A pair of researchers at The University of North Carolina at Chapel Hill is challenging the findings of the team that published a paper called “The Moral Machine experiment” two years ago. Yochanan Bigman and Kurt Gray claim the results of the experiment were flawed because they did not allow test-takers the option of choosing to treat potential victims equally.
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By applying in-sensor computing of analog data, a team of researchers at Vienna University of Technology’s Institute of Photonics has developed a way to speed up machine vision. In their paper published in the journal Nature, the group describes their design and how well it performed during testing. Yang Chai with Hong Kong Polytechnic University has published a News & Views piece in the same journal issue describing the work by the team.
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Twitter is starting to test tweets that disappear after 24 hours, although initially only in Brazil.
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The World Health Organization’s new action plan to speed up universal access to safe blood and blood products pulls together existing recommendations and recommends new improved ways of working. It’s the start of a four-year collaborative effort to improve blood transfusion and blood-based therapies in all countries.
Safe blood saves lives in all sorts of circumstances, not least in emergency and epidemic settings. Blood transfusion and blood products are critical for birth delivery for both the mother and baby; the survival and quality of life of patients suffering from life-threatening conditions such as haemophilia, thalassemia, immune deficiency and cancer; treating severe injuries and carrying out medical and surgical procedures.
But progress in blood safety and availability has been slow in many parts of the world, placing patients’ safety at risk and putting undue pressure on health workers. Progress is also mostly restricted to developed countries. Out of the approximate 118 million blood donations collected globally, 42% are collected in high-income countries, home to 16 % of the world’s population. And one out of four low-income countries do not test all donated blood, while 54% of countries do not have surveillance systems to securitise the supply chain from blood donor to patient.
Challenges include: slow implementation of national blood policies and weak blood regulatory systems; insufficient number of voluntary blood donors (who are considered the safest donors); poor quality management of screening tests, blood grouping and compatibility testing; inappropriate clinical use of blood; insufficient national funding for blood safety.
To address these, WHO has set out six key objectives for all countries and in particular those with weak blood systems:
The Organization looks forward to working with partners worldwide to implement the plan, improve blood supply particularly in the low and middle-income countries where this is so urgently needed, and save lives. The plan will run from 2020-2024.
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https://www.who.int/news-room/detail/26-02-2020-who-steps-up-action-to-improve-access-to-safe-blood
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The meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) to review the current Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) took place on Wednesday, 12 February 2020, from 14:00 to 16:45 Geneva time (CEST).
Members and advisors of the Emergency Committee were convened by teleconference.
The Secretariat welcomed the Committee and thanked them for their support. The meeting was turned over to the Chair, Dr Robert Steffen.
Dr Steffen also welcomed the Committee and gave the floor back to the Secretariat.
Representatives of WHO’s legal department and the department of compliance, risk management, and ethics briefed the Committee members on their roles and responsibilities.
Committee members were reminded of their duty of confidentiality and their responsibility to disclose personal, financial, or professional connections that might be seen to constitute a conflict of interest. Each member who was present was surveyed and no conflicts of interest were judged to be relevant to the meeting.
The Chair then reviewed the agenda for the meeting and introduced the presenters.
Presentations were made by representatives of the Ministry of Health of the Democratic Republic of the Congo (DRC), the WHO Secretariat, and the UN Ebola Emergency Response Coordinator.
The current situation in the DRC was reviewed. As of 10 February 2020, there were a total of 3431 cases, of which 3308 were confirmed and 123 were probable. 2253 persons have died (66%). Between 3 and 9 February 2020, three new confirmed cases were reported in Beni Health Zone, North Kivu. These three cases were already registered as contacts and two were under surveillance at the time of detection. More than 2000 contacts are being followed. There has been an increase in the number of security incidents in recent months.
Challenges that remain include: strengthening of community acceptance for full commitment to response measures; protection of personnel at strategic health checkpoints; improvement of infection prevention and control practices in health facilities; strengthening of the local health system; and comprehensive treatment and support for patients in recovery.
The WHO Secretariat gave an overview of the epidemiological situation, which shows an overall encouraging trend in case incidence and geographic spread. It was noted that sustaining this progress depends on the security situation and control of the well-known drivers of transmission, particularly in traditional health facilities, and on continued trust and communication with the community.
A risk communication and community engagement programme has been developed, as has an EVD survivors programme. It is critical to ensure the long-term sustainability of these two initiatives.
