AddThis Sharing ButtonsShare to FacebookFacebookFacebookShare to TwitterTwitterTwitterShare to EmailEmailEmailShare to RedditRedditRedditShare to MoreAddThisMoreNot many people would celebrate their mailbox getting taken out by a car, but when Crystal Collins experienced the valor and kindness of the particular youth who hit it, she knew she wanted to shout his praises in public.The teenager rang her doorbell while she was at home in Lincoln, Nebraska and told her that he had accidentally hit her mailbox with his truck due to the snow and icy conditions on the road.Not only did the youngster offer his most heartfelt apologies for the incident, he also offered her every dollar in his wallet. RELATED: Man Finds $43K Inside Used Couch and Returns it All to Woman Whose Grandfather Hid it in SecretCollins told him to keep his money, but he returned to her house two days later with a plate of homemade cookies.Collins was so touched, she published a Facebook photo of the young man from her security camera last week in hopes of identifying him and his family.“I’m looking for his parents,” she wrote. “They should know what an outstanding young man they have raised!” After the post was shared several thousand times, the young man was identified as Owen Sullivan. It also reached the social media feed of his mother Jamy—and she was extremely touched by her son’s honesty.“I honestly got teary-eyed, because it was so, it’s just nice to know your kids do good things when you’re not around,” she later told KOLN.(WATCH the heartwarming interview below)Be Sure And Share This Sweet Story Of Kindness With Your Friends On Social Media…AddThis Sharing ButtonsShare to FacebookFacebookFacebookShare to TwitterTwitterTwitterShare to EmailEmailEmailShare to RedditRedditRedditShare to MoreAddThisMore
by Anne Galloway vtdigger.org A legislative committee rejected a proposal on Thursday from the Shumlin administration that would allow nurses to forcibly medicate psychiatric patients.The irony is, they already do.Hospitals in Vermont follow federal regulations for treatment of psychiatric patients. Under Centers for Medicare and Medicaid rules, registered nurses can involuntarily restrain, seclude and medicate patients.Mental health advocates say forcible medication is psychologically damaging for patients and treatments should only be administered by certain trained personnel after a physician has evaluated a patient. In a 1984 court settlement, Vermont advocates and the state set a higher standard for involuntary restraint, seclusion and medication.That standard was the norm at the Vermont State Hospital. The hospital, which cared for patients in the care and custody of the commissioner, was closed on Aug. 28, 2011, after Tropical Storm Irene. Since then, psychiatric patients have been sent to local hospitals for care as part of the Shumlin administration’s decentralized mental health system.After the Vermont State Hospital closed, the state’s rules for involuntarily seclusion, restraint and medication have been in limbo. Advocates say the state hospital regulations established after the Doe v. Miller settlement in 1984 should apply to all the hospitals now in the system. Representatives from the hospital industry and Paul Dupre, the commissioner of the Department of Mental Health, on the other hand, say the federal regulations should be the state standard.The Legislative Committee on Administrative Rules has been wrestling with the issue for more than a year, and voted 6-1 last week to oppose the Department of Mental Health’s plan to allow nurses to forcibly medicate patient without a physician evaluation.But that won’t be the end of the ongoing battle between the Shumlin administration, hospitals and advocates. The department can impose the rule (and risk getting sued) or come back to the Legislature and ask for a change in statute.At the committee’s meeting on Thursday, commissioner Dupre explained to lawmakers that the rules agreed to by the state and advocates in the Doe v. Miller settlement required physicians to assess patients before and after they are involuntarily medicated. Under CMS rules for community hospitals, practitioners can call a doctor once a patient is restrained, describe his or her symptoms and ask for an over-the-phone prescription.Dupre argued the VSH rule is outdated because the state now allows medical professionals, including physician’s assistants and nurse practitioners to perform many of the duties that were once the exclusive purview of doctors. Requiring physicians to evaluate every patient is ‘not the standard in medical care anymore,’ Dupre said.It’s impractical for a physician to be available after regular working hours for evaluations, he continued.