“To combat this issue, Jackson Memorial Hospital and the University of Miami established a Zika response unit made up of doctors from pediatrics, infectious disease and other specialties to follow these children as they grow up.”

A great example of a ZIKA Regional Referral Center. So, why isn’t the federal government designating ZRRCs? (and an important new finding about on AIDS)

Zika virus ‘not controllable’: CDC director’s grim warning

The director of the Centers for Disease Control and Prevention delivered a grim assessment Tuesday of the government’s ability to contain Zika, saying it’s too late to stop the dangerous virus from spreading throughout the United States.

“Zika and other diseases spread by (the Aedes aegypti mosquito) are really not controllable with current technologies,” CDC Director Thomas Frieden said. “We will see this become endemic in the hemisphere.”



How American Doctors Are Preparing Families for Children With Zika

Doctors in Florida are preparing for the possibility of a few hundred babies born with Zika-related birth defects. While few children have been born in the US with Zika, most pregnant women who became infected in South Florida are due this spring.

To combat this issue, Jackson Memorial Hospital and the University of Miami established a Zika response unit made up of doctors from pediatrics, infectious disease and other specialities to follow these children as they grow up.

“Does the child eventually develop developmental issues? Does the child eventually develop learning issues?” said Dr. Patricia Rodriguez, a pediatric Infectious disease doctor with the zika response team. “We don’t know what’s going to happen when they’re 5 or 6 years old.”



Frequent exams only treatment for pregnant woman with Zika

Flores’ experience illustrates the gaps in doctors’ understanding of how Zika affects pregnancy, said Dr. Christine Curry, Flores’ obstetrician-gynecologist and the co-director of the Zika Response Team. For example, doctors don’t currently know why the virus — which is mainly spread by city-dwelling mosquitoes but also can be sexually transmitted — remains detectable in a pregnant woman’s bloodstream far longer than in the bloodstream of a man or a woman who is not pregnant.

“It’s hard to continue to say, ‘I don’t know,’ but it’s not unexpected with a disease that’s really made its mark only in the last few years,” Curry said.



Why and How Did Zika Turn into Such a Fearsome Virus?

So far, Lyle Petersen, MD of the US Centers for Disease Control and Prevention, told attendees of ID Week in New Orleans, LA, today, the biggest one is why it is causing the severe neurological problems that have made it front page news in the past two years. “This virus has been in Asia for at least 15 years,” Petersen said, without causing microcephaly or other birth anomalies.



Mythology of ‘Patient Zero’ and how AIDS virus traveled to the United States is all wrong

The story of how “Patient Zero” and AIDS arrived in New York in 1979 and triggered the epidemic in North America has been told so many times in so many different ways that for many people it’s become an accepted truth of our modern history.

It begins with a single man, a young flight attendant named Gaetan Dugas, who presumably became infected abroad and then unwittingly gave it to some of his sexual partners. His sexual partners in turn gave it to their sexual partners and so forth until the whole continent was full of clusters of people dying of the mysterious disease. In journalist Randy Shilt’s 1987 book “And the Band Played On,” and in various media reports, Dugas was described as sexually adventurous and said to have told Centers for Disease Control and Prevention investigators he had approximately 250 sexual partners each year.

It’s a compelling narrative, but it’s not quite right.






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“Insanity: doing the same thing over and over again and expecting different results.” (attributed to Einstein). Perhaps increasing access to primary care needs a new approach – rewarding evidenced based care, rather than outpatient visits.

Some highly acclaimed initiatives to improve access to quality primary health care and reduce cost have proved challenging. Over the past several weeks we have seen several glaring examples –  hospitals leaving ACOs, no change in ED use, the uphill strategy to train more primary care physicians, and “whatever happened” to medical homes. 

Dartmouth was the national leader in establishing an Accountable Care Organization. “Why Accountable Care? The current health care system, which pays for discrete medical services instead of outcomes, has resulted in fragmented care and fueled enormous growth in health care costs. To create a more sustainable system, we need a new model that holds health systems and providers accountable for the quality of care delivered to patients. By promoting strategic integration and rewards based on quality care, the Accountable Care Organization (ACO) model offers a potential win-win for providers, payers and patients alike.” (A)

The Dartmouth Atlas quickly became the ACO “bible.” “Under the program, primary care physicians are encouraged to join together with other providers to take responsibility for the full continuum of their primary care patients’ care. They must commit to reporting comprehensive measures of the quality and — eventually — outcomes of care. If they are able to improve quality and thereby reduce costs, they will receive a share of the savings achieved. The term “accountable” is intended to mean just that; ACOs should only receive additional payments to the extent that they are demonstrably improving care for their patients.” (B)

