231 Front Street, Lahaina, HI 96761 [email protected] 808.123.4567

Month: November 2020

Trent Brown: Las Vegas Raiders right tackle released from hospital after IV scare | NFL News

first_imgTrent Brown signed a four-year, £51m contract with the Raiders in March 2019 Raiders coach Jon Gruden said on Monday: “(Brown is) up and seems to be doing well. We’re waiting the results of some of the extensive tests he did today and yesterday. I don’t have anything to report other than he had an issue. Andy Dalton was injured by an illegal hit from Washington linebacker Jon Bostic Andy Dalton was injured by an illegal hit from Washington linebacker Jon Bostic

Julianne Hough, Brooks Laich Couldn’t ‘Get Past Their Problems’

first_imgAccording to the first source, Hough and Laich stayed in contact during the summer because of their mutual friends and business deals.“When they took time apart, Julianne was heavily involved with Kinrgy, and because Brooks helped her develop it, they continued to stay in touch and also were connected because they share the same friend group. They missed each other and ended up hooking up a few times during their breakup and have tried to sort out their marriage and business commitments,” the source tells Us.- Advertisement – Julianne Hough and Brooks Laich have “had a lot of back-and-forth moments” since they initially call it quits, but according to a source, their marriage is over for good.“Julianne and Brooks just can’t get past their problems,” the source exclusively tells Us Weekly. “Julianne had a dinner party with friends a few months ago, which Brooks came to. They were trying to be lovey-dovey with each other and have a good night with a few friends, but Brooks ended up bringing up some of their issues in front of everyone and it became a big fight.”- Advertisement – Hough, 32, and Laich, 37, announced their split in May after months of speculation.Julianne Hough and Brooks Laich Couldn’t Get Past Their ProblemsJulianne Hough and Brooks Laich Tonya Wise/Invision/AP/Shutterstock“We have lovingly and carefully taken the time we have needed to arrive at our decision to separate,” the duo said in a joint statement at the time. “We share an abundance of love and respect for one another and will continue to lead with our hearts from that place. We kindly request your compassion and respect for our privacy moving forward.”The Dancing With the Stars alum was subsequently seen with Westworld alum Ben Barnes. Three months later, Hough and Laich, who wed in 2017, were spotted at lunch, sparking reunion speculation. A second source told Us in September that they were “giving things another shot.”- Advertisement – After being seen together on multiple occasions, Hough filed for divorce on Monday, November 2. The Footloose alum’s decision to take legal action came after her brother, Derek Hough, exclusively told Us that he wants both his sister and brother-in-law to be happy.“For anybody that you love and that you care about, that’s all you want. You just want people around you to be happy and to support them in any way you possibly can and to serve them,” Derek, 35, told Us on October 2. “And that’s really the key. … We just want all of our family, we want all of our friends and everybody to be happy. And then if we can help that, then we’re happy to do it.”The same day Julianne filed for divorce, she shared a cryptic quote via Instagram that read, “May your choices reflect your hopes, not your fears.”Listen to Us Weekly’s Hot Hollywood as each week the editors of Us break down the hottest entertainment news stories! – Advertisement –last_img read more

Helen Ward: Wales striker says Watford Ladies being classed ‘non-elite’ during Covid-19 lockdown is tough to take | Football News

first_img“As players and staff, we’ve done everything we can to make sure we’re going along with the protocols. It has been so good being back.“We’re been fortunate enough to have supporters out our games, so I suppose there’s an upside to not being elite, but it’s disappointing. Football for us and our supporters is such an important part of our lives, I just hope it doesn’t have a detrimental effect on mental or physical health.”Watch The Women’s Football Show on Friday at 8.30pm on Sky Sports Football. Watford Ladies captain and Wales’ leading goalscorer Helen Ward admits the new coronavirus restrictions are “tough to take” as she is unable to train with her club ahead of a key international game which falls during the four-week lockdown.England entered a national lockdown on Thursday, but the government gave elite sport the green light to continue during the initial four-week period of heightened restrictions.- Advertisement – The Women’s Super League and Championship will resume as normal, but Watford fell outside of the government’s elite classification as they currently play in the third-tier National League South.On Tuesday, Ward tweeted “I miss being an ‘elite’ sportswoman”, and she told Friday’s edition of The Women’s Football Show about how lockdown has impacted her preparation for Wales’ Euro Qualifer against Belarus on December 1.“It is tough to take, we’ve got another qualifier coming up on December 1 which is still in this period of lockdown,” she said. – Advertisement –center_img – Advertisement – “For me personally, and a few others in our league, we’re going to have to prepare for a very important game without being able to train or play with our club.“On the one hand, you’re considered elite and can carry on internationally, but on the other hand even though we’re doing very much the same things as plenty of the clubs in the Championship, we’re not considered as elite domestically. It’s a weird one to get your head around.“I’m going to have to get back on the treadmill again, training on my own. It’s really hard mentally to motivate yourself. Watford have really backed us and made sure our environment is as safe as it can be.- Advertisement –last_img read more

