Bitcoin rally screeches to a halt

first_img House panel unanimously passes SECURE 2.0 5 Why Tony Robbins, tax shelters and financial advisers don’t mix House committee poised to advance SECURE 2.0 retirement savings bill 3 Subscribe for original insights, commentary and analysis of the issues facing the financial advice community, from the InvestmentNews team. Newsletters 4 InvestCloud to acquire Advicent and NaviPlan planning software The Gates divorce: Lessons for financial advisers 2 You have read 454 of 3 free articles this week. Register now for increased access.Register for free access to this article.By registering, you can read up to 3 articles per week.RegisterAlready registered? Sign in to continue reading or subscribe for unlimited access.,MOST READ 1last_img read more

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2 people die in Baltimore Amazon facility after storm causes building to partially collapse

first_imgiStock/Thinkstock(BALTIMORE) — Two people have died after a heavy storm caused an Amazon warehouse in Baltimore to partially collapse.Baltimore Fire Department Chief Roman Clark said that one of the victims was an adult male who was found trapped underneath heavy debris at the Amazon warehouse. He was rescued and transported to a hospital where he was pronounced dead due to his injuries, according to ABC News affiliate WMAR-tv.A second victim was found about an hour later, he said.Rachael Lighty, a spokesperson for Amazon, told ABC News in a statement that the two victims were third-party contractors and not Amazon employees.Officials said there weren’t any other reports of people missing.Fire officials responded to a call about a potential collapse of the Amazon Fulfillment Center building at around 10:30 p.m. on Friday night.They found that a 50-by-50-foot wall had collapsed at the warehouse, according to Clark.A Baltimore Fire Department spokesperson also told WMAR that the storm had made the roof fall into the facility.“Last night, severe weather impacted one of our facilities in Baltimore City, resulting in two fatalities,” Lighty said in the statement.” First responders remain on-site assessing the damage. The safety of our employees and contractors is our top priority, and at this time the building remains closed.”“We are incredibly thankful for the quick response from emergency services,” she added. “Our thoughts and prayers go out to the families impacted by Friday evening’s tragic event.”Copyright © 2018, ABC Radio. All rights reserved.last_img read more

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Nursing Faculty, Steamboat Springs