‘The problem is, some people feel the need to follow the rule directly as it was at Vermont State Hospital ‘¦ but the same rights and protections at the state hospital are not defined by the law,’ Dupre said.The commissioner said the proposed rule is not a change in policy because the state expanded the authority of nurse practitioners and physician assistants a long time ago. It’s difficult to find psychiatrists, he said, and ‘if we set a rule we can’t follow, we’re going to make things worse.’‘In my mind, the state of Vermont has licensed these folks to do services that are the same as, or similar to, as to a physician,’ Dupre said.The problem with the phoned in assessment and prescription from a doctor, according to Rep. Anne Donahue, a patient advocate, is that there is no physician examination of the patient. Donahue says psychiatric patients should be seen by a doctor who can make an objective assessment on a patient’s condition before a drug is involuntarily administered.Jack McCullough, the project director of the Mental Health Law Project of Vermont Legal Aid, Inc., says the department’s proposed rule violates the legislative intent of Act 79, which requires the state to offer the same rights and protections for patients in the new decentralized state system that they were availed of at the Vermont State Hospital.At the state hospital, the only person authorized to order the emergency, involuntary medication of a patient was a physician, McCullough said. The department’s proposed rule removes that protection from patients in the custody and care of the commissioner, he said.‘This is a big deal,’ McCullough said. ‘The Vermont Supreme Court has looked at the question of commitment and involuntary medication, and it has said involuntary medication is an even greater intrusion on a person’s liberty than detention for psychiatric treatment. It’s a big deal for a hospital hold you under physical restraint and inject a medicine into you that you don’t want to get.’McCullough rejected the commissioner’s argument that changing the state rule is acceptable because nurse practitioners and physician assistants now do the work of doctors in other areas of medicine.‘The area of medical care here is involuntary,’ McCullough said. ‘In any other area of medical care you’re going to the hospital and they say, well, OK, you have a meeting with the physician’s assistant who is going to examine you, give you a diagnosis and prescribe treatment. That’s voluntary and you can decline that service if your wish is not to get service from physician’s assistant and get service from licensed physician.‘People locked up in a facility do not have the ability to decline a service not being provided by a licensed physician,’ McCullough continued.The second area in which the violates legislative intent, McCullough said, is in the scope of who the new rule applies to. The law, he says, is clear that the regulations must apply to all persons in the care and custody of the commissioner of the Department of Mental Health.Under the proposed regulations, the application of the rule would be limited to only patients who are already on psychiatric units.McCullough says limiting the physician assessment rule to patients on psychiatric units violates the law because ‘it fails to include people in care and custody of the commissioner who have an emergency medical need.’ It excludes patients who are treated in emergency rooms and minors.Too often, he said, patients are held in emergency rooms involuntarily and ‘force is used to keep them there.’ The sheriff’s department is there to physically restrain patients in many cases, McCullough said.The Vermont Association of Hospitals and Health Care Administration has advocated for a broader definition of who can forcibly administer drugs. Jill Olson, a government relations representative for the association, says hospitals have a difficult time recruiting psychiatrists.
July 15, 2007 Letters Letters Lawyers’ Perception of Judges We have long suspected incoming Florida Bar presidents must pledge allegiance to the Panglossian view that Florida has the best of all possible legal systems. The March 1 News story “Bar must address lawyers’ perception of judges” strengthens our suspicion.Forty percent of respondents to the Bar’s latest Membership Opinion Survey consider the judges before whom they practice either poor or fair. The poll results impel President Hank Coxe to say that the bench and Bar must work together “to explore why lawyers feel that way” lest the profession become “a lukewarm torch-bearer” for an independent judiciary.President Coxe apparently rejects out of hand the possibility that 40 percent of the poll respondents are correct. He views any criticism of judicial competence as an