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Emily Skeggs Channeled Patti LuPone & Josh Gad Talks Emma Watson’s Singing

first_imgTony nominees Josh Gad and Emily Skeggs stopped by Watch What Happens: Live on July 22 and showed just why they are two of our Broadway faves. Gad revealed a big set secret about the live action Beauty and the Beast movie: “I can tell you that Emma Watson has an incredible singing voice.” Host Andy Cohen wanted to know from bartender Emily Skeggs (we hope those were non-alcoholic drinks!) if the Fun Home cast has had to deal with any bad behavior from audience members. “The other day we did have one guy in his Yankees cap, sitting there, pulling snacks out of bags out of bags,” she said. Skeggs’ method of dealing with him was fabulously Patti LuPone. Check out the video below!. Show Closed This production ended its run on Sept. 10, 2016 Related Shows View Comments Fun Homelast_img read more

Department of Employment and Training announced an unemployment rate of 3.5 percent for Vermont in May

first_imgThe Department of Employment and Training announced Thursday a seasonally adjusted unemployment rate of 3.5 percent for Vermont in May. The rate was unchanged from the April estimate, which was revised down one tenth of a percentage point. The national unemployment rate in May held steady at 5.6 percent.Unemployment rates for Vermonts 13 labor market areas ranged from 1.7 percent in Hartford, to 5.0 percent in Newport. Labor market area rates are not seasonally adjusted; for comparison, the unadjusted rate for Vermont was 3.2 percent.Improvement in the national economy is providing a healthy foundation for lower unemployment in Vermont, said Anne V. Ginevan, Commissioner of the Department of Employment and Training. Our job market is improving gradually in response to the improved economic climate.The total seasonally adjusted job estimates have fluctuated in recent months due in part to atypical events in Vermont and the slow national recovery. After edging above 300,000 in January, the number of jobs dipped for the next two winter months. Spring provided a boost for construction activity that was augmented by a large maintenance project for a major electrical generating facility. The latest data reflects the end of the maintenance project and a less vigorous construction industry. Employment in manufacturing and retail trade showed less strength than expected for May, producing seasonally adjusted losses. Leisure and hospitality, however, had a relatively good month and added a modest number of jobs.Job estimates before seasonal adjustment rebounded by almost 1,000 as warmer weather prompted additional hiring in construction. Administrative and Support services added 450 jobs, which included hiring by temporary help agencies. There were mixed results in leisure and hospitality. Food service and entertainment establishments combined for a gain of about 1,200 jobs; however, lodging establishments offset the gain with seasonal cuts. Employment also fell at state and private colleges due to the start of the summer break. Health care and social assistance showed little change from the previous month. Most of the gain in manufacturing was due to an increase of 100 jobs in computer and electrical equipment manufacturing.The count of nonfarm jobs was up 0.4 percent, about one percentage point less than last month.VERMONT SEASONALLY ADJUSTED NONFARM EMPLOYMENTIn ThousandsBY NAICS Prelim. Revised Revised Change From: May-04 Apr-04 May-03 Apr-04 May-03Total – All Industries 300.6 300.9 298.5 -0.3 2.1Private Industries 248.9 249.1 246.6 -0.2 2.3 Construction 15.8 16.1 15.2 -0.3 0.6Manufacturing 37.0 37.2 37.8 -0.2 -0.8Retail Trade * 38.9 39.1 39.3 -0.2 -0.4Professional & Business Services 20.6 20.6 20.3 0.0 0.3Private Ed. Services* 12.6 12.7 12.5 -0.1 0.1Health Care & Social Assistance* 41.0 41.2 39.6 -0.2 1.4Leisure & Hospitality* 33.1 32.9 32.8 0.2 0.3Total Government 51.7 51.8 51.9 -0.1 -0.2Source: Vermont Department of Employment & Training in cooperation with the U.S. Bureau of Labor Statistics, unless otherwise noted.VERMONT NONFARM EMPLOYMENT, NOT SEASONALLY ADJUSTED PRELIM REVISED REVISED CHANGES FROMINDUSTRY BY NAICS May-04 Apr-04 May-03 Apr-04 May-03TOTAL NONFARM 299,350 298,400 298,100 950 1,250TOTAL PRIVATE 245,350 244,100 244,100 1,250 1,250GOODS PRODUCING 53,850 52,400 54,250 1,450 -400MANUFACTURING 37,050 36,900 