Kamark departs as Etihad restructures operations | News

first_img– Advertisement – “That is why we are taking definitive and decisive action to adjust our business and position ourselves proudly as a mid-sized carrier. “The first stage of this is an operational model change that will see us restructure our senior leadership team and our organisation to allow us to continue delivering on our mandate, ensuring long-term sustainability, and contributing to the growth and prominence of Abu Dhabi.” OlderLight at the end of the tunnel for Marriott Terry Daly will also assume the role of executive director guest experience, brand and marketing.The restructuring is part of a winder transformation as Etihad seeks to turn itself into a mid-sized, full-service carrier concentrating on its fleet of widebody aircraft.Etihad hopes – which once maintained hopes of challenging Emirates as a global super-connector – to emerge with a leaner, flatter and scaleable organisational structure.- Advertisement –center_img Tony Douglas, group chief executive officer, Etihad Aviation Group, said: “After our best-ever first quarter performance, none of us could have predicted the challenges that lay ahead in the remainder of this year.“I am extremely proud of the way my leadership team and the whole Etihad family have navigated the Covid-19 crisis so far, and I must express my gratitude to each member of the team for continually proving our adaptability to the most unexpected of circumstances.”He added: “As a responsible business, we can no longer continue to incrementally adapt to a marketplace that we believe has changed for the foreseeable future. – Advertisement – Robin Kamark has stepped down from his role as chief commercial officer with Etihad Airways as the carrier restructures in the wake of the Covid-19 travel slump. Following his departure, the business units within the commercial department will be separated and transferred to the leadership of Mohammad Al Bulooki, chief operating officer, and Adam Boukadida, chief financial officer. – Advertisement –last_img read more

Zoom and other ‘stay-at-home’ stocks got crushed on the positive vaccine news

first_imgThe losses came after Pfizer and BioNTech reported that their coronavirus vaccine candidate showed a 90% efficacy rate in preventing infections during a late-stage trial. Scientists were hoping for a vaccine that was at least 75% effective. White House coronavirus advisor Dr. Anthony Fauci had said a vaccine that is 50% or 60% effective would be acceptable.“I think we can see light at the end of the tunnel,” Pfizer Chairman and CEO Dr. Albert Bourla told CNBC’s Meg Tirrell on “Squawk Box.”Traders had piled into stocks such as Zoom, Amazon, Netflix, Teladoc and Shopify this year as the pandemic raged on and kept most people from leaving their homes.- Advertisement – Before Monday, Zoom Video skyrocketed 635% year to date. Amazon and Netflix were up 79.2% and 59.1%, respectively, in 2020. Teladoc was up 146.2% this year and Shopify popped 162.8%.However, investors on Monday appeared to be rotating away from those high-flying names and into companies that would benefit from the economy reopening.Bank of America popped 14.2%. JPMorgan Chase jumped 13.5%. Cruise operators Carnival Corp. and Norwegian Cruise line were up 39.3% and 26.8%, respectively. Royal Caribbean closed 28.8% higher. American Airlines, meanwhile, surged more than 15%.- Advertisement – Shares of Zoom Video fell sharply Monday as names benefitting from people staying at home due to the coronavirus pandemic lost their appeal following the release of positive coronavirus vaccine data.Zoom Video closed 17.4% lower. Fellow “stay-at-home” stocks Amazon and Netflix dropped 5.1% and 8.6%, respectively. Teladoc Health slid 13.7% and Shopify declined by 13.6%.- Advertisement – Subscribe to CNBC PRO for exclusive insights and analysis, and live business day programming from around the world. – Advertisement –last_img read more

H5N1 avian flu viruses: What’s in a name?

