Category: rntaoiim

  • Pandemic triage plan addresses tough ventilator decisions

    first_imgDec 1, 2006 (CIDRAP News) – Canadian infectious disease and critical care experts, working on behalf of Ontario pandemic planners, have developed one of the first triage plans for pandemic influenza.The protocol is designed to guide clinicians’ triage decisions for patients with and without influenza during the first days and weeks of a pandemic when the critical care system is overwhelmed and resources are scarce. The report was published in the November issue of the Canadian Medical Association Journal (CMAJ).In developing a protocol for pandemic influenza triage, the group used components from other types of triage plans, such as severity scoring systems. The pandemic triage plan has four components: inclusion criteria, exclusion criteria, minimum qualifications for survival, and a color-coded prioritization tool.The inclusion criteria identify patients who may benefit from critical care treatment, focusing on respiratory failure.Exclusion criteria place patients in three different categories: those who have a poor prognosis despite critical care, those whose care demands resources that can’t be provided during a pandemic, and those who have underlying advanced medical conditions such as malignant cancer or end-stage organ failure that complicates their critical influenza status.The authors write that they struggled with the decision to put an age cutoff in the plan’s exclusion criteria. They did not include one in their original protocol draft because they claim age may not strongly predict critical care outcomes. “However, we received strong and consistent feedback from both expert and stakeholder consultations that an age criterion should be included,” they wrote. Age above 85 is listed among the exclusion criteria, but the authors suggest that the topic of age cutoff requires more research and community input.The “minimum qualifications for survival” component attempts to place a limit on the resources used for any one patient. “This is a concept foreign to many medical systems in developed countries but one that has been used in war zones and refugee camps,” the authors write. In the triage protocol, patients are reassessed at 48 and 120 hours to identify early those who are improving and those likely to have a poor outcome.A tool for prioritizing patients for admission to the intensive care unit (ICU) and access to ventilation is based on a color scheme used for disaster triage plans: blue or black, red, yellow, and green. Patients in the red category have the highest priority for ICU care and ventilation, if needed. Those at the lowest category—blue or black—may receive expectant care or palliative care on the medical ward.The prioritization tool incorporates the Sequential Organ Failure Assessment (SOFA), which allows emergency department personnel to assign patients a score on the basis of physiologic parameters and simple laboratory tests. The authors write that SOFA scores are easy to calculate and have been validated for a variety of critical care conditions.”The goal is to optimize the effectiveness of the triage protocol so that every patient who receives resources will survive,” say the authors.Though they consulted a bioethics guide, Stand on Guard for Thee, produced by the University of Toronto Joint Centre for Bioethics, to develop the triage protocol, the authors note that limited resources during a pandemic will mean not all patients receive the intensive care they need. Communities should review, discuss, and refine the protocol before it is implemented in a pandemic setting, they say.In an editorial in the same issue of CMAJ, two bioethicists from Dalhousie University in Halifax say it isn’t clear how bioethics principles shaped the development of the pandemic triage protocol, which they say gives the document a utilitarian focus. “We must be clear why certain values are privileged and others not. This paper contributes to the project, but there is much tough work yet to be done,” the editorial states.They commend the protocol developers for calling for more community involvement but say the document does not address how to accomplish this goal.John Hick, MD, a disaster medicine expert and emergency medicine physician at Hennepin County Medical Center in Minneapolis, told CIDRAP News that the pandemic triage report contributes to the growing discussion about the decision tools clinicians need in order to make tough decisions about allocating ventilators during a pandemic. He said that while the authors’ use of SOFA scoring is justified because it is easier to use than other systems, there are little data about what difference in SOFA score warrants taking one patient’s ventilator to give to another who might have a better prognosis.”Is a difference of 1, 2, or 5 enough to justify such action? At this time, we do not have good guidance,” Hick said. “Pandemic-specific epidemiological response to treatment will also have to inform these types of systems,” he said, adding that clinicians may have to account for overwhelming mortality for certain age-groups as they use the triage tools.Hick said it would be useful to know how the authors chose the cutoffs for the triage categories and why they included refractory hemodynamic instability in their inclusion criteria in addition to respiratory failure. “The combination of these two factors alone results in a very high mortality, and the limited inclusion criteria may not ‘include’ enough patients to aid decisions when many patients require ventilatory support,” he said.Another component of pandemic triage that would be helpful, Hick said, is an assessment of a patient’s response to a trial of mechanical ventilation. Such an assessment would help clinicians decide if the patient should remain on the ventilator when resources are scarce, he noted.Hick said this and other papers that address pandemic triage are useful for helping shape triage decisions and spur more discussion. “There is clearly a need to improve the science of triage and to establish institutional and governmental processes that will facilitate these decisions, regardless of the actual tool or criteria that may be most appropriate for the event.”Christian MD, Hawryluck L, Wax RS, et al. Development of a triage protocol for critical care during an influenza pandemic. CMAJ 2006;175(11):1377-1381 [Full text]Melnychuk RM, Kenny NP. Pandemic triage: the ethical challenge. (Editorial) CMAJ 2006;175(11):1393 [Full text]See also:University of Toronto Joint Centre for Bioethics report on ethical considerations during a pandemichttp://www.jcb.utoronto.ca/people/documents/upshur_stand_guard.pdfFebruary Academic Emergency Medicine article on ventilator triage during an epidemiclast_img read more