37,750 150 -700Durable Goods 26,400 26,300 27,150 100 -750Computer & Electrical Equipment Mfg. 9,300 9,200 9,850 100 -550Fabricated Metal Products Mfg. 2,900 2,900 2,800 0 100Machinery Mfg. 3,050 3,050 3,000 0 50Transportation Equipment Mfg. 2,450 2,450 2,250 0 200Furniture & Related Product Mfg. 2,500 2,500 2,300 0 200Non-Durable Goods 10,650 10,600 10,600 50 50Food Mfg. 3,750 3,700 3,650 50 100CONSTRUCTION 15,850 14,600 15,550 1,250 300NATURAL RESOURCES & MINING 950 900 950 50 0SERVICE-PROVIDING 245,500 246,000 243,850 -500 1,650TRADE TRANSPORTATION AND UTILITIES 57,400 56,950 57,650 450 -250Wholesale Trade 10,250 10,200 10,200 50 50Retail Trade 38,500 38,200 38,850 300 -350Food & Beverage Stores 9,250 9,100 9,550 150 -300General Merchandise Store 2,850 2,800 2,850 50 0Transportation, Warehousing and Utilities 8,650 8,550 8,600 100 50Utilities 1,750 1,750 1,750 0 0Transportation & Warehousing 6,900 6,800 6,850 100 50INFORMATION 6,550 6,450 6,550 100 0FINANCIAL ACTIVITIES 13,100 13,050 13,150 50 -50Finance & Insurance 10,050 10,100 10,100 -50 -50Real Estate, Rental & Leasing 3,050 2,950 3,050 100 0PROFESSIONAL AND BUSINESS SERVICES 20,850 20,250 20,550 600 300Professional, Scientific and Technical 12,150 12,050 12,250 100 -100Administrative, Support and Waste 8,300 7,850 8,050 450 250EDUCATIONAL AND HEALTH SERVICES 53,750 54,200 52,250 -450 1,500Educational Services 12,800 13,200 12,700 -400 100College, Universities and Professional 7,050 7,350 7,000 -300 50Health Care and Social Assistance 40,950 41,000 39,550 -50 1,400Ambulatory Health Care Services 15,750 15,750 15,500 0 250Hospitals 10,300 10,300 10,050 0 250Nursing and Residential Care Facilities 6,750 6,750 6,600 0 150LEISURE AND HOSPITILITY 29,750 29,950 29,550 -200 200Arts, Entertainment and Recreation 3,600 3,100 3,800 500 -200Accommodation and Food Services 26,150 26,850 25,750 -700 400Accommodations 8,750 10,150 8,250 -1,400 500Hotels & Motels 7,850 9,200 7,200 -1,350 650Food Services and Drinking Places 17,400 16,700 17,500 700 -100OTHER SERVICES 10,100 10,850 10,150 -750 -50GOVERNMENT 54,000 54,300 54,000 -300 0Federal Government 6,100 6,100 6,250 0 -150State Government Education 7,500 8,500 7,400 -1,000 100Local Government Education 24,300 24,000 24,350 300 -50Other State Government 9,200 9,050 9,250 150 -50Other Local Government 6,900 6,650 6,750 250 150Source: Vermont Department of Employment & Training in cooperation with the U.S. Bureau of Labor Statistics.VERMONTLABOR FORCE AND UNEMPLOYMENTBY LABOR MARKET AREANot Seasonally Adjusted MAY’04 APR’04 MAY’03 MAY’04 APR’04 MAY’03BARRE-MONTPELIERMORRISTOWN-STOWELabor Force 40,400 40,550 39,800Labor Force 17,950 18,900 18,250Unemployment 1,250 1,550 1,550Unemployment 750 1,100 950Rate(%) 3.0 3.8 3.9Rate(%) 4.2 5.8 5.2Employment 39,200 39,000 38,250 Employment 17,200 17,800 17,300BENNINGTON-MANCHESTERNEWPORTLabor Force 21,100 21,250 21,600Labor Force 13,500 13,400 13,500Unemployment 700 850 1,050Unemployment 700 950 850Rate(%) 3.4 4.0 4.8Rate(%) 5.0 7.1 6.3Employment 20,400 20,400 20,550 Employment 12,800 12,450 12,650BURLINGTONRANDOLPHLabor Force 108,550 107,550 106,950Labor Force 6,400 6,550 6,350Unemployment 2,600 2,900 3,450Unemployment 250 350 250Rate(%) 2.4 2.7 3.2 Rate(%) 4.3 5.5 4.1Employment 106,000 104,650 103,500 Employment 6,150 6,200 6,100ENOSBURGRUTLANDLabor Force 11,100 10,500 11,200Labor Force 30,900 30,900 30,000Unemployment 450 600 600Unemployment 1,500 1,600 1,750Rate(%) 4.0 5.8 5.4 Rate(%) 4.8 5.1 5.9Employment 10,650 9,850 10,600 Employment 29,400 29,300 28,200HARTFORDST. JOHNSBURYLabor Force 29,300 29,150 29,050Labor Force 14,900 15,100 15,100Unemployment 500 650 650 Unemployment 500 750 750Rate(%) 1.7 2.2 2.2 Rate(%) 3.3 5.0 4.9Employment 28,800 28,500 28,400Employment 14,400 14,350 14,350BRATTLEBOROSPRINGFIELDLabor Force 23,750 23,950 23,550Labor Force 9,400 10,100 9,700Unemployment 950 950 1,000 Unemployment 450 500 700Rate(%) 3.9 4.0 4.2 Rate(%) 4.9 5.1 7.3Employment 22,850 23,000 22,550Employment 8,950 9,600 9,000MIDDLEBURYSTATEWIDELabor Force 21,350 21,000 21,550Labor Force 348,700 348,850 346,500Unemployment 500 650 650 Unemployment 11,000 13,400 14,200Rate(%) 2.2 3.0 3.0 Rate(%) 3.2 3.8 4.1Employment 20,900 20,350 20,900 Employment 337,700 335,450 332,350Note: Estimates by place of residence.Source: Vermont Department of Employment & Training in cooperation with the U.S. Bureau of Labor Statistics.last_img read more