first_imgDec 30, 2005 (CIDRAP News) – Last month, officials in Italy and Canada aroused concern by announcing they had found an H5N1 influenza virus in wild birds. Neither country had previously been troubled by any reports of the virulent H5N1 virus that has been plaguing poultry and occasionally sickening and killing humans in Asia.But in both cases, health officials said the virus was not dangerous and was unrelated to the H5N1 virus in Asia.This suggested an obvious question: If a virus has the same name as the one in Asia, why isn’t it just as dangerous?The answer has to do with the rather outdated conventions for naming influenza viruses, according to David Halvorson, a veterinary pathologist and avian influenza expert at the University of Minnesota in St. Paul.The “H” and “N” in the name of a flu virus stand for hemagglutinin and neuraminidase, two proteins on the surface of the virus that allow it to enter and exit host cells. Sixteen different hemagglutinins and nine different neuraminidases have been identified to date.Hemagglutinin and neuraminidase were the first aspects of the flu virus to be identified, so the nomenclature was built around the two genes that code for them, Halvorson explained to CIDRAP News. The types are numbered according to when they were discovered; H1 was identified first.However, a flu virus also has six other genes and corresponding proteins. Thus a name like “H5N1″ is a very incomplete description of the virus.”The H5N1 only describes two of the eight genes, so there are six other genes,” Halvorson said. It’s possible to have an H5N1 strain with six other genes from an avian flu virus, or an H5N1 with six other genes from a human-adapted or pig-adapted flu virus. “That’s how far apart they can be.”For example, the other six genes in a given H5N1 virus could be identical to the other six genes in an H6N2 virus, he said.In an analogy Halvorson uses with his students, he said that assuming that all H5N1 viruses are identical would be like assuming that all men wearing navy blazers and gray pants are the same in other ways.”You can have the mafia wearing that outfit or you can have a college professor wearing that outfit—or a used car salesman,” he said.”We’re stuck with something we have difficulty explaining because we don’t really have good nomenclature,” Halvorson summed up.Mild viruses can turn nastyAvian flu viruses of the H5 and H7 types can be either relatively harmless or highly lethal to poultry—low-pathogenic or highly pathogenic. (The conventional abbreviations are LPAI and HPAI, for low-pathogenic and highly pathogenic avian influenza.) In fact, all known HPAI strains are either H5 or H7 subtypes.HPAI strains typically are detected as a result of poultry deaths, Halvorson said. The designation of high pathogenicity generally is based on what happens to healthy chickens when they’re exposed to the virus. If the virus kills at least 6 out of 8 chickens in a challenge trial, it is deemed highly pathogenic.Unfortunately, a low-pathogenic strain won’t necessarily stay that way. It can evolve unpredictably into a highly pathogenic strain—a change that may take weeks, months, or even years.What differentiates LP from HP strains at the molecular level, Halvorson explained, is the nature of the hemagglutinin cleavage site, where the hemagglutinin is split by an enzyme or some other factor, enabling the virus to enter a host cell.In most human and poultry flu cases, the virus is cleaved by protease, an enzyme found in the respiratory tract, Halvorson said. But an HPAI virus doesn’t need that protease assistance to split; “It gets cleaved almost by itself.” Consequently such viruses can spread in many tissues, not just the respiratory tract.Scientists now can identify HPAI viruses not only by how they affect chickens, but also by examining the amino acid sequences at the hemagglutinin cleavage site, according to Halvorson. (Most of the time, however, HPAI viruses are detected by their effects on poultry.)Generally, HPAI viruses are defined by having four basic (as opposed to acidic) amino acids at the cleavage site, he said. However, in the last few years there were two cases in which an HPAI virus emerged without those four basic amino acids. Those viruses had an insert from another gene at the cleavage site that allowed it to split more easily. The outbreaks involved H7 strains in Chile in 2002 and in British Columbia in 2004.Viral instability tough on poultry industryThose outbreaks illustrated once again the highly unstable nature of flu viruses. Mutations occur constantly as the virus tries “to find the best fit for the species” it depends on, Halvorson said.Flu viruses, including H5 and H7 varieties, circulate all the time in wild waterfowl, usually without making them sick. “Occasionally there’s going to be spillover into poultry someplace. Even though it may be low-path, it’s cause for concern,” he explained.The US poultry industry is “99.99% free of influenza,” but every year flu turns up in one or more flocks in one or several states, he added.When the strain is a low-pathogenic H5 or H7, there’s no way to predict if, or how soon, it might evolve into a highly pathogenic form. In the outbreaks in Chile and British Columbia, the transition took just a few weeks. But in Pennsylvania in 1983, it took 6 months. And a low-pathogenic H7N2 virus has persisted in live-bird markets in New York since 1994 without changing into the lethal form.The World Organization for Animal Health (OIE) recently recommended that all low-pathogenic H5 and H7 avian flu outbreaks be reported to veterinary authorities, given the risk that they can turn virulent, Halvorson said. This has increased the level of awareness and concern about the viruses.”So states like Minnesota, which never destroyed any poultry before, if we were to get an H5 or an H7 [that’s low-pathogenic], we’d be under tremendous pressure to destroy the flock,” he noted.The heightened concern has economic consequences. Halvorson said there’s no legal basis for banning poultry imports from an area where LPAI has been found, yet the US Department of Agriculture promptly (though temporarily) banned poultry from British Columbia recently when an LPAI strain turned up there.H5N1 may lead to use of risky vaccinesAs the virulent H5N1 virus continues to evolve and kill poultry in Eurasia, Halvorson predicted, scientists may turn toward a hitherto unthinkable option: a live influenza vaccine for poultry. Such vaccines use a live but weakened form of flu virus.Such vaccines have long been considered too risky in poultry. “Because these viruses are so unstable, the concern was that they could recombine with some other virus that’s there and make something worse,” he said.But with the H5N1 virus now present in 15 or more countries and endemic in several of them, using a live vaccine may be worth the risk, he said. “People are now saying we’ve got to attack this with everything at our disposal, and that’ll have to include a live vaccine. The door is open now for a live H5 vaccine in birds.”Live vaccines offer important advantages, Halvorson explained. One is that they require less antigen (active ingredient) than killed vaccine. A live vaccine may contain too few copies of the weakened virus to trigger an immediate immune response, but once inside the host, the virus replicates to the point where the immune system detects and responds to it. A killed virus must be injected in larger doses, because it doesn’t multiply inside the recipient.A second advantage is that live viruses don’t have to be injected into each bird individually; they can be put into drinking water or sprayed into the air in a chicken coop. That way, hundreds or thousands of birds can be immunized quickly. Killed viruses, by contrast, must be injected, because there’s no other way to administer them that will bring them into contact with the immune system.Earlier this week, not long after Halvorson predicted that live vaccines would be used against H5N1, Chinese veterinary officials announced they had developed a live-virus vaccine covering both H5N1 flu and another devastating poultry virus, Newcastle disease.In a follow-up interview, Halvorson said it appeared that the Chinese vaccine involved a genetically engineered Newcastle disease virus, rather than a live influenza virus. “I believe they’re talking about a recombinant Newcastle vaccine virus that will express a protein from an [H5N1] influenza virus, and the body would produce antibodies against that H5 virus,” he said.”A similar thing was done here [in the United States] a few years ago,” but it didn’t lead to a marketable vaccine, he said.See also:Nov 11 CIDRAP News story dealing with H5N1 virus in Italyhttp://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/nov1105avian.htmlNov 21 CIDRAP News story mentioning H5N1 virus found in Canadahttp://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/nov2105canada.htmllast_img read more