first_imgAbout Colorado Mountain CollegeImagine working at a college that welcomes everyone — students,faculty, staff, and community members — regardless of theirbackgrounds, beliefs, or traditions. An institution that is alsointegrally connected to, appreciated by, and supported by thosesame communities.Envision yourself at a dynamic, innovative, forward-leaning collegethat has an enterprising spirit and deep commitment to everylearner – from first-generation college students to adult learnersto academically motivated students seeking a more traditionalliberal arts education – all within a robust and highlypersonalized learning environment.Visualize applying your energy and skills to an organization thatrespects and cares about its employees enough to offer competitivecompensation and benefits while encouraging every team member torenew and recharge in places of inspiration, reflection, andworld-class outdoor recreation.Welcome to Colorado Mountain College and its eleven campuslocations sprinkled across a spectacular region of Colorado’scentral Rocky Mountains.Our visionColorado Mountain College aspires to be the most inclusive andinnovative student-centered college in the nation, elevating theeconomic, social, cultural, and environmental vitality of itsbeautiful Rocky Mountain communities.The collegeCMC is a comprehensive, public, open-access dual-missioninstitution offering 136 academic programs ranging from specializedcertificates to associate and bachelor’s degrees, a wide range ofonline, non-credit and lifelong learning courses, as well asextensive concurrent enrollment opportunities in close partnershipwith neighboring school districts.Over 15,000 students attend CMC annually, and 40% of degree-seekingstudents earn a certificate or degree every year. The college’sLatinx enrollment has doubled in six years to 27%, making CMCeligible for federal Hispanic Serving Institution (HSI) status. CMCcourses are highly personal and many are experiential by design,each with a maximum registration of 25 students.Colorado Mountain College campuses are located in Aspen,Carbondale, Breckenridge, Dillon, Steamboat Springs, GlenwoodSprings, Glenwood Springs-Spring Valley, Leadville, Rifle, the VailValley, and Salida. Of these locations, three areresidential—Spring Valley, Leadville, and Steamboat Springs — andstudents in Breckenridge have access to college-owned off-campushousing. CMC campuses are close-knit communities, on averageserving between 1,000 – 2,000 students.The majority of the college’s financial support comes from localproperty taxes, not tuition or state revenues. Consequently, CMC isuniquely positioned to be entrepreneurial, nimble, mission-focused,and responsive to community and workforce needs. The college’scentral administrative office, which supports all campus locations,is located in historic downtown Glenwood Springs, the town fromwhich CMC originally launched in 1965.Colorado Mountain College is accredited by the Higher LearningCommission and authorized by the Colorado Commission on HigherEducation. For general information about CMC, its programs,locations, students, faculty, and offerings, go to: www.coloradomtn.edu .Our commitment to an environment where everyonebelongsOur college and beloved mountain communities are enriched by avariety of voices and experiences.At Colorado Mountain College, we continually work to improvelearning and working environments that welcome everyone. We aredeeply committed to promoting a free and open exchange of ideas,improving critical thinking, deepening mutual empathy and respect,and ensuring that every learner and team member has equalopportunities for personal and professional success.The college prioritizes the recruitment, hiring and retention of anengaged workforce that reflects and supports the backgrounds,characteristics and aspirations of the students enrolled at CMC.Therefore, we value applicants who bring a richness of priorexperience and training, and a commitment to the concepts ofinclusive and equitable practices, as well as an understanding ofhistoric and current social issues that impact groups fromdifferent socioeconomic and cultural backgrounds.CMC employees enjoy regular opportunities to raise their awarenessabout pressing societal issues, develop individual criticalthinking skills, and expand their understanding of and empathytoward others regardless of race, gender, ethnicity or otherfactors. Our goal is to deliver personalized teaching methods andeffective student support services that enable students to achievetheir goals, regardless of academic, financial, or experientialbarriers.Applicants to Colorado Mountain College must demonstrate acommitment and competence to work