Debate: Should Performance-Enhancing Drugs Be Legalized?

first_imgShould performance-enhancing drugs be legalized? Our experts debate.YESIn theory, banning doping prevents athletes from taking unfair shortcuts and keeps sports on a level playing field. In reality, these bans have done less to protect fairness and punish rule-breakers and more to discourage athletes from reaching the highest levels of success.Lance Armstrong, the face of doping to many, is an example of the flawed logic behind bans. Yes, Armstrong had an advantage because of his illegal activities. But is it really an unfair advantage if the majority of your competitors are also using performance enhancing drugs (PEDs)? According to Business Insider, 20 out of 21 top three Tour de France finishers from 1999 to 2005 were taking PEDs, and 36 of 45 top three finishers from 1996 to 2010 were also doping. While “everybody’s doing it” might not fly in a kindergarten classroom, sports can and should have an internal standard of behavior. The current bans simply don’t work, and keep rule-following athletes from being competitve with their peers.Sports are constantly evolving. Walter Payton wasn’t training with world-class coaches in state-of-the-art facilities when he dominated. Babe Ruth wasn’t drinking Gatorade or using creatine when he amazed his fans. We don’t ban the advantages that modern day athletes have over their predecessors, and that attitude of progress should apply across the board. Getting a better night’s sleep can enhance performance. Eating a healthy breakfast, taking vitamins and supplements, training harder or simple genetic advantages—there are countless factors that contribute to sports being “unfair.” But that’s the whole point of competition.How many people would have cared about the Tour de France without Armstrong’s stunning feats? Before failing a drug test in 2006, Shawne Merriman was in highlight reel upon highlight reel during his 2005 season as the NFL Defensive Rookie of the Year. Who can deny the excitement of 1998’s record-breaking MLB home run chase between Mark McGwire and Sammy Sosa? Recently busted Alex Rodriguez is a career .300 hitter with 647 career homeruns, a 14 time all-star, a 3 time AL MVP and a World Series Champion.We can continue the trend of hand-wringing and hysteria, with one doping scandal after another, further embarrassing the field of professional athletics – or we can legalize and regulate performance-enhancing drugs to the benefit of sports and sports fans alike. Let’s do ourselves and our athletes a service by allowing them to perform at their best.Mac McCann is a columnist for The Horn at the University of Texas-Austin.NOAmericans love high performance and we love technology. Why, then, do we get our knickers in a twist when professional athletes—think Lance Armstrong or A-Rod—turn out to have achieved their great feats with a boost from performance-enhancing drugs and other banned technologies?Not everyone turns up their nose when a high-profile athlete dopes. Some offer excuses: the pressure to perform is overwhelming, and the rewards are too tempting to resist. We allow special diets, scientifically optimized training, and novel equipment, so why ban drugs, or, in Lance’s case, bags of whole blood? Aren’t they all just technologies intended to produce outstanding performances? In some sports in some eras, nearly every competitor was doping: how else could an athlete have a shot at winning?That last argument—everyone does it, so I’m just leveling the pharmaceutical playing field—provides half of the answer. When I first asked elite athletes more than 30 years ago why drugs were being used, the answer was unequivocal: Whatever reservations you might have, no one wants to give up a competitive advantage, especially to someone who might not be as talented or dedicated as you but can get enough of an edge from drugs to beat you.That story of a drug race spiraling ever upwards, much as the arms race drove nations to build more and deadlier weapons, is one of the best reasons to ban doping in sports.  It doesn’t end with the pros either. Amateur athletes, including high school and perhaps younger participants, look to their heroes for examples of how to succeed in sport. If doping was allowed, we could expect non-elite athletes to pursue the latest advances in performance enhancing drugs just as they buy the latest running shoes, bikes, or tennis rackets. In no universe is this a healthy development. Pros and those who emulate them will be driven to use drugs in doses and combinations no scientist has ever studied.Doping in pro sports is a useful prod that forces us to ask what sport is all about anyway? Why do we play? When we see an exceptional performance, when we experience one of those moments of grace and excellence in ourselves, what makes it so special? If excellence in sport is the intersection of talent and dedication, as I believe, then drugs distort and distract. eOur shared understanding of the meaning and value of sport will determine whether doping should continue to be banned. That decision is up to all of us.Thomas Murray is the president emeritus of the Hastings Center, a non-profit bioethics research institute. What do you think readers? Join the debate by leaving a comment below with your opinion.last_img read more