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

NEWS SCAN: E coli outbreak, viable frozen flu viruses, progress on virus-sharing

first_img Chan sees progress toward a deal on virus sharingDr. Margaret Chan, director-general of the World Health Organization (WHO), said governments are making progress toward an agreement on the sharing of virus samples and vaccines and drugs derived from them, according to a Reuters report published today. In response to developing countries’ concern about access to vaccines developed from their virus samples, governments have been negotiating on the issue since 2007. A meeting last week did not produce a final agreement, but at the WHO’s annual meeting today, Chan won broad support for a proposal for her to “facilitate a process to finalize the remaining elements including the standard material transfer agreement” and then present a deal to the WHO’s executive board next January, according to Reuters. Chan said the novel H1N1 flu epidemic has prompted an unprecedented commitment by affected countries to the sharing of information, genetic sequences, viruses, diagnostic kits, and lab equipment. [May 21 Reuters report] E coli cases in three states prompt ground beef recallAn outbreak of Escherichia coli O157:H7 infections in three states has prompted an Illinois company to recall 95,898 pounds of ground beef because of possible contamination, the US Department of Agriculture (USDA) announced today. The products, produced Mar 10, were recalled by Valley Meats, Coal Valley, Ill., the USDA Food Safety and Inspection Service (FSIS) said. The products were distributed nationwide, carry the establishment number “EST. 5712,” and were sold under the brand names 3S, Grillmaster, J & B, Klub, Thick ‘N Savory, and Ultimate. The agency said the Ohio Department of Health reported a cluster of illnesses on May 13, and cases also have been found in Illinois and Pennsylvania. Kristopher Weiss, a spokesman for the Ohio Department of Health, told CIDRAP News that Ohio has had three cases, all in the Cleveland area, involving matching E coli isolates and with illness onset dates of Apr 11, 12, and 14. Weiss said two of the patients were hospitalized, but all three recovered. The FSIS did not specify how many cases were identified in Pennsylvania and Illinois. [May 21 FSIS release] Researchers say flu viruses frozen in lakes stay viable for decadesInfluenza A viruses that have been frozen in lake and pond ice remain viable and potentially infectious when the ice thaws, a team from Bowling Green State University reported yesterday at the general meeting of the American Society for Microbiology in Philadelphia. Zeynep Kocer and Scott Rogers found that flu viruses from frozen lakes and ponds in the Arctic and in Ohio, along major flyways for migrating ducks, were still infectious under lab conditions, and could account for flu strains re-emerging after decades.center_img May 21, 2009last_img read more