The situation in countries neighbouring DRC was reviewed, as was preparedness in nonaffected areas of DRC. An EVD operational readiness standardized approach has been implemented in 9 priority countries. More than 2400 alerts have been investigated, and more than 14,600 health workers have been vaccinated.
The UN Ebola Emergency Response Coordinator gave a brief report on operational support, focused on security challenges and preparations for any resurgence of disease.
The Committee noted a great deal of progress in the situation since its last meeting and commended the response, under the leadership of the DRC Ministry of Health and the multisectoral coordination commission established in July 2019. Support provided by WHO, UN agencies, nongovernmental organizations and other partners has also contributed to limiting the spread and impact of this virus in a difficult context. An increase in the number of alerts was attributed to strong and proactive community surveillance.
It was the unanimous view of the Committee that this event still constitutes a public health emergency of international concern (PHEIC) under the IHR (2005).
The Committee acknowledged the revised risk assessment, which puts the risk now as high at national and regional levels, and low at the global level.
The Committee was concerned that withdrawing the PHEIC now might have adverse consequences for the response efforts through diminishing focus. Additionally, although the primary concern of the Committee is EVD, there are serious ongoing outbreaks of other diseases, including measles and cholera, in DRC. The country continues to need support to combat infectious diseases as well as to strengthen its health system. Further, there remains an urgent need to maintain international solidarity for the response.
The Committee noted the ongoing discussions about the interpretation in the text of the IHR (2005) of the terms international and regional spread, and about creating an intermediate level of response between the binary possibilities of PHEIC or no PHEIC, in a way that does not require reopening negotiations on the Regulations. The Committee supports these discussions, as an intermediate level would be as useful for gradually ending a PHEIC and for signaling the potential for one to be declared.
The Committee provided the following advice to the Director-General for his issuance as revised Temporary Recommendations under the IHR (2005).
For DRC:
For countries at risk:
For all countries:
The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of these recommendations.
Based on this advice, the reports made by the affected State Party, and the currently available information, the Director-General accepted the Committee’s assessment and on 12 February 2020 maintained the Ebola outbreak in the Democratic Republic of the Congo as a Public Health Emergency of International Concern (PHEIC).
The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005) to reduce the international spread of Ebola, effective 12 February 2020. The Director-General thanked the Committee Members and Advisors for their advice and requested their reassessment of this situation within two months or earlier if the situation requires.
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https://www.who.int/news-room/detail/12-02-2020-statement-on-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee-for-ebola-virus-disease-in-the-democratic-republic-of-the-congo-on-12-february-2020
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Good afternoon everyone and apologies for being late, and apologies too from Dr Tedros, who is just about to land in the Democratic Republic of the Congo where he is following up on important Ebola matters and meeting with President Tshisekdi and many others to look at the future post-Ebola of the health system in Congo.
I’m sure you’ll understand how important a task and mission that is given the last year-and-a-half in Congo and the ongoing struggles in that country to deliver effective healthcare and reduce suffering and mortality from infectious diseases.
Let me start by updating you on the latest numbers.
In the last 24 hours China has reported 1,820 laboratory-confirmed cases, bringing the total to 46,550.
In addition, China reported 13,332 clinically confirmed cases in Hubei province, and crucially, we understand that most of these cases relate to a period going back over days and weeks and are retrospectively reported as cases, sometimes back to the beginning of the outbreak itself.
So this increase that you’ve all seen in the last 24 hours is largely down to a change in how cases are being diagnosed and reported.
So, in other words, in Hubei province only, a trained medical professional can now classify a suspected case of COVID-19 as a clinically-confirmed case on the basis of chest imaging, rather than having to have a laboratory confirmation.
This allows clinicians to move and report cases more quickly, not having to wait for lab confirmation, ensuring that people get to clinical care more quickly, and also allows public health responses in terms of contact tracing and other important public health measures to be initiated.
As you’ve noticed with suspect cases, there have been some backlogs in testing and this is also going to help ensure that people get adequate care and adequate public health measures can be taken.
So we are not dealing, from what we understand, with a spike in cases of 14,000 on one day.
To an extent this is an artefact of the reporting and we are working with our colleagues in China, and our team there are working very hard to see exactly how many days and weeks and how those numbers are spread across those days and weeks.
In the rest of China and the rest of the world, laboratory confirmation for reporting is still required.