Official Notice: Advertising Update

first_imgOfficial Notice: Advertising Update May 1, 2002 Regular News Official Notice: Advertising Update Prepared by the Staff of The Standing Committee on Advertising 1. Compliance Review Program As part of its duties designated by the Board of Governors, each year the Standing Committee on Advertising directs staff to review yellow pages advertisements of attorneys around the state to determine whether non-exempt ads have been filed, as required by Rule 4-7.7, Florida Rules of Professional Conduct. If your current yellow pages ad contains a picture, illustration or other non-exempt information, it is required to be filed. If an attorney did not file such a non-exempt ad, he or she will be receiving a letter from Committee staff directing the attorney to remit a $250.00 late fee and to file the advertisement for review. 2. Letters to Attorneys Regarding Absence of Geographic Location in their Ads All advertisements for Florida attorneys must contain a reference to a bona fide office location of the lawyer’s firm, stating the city or town in which the lawyer’s office is located. Rule 4-7.2(a)(2), Florida Rules of Professional Conduct, requires all advertisements by Florida lawyers to contain the name of the city in which the lawyer practices. Pursuant to the compliance review program of the Standing Committee on Advertising, during the next month some lawyers may be receiving a notice of noncompliance letter regarding the lack of a geographic location in their yellow pages ads. If you receive one of these letters you are not required to pay a late fee. However, the letter serves as a reminder for you to include the city in which you practice in your yellow pages ad for the upcoming year. This rule applies even if your office is in Jacksonville, for example, and your ad is in the Jacksonville yellow pages. Recent SCA Decisions Prohibited Visual Images, Generally: Pursuant to Rule 4-7.2(b)(4) : “Visual or verbal descriptions, depictions, or portrayals of persons, things, or events must be objectively relevant to the selection of an attorney and shall not be deceptive, misleading, or manipulative.”Similarly, Rule 4-7.2(c)(1) provides: “All illustrations used in advertisements shall present information that is directly related and objectively relevant to a viewer’s possible need for legal services in a specific type of matter. Such illustrations shall be still pictures or drawings and shall contain no features that are likely to deceive, mislead, or confuse the viewer.”Applying these two rules, the SCA recently determined:• A picture of a fast car is a prohibited illustration under Rule 4-7.2(c)(1).• An illustration of a woman’s hand dropping an engagement ring is manipulative in violation of Rule 4-7.2(b)(4).• A photograph of an elderly woman using a walker is manipulative in violation of Rule 4-7.2(b)(4).• A picture of the American flag is not relevant to an advertisement for personal injury representation and is therefore impermissible.• An illustration of the American flag is also impermissible in a criminal defense advertisement. Statements Creating Unjustified Expectations: Rule 4-7.2(b)(1)(B) prohibits any statement in lawyer advertising that “contains any reference to past successes or results obtained or is otherwise likely to create an unjustified expectation about results the lawyer can achieve except as allowed in the rule regulating information about a lawyer’s services provided upon request.”The SCA determined that the following language violated Rule 4-7.2(b)(1)(B) because it created unjustified expectations:• “Trusted by thousands.”• “Who can you trust? An attorney on your side.”• “Law Firm of X and Y, ‘Tipping the scales of justice in your favor.’”• “You can also be represented, and thereby, ‘level the playing field,’ without incurring any attorney’s fees.”• “Avoid Criminal Conviction.. . Avoid Court appearances.”• “With our vast experience, we will help you achieve the most compensation you are entitled to.”• “I insure that property and business owners have the representation they need so they can get full compensation for what is taken from them.”The SCA also determined that the following language created unjustified expectations and improperly referred to an attorney’s track record, in violation of Rule 4-7.1(b)(1)(B):• “When you consult with an attorney, you want to know the attorney’s results in other cases like yours. Results speak for themselves. I would appreciate the opportunity to speak with you about my results. The consultation is free.”• “Results are what matter.” Statement Describing the Quality of Legal Services: Pursuant to Rule 4-7.2(b)(3) : “A lawyer shall not make statements describing or characterizing the quality of the lawyer’s services in advertisements and written communications; provided that this provision shall not apply to information furnished to a prospective client at that person’s request or to information supplied to existing clients.”The SCA found this rule was violated by the following language:• “Pioneering leadership in [area of practice] for the past three decades.. . . Industry Pioneers.”• “Our firm is recognized as a leading authority in this area of the law.”• “A powerful number for powerful representation.” Geographic Location Requirement Rule 4-7.2(a)(2) requires all attorney advertisements to contain a listing “by city or town, [of] one or more bona fide office locations of the lawyer or lawyers who will actually perform the services advertised.”The SCA recently determined:• The reference to a city at the top or bottom of a page in the Yellow Pages is not sufficient to meet the requirements of Rule 4-7.2(a)(2). The attorney’s ad must also contain the geographic location of the attorney’s practice. Recent Decisions of the Board of Governors The Board of Governors made the following determinations regarding lawyer advertisements. The Board determined that the following phrase was improper:• “Specializing in Injury and Insurance Claims.”Voted 4-0 to affirm staff’s opinion that the use of the word “specializing” violates Rule 4-7.2(c)(3) unless the attorney is Florida Bar Certified in that area of practice.If you have any questions regarding lawyer advertising call the Ethics Hotline at (800) 235-8619 and we will be happy to assist you. You may also review the advertising rules and sample advertisements on the Bar’s Web site at www.FLABAR.org or by clicking here.last_img read more