Michelin awards presented to Zagreb restaurants

first_imgAgava, Apetit City, Bistro Apetit, Boban, Dubravkin put, Gallo, Le Bistro Esplanade, Mano, Mundoaka, Takenoko and Zinfandel’s have entered the selection of MICHELIN’s gastro guide for 2017 and now operate with the prestigious recommendation of one of the most important restaurant guides in the world.The awards of the MICHELIN guide, the so-called MICHELIN plates, were earned by 34 Croatian restaurants which, according to anonymous inspectors, serve good and simple food, while the Monte restaurant from Rovinj was awarded the first and, for now, only MICHELIN star in Croatia. ”Jeleven Zagreb restaurants with the recommendation of MICHELINA are long-term partners of METRO with whom we share the philosophy and passion for culinary perfection and top quality products. We are extremely pleased that MICHELIN inspectors have recognized their quality and we are proud that the cooperation with MICHELIN’s guide has enabled METRO to be a part of the success of top Croatian restaurants and caterers in this way as well.”  said Roberto Mancuso, CEO of METRO, who presented awards and plaques to restaurants.With more than 100 years of experience in restaurant selection, the MICHELIN guide today recommends more than 20.000 restaurants in 30 countries around the world. Whether it is Europe, Asia or America, MICHELIN inspectors apply the same criteria in assessing the quality of every restaurant they visit anonymously. Using a unique process perfected over the decades, the MICHELIN guide has become an international reference for fine-dining, and the plaque of the MICHELIN guide is the official recognition that the restaurant is part of the selection for 2017.Related news:ISTRIA GOT ITS MICHELIN GUIDElast_img read more

Sandra Gobin, Uniline: Slavonia has a beautiful future as a destination

first_imgThe management and the leading team of Uniline, the leading Croatian tourist operator, visited the Osijek-Baranja and Vukovar-Srijem counties in order to see the possibilities for the development of multi-day destination and daily excursion programs.A more intensive opening of the foreign market of Slavonia is a prerequisite for a quality start and recognition on the domestic market and thus an increase in the arrival of domestic guests, which will certainly contribute to the working visit of the Management and leading team Unilineam, as well as all other travel agencies. they would meet and experience it. “We chose Slavonia as the destination for our team building in order to give it business and social support considering our know-how and the sales channels we have at our disposal.” said Boris Žgomba, CEO of Uniline.Sandra Gobin, Member of the Management Board and Director of the Tourism Sector: We are ready to take a share in the tourism development of Slavonia Slavonia as a destination has a beautiful future is the conclusion of the working visit, and as they point out from Uniline, it is a series of new jobs and activities on which tourism is based today – from specialized tourist tours, hunting tourism, wine roads, bird watching, school and riding trails, family farms, camps, family hotels to original restaurants and wine cellars given what Slavonia abounds in. “We are ready with other colleagues from the sector to take over our share in tourism and destination development in this area. We are thrilled with what we have experienced. We are still collecting impressions, but it is clear that there are undoubted potentials for eno-gastro, cultural tourism and historical, ie archaeological tourism, which we will gradually introduce into our programs for some foreign and domestic market niches with special interest.”Said Sandra Gobin, Member of the Management Board and Director of the Tourism Sector.Uniline, which also has the Europcar franchise in its portfolio, a rent a car operation with more than 1.200 vehicles in its fleet, is a leading Croatian tour operator that annually provides tourist services to over 350 guests in Croatia and the region of Southeast Europe. By entering the management of sales processes and the entire hotel business (hotel management), the company is just being transformed into a complete business tourism group, ie a one-stop tourist company.I hereby invite all other travel agencies to visit Slavonia and experience it with their own eyes in order to see for themselves the extremely great potential for the development of tourism in Slavonia, as well as the solution of year-round tourism. I also invite all other companies to organize their team building programs in Slavonia.Also, I invite you to support the initiative to hold the Days of Croatian Tourism in 2018 in Slavonia # DHTSlavonija2018last_img read more