WHO will continue to track both laboratory and clinically-confirmed cases in Hubei province.
We’ve seen this spike in the number of cases reported in China, but this does not represent a significant change in the trajectory of the outbreak.
Outside China, there are 447 cases from 24 other countries, and now two deaths. In addition to the death in the Philippines, there is now one more death in Japan.
We have said consistently that we need to be cautious when drawing conclusions from daily reported numbers. I think we were having that discussion yesterday and I think the numbers today speak to that.
We need to be very careful when interpreting any extremes. Be it in incubation period, be it in daily numbers, we must take all numbers into account, we must look at all numbers seriously but we also must try and interpret what those numbers mean and not react directly to the number itself.
The number of countries reporting cases has still not changed and outside the cases on the Diamond Princess cruise ship, we’re not seeing a dramatic increase in transmission outside China.
That is the current picture. We’re still saying to governments around the world that we still have an opportunity to prepare for the potential spread of the virus.
Regarding the Diamond Princess cruise ship, which is currently quarantined in Yokohama, 218 passengers have tested positive for the virus, which does represent the largest cluster of COVID-19 cases outside China.
This morning, I briefed health ministers from the European Union, convened by Croatia, the presidency, about COVID-19 and our teams are working with governments and partners of the European Union to ensure that the latest information is disseminated, that preparations are made and there’s good coordination between ourselves and the European Union and our WHO Regional Office for Europe.
And we very much welcome the strong support from the European Union in supporting countries with weaker health systems and ensuring that other countries have the investment and support needed to prepare for the arrival of the virus.
In terms of the international mission, the advanced team and their Chinese counterparts have now finalized the scope of work and design of the mission and we expect the rest of the international team to start arriving in China over the weekend.
Thank you.
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https://www.who.int/news-room/detail/13-02-2020-remarks-by-dr-michael-ryan-executive-director-who-health-emergencies-programme-at-media-briefing-on-covid-19-on-13-february-2020
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Women who are pregnant or breastfeeding in an Ebola outbreak face similar challenges as other population groups, but they have specific health needs which must be met.
As the second largest Ebola outbreak in history continues in the Democratic Republic of Congo, WHO has released new clinical guidelines for healthcare providers supporting pregnant or breastfeeding women in the context of Ebola virus disease.
Clear and coherent guidance is needed to meet the combined needs of women requiring Ebola treatment, pregnancy care and management of complications.
Information on how to protect breastfeeding children and other members in the community from transmission of the disease is also critical.
Limited scientific evidence on how to best manage these needs has previously been a challenge for affected countries. In addition, misconceptions that pregnant women have a higher mortality rate than other populations with Ebola may in some contexts have put pregnant women at risk of not receiving standard care.
WHO’s Guideline on the management of pregnant and breastfeeding women in the context of Ebola virus reviews existing evidence and provides a single set of recommendations on the care continuum for women exposed to, diagnosed with, or recovered from Ebola.
This will enable healthcare providers, emergency response teams and health policy-makers to improve prevention and treatment measures in an Ebola outbreak.
Optimal supportive care should be offered to all pregnant women with Ebola. Likewise, they should be offered experimental treatment and vaccination under the same conditions as non-pregnant populations.
Ebola virus disease does increase the risk of miscarriage and early labour, requiring close clinical management at Ebola treatment centres. It is important to engage both obstetric providers and those trained in Ebola response.
This dual expertise is also important because early Ebola and pregnancy-related symptoms can overlap. Pregnant women should be prioritised for testing to confirm an Ebola infection.
Ebola virus can persist in pregnancy related fluids as well as breastmilk. If healthcare providers are not clear on how to manage Ebola infection risk, they may be less willing to provide care. This stigma can be life-threatening for women who experience complications during delivery.
The new WHO guidelines advise healthcare workers on how to protect themselves while caring for pregnant women with Ebola virus disease. This includes induced labour or surgical procedures, which carry greater risk of transmission in cases of acute infection. Any invasive treatments should be carried out in full personal protective equipment.
WHO recommends that women with suspected or confirmed Ebola immediately stop breastfeeding and are prioritised for diagnostic testing. Any child exposed to Ebola through breast milk should be placed into safe care, closely monitored for symptoms over a 21-day period and fed with an appropriate breast milk substitute.
The guidelines strongly recommend that breastfeeding is only restarted following two consecutive negative tests of breast milk, separated by 24 hours.