Results negative for 2nd Cornell student tested for Coronavirus

first_imgThere are no confirmed cases of the coronavirus in New York. The university made the announcement on Feb. 9. ITHACA, N.Y. (WBNG) — Results for the 2nd student at Cornell University to be tested for the coronavirus are negative.center_img Cornell University announced last week that an initial student was tested for the coronavirus and the results turned out negative.last_img

Critical care experts tackle disaster preparation, surge capacity, and rationing

first_imgMay 13, 2008 (CIDRAP News) – Anticipating that a terrorist attack, influenza pandemic, or natural disaster will someday exhaust regional or national critical care systems, an expert task force recently issued a comprehensive series of reports that takes stock of current capabilities and recommends a surge framework that would care for as many patients as possible but would necessarily exclude some.The series, from the Critical Care Collaborative Initiative’s January 2007 Mass Critical Care Summit, appeared recently in a May supplement issue of the journal Chest. The five articles from the 37-member task force of American and Canadian experts include an executive summary and individual papers on current capabilities, a framework to optimize surge capacity, medical resource guidance, and recommendations for allocating scarce critical care resources in a mass critical care setting.Task force member John Hick, MD, told CIDRAP News that, although initial mainstream media focus was patient exclusion issues surrounding the task force’s ventilator triage criteria, the guidelines are so far receiving good support in the medical community.”It [the series] provides both a systems and facility-based approach to resource-poor situations,” he said. “Whether the goals are reasonable or not, we’ll have to see,” added Hick, medical director of bioterrorism and disaster preparedness and an emergency medicine physician at Hennepin County Medical Center in Minneapolis and coauthor on three of the five articles.Though the group covered an expansive array of controversial ethics and resource topics related to critical care in a disaster scenario, they had few disagreements on about 90% of the materials, Hick said. Not surprisingly, the critical care inclusion-exclusion generated the most discussion and required a great deal of compromise, he said.  “It’s not exactly what we would do as individuals, but it’s a good framework nonetheless,” Hick said.Perhaps the biggest sticking point was the group’s recommendation for intensive care unit (ICU) expansion, he said, adding that the group settled on 200% because of pandemic concerns, though many advocated 100% ICU expansion as a more achievable goal.”My only fear is that people will see that as unrealistic and not aim for what they can achieve, and I think we tried to be clear to do at least what you can,” Hick said.Assessing current resourcesIn an assessment of current US and Canadian capabilities for critical care during a disaster, including equipment and supplies, staff, and space, the task force points to the likelihood of shortages in many areas.Mechanical ventilators are essential in critical care, and estimates of the number of ventilators in the US range from about 53,000 to 105,000, the report says. The task force estimates that at least 10,000 ventilators are available nationwide at any given time, but logistical problems would hamper their rapid distribution to areas of need during a disaster.Moreover, all predictions are that the need for ventilators in a major pandemic will far exceed the supply. The US national stockpile has about 4,600 ventilators, the report says.One consumable medical item that may run short in a disaster is oxygen, the report says. The number of oxygen suppliers and the number of tanker trucks for shipping oxygen are limited.Concerning personnel, the report says staff shortages have not typically been a problem in past disasters, but absenteeism has been high in some crises that were prolonged or affected employees personally. In addition, critical care physicians in general are poorly prepared for mass-casualty disasters, and there is evidence that other physician groups are not well prepared for bioterrorism or other public health emergencies, according to the task force.As for space, the report says that a recent study in Ontario showed that occupancy rates for critical care beds approached 90%. To some extent, hospitals can expand critical care to other areas, such as postanesthesia care units, but shortages of equipment and staff are likely to limit that option.A hospital facing a major surge of critical care patients might consider sending them to another facility, but for a variety of reasons, this is not likely to be a good immediate option in a disaster, the report says. The possibility of bringing in outside help is not very promising either, the task force asserts.One possible source of help is the National Disaster Medical System, which was set up to deal with disasters causing a large number of casualties that can’t be accommodated by military or Veterans Affairs hospitals. But there are “significant concerns that the system is not equipped to respond to an event involving large numbers of critically ill patients, particularly a biological event, such as a pandemic,” the report says.Critical but limited careIn a separate article, the task force seeks to define the limited level of critical care that hospitals could try to provide in a major disaster and suggests what level of surge capacity hospitals should aim for in this regard.”Provision of essential rather than limitless critical care will be needed to allow many additional community members to have access to key life-sustaining interventions during disasters,” the report states. It stresses that hospitals should use limited, essential critical care, or “emergency mass critical care (EMCC),” only in overwhelming events.The task force says that EMCC should