assault on judicial independence. That is nonsense.We do not protect judicial independence by sweeping judicial incompetence under the rug. Instead of exploring “why lawyers feel that way,” we should openly recognize that many judges are deficient and discuss ways to improve the quality of the judiciary.Edward B. Greene Robyn Greene Ponte Vedra Beach Court-appointed Counsel The Florida Legislature’s recent passage of SB 1088 relating to court-appointed counsel is appalling.SB 1088, passed during the regular session, creates five new state bureaucracies to handle representation in both criminal conflict and dependency cases.This bill provides for the creation of five “regional conflict and civil counsel” to oversee representation in each circuit within the DCA region but authorizes only one-half of the salary paid to the public defender of each circuit for that position for more than twice the responsibility for the public defender in each circuit.The creation of this “uber-public defender’s office” flies directly in the face of prevailing philosophies of “less government is better” and “tax cuts now.”Moreover, the expectation is that competent counsel will be hired to handle both criminal and dependency cases (including death penalty cases) at salaries less than one-third of starting salaries for new associates in South Florida law firms.Finally, the bill sets shockingly low fees for court-appointed counsel in cases in which the regional conflict counsel will have a conflict (and for court-appointed cases after July 1, 2007) — between $750 and $1,500 (including jury trial) for felonies and a $15,000 cap in death penalty cases. These fees are wholly absurd — some attorneys command $15,000 fees for first-time DUIs alone.I cannot imagine any attorney competently handling through jury trial a first-degree felony (a complicated child-sex case, perhaps) for $1,500. Certainly the legislature failed to consider the consequences of this insidious legislation: a clogged felony court system, violation of defendants’ rights, and the specter of endless post-conviction claims for ineffective assistance of counsel.Teresa J. Sopp Fernandina Beach Bar Exam Prep I invite my fellow members of The Florida Bar to join with me in applauding Gov. Charlie Crist’s veto of the improvident $300,000 that had been targeted for the ill-begotten and disingenuously named “Florida Bar Preparation Project.”This race-based “project” unduly benefits those who have already benefited from a variety of “affirmative action/diversity” measures which already have unjustly favored them at, before, and beyond law school admission. These and like-minded “programs” have worked to the prejudice of those with superior GPAs and LSAT scores by denying them law school admission based solely on their lack of skin pigmentation.It is well known and well documented that those who achieve lower standardized test scores and who have lower figures of merit such as grade point averages, those who are the traditional beneficiaries of race-based programs, predictably and not surprisingly perform correspondingly and consistently poorly on bar admission examinations, both in Florida and elsewhere.The Florida Bar should not patronize, participate in, or pander to the race-based industry that divisively seeks to distinguish and to benefit favored groups based on dubious criteria including skin color. Indeed, it should condemn these efforts.Forcing the taxpayers of the state of Florida to subsidize bar preparation fees in furtherance of this shamelessly effete, morally bereft, and bankrupt “skin color diversity” program would have added further injustice to injury. I applaud Gov. Crist for his principles and integrity.Melvyn L. Bernstein Bedford, TX Just Rude or Malpractice? I have been practicing law for more than 29 years and am constantly surprised at my fellow lawyers’ refusal to return phone calls. I rarely call a fellow attorney to discuss the status of the Dolphins’ draft choices or my choice of locations for my family vacation. Rather, my calls are directed at avoiding unnecessary hearings, agreeing on those matters when possible, eliminating delays in moving cases toward resolution, reducing litigation expenses when possible, and seeking what compromises may be available to serve the interests of the clients. I am astounded by the amount of calls that simply go unreturned. From everything I have been taught in life I know this is rude — but is it more? Is it malpractice? I often wonder how opposing counsel’s clients would react if they knew I was trying to resolve the clients’ dispute only to be thwarted by their lawyers’ unresponsiveness. Rule 4-1.4 (a) (3) of the Rules Regulating The Florida Bar requires that the lawyer “keep the client reasonably informed about the status of the matter.” How is this possible when that very lawyer does not keep informed? Rule 4-3.2 requires that “a lawyer shall make reasonable efforts to expedite litigation consistent with the interests of the client.” Wouldn’t the client want to know that opposing counsel was making an effort to resolve the disputed issues in the case but that his or her attorney was playing a game of avoidance? Some may call it rude, others may call it malpractice, but at a very minimum it is unprofessional.Michael Friend Miami July 15, 2007 Letters