effectively with students,employees, and community members of all backgrounds.The positionColorado Mountain College is seeking full-time faculty to join ourNursing faculty team at the Steamboat Springs campus. With teachingand learning at the center of what we do, chosen candidates willjoin a team of 10 full-time faculty and over 20 part-time facultyacross three campuses dedicated to inspiring and educating the nextgeneration of highly skilled, caring and compassionatenurses.Full-time faculty positions have a 30 credit hour (170 day contractper Board Policy 4.12) teaching load annually.Colorado Mountain College is expanding our growing nursing program.Nursing faculty work under the supervision of the Nursing ProgramDirector and Chief Nursing Officer. The position will focus on thenursing courses in the Associate Degree program of Nursing. Majorareas of instruction include but are not limited to: Basic andComplex Concepts of Medical Surgical Nursing in both the classroom,simulation, and clinical setting. A second area of focus on theMental Health and Psychiatric content or Obstetrical-Pediatricnursing content in the Associate Degree Nursing program isdesirable. Other major areas of instruction including, but notlimited to: Fundamentals of Nursing Practice, classroominstruction, simulation lab and clinical teaching.The academically prepared and experienced candidates could also beresponsible for teaching courses at the Baccalaureate levelincluding but not limited to: Dimensions of Professional NursingPractice & Transition, Advanced Health Assessment, Gerontology,and Nursing Ethics and Informatics. Assignment of responsibilitieswill be based on experience and program need.This position may include night, weekend, and teaching at alternatelocations, along with possible interactive video teaching and otheruse of technology in teaching.Teaching responsibilities expected of all faculty include: teachingcourse load as assigned, evaluate courses and assess studentlearning, meet established course, program and learning outcomes,comply with guidelines and policies, maintain office hours perestablished standards, develop rapport with students, assist withand participate in advising, orientation and registrationactivities.CMC Faculty are expected to engage in scholarly endeavors as wellas service activities such as campus and college committees,participation in relevant projects, mentor peers, participate inand assist with assessment activities, program review, studentorganization, recruiting and retention.Salary range: $88,686.19 – $103,005.72 depending upon education andexperience. Excellent benefits include, Medical, Dental, Vision,Life Insurance, Pet insurance, 12% retirement contribution, tuitionreimbursement, sick time accrual, mental health resources, andhealthy life style benefits. For more information on our benefits,please see here .Pre-requisites for Position (Qualifications Standards)Qualified candidates must be credentialed to teach in this program,or eligible to be credentialed. Examples of ideal qualificationsinclude:A Master’s degree in Nursing and 2000 verifiable relatedoccupational experience within the past 5 years and a minimum ofone year demonstrated teaching/training experience (or equivalentin part-time role). An active, unencumbered Colorado RN license orthe ability to obtain a Colorado Nursing license is required. ADoctoral degree or current enrollment in a Doctoral program ispreferred. Colorado Mountain College is actively seeking a mix ofboth Master’s and Doctoral prepared candidates for itsprograms.Diverse. Inclusive. Innovative. Focused on Student Success. Theseprinciples reflect the soul of CMC. They guide us in building ourteams and cultivating leaders. They guide us to be an institutionof higher education that’s the right fit for every faculty member,staff, student, and community member in its trust. Applicants mustdemonstrate a commitment to working effectively with students,employees, and community members of all backgrounds.Bilingual (English/Spanish) or conversational language abilitiespreferred.To Apply: Please submit the required letter of interest,resume, list of three professional references and transcripts. Tobe considered for a full time faculty position, transcripts must beincluded with application material. Please do not send officialtranscripts; please use copies for application purposes. CMC is anEOE committed to diversifying its workforce.External Applicants: Apply OnlineInternal Applicants: Please proceed to the HR page ofBasecamp or by searching in Learning Hub for instructionson applying for a full time position as an internalapplicant.Review of application will begin March 15, 2021.last_img read more

