryant — Laker for LifeBryant then hugged Johnson, though he hardly could accept Johnson’s compliments.“I refused to believe it because Magic is my hero,” Bryant said. “I don’t think you guys understand how much of a die-hard Lakers fan I was. Magic was all over my wall. I used to wear really big knee pads because Magic wore really big knee pads. I used to practice the baby hook. He is and always will be No. 1 for me.”That did not stop Flea, the Red Hot Chili Peppers bassist, from playing the national anthem. Or Bryant from hearing more tributes from Jerry West, Bill Bertka, Kareem Abdul-Jabbar, James Worthy, Brian Shaw and Rick Fox and most of his current teammates. Or rapper Ice Cube from pleading with Bryant to play five more years. Or actor and longtime Lakers fan Jack Nicholson from saying, “You’ve been an inspiration to us all, and L.A. loves you.”Hence, Bryant expressed his love to the 18,997 fans at Staples Center. “Man!! I can’t believe how fast 20 years went by. This is crazy, absolutely crazy!!” Bryant said to the crowd afterward. “We’ve been through our up and downs. The most important part is we all stayed together throughout.”It seemed destined to happen.In one of the tribute videos, late Lakers announcer Chick Hearn asked a 17-year-old Bryant how many years he would play in the NBA. Bryant answered confidently, “At least 19 or 20.”Bryant did not sound as confident when O’Neal said last month in a TNT interview that Bryant should try to score 50 points in his career finale. Bryant responded, “You’re crazy.” Actually he isn’t. Bryant joined Abdul-Jabbar and Michael Jordan as the only NBA players at 37 years old to log at least 43 points. Bryant’s 60-point game against Utah matched the 60 points he logged against Memphis on May 22, 2007, as his fifth-highest scoring game. As the Lakers trailed by 10, Bryant scored seven points in 53 seconds. He drove to the basket. He made two foul shots. He nailed a 20-foot fadeaway to give the Lakers a 97-96 lead with 30 seconds left. “Somehow, (it’s) just his sheer will and sheer determination and the guts that he has and putting everything on his back and carrying the game,” Scott said. “He took it over, and it was amazing to me. It’s mind-boggling.”In so many ways. Bryant went 8-of-16 in the fourth quarter. His last play ended in an assist with a cross-court pass to Clarkson for a dunk that gave the Lakers a 101-96 edge with 4.1 seconds left. Bryant then exited the game amid a rousing ovation.“I was physically really, really tired. There’s just no way I can continue to push it. But the fan support was tremendous,” Bryant said. “The fans that have been coming here from Day One. To give them this type of show on my last one means everything.”It seemed like Bryant wanted to stay a Laker for a while longer.He still wore his jersey at his post-game press conference partly because “taking it off is going to be very strange.” Bryant sounded reflective and joyful in the 32-minute press conference. After spending about an hour with family and friends, Bryant posed for pictures with his wife, Vanessa, and two daughters, Natalia and Gianna. “The coolest thing is that my kids actually saw me play like I used to play,” Bryant said. “It’s like, ‘Whoa, dad!’ It’s like, ‘Yeah, I used to do this pretty often.’ They’re like, ‘Really?’ (I’m like), ‘Dude, YouTube it.’ It was pretty cool for them to actually see that.”It was also pretty cool to see Bryant then thank a few national and local media members individually at center court. Yet that celebration did not carry over out of Staples Center. The Lakers planned to host a party for Bryant and the team afterward. The plans changed amid Bryant’s quest to work out early on Thursday morning before diving into his job at Kobe Inc. The Lakers’ star also made progress by working from 8 a.m. to 2 p.m. on Wednesday, merely a few hours before his grand finale. “The important thing is to get into a routine, to maintain discipline and to find a new routine,” Bryant said. “I’ve been in a certain routine for my entire career, and I think the worst thing I could possibly do is not have one, because then you wake up without a sense of purpose or a sense of direction. I have to find a routine, and I have to get into it.”On Wednesday, Bryant followed a routine that produced more magical moments. Instead of delivering another Lakers NBA championship as he wished, Bryant provided something else grand. For one last time, Bryant showcased his greatness once again, no matter how amazing or awful his shots became. last_img read more