  • Last week, 21 percent fewer accounts were fiscalized than last year

    first_imgIn activity I – providing accommodation and food preparation and serving is visible 31% account reduction, and the invoice amount of 45%. In all activities from the fiscalization system, 21 percent fewer accounts were fiscalized last week than last year, according to data from the Tax Administration. For all activities in the period from 29.06.- 05.07.2020. year compared to the same period in 2019 is visible 21% reduction in the number of accounts, i reduction of the invoice amount of 17%, in activity G – Wholesale and retail trade, repair of motor vehicles and motorcycles is visible 16% account reduction, the a 7% reduction in the invoice amount. center_img Also, in the period from 24.02.-05.07.2020. in relation to the same period last year in activity I – providing accommodation and food preparation and serving is visible 51% reduction in the number of accounts and 61% in the account amount.last_img read more

  • It’s wise for opponents to give Trump some credit

    first_imgCategories: Editorial, OpinionApple’s announcement last Wednesday that it will repatriate most of the estimated $274 billion that it holds in offshore earnings is great news for the United States. The failure to understand this meant a failure to appreciate the depth of American discontent.It helps explain how Hillary Clinton lost her unlosable election to a man whose central claim to office was that he understood business.More recently, Democrats have convinced themselves that Trump is merely the beneficiary of Obama’s economic legacy.But how can the critics who previously assured us that Trump’s election would cause certain calamity now explain that he’s nothing but a lucky bystander to forces beyond his control?Had the economy tumbled over the past year his critics would surely have blamed him. It’s ill grace to deny him all credit when it’s doing so well.The truth is that it’s hard to account exactly for why the economy does well or poorly from one year to the next.But it’s also true that the president has been nothing if not aggressive in his efforts to remove regulations, cut taxes and promote American businesses (not least his own), and animal spirits on Wall Street have responded accordingly. Uncle Sam will get a one-time $38 billion tax payment.The company promises to add 20,000 jobs to its U.S. workforce, a 24 percent increase, and build a new campus.Another $5 billion will go toward a fund for advanced manufacturing in America.C’mon. What’s with the long face?In December this column warned that hysterical opposition to the Republican tax bill was a fool’s game for Democrats that could only help President Donald Trump. Yes, there were things to dislike in the legislation, from both a liberal and a conservative perspective.But it was not the moral and fiscal apocalypse its critics claimed. Also true is that Americans will generally give credit for a good economy to whichever president presides over it.Yet one gets a distinct sense that Trump’s relentless critics would rather bury the Apple news or look for the cloud within the silver lining.This is not a good look. If making confident but lousy predictions is one form of political malpractice, wanting things to fail is another.The same goes for the government shutdown. Democrats placed a large bet that it’s a political showdown they could win.But what they are mainly doing is wrecking their chances of retaking the House or Senate by appearing to put the interests of DACA’s immigrant “Dreamers” ahead of the rest of America.How that helps Dreamers, Democrats, Americans or anyone other than the president and maybe California Sen. Kamala Harris is anyone’s guess. “The global financial destruction that will happen under President Trump has already begun.”That was a headline in London’s Independent newspaper on Nov. 9, 2016. Those whom the gods will mock, first they make pompous economic forecasters.It’s worth thinking carefully about why Trump’s critics have been so wrong about the economy, and of the damage their hubris does to the anti-Trump case.Democrats entered the 2016 election cycle on what they thought was the back of a strong economy.It wasn’t.Barack Obama presided over the weakest expansion in postwar history.The economy grew by 15.5 percent from the second quarter of 2009 to the second quarter of 2016. During the (slightly longer) Reagan boom of 1982-90, it grew by more than 38 percent. And its central achievement — a dramatic cut in corporate rates to 21 percent from 35 percent — was an economic no-brainer that many Democrats, including President Barack Obama, had supported (albeit less steeply) just a few years ago.Apple will not be the only multinational that will soon bring back gigantic profits to take advantage of new low repatriation rates.Microsoft holds $146 billion in overseas earnings, Pfizer $178 billion, General Electric $82 billion, Alphabet $78 billion, and Cisco $71 billion, according to estimates from the Zion Research Group.The total stash is about $3 trillion — by one measure nearly three times what it was just a decade ago.Assume that just half of that money comes home to the United States.It’s still the equivalent of Canada’s entire gross domestic product.Not too shabby, especially considering all the hyperbolic predictions of economic doom that went with Trump’s election. Donald Trump is a profoundly defective person who nearly every morning does grave political self-harm with no assistance from his opponents.But he is also president, and normal Americans — that is, those who hold the outcome of the next election in their hands — do not want him to fail.They want statesmanship, not schadenfreude.Wouldn’t it be smart of all of Trump’s opponents to show they are superior to him in the former?And wouldn’t a good way of doing that be to abjure the latter, even if it sometimes means giving him some credit?Bret Stephens is an op-ed columnist for The New York Times.More from The Daily Gazette:Foss: Should main downtown branch of the Schenectady County Public Library reopen?EDITORIAL: Find a way to get family members into nursing homesEDITORIAL: Urgent: Today is the last day to complete the censusEDITORIAL: Beware of voter intimidationEDITORIAL: Thruway tax unfair to working motoristslast_img read more

