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IOM says community measures may help in a pandemic

first_img The pandemic began with a relatively mild wave in the spring of 1918, and was followed by a second, much more severe and widespread wave in the fall. Osterholm told CIDRAP News there is strong evidence that military camps that were hard hit in the spring had lower illness and death rates in the fall wave, presumbably because many people developed immunity. He suggested that the same might have been true of cities. In other conclusions, the report says there is probably a role for isolating sick people at home while providing social support for them, though this is based mainly on common sense and evidence from other illnesses. IOM. Modeling community containment for pandemic influenza: a letter report. Released Dec 11, 2006 [Full text] Antiviral prophylaxis and treatment in households and healthcare settings Participants in the workshop said differences between the world of 1918 and today may limit the usefulness of historical data, the report notes. For two examples, population density is different today, and antibiotics now available to treat secondary infections could increase survival. But the panel warned that public health officials, in recommending such steps, should take care not to overstate the evidence for their effectiveness. The group also said that any plans to use such measures should be linked with plans for mitigating their side effects. Similarly, Dr. Marc Lipsitch found in a study of 17 cities that early interventions were significantly associated with lower peak death rates and that early school closures were most closely linked with lower peaks. Further, an analysis presented by Dr. Neil Ferguson, combining 1918 data with mathematical modeling, suggested that community interventions could significantly reduce overall illness rates if they were imposed for the full duration of the pandemic. Contact tracing to allow contacts to take actions such as voluntary sheltering and quarantine The report also critiques existing models for focusing too narrowly on flu-related outcome measures and ignoring other effects of interventions. For example, extended school closings could expose children to increased violence or result in malnutrition by depriving children of free or subsidized school lunches. “It is almost impossible to say that any of the community interventions have been proven ineffective,” says the committee’s report. “However, it is also almost impossible to say that the interventions, either individually or in combination, will be effective in mitigating an influenza pandemic.” Markel, of the University of Michigan, is conducting the research with the Centers for Disease Control and Prevention, the AP reported. Markel called the effort “a Manhattan project of history.” The committee reviewed 6 mathematical simulations of community containment strategies and found none of them entirely convincing. Many key assumptions used in the models, such as those regarding virus transmissibility and compliance with interventions, were based on little evidence, the report says. Accordingly, the panel calls for prospective epidemiologic studies of seasonal flu to bolster the assumptions used in the models. Risk communication, meaning the identification of “key and trusted spokespersons” to promote public acceptance of community containment measures The committee offers 11 recommendations for improving the understanding and use of community interventions. One calls for the development of “decision-aid models that can be readily linked to surveillance data to provide real-time feedback during a pandemic.” So far, evidence shows that the more restrictions were used and the longer they were in place, the milder the pandemic, the story said. Wearing masks in public, restricting door-to-door sales, canceling church, and quarantining sick people were among the measures that seemed helpful. But the researchers said they hadn’t determined which measures were most effective, and they couldn’t prove those steps were the reason some cities did better than others. Dec 14, 2006 (CIDRAP New) – The Institute of Medicine (IOM) weighed in with a clear “maybe” this week on whether community interventions such as school closures, quarantine, and respiratory etiquette could help blunt the impact of an influenza pandemic.center_img Containment measures endorsed by the panel include home isolation of patients plus social support, voluntary sheltering at home, quarantine, hand hygiene, respiratory etiquette, preventive antiviral treatment, and community restrictions such as school closures. The group also supported standard public health measures such as disease surveillance and contact tracing. The committee’s conclusion on the key question of community restrictions, such as closing schools and limiting public gatherings, is that they have a role, but the evidence does not permit any predictions about the effects of specific types of restrictions or the comparative effects of voluntary versus mandatory restrictions. “There is simply a dearth of strong evidence concerning the efficacy of community containment strategies, which is particularly troublesome given the fact that many of the interventions will carry significant economic, social, ethical, and logistical consequences,” adds the report, titled “Modeling Community Containment for Pandemic Influenza: A Letter Report.” The report, released Dec 12, was prepared by a 13-member committee chaired by Adel A.F. Mahmoud, MD, PhD, former president of Merck Vaccines. It is based on a workshop held Oct 25 in Washington, DC. The committee also reviewed several analyses of data from the 1918 flu pandemic. These included preliminary results from Dr. Howard Markel of a study of nonpharmaceutical interventions (NPIs) in 45 US cities. He concluded that NPIs may have lowered peak death rates and flattened the epidemic curves in those cities, though some cities had severe epidemics despite using NPIs. After looking at mathematical models and historical evidence, an IOM committee said that a wide range of community interventions may be helpful, but there is no conclusive evidence for their effectiveness. As with any infectious disease, the evidence indicates that early restrictions are better than later ones,” the report says. “The main effect might be to slow the time to peak of the outbreak in a community, which could be important for hospital-based management of ill patients and to allow for delivery of vaccine if available.” Other measures the committee affirmed as potentially beneficial, based on varying kinds of evidence, include: The IOM report’s release came a day after health officials meeting in Atlanta heard about Markel’s research suggesting that cities which had implemented early “social distancing” measures in the pandemic of 1918 had lower death rates than other cities. Summarizing the lessons of the simulation models and historical analyses, the report says, “The models generally suggest that a combination of targeted antivirals and NPIs can delay and flatten the epidemic peak, but the evidence is less convincing that they can reduce the overall size of the epidemic. Delay of the epidemic peak is critically important because it allows additional time for vaccine development and antiviral production. Lowering the peak of the epidemic is crucial also because it can reduce the burden on healthcare infrastructure by avoiding an extremely large influx of patients.” According to an Associated Press (AP) report on the meeting, researchers found that cities such as St. Louis, which instituted social distancing at least 2 weeks before the peak of the local epidemic, had flu-related death rates less than half that of Philadelphia, which was slower to act. One factor that may confuse the interpretation of the 1918 data on community interventions is that the two waves of the pandemic that year might have affected cities differently, according to Michael T. Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of the CIDRAP Web site. “All of us really want to demonstrate protection from these interventions—it’s our greatest hope for a future pandemic—but we also want to be certain that the information we give people is based on science and not wishful thinking,” Osterholm commented. Surveillance and case reporting, rapid diagnosis, hand hygiene, and respiratory etiquettelast_img read more