Sports leaders predict at least 220 gold medals for Philippines in SEA Games

first_imgOnyok Velasco see bright future for PH boxing in Olympics PLAY LIST 00:45Onyok Velasco see bright future for PH boxing in Olympics05:25PH boxing team determined to deliver gold medals for PH03:07PH billiards team upbeat about gold medal chances in SEA Games00:50Trending Articles03:04Filipino athletes share their expectations for 2019 SEA Games02:25PH women’s volleyball team motivated to deliver in front of hometown crowd01:27Filipino athletes get grand send-off ahead of SEA Games00:36Manny Pacquiao part of 2019 SEA Games opening ceremony00:59Sports venues to be ready in time for SEA Games Athletes from contact sports are expected to bring in majority of the haul with arnis projecting at least 15 golds out of 20 events while fighters from judo, kickboxing, jiu-jitsu, sambo, wrestling are confident they can contribute at least five victories each.A reliable source told the Inquirer that these fearless forecasts came out during the coordination meeting of the NSAs with Team Philippines chef de mission and Philippine Sports Commission Chairman Butch Ramirez.FEATURED STORIESSPORTSGreatest ever?SPORTSFormer PBA import Anthony Grundy passes away at 40SPORTSSan Miguel suspends Santos, Nabong, Tubid indefinitely after ‘tussle’ in practiceThe national boxers, a perennial multiple-gold performer, and wushu fighters have not declared their medal prospects as well as the taekwondo jins and dragonboat paddlers, but are certain to deliver based on their track records in previous SEAG editions, especially on local turf.There were apprehensions whether the NSAs can really pull it off, but sports leaders have high hopes that a repeat act of 2005, the last time Team Philippines hosted the 11-nation biennial tourney and won its first-ever overall title, is completely doable. Ethel Booba on SEA Games cauldron: ‘Sulit kung corrupt ang panggatong’ MOST READ MANILA, Philippines—Leaders of national sports associations individually made a bold gold-medal prediction on Friday that collectively resulted in an astounding figure never achieved by Team Philippines in the Southeast Asian Games.According to 45 out of the 56 NSAs which will see action in the Nov. 30-Dec.11 meet here in the country, at least 220 gold medals can be won by Filipino athletes, enough to secure the overall title in the biggest edition of the Games.ADVERTISEMENT Dancesports have projected at least 10 gold medals, athletics and gymnastics are convinced they can capture a minimum of nine golds each and skateboarding, which features Asian champion Margielyn Didal, are targeting to sweep the eight-event competition.The sportsfest to be held in scattered venues across Metro Manila and Southern Luzon, Subic and New Clark City in Capas, Tarlac, will see 1,115 Filipino athletes from 56 sports participating in 530 events plus 753 coaches and officials.Also anticipated to produce the needed golds are archery, billiards, bowling, chess, cycling, fencing, golf, ice skating, karatedo, muay, pencak silat, sailing, sepak takraw, shooting, tennis, triathlon, weightlifting and windsurfing.Team sports will likewise contribute to the golden collection with baseball, basketball, ice hockey, rugby, softball and polo foreseen to emerge triumphant.ADVERTISEMENT Duterte officials’ paranoia is ‘singularly myopic’ Rice industry paralysis Drilon apologizes to BCDA’s Dizon over false claim on designer of P50-M ‘kaldero’ Priority legislation in the 18th Congresscenter_img What’s behind the display of Chinese flag in Boracay? New import for SMB LATEST STORIES Sports Related Videospowered by AdSparcRead Next Duterte calls himself, Go, Cayetano ‘the brightest stars’ in PH politics Don’t miss out on the latest news and information. Matteo Guidicelli had saved up for Sarah G’s ring since 2014? View commentslast_img read more

BP Plans Alaska Layoffs

first_imgBP plans to cut its Alaska workforce by 17 percent by early next year.The oil company announced on Monday that it will reduce its staff by 275 employees and full-time contractors to match a “reduced operational footprint” in the state. BP will offer early retirement and severance packages to employees who choose to take a buyout option.Spokesperson Dawn Patience attributes the layoffs to the sale of four North Slope assets to Hilcorp, a smaller oil company with a growing presence in Alaska. The deal, which was announced in April, includes the Endicott and Northstar fields, along with 50 percent interest in the Milne Point and Liberty fields. BP is transferring 200 field workers to Hilcorp as a result of the agreement, in addition to the 275 support staff they plan to lay off.Patience describes the 275 positions as “overhead” that is no longer needed with a smaller presence on the North Slope. She says the company intends to focus more on oil production in Prudhoe Bay and development of a natural gas megaproject. “BP’s operations may be shrinking in Alaska, but we announced $1 billion of additional investment in Prudhoe Bay, and the addition of two rigs –- one this year and one the year after — and those commitments stand,” says Patience.BP informed Hilcorp of their additional staff cuts on Monday, after they told employees. Hilcorp spokesperson Lori Nelson says the BP announcement was unexpected because only 250 employees were directly associated with the purchased assets and Hilcorp agreed to absorb most of them.“The number today was a bit of a surprise, but that’s BP’s decision,” says Nelson.The layoff announcement arrives less than a month after Alaskans narrowly voted to maintain a capped tax rate on oil production. As one of the three major players on the North Slope, BP contributed nearly $4 million to fight the ballot referendum on Senate Bill 21.Sen. Bill Wielechowski, an Anchorage Democrat who advocated for repeal of Senate Bill 21, calls the BP’s announcement “disturbing.” He notes it comes just as fellow North Slope producer Exxon is projecting a continued decline in oil production in Alaska.“We were promised a lot of things during the [Senate Bill 21] debate, and one of the most powerful things was jobs,” says Wielechowski. “And here we are, a couple weeks after the people of Alaska voted on this, thinking they were going to get a lot more jobs [and] thinking they were going to get a lot more production. And we’ve already had sworn testimony by Exxon that we’re getting less production and then we’ve got BP saying they’re laying off hundreds of Alaskans and contractors.”Wielechowski also finds the timing of BP’s announcement “suspect.”“Had the referendum passed, they probably would have blamed these layoffs on the referendum passing,” says Wielechowski.In a press release, Gov. Sean Parnell also stated he “extremely disappointed” by the announcement, and noted that oil and gas employment in the state was otherwise strong with 15,000 working for the industry.last_img read more