A breast milk substitute should be used even if infection is confirmed for both the mother and her child. Exceptions can be made for infants under 6 months of age who are already infected, if breast milk substitutes are not feasible, affordable, sustainable or safe and separation cannot be implemented safely.
A disease outbreak does not change women’s and adolescent girls’ fundamental human right to sexual and reproductive healthcare, including evidence-based care during pregnancy and childbirth.
Women need support to make informed reproductive health care choices for themselves and their children. Women living in an Ebola outbreak should have access to all relevant reproductive options, regardless of economic, cultural, racial or religious status, including contraception and safe abortion to the full extent of the law.
Pregnant and breastfeeding women across affected communities need equitable and respectful care that considers the risks they face and supports the choices they make.
These guidelines are now available online and may be freely downloaded. The executive summary will be available in French.
WHO will closely monitor new data as it emerges, as there is still a pressing need to prioritise ongoing research related to Ebola virus transmission.
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https://www.who.int/news-room/detail/10-02-2020-pregnancy-and-breastfeeding-during-an-ebola-virus-outbreak
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The last time you called your doctor’s office, how long did you have to wait for a reply? How long do you usually have to wait to get an appointment or wait for a prescription to be called in? When you get to the office, how long do you spend in the waiting room and how much time does the doctor spend with you?
Did you get all your questions answered? How many seconds do you have in the beginning of your appointment to explain your symptoms before you are interrupted? Do the nurses and doctors seem to be more interested in their computers or their charts than they are to you?
If your experiences are like most people, your answers to these questions are not very flattering to the medical profession and to the health care system in general. Most doctors don’t really want their practices to be like this, but they don’t have much choice. They have to have a high volume of patients in order to make ends meet financially. The high volume makes the clinic a very busy place and most patients don’t feel like they get much attention.
In 1996 in Seattle, a doctor named Howard Moran thought there should be a better way to do this. He pioneered the concept of having a lower volume practice with highly attentive medical care provided as a service for patients in return for a retainer fee, much like many attorneys or accountants use. This fee may be in addition to, or in lieu of, the regular office fees that are billed to insurance companies. This concept allows the practice to remain financially solvent while providing better, more attentive medical service to its low volume of patients (usually keeping the patient count down to about one tenth of the number in a typical traditional primary care practice).
Unfortunately, health insurance companies currently don’t pay for this type of service, so that means the patients have to pay this out of pocket, but if the service is good, it may be worth it. Patients who join these practices are encouraged to keep their usual insurance which they will need for visits to other specialists, laboratory testing, radiological testing and/or hospital services if needed.
Many concierge practices offer same or next day appointments, no long waits for appointments or prescription refills, direct access to your personal physician day or night, house calls if necessary, continuing care if hospitalized, complete physical examinations, audiometry screening, cardiovascular and cancer risk screening, more attention to preventive care, unrushed appointments, all questions answered, family meetings if needed, coordination of care with specialists, provision of personal health records on CDs or flash drives, etc., etc.
Depending on the type and number of services that are provided, the flat retainer fee can vary widely from one area to the next ranging from $100 to $20,000/ year, most probably averaging around $1500-3000/year. There were only a few hundred of these physicians a few years ago, but there are over 5000 of them now all over the country. Many of them, but not all, are listed at the main website for the American Academy of Private Physicians – http://www.aapp.org/. Patients may be able to find a concierge physician in their area on this site.
There has been some controversy surrounding some of these practices because some authorities feel the growth of concierge medicine will lead to a 2-tiered medical system in this country – one for the wealthy and one for the not-so-wealthy. Also, with the current shortage of primary care physicians (PCPs), with increasing numbers of concierge practices, the number of PCPs available for traditional offices will be even smaller, and access to care for patients served by those practices will suffer. On the other hand, more medical students may become interested in primary care if opportunities in concierge medicine are available to them when they finish their residencies.
Some of these practices have come under fire from insurance companies who say that concierge physicians are basically providing an insurance plan for their patients without having an insurance license to do so. The practices must therefore be legally and financially structured in such a way that avoids this criticism.
Overall, the concept of concierge medicine provides a good alternative to the currently unsatisfying traditional model of medical practice. The fee may seem high to some, but in most instances, it probably isn’t much higher than the cost of the local cable or telephone bill, or about the same as what a family would spend eating out at a restaurant once a week.
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Source by Greg Warth, M.D.
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