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Mass Transit line-up offered by David Fishwick

first_imgAn up-and-comer for minicoach and minibus buyers is the latest-generation Ford Transit. Dealership David Fishwick offers a range of them to meet many needs, including accessible and minicoach modelsThe range of Transits offered by Fishwick includes several variantsLots can be said for the current-generation Ford Transit as a minicoach or minibus. It offers a respectable capacity and many options at prices that compare well with other models in its sector.Colne-based dealership David Fishwick supplies a range of Transit conversions to suit various applications, including minicoach, accessible minibus and even stage carriage work. All are proving popular.“We can do many things with a Transit because it’s an excellent starting point for conversion,” says Business Development Manager Matt Eames.Fishwick’s Transit range extends from 11 to 17 seats – with a wheelchair lift if required – and it includes a variety of higher-end configurations; as an example, recently supplied was a nine-seater with a large boot, a water cooler and a coffee machine.Transits are supplied by Ford as factory-finished minibuses. They are then converted to the desired layout without affecting the OEM warranty.Various base modelsThree base Transit models are utilised. The smallest, with a GVW of 3,500kg, carries up to 11 passengers, while the 4,100kg GVW long-wheelbase model goes as far as 14 seats. At both of these weights, vehicles are ordered specifically for the customer.Extra-long wheelbase examples are always in stock and thus finished conversions can be supplied quickly. GVW is 4,600kg, and a twin bench next to the driver delivers a 17-passenger capacity; with a single nearside front seat, 16 is the maximum.The largest Transit comes as standard with the highest roof option, allowing people who are over 6ft tall to stand easily. On all high-roof Transits, sizeable overhead luggage racks are factory fit and they have LED lights and, where applicable, rear air-conditioning vents.The heaviest Transit accounts for the vast majority of those supplied by Fishwick. To ex-factory specification, they have a payload of 1,589kg and a towing capacity of 2,100kg, both of which will be useful on luggage-heavy work.Transits well-equipped for their role and come with competitive price tagsTwo trim levels are offered: Base and Trend. The Base retails ex-factory at £26,995; the enhanced Trend has a £2,000 premium, but it is more popular because the value of its additional equipment more than outweighs that uplift. To those figures must be added an additional sum for the conversion work.Among the Trend’s additional items is independent saloon air-conditioning. Others include powered mirrors, rain-sensing wipers, parking sensors, metallic paint, titanium-effect grille and an upgraded driver’s seat.As standard, the Transit has a 125bhp engine, although a 155bhp option is available at extra cost, as are a rear-view camera, satellite navigation and a towbar.No automatic gearbox is yet available, and so all Transits come with the six-speed manual. All of those supplied new by Fishwick are Euro 6 models.Conversion workA basic conversion, which Fishwick calls the Operator’s Minibus, adds £1,000 to the ex-factory prices, putting a comfortably-specified 16- or 17-seat Trend at £29,995.This Operator’s Minibus includes PSV preparation – legal lettering, the addition of a first aid kit and a fire extinguisher, and the issue of a COC – along with relocation of the tachograph, lowered rear wheel arches and the addition of chrome trim. Additional options are available, including a boot in place of the rear row of seats, a powered sliding side door, and USB sockets.Fishwick is keen to work with buyers to deliver Transits that are suitable for niche applications. That is demonstrated by several that have been built for bus operators in the Outer Hebrides.They are configured with front LED destination display units and powered sliding side doors. They are covering high mileages in tough conditions, and are proving reliable.Accessible Transits can carry up to four wheelchair users at 4,600kg GVWAccessible alternativeThe Transit is a good base for a cost-effective accessible minibus, and on the 4,600kg GVW model Fishwick can offer a product able to carry up to four wheelchair users.As part of the conversion to accessible layout, the Transit receives a tracked Koller Smartfloor and a PLS cassette lift, and the seats are replaced with one of a choice of removable types.The latter point is important; the removable seats are lighter than those used by Ford, and thus the overall capacity of an accessible Transit is identical to an unmodified one.“We can do accessible variants at all three GVWs, but experience shows that buyers in this sector usually want the heaviest variant,” says Matt.“Even so, this year we will examine whether it is possible to uprate the 4,100kg GVW Transit to 4,250kg when a lift is fitted. That would retain a passenger capacity of 13 or 14.”Wheelchair-accessible Transits come with the necessary testing having been undertaken and the requisite paperwork to enable them to go straight to work.“On a 4,600kg GVW Transit, the cost of conversion to an accessible layout is £15,000, meaning that a Base model comes in at £41,995,” he adds. “The standard specification on an accessible Trend model blows many other welfare-type minibuses out of the water.”Fishwick converts accessible Transits in-house on a rolling programme, and the type accounts for around 20% of volume.Package for stage carriage work is available, including an LED blind unitWhy take Transit?The Transit’s capacity and the extent of its options list have made it a realistic option in the markets that Fishwick is targeting. Pricing and availability are good, and an anti-corrosion dipping process at the build stage will aid durability.Parts availability is via Ford’s extensive dealer network, and the manufacturer promises excellent fuel consumption.While its figures have been generated in a controlled environment, an unladen weight of little over 3,000kg at its heaviest and an efficient driveline should see in excess of 30mpg achievable in many applications.“We believe that the Transit will become a standard platform for many operators’ requirements, although for top-end and higher-capacity vehicles the Iveco Daily and Mercedes-Benz Sprinter will remain the natural choice,” says Matt.“The Transit is so good that it has already taken a chunk of the 16-seat market. The gulf between the Ford and its competitors has shrunk a great deal in recent years, and it will continue to do so.”www.davidfishwick.comlast_img read more

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Khruangbin Announce Global ‘Late Night Tales’ Compilation, Share Kool & The Gang Cover [Listen]