  • Zara hits Glasgow

    first_imgTo access this article REGISTER NOWWould you like print copies, app and digital replica access too? SUBSCRIBE for as little as £5 per week. Would you like to read more?Register for free to finish this article.Sign up now for the following benefits:Four FREE articles of your choice per monthBreaking news, comment and analysis from industry experts as it happensChoose from our portfolio of email newsletterslast_img

  • NasDem to nominate Jokowi’s son-in-law as Medan mayoral candidate

    first_img“We will give our utmost support to Bobby. He did well in our survey, too well, even,” Surya told journalists in Medan on Thursday.He added that several people had registered with the party to run in this year’s Medan mayoral race, including incumbent mayor Akhyar Nasution. However, an internal survey revealed that Bobby ranked higher than Akhyar.Read also: Jokowi’s son-in-law meets with Prabowo over Medan mayoral raceSurya denied the party had given its support to Bobby due to his relationship with President Jokowi. The NasDem Party has confirmed its plan to nominate President Joko “Jokowi” Widodo’s son-in-law, Bobby Afif Nasution, as its candidate for the 2020 Medan mayoral election in North Sumatra.NasDem chairman Surya Paloh said the party decided to give its support to Bobby because the latter had earned the top spot in the party’s recent internal survey. Topics :center_img “He became the President’s son-in-law by a stroke of luck. Why should we even care about that?” Surya said, adding that his son Prananda Surya Paloh would not join the Medan mayoral race.The President’s in-law registered with NasDem’s North Sumatra branch on Jan. 22 to run in the mayoral election. Aside from NasDem, Bobby had also registered with the Indonesian Democratic Party of Struggle (PDI-P) and the Golkar Party.NasDem is unable to nominate Bobby by itself since the party only gained four seats on the Medan Legislative Council. A political party is only eligible to nominate a candidate if it has a total of 10 seats on the legislative council.Such provision would urge NasDem to form a coalition with other parties so it could gain additional seats and fulfill the nomination requirement. (dpk)last_img read more