include the following:Mechanical ventilationIntravenous fluid resuscitationVasopressor administrationAntidote or antimicrobial administration for specific diseasesSedation and analgesiaSelect practices to reduce adverse consequences of critical illness and critical care deliveryOptimal therapeutics and interventions, such as renal replacement therapy and nutrition for patients unable to take food by mouth, if warranted by hospital or regional preferenceThe report states that every hospital with an intensive care unit should plan to provide EMCC and should coordinate with regional hospital planning efforts in doing so.As for exactly how much EMCC capacity to aim for, the task force says that multiple uncertainties make it impossible to confidently predict critical care needs for particular types of disasters, but the panel offers recommendations anyway: Hospitals with ICUs should prepare to provide EMCC for at least three times the usual number of critically ill patients and to maintain such care for 10 days without “sufficient external assistance.” Ten days is reasonable because most disaster victims’ critical care needs are not expected to resolve rapidly, the report says.The panel also offers a progressive list of changes in resource use for coping with shortages. It starts with substitution and runs through adaptation, conservation, reuse, and finally reallocation, the last meaning taking a resource from one patient and giving it to another with a better prognosis or greater need.Further, the panel asserts, “All communities should develop a graded response plan for events across the spectrum from multiple casualty to catastrophic critical care events. These plans should clearly delineate what levels of modification of critical care practices are appropriate for the different surge requirements.”The report offers a detailed chart of tiered responses to critical care needs, listing criteria for moving from one level of response to the next. The chart suggests moving to EMCC only at tier 6+, meaning after calls for assistance from local, regional, state, interstate, and federal authorities have been exhausted.”Sustained EMCC is appropriate when calls for assistance are exhausted and resources are not available or will take days to arrive, and yet critically ill patients remain at high risk for bad outcomes unless critical practice is rationally modified,” the article states.Stocking up for the surgeThe task force, in another article focusing on surge capacity, shared guidance on the medical equipment, treatment space, and staffing that will be needed to deliver critical care during a major disaster. The task force said most of the Department of Homeland Security’s disaster scenarios represent a double-edged sword. Events, such as a terrorist attack or influenza pandemic, have the potential not only to raise the demand for critical care medical supplies, they also can also sever supply lines.Hospitals typically rely on “just-in-time” inventories to reduce supply, equipment, and storage costs, they note. “Critical care equipment is no exception, so the quantity of additional critically ill patients a hospital can care for without resupply is impressively small,” they wrote.However, the task force acknowledged that expecting hospitals to stockpile mass quantities of critical care supplies for use during rare catastrophic events is “unrealistic and perhaps even reckless.” Instead, the group said its streamlined EMCC framework allows for a more restricted resource list for critical care surge capacity that most communities can accommodate.They include two tables that list recommended treatment supplies, from endotracheal tubing to blood pressure cuffs, along with minimum quantities for 10 treatment spaces over a span of 10 days. To factor in the uncertainties of patient turnover, the task force suggests increasing stock of consumable supplies above what one patient would require for 10 days.The authors said they focused a large portion of their surge-capacity equipment recommendations on ventilators because there is little guidance in the medical literature and they anticipate that most patients who will require mechanical ventilation in a mass critical care event will have severe airflow obstruction or lung injury. Given that each patient will probably require several days of ventilation, the task force recommends that each should have his or her own ventilator.The guidance includes suggestions on short-term strategies to boost ventilator capacity, such as repurposing other types of ventilators, such as anesthesia machines, noninvasive devices, and transport devices, and borrowing from other hospitals that aren’t having critical care shortages.”Hospitals should work with their local, regional, and state partners to perform a PPV [positive-pressure ventilation] need analysis for all plausible mass critical care events, such as a severe influenza pandemic,” the task force wrote.In a surge setting, ventilators should be able to operate without high-pressure medical gas, the task force emphasized. In health facilities, patient care areas outside of critical care units don’t typically have the equipment to deliver high-pressure medical gas. Also, a disaster—and subsequent supply chain and transportation disruptions—may require critical care providers to use a patchwork of different oxygen sources.When addressing where critical care patients should be treated, the expert team discouraged communities from using alternate care sites because of logistical hurdles. Instead, they recommended that general medical patients be discharged to homes or other nonacute settings to allow more critical care patients to be treated in hospitals.The task force suggested several strategies that healthcare groups could use to augment critical care staffing:Physicians willing to serve in intensivist roles could be encouraged to join critical care teams.Critical care nurses could help mentor noncritical care caregivers.Noncritical care nurses