first_imgOn Wednesday, Khruangbin announced their own edition of the Late Night Tales compilation series, out on December 4th. This announcement brings the Houston-bred, internationally-renowned trio’s career full circle, as Khruangbin got their start by being included on LNT several years ago.Back in 2013, Khruangbin was still a trio of budding musicians working the scene in Texas when the band’s cut of “A Calf Born In Winter” was hand-picked by producer/DJ Bonobo for his edition of Late Night Tales. From there, the band has grown to international stardom with three albums under their belts and fans around the globe. You can read out full 2019 feature interview about the band’s origins and initial Late Night Tales here.Related: Khruang Binatra Answers Age Old Question: What If Frank Sinatra Sang Lead Vocals For Khruangbin [Watch]Ahead of the release of Khruangbin’s Late Night Tales, the band has also shared an exclusive cover of “Summer Madness” by Kool & The Gang. The song, available now on YouTube, features the classic hallmarks of the Thai-funk trio with Mark Speers‘ reverb-soaked guitar, Laura Lee Ochoa‘s understated bass lines, and Donald “DJ” Johnson tying the whole thing together with the snap of a drumstick on the edge of the snare.“‘Summer Madness’ became a staple in this medley that we play,” Johnson said in a press release. “Specifically, one of my favourite things about it is the tone of the bass, which really reminds me a lot of Laura Lee’s bass which has this chunky, peanut butter, rich tone. It was always a special moment, getting to that song because, it just did something to the room, everywhere.”The rest of the songs on Late Night Tales take listeners on the international journey that Khruangbin has prepared them for with their diverse influences. Late Night Tales jumps from Asian pop to Nigerian reggae, South Korean rock to Hindi-disco, and everything in between. The band also highlights Texas locals David Marez and Kelly Doyle, as well as an exclusive spoken-word track produced by Khruangbin from Tierney Malone and Geoffrey Muller.“We definitely wanted to cover as much global territory as possible,” Khruangbin said of their Late Night Tales mix. “So it was the globe and then home. We wanted to show the treasures from our hometown, or people from our hometown that the rest of the world probably doesn’t know. Then these gems from across the world, showcasing them in the same way. That’s what makes Khruangbin Khruangbin. The stubbornness about being so hometown-centric. But what makes Houston is this constant international influence; that’s the gulf stream, bringing it right into the city.”Listen to Khruangbin’s take on “Summer Madness” by Kool & The Gang below, and pre-order their Late Night Tales here. Scroll down to see the full tracklist.Khruangbin – “Summer Madness” (Kool & The Gang)[Video: Late Night Tales]Khruangbin’s Late Night Tales Tracklist:01. Devadip Carlos Santana And Turiya Alice Coltrane – “Illuminations”02. Brilliantes Del Veulo – “I Know That (When The Springtime Comes)”03. Nazia Hassan – “Khushi”04. Kelly Doyle – “DRM”05. Sanulim – “Don’t Go”06. Maxwell Udoh – “I Like It (Don’t Stop)”07. David Marez – “Enséñame”08. Gerald Lee – “Can You Feel The Love (Reprise)”09. Justine & The Victorian Punks – “Still You”10. George Yanagi + Nadja Band -「祭ばやしが聞こえる」のテーマ11. Песняры – “Зачарованная моя”12. Khruangbin – “Summer Madness” (Exclusive Kool & The Gang Cover Version)13. Paloma San Basilio – “Contigo”14. Roha Band – “Yetikimt Abeba”15. Tierney Malone / Geoffrey Muller – “Transmission for Jehn: Gnossienne No 1” (Produced by Khruangbin) (Exclusive Track)View Lyricslast_img read more

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Homeless Man in Blizzard Just Wants to Help, Pushes Out Cars

first_imgPush This Story To Your Friends…AddThis Sharing ButtonsShare to FacebookFacebookFacebookShare to TwitterTwitterTwitterShare to EmailEmailEmailShare to RedditRedditRedditShare to MoreAddThisMore AddThis Sharing ButtonsShare to FacebookFacebookFacebookShare to TwitterTwitterTwitterShare to EmailEmailEmailShare to RedditRedditRedditShare to MoreAddThisMoreA homeless good Samaritan rushed to help when he saw motorists stuck in the winter storm that hit the Eastern U.S. last weekend.The man, identified only as Curtis, had been taking shelter between two buildings when he noticed cars getting stuck in the snow, so he ran out to help.DIG OUT ALL THE GOOD NEWS WITH OUR APP—>  Download FREE for Android and iOS“It’s just the right thing to do,” he told WWBT News in Richmond, Virginia. “Because at times, people help me out. One hand washes the other one.”Many of the more than half dozen drivers that he helped while the TV crew was there thanked him, but never knew he was homeless.Curtis still didn’t have any idea where he would spend the night as the storm dropped more than two feet of snow on the area. People posting to Facebook wanted to raise money for Curtis, but he didn’t leave any information to make himself easily found.WATCH: Virginia Jeep Club Shuttles 150 Nurses to Hospital During BlizzardReporter Ashley Monfort and her cameraman gave him some hot coffee and a warm meal, and money to pay for transportation to a homeless shelter – then he was back to pushing cars down the road.(WATCH the video from WWBT News below) — Photos: WWBT videolast_img read more