A beach shack at Fingal Head has sold for a cool $1.475 million

first_img32 Lagoon Rd, Fingal Head.A BEACH shack at sought-after Fingal Head has sold for $1.475 million.The three-bedroom, three-bathroom home at 32 Lagoon Rd is on an 809sq m block within the tightly-held waterside peninsula.More from news02:37Purchasers snap up every residence in the $40 million Siarn Palm Beach North10 hours ago02:37International architect Desmond Brooks selling luxury beach villa1 day agoBacking on to Dreamtime Beach and opposite Wommin Lagoon, the well-maintained home has a rainforest setting.It is within walking distance of the Tweed River and Fingal Village. 32 Lagoon Rd, Fingal Head.The property also includes a garage conversion which could be suitable as a granny flat, along with a separate artist’s studio.It was marketed by Tony Holland and Rachael Ford from McGrath Coolangatta/Tweed Heads.last_img read more

Draft of UCITS V aims to tighten rules for custodial services

first_imgThe Council of the European Union has agreed on a draft for an amendment to the UCITS Directive that would tighten rules for delegating custodial services.The Permanent Representatives Committee of the Council said amendments on UCITS had become necessary because the interpretation of the current directive had had “consequences that came to the fore following the Lehman bankruptcy and the Madoff fraud case”.The Council said: “The depositary is liable for losses suffered as a result of a failure to perform its duties, though the precise contours of those duties is defined by the laws of the member states.“As a result, different approaches have developed across the EU.” In the most recent draft of the Directive, the Council states: “It is necessary to clarify that a UCITS should appoint a single depositary having general oversight over the UCITS’s assets.”Only certain custodial services such as the physical safekeeping of the assets can be outsourced under UCITS V, but other services such as the actual oversight of sales and evaluations can no longer be delegated to third parties.“In order to ensure a harmonised approach to the performance of depositaries duties in all member states irrespective of the legal form taken by the UCITS,” the Council continued, “it is necessary to introduce a uniform list of oversight duties that are incumbent on both a UCITS with a corporate form (an investment company) and a UCITS in a contractual form.”Another point clarified in the draft was the outsourcing of certain services to securities settlement system (SSS).Some commentators had argued that the AIFM Directive had opened a loophole for banks to evade liability for assets in custody by using central securities depositories (CSD) in which they would still hold the assets under custody directly.According to the AIFMD, delegating custody services triggers liability, but analysts disagreed on whether using an SSS would also qualify as a delegation. The draft on a new UCITS Directive now clearly states “entrusting the custody of securities of the UCITS to a CSD, or to a third-country CSD, should be considered a delegation of custody function”.The Council noted the “revised compromise, as set out in document 17095/13, is now supported by a strong qualified majority of delegations” and would now be put before the European Parliament.However, the Council added that “some isolated concerns” remain in relation to sanctions, depositary liability and eligibility of entities to perform depositary functions.last_img read more