and pharmacists could become responsible for medication delivery to all of the critical care patients.Paramedics could help maintain airways of critical care patients.Respiratory therapists who specialize in critical care could oversee groups of their noncritical care colleagues who could quickly ramp up their skills with just-in-time training materials.Pharmacists from regional health systems could help redistribute scarce pharmaceutical resources.Tough rationing decisionsThe last of the task force’s five articles has generated most of the news headlines because it offers a roadmap on which patients should be considered when disaster demands and shortages exhaust the medical system so that not all can receive critical care.”The lack of a plan to address these issues will result in the perception of unjust allocation of resources, or actual injustice may take place,” task force members wrote. The shift from individual to population-based care is best achieved before a disaster occurs, they added.Though previous antiviral rationing guidance in the event of an influenza pandemic has generally placed healthcare providers in top-priority tiers, the task force does not recommend that health workers—or any other population group—receive preferred status.According to the group’s critical care triage recommendations, critical care resources should be reallocated to other patients in instances when a given patient has a high risk of death and little likelihood of long-term survival and is unlikely to benefit from critical care.Clinicians should consider two factors when weighing if a patient should receive critical care: daily Sequential Organ Failure Assessment (SOFA) scores and the patient’s chronic illness severity. Patients’ SOFA scores would be evaluated if their risk of hospital mortality is 80% or greater. Life-limiting illnesses that would exclude patients from receiving scarce critical care resources include conditions such as:Severe traumaSevere burns in certain circumstancesCardiac arrest (unwitnessed or witnessed events that don’t respond to electrical therapy)Severe baseline cognitive impairmentMetastatic malignancyAdvanced, irreversible neurological events or neuromuscular diseaseEnd-stage organ failureAge above 85 yearsThe task force recommends that a triage officer—ideally a highly experienced surgeon who has outstanding leadership and communications skills—review all patients’ exclusion and inclusion criteria. “He or she is expected to make decisions that benefit the greatest number of patients given potentially limited resources, even though these decisions may not necessarily be best for any individual patient,” the task force wrote.Attending clinicians will inform patients and family members of the triage officer’s decisions, and a triage team made up of clinical care nurses, respiratory therapists, and/or pharmacists will update the triage officer and assist with rationing decisions, the authors wrote.Decisions to reallocate critical care resources among patients will require a high degree of transparency and regular reviews to ensure that established processes are being followed.Patients who are excluded from critical care should receive palliative care, the task force said. “During challenging times, it is imperative to uphold the ethical commitment to alleviate discomfort without intentionally hastening death; euthanasia is not acceptable,” they wrote. “Thus, it is mandatory that mass disaster preparation anticipates palliation for large numbers of individuals.”The group pointed out that the triage process only applies to patients in acute care settings and that rationing should apply to all acute-care patients, even if their condition isn’t related to the disaster events.They identified several areas that would benefit from more research and care protocols. For example, they said illness severity and scoring systems need more refinement, particularly for pediatric patients.Also, they wrote that more efforts are needed to train healthcare providers about critical care triage and that strategies are needed for communicating rationing concepts to the public and to the families affected by the triage decisions.Looking aheadHick said now that critical care experts have released their assessments, surge capacity recommendations, and resource allocation guidance, the next step is for states to address liability issues that could protect caregivers and health systems when disasters reduce normal levels of care.”I hope also that staring down the actual triage criteria from a large group will force states and the federal government to confront these issues and the scarcity of healthcare issues,” he said.The task force doesn’t have any more meetings scheduled, but Hick said there are signs that the international community is willing to take on critical care triage issues, such as a research push for better predictive tools for triage.Devereaux A, Christian MD, Dichter JR, et al. Summary of suggestions from the Task Force for Mass Critical Care Summit, January 26-27, 2007. Chest 2008 May;133(5) Suppl:1S-7S [Full text]Christian MD, Devereaux AV, Dichter JR, et al. Definitive care for the critically ill during a disaster: current capabilities and limitations. Chest 2008 May;133(5) Suppl:8S-17S [Full text]Rubinson L, Hick JL, Hanfling DG, et al. Definitive care for the critically ill during a disaster: a framework for optimizing critical care surge capacity. Chest 2008 May;133(5) Suppl:18S-31S [Full text]Rubinson L, Hick JL, Curtis JR, et al. Definitive care for the critically ill during a disaster: medical resources for surge capacity. Chest 2008 May;133(5) Suppl:32S-50S [Full text]Devereaux AV, Dichter JR, Christian MD, et al. Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care. Chest 2008 May;133(5) Suppl:51S-66S [Full text]See also:May 5 American College of Chest Physicians press releaseApr 30, 2007, CIDRAP News story “New York group offers plan for rationing ventilators in a pandemic”last_img read more