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Laorr paces Minnesota to best score of spring

first_imgAs a result, the greens were slow and soft in the opening rounds but sped up for Sunday’s final round.“I definitely think that the short game was a lot more difficult,” Laorr said about Sunday’s conditions. She said players had to be more conservative because of the fast and firm greens.Laorr said the course was deceivingly windy at times as well.Junior Banchalee Theinthong finished three shots behind Laorr in a tie for 28th after shooting a 74 in each of her first two rounds. Sophomore Carmen Laguna had the Gophers’ best round Sunday, also a 74.Laorr said the Gophers had struggled in their past few tournaments when Laguna and Theinthong were out of the lineup. Both returned to the lineup this week.Another incentive was to play well in the absence of coach Michele Redman, who did not travel due to a death in the family. Assistant coach John Cleary traveled with the team instead.Laorr said the team’s schedule for the rest of the year is favorable. Minnesota’s next event will be the BYU Entrada Classic on March 18-19 in St. George, Utah. Laorr paces Minnesota to best score of springMinnesota finished 8th out of 16 teams at the Clover Cup. Nickalas TabbertMarch 11, 2013Jump to CommentsShare on FacebookShare on TwitterShare via EmailPrintThe Gophers women’s golf team shot 40-over par to finish eighth out of 16 teams at the Clover Cup in Mesa, Ariz.Minnesota shot a team score of 904 at the Longbow Golf Club — its best score of the spring season by 17 strokes.Oklahoma ran away with the tournament, finishing with a team score of 862. Southern Methodist finished second at 18 strokes behind the Sooners.Sophomore Anna Laorr tied for 19th to lead the Gophers with a season-best score of 223. She shot 7-over par in her first top-20 finish of the spring season.Laorr said the team played its first solid tournament of the spring.“We played pretty well,” she said. “We finished higher in the tournament than we were supposed to.”Heavy rain and lightning forced the first round to be played Saturday, Laorr said.last_img read more

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Technology carries real estate through healthcare changes