Coronavirus outbreaks now reported at 23 Iowa nursing homes

first_imgJOHNSTON — State officials have confirmed a coronavirus outbreak at the state’s largest nursing home,  the Iowa Veterans Home in Marshalltown.At least three residents of a long-term care facility must test positive for COVID-19 to meet the Iowa Department of Public Health’s definition of an outbreak. Additional outbreaks were announced Tuesday at nursing homes in Dallas and Dubuque Counties. Two nursing homes in Jasper County and two homes in Polk County now have outbreaks.Governor Kim Reynolds this morning said COVID-19, unfortunately, spreads quickly in these kinds of congregate settings.“We’re deploying long term care strike teams to conduct surveillance testing of employees in areas where virus activity is high,” Reynolds said during her daily news conference, “and will continue to ramp up these efforts.”There are now confirmed coronavirus outbreaks at 23 Iowa nursing homes. On Monday, the commandant of the Iowa Veterans Home said 15 employees had tested positive for COVID-19.last_img read more

Tottenham and England sweat on Kane injury

first_img0Shares0000Tottenham and England striker Harry Kane receives medical attention during the match against Bournemouth on March 11, 2018 © AFP / Adrian DENNISLONDON, United Kingdom, Mar 12 – Tottenham and England face an anxious wait to find out the full extent of Harry Kane’s ankle injury, saying they will not know the severity of the damage until Tuesday at the earliest.The England striker, 24, was due to undergo a scan after limping off during the first half of Spurs’ 4-1 win at Bournemouth on Sunday, just three months before the start of the World Cup in Russia. Reports said that swelling around Kane’s right ankle needs to reduce before the extent of the injury can be determined.Spurs play Swansea in the FA Cup quarter-finals at the weekend while England manager Gareth Southgate will on Thursday name his squad for forthcoming friendlies against the Netherlands and Italy.Kane, who has 39 goals for club and country this season, left the stadium in Bournemouth on crutches and wearing a protective boot after sustaining the injury in the process of scoring a disallowed goal in the first half.He hobbled around the side of the pitch and appeared to be preparing to come back before disappearing down the tunnel to be replaced by Erik Lamela.Kane suffered ligament damage to the same ankle twice last season.He was sidelined for seven weeks and missed 10 Spurs games due to the initial injury, picked up against Sunderland in September 2016.However, he then returned to action within a month of sustaining a similar problem in an FA Cup tie with Millwall last March.Tottenham manager Mauricio Pochettino, whose side are chasing a top-four finish in the Premier League, was optimistic about the latest injury setback and said Kane remained upbeat.“We hope that it’s not a massive issue,” said the Argentine coach. “He felt that when he ran and twisted his ankle that it was impossible to stay on the pitch.“Harry has a great character and is always positive, happy with the victory for the team, of course disappointed with his problem. But if you’re positive you start the recovery from injury from now.”0Shares0000(Visited 1 times, 1 visits today)last_img read more


first_imgThe popular Donegal Ice Skating facility located in Newtoncunningham has announced it will close at the end of the month.Management said the combination of running costs and insurance claims were crippling the business.The Ice Rink will officially be closed down in three weeks time on Sunday February 1st. Management posted the following message on Facebook, “I cant believe I’m writing this. Even with the best staff and loads of laughs it just wasn’t enough to keep up with insurance claims and running costs.“Any ticket sales for February have been refunded. If you have a gift voucher it can be redeemed in Donegal Airsoft for Airsoft, Archery or crazy golf.“A huge THANK YOU to all our customers and to my staff/friends for working so hard and for all the laughs.“The next three weeks will be our last and I hope you all can make the most of the rink with family and friends before we close.Please Call 00353 749108622 to reserve. (no deposit required ) Advertisement Thanks, Andrew. DONEGAL ICE SKATING RINK ANNOUNCES IT’S TO CLOSE AT THE END OF THE MONTH was last modified: January 14th, 2015 by Mark ForkerShare this:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to share on Pocket (Opens in new window)Click to share on Telegram (Opens in new window)Click to share on WhatsApp (Opens in new window)Click to share on Skype (Opens in new window)Click to print (Opens in new window) Tags:BusinessclosureCostsDonegal Ice SkatingFebruaryinsurancenewslast_img read more

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