Surakarta deputy mayor tests positive for COVID-19, tested shortly after meeting Jokowi

first_imgThe deputy mayor of Surakarta in Central Java, Achmad Purnomo, has contracted COVID-19, a city administration official has confirmed, as a swab test he took shortly after meeting President Joko “Jokowi” Widodo in Jakarta has come back positive for the coronavirus.City administration secretary Ahyani confirmed the test results, which came out on Thursday after the deputy mayor was tested last Saturday.”[The deputy mayor is now in] self-isolation,” Ahyani said as quoted by kompas.com on Friday. Ahyani, who is also the head of Surakarta’s COVID-19 task force, said the team would trace the deputy mayor’s contacts to identify other individuals that might have been exposed to the disease.On July 16, Achmad met with Jokowi at the State Palace in Central Jakarta, during which, the latter claimed, the two discussed the state and development of the city, which is the President’s hometown.The day after the meeting in Jakarta, Achmad took a swab sample to be tested for COVID-19 and the result came in negative. He then took another test the following day, which showed a positive result.Surakarta Mayor FX Hadi Rudyatmo said he would also take COVID-19 swab test after finding that Achmad had been infected.Separately, Presidential Secretariat head Heru Budi Hartono said Jokowi would immediately take the COVID-19 test following the announcement from Surakarta.“The President and all of his aides routinely take swab tests. For the specific case relating to the Surakarta deputy mayor, I think he will take the test sooner than [usually scheduled] after hearing that [Achmad] has tested positive,” Heru said on Friday.He added that the Presidential Palace applied strict health protocols for all visitors and gave an assurance that the palace was “sterile”. (mfp/mrc)Topics :last_img read more

CMPort to Buy 50 Pct Stake in Newcastle Port

first_imgHong Kong’s China Merchants Port Holdings Company Limited (CMPort) plans to acquire a 50% stake in Australian Port of Newcastle for AUD 607.5 million (USD 477.7 million).The company inked an agreement to buy the interest from China Merchants Union (BVI) Limited (CMU) and Gold Newcastle Property Holding.The Port of Newcastle is currently 50% owned by CMU and its subsidiary Gold Newcastle.The remaining 50% stake in the port is held by TIF Investment Trust.With this move, CMPort said it intends to expand global footprint to Oceania, leverage on land resources to capture development upside and provide a financial return.The Port of Newcastle is the largest port on the east coast of Australia and one of the world’s leading coal export ports. It consists of four port zones, including 21 berths with a total design capacity of 211 million tons. In the year 2016, it handled bulk cargo volume of 167 million tons, of which 161 million tons are generated from coal export.last_img read more

India approves Praxair-Linde merger

first_imgFor illustration purposes only (Image courtesy of Linde)The Competition Commission of India (CCI) on Friday approved the proposed merger of industrial gases giants Linde and Praxair.“CCI India approves combination of Linde and Praxair, subject to compliance of certain modifications,” the regulator said in a tweet.As previously disclosed, Both Linde and Praxair would hold approximately 50 percent of the new holding company that will adopt the Linde name and have a market value in excess of $65 billion.The combined company would be governed by a single board of directors with equal representation from Linde and Praxair.In a statement on Friday, Linde and Praxair said that the combination remains subject to timely approval by requisite government regulators and authorities under applicable competition laws.last_img read more

£60m forward Traore placed on top of Klopp’s transfer wishlist

first_img Liverpool are missing out on millions in matchday revenue and have the threat of a TV hit too. The Anfield club badly need the season to finish with just two wins needed to confirm their title and avoid any further damage. Klopp could finance a move for Traore by selling a fringe man or two but that is unlikely to raise enough cash. read also:Adama Traore open to Wolves exit If striker Mo Salah left it would bring in funds but that exit is clearly not currently part of the ­Liverpool masterplan for next season Klopp will keep his ­fingers crossed that the season is completed and he can add the threat of Traore to his attack options which include Salah, Sadio Mane and Roberto Firmino. FacebookTwitterWhatsAppEmail分享 Liverpool boss, Jurgen Klopp, is aspiring to lure Wolves speed machine, Adama Traore to join his champions-elect. Klopp has the powerful £60million-rated wideman at the top of his summer hitlist as he looks for a squad upgrade and to ease pressure on his front three. Traore, 24, has been a sensation under Wolves manager Nuno Espirito Santo this season and has terrorised defences with his pace and improved use of the ball. Wolves, who have used him at wing-back and in more attacking positions, would want more than £60m for the former ­Barcelona kid – who has also reportedly attracted interest from Manchester United and Man City. Traore joined Wolves in August 2018 for under £20m from Middlesbrough but his recent displays will see that price rocket. That will stretch the Kop coffers to the limit as they feel the pain of losses during the pandemic.Advertisement Promoted Content5 Of The World’s Most Unique Theme ParksWhat Happens To Your Brain When You Play Too Much Video Games?Couples Who Celebrated Their Union In A Unique, Unforgettable WayTake A Look At The Celebs Who Lost Their Money And WhyWho’s The Best Car Manufacturer Of All Time?Who Is The Most Powerful Woman On Earth?What Is A Black Hole In Simple Terms?Boys Deserve More Than Action-Hero Role ModelsTop 10 Most Romantic Nations In The World9 Facts You Should Know Before Getting A TattooThe Highest Paid Football Players In The WorldWhich Country Is The Most Romantic In The World? Loading… last_img read more