first_imgA patient sits in the ICU at Banner Health’s Fairbanks Memorial Hospital in Alaska.It’s late, many of the staff have gone home. He watches the glowing blinks of the machines monitoring his vital signs lighting the room in little blue and green bursts. Suddenly, a nurse is beckoned to his bedside by an abnormal fluctuation in his stats. The patient’s physician is notified and, if off-duty, with the press of a button, a critical care specialist or nurse sitting in what’s affectionately called “the bunker,” staffed 24/7 by highly specialized physicians known as intensivists at Banner Desert in Mesa, can appear on a two-way video communications system to assist.This is the future of medicine. Though Banner Health has been working on its eICUs in the seven states where its located since 2006, telemedicine is continuing to affect change throughout real estate.Behind the ScreenA COMPACCS study found that patients who would need critical care require, on average, 45 minutes of an intensivist’s time per day, according to “The Critical Care Workforce.” After crunching the numbers, the report claims ICU patients use 18 million ICU days every year. This is on the condition that only a third of ICU patients are seen by an intensivist. To meet this demand, 3,100 intensivists would have been required to treat the patient demand in 2000. That’s more than 65 percent of those who were available in the U.S.There’s a shortage of these critical care specialists, even 15 years later. This has a direct effect on care.Mortality rate in ICUs is between 12 and 17 percent, according to U.S. Department of Health & Human Services’ “The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians.”“If demand grows only as a result of the growth and aging of the population, demand for intensivists will increase from about 1,880 in 2000 to 2,600 in 2020 (an increase of about 38 percent),” according to “The Critical Care Workforce.”“Every ICU could hire a specialist, but it would outstrip the supply in the entire country,” Bollinger says.With the Affordable Care Act, hospitals are seeing inpatient days decrease. The reimbursement methodology has turned toward value and outcomes at affordable costs versus being reimbursed for doing more, says Kathy Bollinger, vice president of academic delivery at Banner Health.“There is a change in incentives to provide the right care in the right setting at the right time,” Bollinger says.Inpatients are spending fewer days in hospitals, and bed and room quantity focuses are now on quality rooms with the appropriate infrastructure.When Banner Health renovates the patient tower at the existing University Medical Center in Tucson, it will only add 10 additional beds.“The hospitals are not getting bigger, but they need to get smarter,” said Bollinger.Banner Health has 500 of its senior patients participating in a pilot program. They are provided an iPad and home technology that facilitate e-visits from their physicians.“Our early evidence on that project is we’re decreasing those patients’ trips to the emergency department,” Bollinger says.The BrainsBollinger says hospitals need to get smarter, and DPR’s national healthcare leader Hamilton Espinosa agrees.“Their payer mix is getting thrown off skew by the amount of Baby Boomers and reimbursement rates offered by Obamacare,” he says. “The need to be smarter…part of that is leaner, smarter operation.”The amount of technology used by a hospital requires a larger amount of data that must be managed. This requires updates. Hospitals have also been upgrading their presentation.“Banner is (Arizona’s) largest hospital system, so they have been moving the fastest and doing the largest amount of work in terms of positioning themselves to streamline and provide healthcare in more efficient manner,” says GPE Commercial Advisors Executive Vice President Julie Johnson. She is referring to the number of satellite Banner clinics that have popped up in the East Valley. There is a grab for market share, she says.“Dignity has been looking at several different clinics,” she says. “I don’t think they have been implementing them as quickly as Banner.”These large hospital care providers can afford to expand. However, clinics that have been traditionally geared toward lower income patients are now in a market where these patients have Obamacare and the power of choice. Johnson says Adelante and Mountain Park facilities have expanded their programs to compete. Most recently, Adelante Healthcare in Peoria moved into a retail center and put a huge emphasis on outfitting the space with attractive interiors.“Real estate is a really expensive part of healthcare delivery,” says Johnson. “(Telemedicine) changes how real estate is delivered. It may not change quickly. People still need to be touched and seen, but it will definitely evolve and change.”In addition to the adoption of telemedicine, the healthcare industry is seeing aesthetic changes.There is a greater emphasis on patient care and reducing the amount of time a patient stays at the hospital as well as return trips.“I think the hospital campus is always going to be a hub of activity, but there is more and more being done at these outpatient clinics,” says Johnson. “Heart surgeries will soon be done in outpatient settings. There is less of a need for hospital beds and more of a need for ambulatory settings. It’s cheaper to provide (care) in those settings. The synergies of proximity around hospital campuses will always be there. Even though the trend is for clinics to be off-campus in the hub and spoke method from 12 years ago, there will always be a synergy.”For example, HonorHealth, formerly John C. Lincoln, built Sonoran Health and Emergency Center that is an emergency department with an attached clinic. In the event of needing a hospital, patients are transferred to Deer Valley.“The actual patient is going to have a lot more choice in today’s market,” Johnson says. “There is going to be more hospitality element in providing healthcare. People want to choose it because of health care but also because it has a nice hospitality setting. As more people are having the ability to control their healthcare, if their first $5K is out of pocket and they have a choice of where to get an MRI or where to have my baby, they’re going to go where they’re most comfortable.”last_img read more

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Many natural depression therapies are better than pills