  • Maldives gets Amal Clooney to fight for Rohingya at UN court

    first_imgTopics : “Accountability for genocide in Myanmar is long overdue and I look forward to working on this important effort to seek judicial remedies for Rohingya survivors,” Clooney was quoted as saying by the Maldivian government.Thousands are suspected to have been killed in the Rohingya crackdown and refugees brought widespread reports of rape and arson by Myanmar’s military and local Buddhist militias. Clooney successfully represented former Maldives president Mohamed Nasheed and secured a UN decision that his 2015 jailing for 13 years was illegal.With the fall of strongman president Abdulla Yameen in 2018, Nasheed as well as several other dissidents in the Sunni Muslim nation of 340,000 have been cleared of any wrongdoing. Nasheed is currently the atoll nation’s speaker in the national legislature.The government said it welcomed the ICJ’s decision to order provisional measures to secure the rights of victims in Myanmar and prevent the destruction of evidence in the ongoing case.center_img The luxury tourist destination of the Maldives has hired prominent human rights lawyer Amal Clooney to represent it at the UN’s highest court in seeking justice for Myanmar’s persecuted Rohingya Muslims.The Maldivian government said Wednesday it will formally join the mainly Muslim African state of The Gambia in challenging Myanmar’s 2017 military crackdown that sent around 740,000 Rohingya fleeing into neighboring Bangladesh.In a unanimous ruling last month, the International Court of Justice (ICJ) ordered Buddhist-majority Myanmar to implement emergency measures to prevent the genocide of Rohingya — pending a full case that could take years.last_img read more

  • Driver escapes vehicle minutes before train crash in East Java

    first_imgAccording to a statement from state-owned railway operator PT Kereta Api Indonesia’s (KAI) operational region (DAOP) VII in Madiun, the accident occurred at 10:26 a.m.Read also: This year’s Idul Fitri traffic accidents fall by 31 percent“The driver was coming from the north and heading south, crossing the train track without looking left or right. The train had blown its horn but was ignored by the driver. The train only brushed the car,” PT KAI DAOP VII spokesperson Ixfan Hendriwintoko said as quoted by kompas.com.Jombang Police traffic unit head Adj. Comr. Risky Fardian Caropeboka said there were no casualties in the incident.“We suspect the accident occurred due to the driver’s carelessness,” Risky said.The KA Ranggajati experienced a 14-minute delay due to the accident, as the locomotive needed to be repaired before continuing its journey. (dpk)Topics : A motorist was able to get out his vehicle minutes before it was hit by a train in Sumbermulyo village, Jombang regency, East Java, on Friday.The driver, identified as AM, 46, was driving through an ungated railway crossing when his car suddenly stalled. In the meantime, the KA Ranggajati train from Surabaya was approaching the crossing.AM was able to escape his car before the train hit his vehicle.last_img read more

  • Drinkwater future at Villa doubtful after ‘headbutting Jota’

    first_img The midfielder is on loan from Chelsea as he looks to rekindle his career in the Premier League. Danny Drinkwater’s future at Aston Villa is in serious jeopardy after the midfielder reportedly headbutted Jota in training.Advertisement Loading… But Villa chiefs are holding talks over whether or not to cut short his time at the club and send him back to London.It comes after an angry exchange with team-mate Jota in training.The Daily Mail report that the former Manchester United trainee planted a headbutt on the 28-year-old.He is also expected to be handed a fine and faces disciplinary action at the club.A decision over his future at the Villans remains to be made, the Daily Mail report.But it is the latest incident in a string of events of a turbulent couple of years for the ex-Leicester star.Towards the end of the last campaign he was banned for 20 months from driving after being found guilty of being over the limit behind the wheel.A loan move to Burnley was also ended in January after failing to impress Sean Dyche, making one Premier League start.His time at Turf Moor was marred by a fight outside a Manchester club when he appeared to headbutt someone.Danny Drinkwater’s future at Aston Villa is in serious jeopardy after the midfielder reportedly headbutted Jota in training.Read Also:Mayweather calls out Joshua as speaks on what he dislikes in boxingDrinkwater has made just four appearances for Villa since arriving in January.Fitness has been a problem for the 30-year-old and he now sits on the peripherals of the first-team.However, after this latest incident it is hard to envisage Dean Smith giving the former Premier League champion another chance.FacebookTwitterWhatsAppEmail分享 Promoted Content8 Superfoods For Growing Hair Back And Stimulating Its Growth7 Famous And Incredibly Unique Places In ThailandWho Is The Most Powerful Woman On Earth?2020 Tattoo Trends: Here’s What You’ll See This YearThe Very Last Bitcoin Will Be Mined Around 2140. Read More8 Addictive And Fun Coffee Facts10 Risky Jobs Some Women Do7 Actors Who Quit Movies For Shocking ReasonsYou’ve Only Seen Such Colorful Hairdos In A Handful Of AnimeBest Car Manufacturers In The WorldTop 10 Most Romantic Nations In The World10 Places On Our Planet Where The Most People Livelast_img read more