Bay Area Legal Services opens a St Pete office BAY AREA LEGAL SERVICES celebrated the grand opening of its new office in St. Petersburg with local community leaders. St. Petersburg Mayor Bill Foster praised Bay Area for relocating to the low-income neighborhood of Greater Childs Park. “This decision demonstrates Bay Area’s commitment to serving the public and providing access to legal services.” Pictured from the left are Director Dick Woltmann, City Council Chair Leslie Curran, Councilman Wengay Newton, Mayor Foster, Managing Attorney Lisa Brody, State Rep. Bill Heller, D-St. Pete, Councilman Jeff Danner, and Deputy Director Joan Boles. July 15, 2010 Regular News
-The Gophers have six targeting calls this season, with three of them coming in their last three games. Andy Greder of the Pioneer Press examined the average number of targeting penalties on each FBS team, and takes a look at each call on the Gophers with comments from defensive coordinator Jay Sawvel and head coach Tracy Claeys.3. Prepping for Gameday: From hot dogs to Runzas to Val’s, food is big business at Husker games-I’m a sucker for these stories. The Lincoln Journal Star’s Ken Hambleton looked at the numbers for how much food is sold at Nebraska football games. This is a well-sourced story with awesome statistics. Spoiler alert: for an average game, Nebraska sells somewhere around 16,000 to 17,000 hot dogs and 13,000 Runzas. 4. Scoggins: Despite 7-2 record, how good the Gophers are remains a mystery-The Star Tribune’s Chip Scoggins wrote that even with only three games left, how good the Gophers have been is still somewhat of a mystery due to their easy schedule. A good note from Scoggins’ story: The Gophers’ first nine opponents have a combined record of 36-46 … Their final three opponents combined are 18-9. As he wrote, Minnesota’s next three games will tell us a lot more about the team then the previous nine will and may just decide Claeys’ future with the program.5. Nierengarten: Saturday’s loss brought Nebraska back to Bo Pelini era-Nebraska lost 62-3 (!!!) to No. 6 Ohio State last Saturday. Brett Nierengarten of the Daily Nebraskan wrote about how it brought up memories of the Bo Pelini era. Nebraska started the season 7-0 but now have the same record as Minnesota. Nierengarten wrote that games like this happened a lot with Pelini but this was the first of its kind under Mike Riley. A good column on a bad loss and what one game can mean for a program.Three takes:1. A win against Nebraska would be big, but still not enough to win the West-A Minnesota win against a ranked Nebraska team in Lincoln would be huge for the Gophers. It would keep their Big Ten West hopes alive and show themselves they have the ability to win these tough games. However, the Gophers would still have a ways to go if they want to win the Big Ten West. A home matchup against Northwestern won’t be easy and then Minnesota would still have to beat No. 7 Wisconsin on the road for the first time since 1994. The Gophers could be 9-2 heading into Madison with the Big Ten West on the line, but that matchup against Wisconsin will be incredibly difficult to win.2. Rodney Smith still hasn’t been tested-I touched on this in a mini-tweet storm earlier in the week and above in this column, but Rodney Smith has yet to face a good rushing defense, and that needs to be considered when talking about him as one of the best running backs in the Big Ten. There is no doubt in my mind that Smith is a very talented player. He’s second in the Big Ten in rushing yards a game and averages over a touchdown a game, but he needs to replicate those against harder defenses to prove that he is one of the best in the conference. A good game against Nebraska would be a step in the right direction; something he is very capable of.3. Leidner’s streak without a touchdown pass concerning-The last time Mitch Leidner threw a touchdown pass came on Oct. 1 against Penn State. Since then, he has 116 pass attempts without throwing for a touchdown, easily a career high. The Gophers have still done well in that time, as they’re on a four game winning streak, and Leidner has done well on the ground. He’s rushed for four