first_imgLinkedIn Share on Facebook Share on Twitter I practice critical-care medicine in Guelph, Ontario. Sadly, 10 to 15 per cent of my practice is the resuscitation and life support of suicide and overdose patients.It is not uncommon for these patients to have overdosed on the very antidepressants they were prescribed to prevent such a desperate act. The failures of antidepressants are a clear and present part of my clinical experience.Wedded to drugs that barely workTen years ago, when finishing medical school, I carefully considered going into psychiatry. Ultimately, I was turned off by my impression that thought leaders in psychiatry were mistakenly wedded to a drug treatment that barely works.A 2004 review by the Cochrane Foundation found that when compared against an “active” placebo (one that causes side effects similar to antidepressants), antidepressants were statistically of almost undetectable benefit.Studies that compared antidepressants to “dummy” placebos showed larger but still underwhelming results. On the 52-point Hamilton Depression Rating Scale (HDRS), patients who took the antidepressants fluoxetine (Prozac) or venlafaxine (Effexor) experienced an average decrease of 11.8 points, whereas those taking the placebo experienced an average decrease of 9.6 points.I am not suggesting that antidepressants do not work. I am suggesting that they are given a precedence in our thinking about mental health that they do not deserve.I leave it to readers to look at the Hamilton Depression Rating Scale and decide for themselves whether a drop of 2.5 points is worth taking a pill with myriad potential side effects including weight gain, erectile dysfunction and internal bleeding.It might be, but do note that taking an antidepressant does not seem to decrease the risk of suicide.Natural therapies that workThe far more exciting and underplayed point, to me, is that multiple non-drug treatments have been shown to be as effective. As a staunch critic of alternative medical regimes such as chiropractic, acupuncture and homeopathy, it surprises me to note that the following “natural” therapies have rigorous, peer-reviewed scientific studies to support their use:1. ExerciseIn 2007, researchers at Duke University Medical Center in North Carolina randomly assigned patients to 30 minutes of walking or jogging three times a week, a commonly prescribed antidepressant (Zoloft), or placebo. Their results? Exercise was more effective than pills!A 2016 review of all the available studies of exercise for depression confirms it: Exercise is an effective therapy. And it’s free!2. Bright light therapyYou know how you just feel better after an hour out in the sun? There probably is something to it. Bright light therapy is an effort to duplicate the sun’s cheering effects in a controlled fashion. Typically, patients are asked to sit in front of a “light box” generating 10,000 Lux from 30 to 60 minutes first thing in the morning.A review of studies using this therapy showed significant effect. The largest study showed a 2.5 point drop on the HDRS, roughly equal to that seen from antidepressants.The sun gives 100,000 lux on a clear day and I can’t think of a reason why sunlight itself wouldn’t work, weather permitting.3. Mediterranean dietThis one surprised me when it came out last year. Researchers in Australia randomly assigned depressed patients to receive either nutritional counselling or placebo social support.The nutritionists recommended a Mediterranean diet, modified to include local unprocessed foods.Thirty-two per cent of the depressed dieters experienced remission versus eight per cent of those who only received social support, a far larger effect than seen in antidepressant trials.4. Cognitive Behavioural Therapy (CBT)This is the best recognized of the “natural” treatments for depression and the evidence is indisputable.CBT is as effective as antidepressants but more expensive in the short term. However, antidepressants stop working when you stop taking them, whereas the benefits of CBT seem to last.And as an aside, it is very difficult to overdose fatally on a bottle of therapy.I freely admit that the trials I have mentioned are smaller than the major antidepressant trials. But whereas antidepressants are projected to bring in almost $17 billion a year for the pharmaceutical industry globally by 2020, the jogging and sunlight industries will never have the resources to fund massive international trials. With this in mind, I am convinced that they are at least as worthwhile as the pills.Physicians have a responsibility to at least talk to their patients about these options before reaching for the prescription pad.Dr. Strauss does not recommend changing one’s medication or course of treatment for depression without consulting a physician. If you are feeling suicidal or are concerned about a friend, family member or work colleague, visit www.suicideprevention.ca to find a crisis centre near you.By Matt Strauss, Fellow in Global Journalism, University of Toronto and Assistant Clinical Professor, General Internal Medicine, McMaster UniversityThis article is republished from The Conversation under a Creative Commons license. Read the original article. Emailcenter_img Pinterest Antidepressants bring in almost $17 billion a year for the pharmaceutical industry, and yet science shows their benefit to be small. Natural therapies such as diet, exercise, light therapy and cognitive behavioural therapy are just as effective.Winter is upon us. And with it comes the annual worsening of depressive symptoms. Sadly, in the United States, suicide continues to claim more lives than firearms, and suicide rates are increasing in nearly all states. The U.S. Centers for Disease Control and Prevention reports that death by suicide has increased by 30 per cent since 1999 and a similar trend is observed in CanadaI was distressed but not surprised to learn that these increases occurred over a period of time in which use of antidepressants skyrocketed by 65 per cent. By 2014, around one in eight Americans over the age of 12 reported recent antidepressant use. Sharelast_img read more

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