  • New Zealand sit comfortably against England in Hamilton Test

    first_imgHamilton: A century by Tom Latham followed by a decent spell of fast bowling by Tim Sou thee and Matt Henry have put New Zealand in a strong position in the ongoing second and final Test against England being played at the Sedden ParkAfter scoring 375 in their first innings, New Zealand had England at 39/2 at Stumps on Day 2, with Rory Burns and skipper Joe Root batting on 24 and 6 respectively.Earlier, starting the day at 173/3, the Black Caps lost Latham early as he could add just four runs to his overnight score before being clean bowled by Stuart Broad. Henry Nicholls also couldn’t stay long as he was dismissed on his individual score of 16.However, BJ Watling, who became New Zealand’s first wicket-keeper to score a Test double hundred in Mount Maunganui, continued from where he left and scored a patient half-century to put the hosts in the driver’s seat.Along with Daryl Mitchell, Watling shared a 124-run partnership before he lost his wicket at 55. Mitchell however continued and played a handful knock of 73 runs.First Test centurion Mitchell Santner and Tim Sou thee made useful contributions of 23 and 18 down the order and helped New Zealand go past the 350-run mark.Eventually, the hosts were bundled out for 375 in the 130th overs of their innings. Broad was the pick of the England bowlers as he returned with figures of 4/736 in his 28 overs. Chris Woakes picked three wickets while Sam Curran scalped two. Trailing by 375, the visitors didn’t have a great start as they lost opener Dominic Sibley with just 11 runs on the scoreboard. Joe Denly who came in next couldn’t stay long at the crease either and went back to the pavilion after scoring just 4 runs.Root and Burns then played cautiously and made sure England didn’t lose any more wickets till the end of the day’s play. The hosts, who already have a lead of 336 runs, could have been in a better position had Burns — who was dropped twice — been caught.Brief scores: New Zealand 1st innings 375 all out (Tom Latham 105, Daryl Mitchell 73; Stuart Broad 4/73), England 39/2 at Stumps on Day 2 (Rory Burns 24*, Joe Root 6*; Matt Henry 1/10) trail by 336 runs. IANSAlso Read: Ramkumar, Sumit Nagal thrash Pakistan as India lead 2-0 in Davis CupAlso Watch: DGP Kuladhar Saikia officially handed over charge to Bhaskar Jyoti Mahanta in Guwahatilast_img read more

  • Football News FIFA World Cup 2018: ISIS threatens to behead Lionel Messi, Cristiano Ronaldo

    first_img For all the Latest Sports News News, Football News News, Download News Nation Android and iOS Mobile Apps. New Delhi: ISIS has threatened to behead Lionel Messi and Cristiano Ronaldo at the FIFA World Cup in a spine chilling series of photographs.The terror group has been repeating calls for ‘lone attackers’ to strike ahead of the mega event in Russia which will commence from June.The group have already released a series of photographs, threatening the authorities and players as they lose ground in Syria and Iraq.The photographs show Messi and Ronaldo pinned to the ground by jihadis in a jam-packed football stadium. The picture was captioned ‘Your blood will fill the ground’ displays the extremists hacking at the footballers’ heads.The latest threat was revealed by the cyber intelligence firm Sixgill, which monitors ISIS, as per reports.The photograph was released by a pro-ISIS group on Telegram.Earlier, ISIS warned Vladimir Putin by saying ‘he will pay the price for killing Muslims’ in a poster showing a jihadist with an AK-47.The FSB security service has hinted that terrorism is the main threat to the FIFA World Cup. last_img read more