touchdowns, but that is still a lot of pass attempts without a touchdown pass. He’ll need to improve if Minnesota wants to win against Wisconsin, as the Badgers have an elite rushing defense but an average passing defense.The Minnesota Daily’s coverage of the team from this past week:1. Carpenter continues special teams consistency-Emmit Carpenter hit two field goals of over 50+ yards on Saturday, earning him Big Ten Special Teams Player of the Week honors for the second time this season. The kicker was next door neighbors with former Minnesota punter Peter Mortell growing up, and Mortell speaks about Carpenter’s strong season and gives his thoughts on it.2. Questions from the Other Side: Nebraska football beat writer Brett Nierengarten-For this week’s Questions from the Other Side, the Minnesota Daily spoke with Brett Nierengarten, the senior sports editor and a football beat writer for the Daily Nebraskan. Nierengarten talks about the status of Nebraska’s football team after two straight losses, how the Gophers and Huskers stack up against each other and shares his predictions for the Big Ten Player of the Year and the Heisman.3. Gophers bring Big Ten hopes to Nebraska-An update from Tuesday on the Gophers heading into the matchup against Nebraska and what their Big Ten West chances are looking like.4. Minnesota turns it around in second half against Purdue-Feature from the Purdue-Minnesota game on the Gophers staging a second half comeback against the Boilermakers.5. Minnesota defeats Purdue 44-31 behind career day from Smith-Game recap from the Minnesota-Purdue game.Everything else you need to know:Start time: 6:30 p.m. CST, Saturday, Nov. 12Network: Big Ten NetworkRadio: KFAN 100.3 FMLine: Nebraska by 5.5Minnesota depth chartNebraska depth chart Daily Breakdown: Minnesota’s Big Ten West chances on the line at NebraskaMaddy FoxGophers linebacker Kamal Martin runs into the end zone in an attempt to score for the Gophers during their game against Purdue at TCF Bank Stadium on Nov. 5, 2016, where the Gophers won 44-31. Mike HendricksonNovember 12, 2016Jump to CommentsShare on FacebookShare on TwitterShare via EmailPrintThe Gophers’ (7-2, 4-2) Big Ten West chances hang in balance with a road game at No. 21 Nebraska (7-2, 4-2). A full breakdown, prediction, and other notes can be found below.When Minnesota runs the ball:There’s no question the Gophers’ rushing offense has been prolific this year. Running back Rodney Smith is second in the Big Ten in rushing yards and Shannon Brooks has done well in the games he hasn’t been injured.However, some of that can be attributed to the easy rushing defenses the Gophers have faced. Minnesota has played six Big Ten games this season, and those six conference teams are the bottom six rushing defenses in the Big Ten.Nebraska’s rushing defense ranks sixth in the Big Ten, so they will be the best group Minnesota has faced this year. Still, the Huskers have allowed over 200 rushing yards in a game three times this season, so Minnesota could see success here. It might be tough but the Gophers have the edge.Matchup to watch: RB Rodney Smith vs. LB Michael Rose-IveyAdvantage: MinnesotaWhen Nebraska runs the ball:Nebraska doesn’t have a running back of Brooks’ or Smith’s caliber, but its rushing offense is still good.Quarterback Tommy Armstrong Jr. – who is currently listed as questionable for the game – is a mobile quarterback and averages 48.7 rushing yards a game. Nebraska running back Terrell Newby averages 71.3 yards a game, only 10th in the Big Ten.The Gophers’ rushing defense has been very good this season. They are third in the Big Ten and opponents have combined for only 112 rushing yards in the last two games. With Armstrong Jr. questionable for Saturday, limiting Nebraska on the ground should be easy for the Gophers.Matchup to watch: RB Terrell Newby vs. LB Jonathan CelestinAdvantage: MinnesotaWhen Minnesota passes the ball:It has been over a month since quarterback Mitch Leidner threw his last touchdown. In that span, he’s thrown five interceptions but rushed for four touchdowns on the ground. He has done well, but it hasn’t come through the air.Leidner’s receiving options have been limited. Senior Drew Wolitarsky leads the team with 45 receptions, and the next closest player was Brian Smith Jr., who had 17. Smith Jr. was kicked off the team ahead of Saturday’s game against Purdue.Nebraska’s passing defense allowed 352 yards against No. 6 Ohio State but has done reasonably well in other games. The Huskers are 10th in the Big Ten in passing yards allowed but lead the conference in interceptions. Leidner hasn’t played well enough recently in the air to take advantage of Nebraska.Matchup to watch: WR Drew Wolitarsky vs. S Nathan GerryAdvantage: NebraskaWhen Nebraska passes the ball:There are a lot of unknowns about this matchup because Armstrong Jr. is still questionable for the game. His backup, Ryker Fyfe, only has 23 attempts this season so it would be a break for Minnesota if Armstrong is out.Nebraska has a good group of receivers. Four players – Stanley Morgan Jr., Jordan Westerkamp, Alonzo Moore and Brandon Reilly – have all averaged over 40 yards a game. Fyfe will have a lot of options if he were to start Saturday.Nine games into the season, Minnesota’s passing defense has been very bad. They are second to last in the Big Ten in passing yards allowed per game and have allowed 18 touchdowns to just eight interceptions. Armstrong Jr.’s status changes this matchup greatly, but Nebraska still gets the edge here no matter who plays.Matchup to watch: WR Jordan Westerkamp vs. CB KiAnte HardinAdvantage: NebraskaPrediction: Nebraska 21, Minnesota 16.Nebraska beat Minnesota at TCF Bank Stadium by 23 points last year. This game should be closer, but still expect a home win for the Huskers.Prediction record: 7-2Around the web on the Gophers and the Huskers:1. Chatelain: Mike Riley stayed patient in establishing Husker culture of ‘doing the right thing’-Dirk Chatelain of the Omaha World-Herald penned a great column on Mike Riley’s culture change in Nebraska. Riley is a very different coach from Bo Pelini and this piece is about who Riley is and how he’s changed Nebraska football. Good, long and fascinating read. 2. Half of six targeting calls on Gophers could have gone other way
Newmark Grubb Knight Frank’s (NGKF) Phoenix office, in collaboration with Global Healthcare Services, announced the completion of a $141 million sale of the Integrated Medical Services portfolio encompassing four Class A medical office buildings totaling 406,894 square feet. This portfolio sale sets a new record for the Phoenix Metro area as the highest price paid at $347 per square foot for an on-campus, multi-tenant medical office portfolio.NGKF Global Healthcare Services Executive Managing Directors Garth Hogan and Todd Perman, along with Directors Trisha Talbot and Kathleen Morgan in the Phoenix office, represented the sellers. The buyer, Physicians Realty Trust, a self-managed healthcare real estate company, was self-represented.“This portfolio commanded such a high price because of the quality of the buildings and its ownership by physician-led organizations. It’s rare to have such a collection of trophy assets built by doctors who are immersed in the healthcare community. As experts in the field, they have exceptional insight into the location and development of these assets,” Hogan said. He added that the team fielded numerous offers during the marketing process, further underscoring the unique value of the asset and ownership.“This sale provided an important opportunity to monetize our assets at a point when we knew we’d gain the greatest value. The buyer, Physicians Realty Trust, truly understands the physician’s perspective and we respect their approach to healthcare real estate. We look forward to working with them,” said John Dover, MD, the management representative for the sellers.The portfolio is currently 96% leased and anchored by physician practice groups. The properties, built from 2004 to 2009, are situated in premier locations for medical practices in Maricopa County; three of the medical office buildings are located on hospital campuses. The buildings include: Paradise Valley IMS totaling 122,790 square feet; North Mountain IMS Medical Building totaling 121,976 square feet; Palm Valley Medical Office Building totaling 101,241 square feet, and Avondale IMS totaling 61,614 square feet.“These newer, well-occupied MOBs that attract strong tenants reflect the continued performance of MOB assets,” Talbot commented. “Physicians Realty Trust targets their investment in physician-owned MOBs throughout the country. For this reason, they will create a smooth ownership transition here in Phoenix.”According to NGKF, the medical office market has continued to outperform the general commercial real estate market, which has accelerated investor demand for this asset class. As a result of the proven resiliency and long-term security, medical office buildings have become a mainstream asset for institutional and private investors and are viewed as one of the most highly sought after asset types in commercial real estate.“This transaction is indicative of the appetite of institutional capital to acquire provider/physician-owned medical office properties in strong markets throughout the country. There has never been a better time for physicians who own their medical buildings to sell and capitalize on the highest values we’ve seen,” Hogan added.
According to a 2013 poll from the insurance company Nationwide, around 25 percent of car owners have named their ride. Granted, the survey isn’t exactly scientific, but while the statistic may not be a perfect reflection of reality, it does align with something you may have already seen in the wild: Plenty of people like to name the appliances in their lives — cars, laptops, bikes. Maybe you know someone who does it. Maybe it’s you!…“We think there are multiple reasons why this happens,” says psychologist Nicholas Epley, a professor of behavioral science at the University of Chicago Booth School of Business. “Some of them have to do with just how similar some inanimate object or animal seems to a person. This can sometimes be an appearance, how it behaves or acts, or any other cues or similarities that lead us to treat nonhuman agents as humanlike.” Read the whole story: New York Magazine More of our Members in the Media >
May 3, 2013 (CIDRAP News) – Although no new H7N9 influenza cases or deaths were announced in China today, a team that treated severely ill patients in Shanghai raised questions about the benefits of oseltamivir (Tamiflu), and health groups issued updates on preparedness steps.Hong Kong’s Centre for Health Protection (CHP) said no new human cases were reported on the mainland today, keeping the outbreak total at 128 infections and 27 deaths.Treatment detailsA team from Shanghai Public Health Clinical Center (SPHCC) today described the first four severely ill H7N9 patients that were transferred to the facility on Apr 6 and Apr 7 after their infections were diagnosed at other hospitals. The group published its findings in Emerging Infectious Diseases.All of the patients were men ages 58 to 73 who lived in Shanghai. Three had underlying medical conditions. One raised chickens in his home and although the three others didn’t have close contact with poultry, they all had visited markets that sold live poultry.The men had cold-like symptoms and fatigue before their flu symptoms began, and they had fever and a productive cough for 6 or 7 days before they were transferred to SPHCC.The hospital formed an emergency team to care for the H7N9 patients and followed a protocol for treating them. All four patients received antibiotics and oseltamivir at the hospital, but they received the treatment at different stages of their illness, with one started on treatment 16 days after his symptoms began.One of the patients died from respiratory failure 11 days after his symptoms began and 2 hours after he was intubated and placed on a mechanical ventilator. Two patients improved and were discharged, 18 and 21 days after illness onset, respectively.The fourth patient was still in critical condition on Apr 21. His condition deteriorated after he was admitted to SPHCC, and he was first put on a ventilator and then treated with extracorporeal membrane oxygenation (ECMO).The authors said the clinical course is consistent with those of other patients infected with H7N9. Two of the patients had more severe disease that included rapidly progressing acute respiratory distress syndrome and acute kidney injury.Earlier higher doses of oseltamivir might improve patient outcomes, the group wrote, adding that they now use 150 mg of the drug twice a day for severely ill patients, while monitoring them for toxicity. They questioned, however, the benefits of oseltamivir treatment for H7N9 patients, because two of the men tested positive for the virus after 9 and 11 days of drug therapy.They wrote that the drug’s ineffectiveness may have contributed to treatment failure in two of the patients, and the drug may not have been well absorbed in severely ill patients. The next crucial steps are to determine if the virus has developed resistance to oseltamivir or patients might benefit from an intravenous or parenteral version of the drug, if one were available, they wrote.An early genetic analysis of some of the first human H7N9 isolates found that one had a marker for neuraminidase inhibitor resistance. However, sensitivity tests on one of the isolates that China sent to the US Centers for Disease Control and Prevention (CDC) found that it was sensitive to oseltamivir and zanamivir, according to a previous report. The CDC has said it will do further testing on more isolates it receives.The patient who died is the one who had close contact with chickens, and it’s not clear if that factor played a role in his rapid disease progression, they wrote. No close contacts of the four patients had symptoms of infection.Readiness stepsIn preparedness developments, the World Health Organization (WHO) yesterday posted an update on the development of an H7N9 candidate vaccine virus.It said H7N9 viruses have been shipped from China to WHO collaborating centers and essential regulatory laboratories in the Global Influenza Surveillance and Response System (GISRS) for candidate vaccine virus development and other preparedness efforts, such as the development of diagnostic tests and risk assessment.The WHO noted that the candidates have also been developed for other flu viruses that have pandemic potential, including H5N1 and H9N2.Labs are using classical reassortment and reverse genetics to develop high-growth reassortants that would be useful for H7N9 vaccine development and production. It said it will regularly provide status updates. The viruses are typically released to manufacturers after characterization and safety tests have been completed, but the release can be expedited in certain situations.The European Centre for Disease Prevention and Control (ECDC) today released an interim case definition for H7N9 infections, along with an algorithm for reporting cases. It said the tools are for surveillance purposes only and will be adjusted as the outbreak develops.See also:May 3 CHP statementMay 3 Emerg Infect Dis reportMay 2 WHO candidate vaccine virus updateMay 3 ECDC statement
Daily Postcard: Signs of fall spotted Sunday in Pajarito Acres in White Rock. Photo by Richard Henderson
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