Now: “Dartmouth-Hitchcock Medical Center will abandon the Pioneer Accountable Care Organization program, the system confirmed Tuesday, after losing more than $3 million over the past two years in the Centers for Medicare and Medicaid model.” (C)

“Will Medicaid expansion save the country money as people stop using expensive emergency rooms for primary care? Not yet, suggest the latest findings from a landmark study published online Wednesday in the New England Journal of Medicine. The study of Medicaid patients in Oregon who got Medicaid in 2008 found their ER use stayed high two years after they gained the health insurance coverage — even as they also increased their visits to doctors’ offices.” (D) “People covered by Medicaid were more likely to both see a physician at a regular office visit and also go to the emergency room, casting doubt on the idea that people were using health coverage to shift their health care to a primary care doctor.” (E)

“One “hidden” benefit of the Affordable Care Act is its potential to make primary care more accessible. The U.S. has long lagged behind other industrialized countries on primary care—at great cost to our health and our economy. Throughout the legislation are provisions that, if considered together and implemented effectively, will strengthen primary care for all Americans. With stronger primary care, people will be more likely to receive recommended preventive care and timely care for medical problems before they become serious and more costly to treat.” (F)

Well over twenty new medical schools have opened in the last ten years with more in the pipeline. “Many of the schools under development are making a bigger push to educate future primary care physicians, which will be in greater need to improve the quality of medical care and lower costs by keeping patients out of the more expensive hospital setting.” (G)

But in 2013 AARP reported: “Today, the United States is short about 16,000 primary care doctors — the very doctors (family practitioners, internists and pediatricians) who offer the treatments and preventive screenings that save lives and head off expensive emergency room visits and hospitalizations. Why the shortage? It starts with huge medical school debts and ends with a doctor who is often overworked and underpaid. While students may enter medical school wanting to practice primary care medicine, they graduate saddled with heavy debt — $250,000 is not unusual — which prompts them to switch to a more lucrative specialty. The starting salary for a primary care physician is $150,000 to $170,000; a radiologist or gastroenterologist can make two to three times that. Only one in five graduating internal medicine residents plans to go into primary care medicine……” (H)

“The number of primary care physicians is projected to increase from 205,000 FTEs in 2010 to 220,800 FTEs in 2020, an 8-percent increase. The total demand for primary care physicians is projected to grow by 28,700, from 212,500 FTEs in 2010 to 241,200 FTEs in 2020, a 14-percent increase. Without changes to how primary care is delivered, the growth in primary care physician supply will not be adequate to meet demand in 2020, with a projected shortage of 20,400physicians. While this deficit is not as large as has been found in prior studies, the projected shortage of primary care physicians is still significant.” (I)

The “medical home” was the moon shot to improve access to primary care. “The medical home is best described as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety. It has become a widely accepted model for how primary care should be organized and delivered throughout the health care system, and is a philosophy of health care delivery that encourages providers and care teams to meet patients where they are, from the most simple to the most complex conditions. It is a place where patients are treated with respect, dignity, and compassion, and enable strong and trusting relationships with providers and staff. Above all, the medical home is not a final destination instead, it is a model for achieving primary care excellence so that care is received in the right place, at the right time, and in the manner that best suits a patient’s needs.” (J) “Medical home” has fallen off the innovation radar.

Some extreme, perhaps patient “unfriendly,” options to think about:

VALUE BASED INSURANCE. “The additional cost when patients choose procedures that research shows are unlikely to help their condition is a key element of ….value-based insurance, the premise of which is that a mix of financial carrots and sticks can steer patients toward medical services that will help them and away from ineffective or unnecessary ones.” (K)

REFERENCE PRICING.  “Reference pricing serves as a reverse deductible. Rather than the patient paying up to a defined limit and then the insurer covering the remainder, the insurer pays up to a defined limit and the patient pays the remainder. This has the remarkable feature of exposing the patient to the variation in prices for treatments that are above deductible thresholds. And the patient’s contribution isn’t limited by an annual out-of-pocket maximum. “(L)

Perhaps we can do better! by rewarding evidenced based care, rather than outpatient visits.




(A)      http://tdi.dartmouth.edu/research/evaluating/health-system-focus/accountable-care-organizations

(B)      http://www.dartmouthatlas.org/keyissues/issue.aspx?con=2943

(C)      http://www.healthcarefinancenews.com/news/dartmouth-hitchcock-exit-pioneer-aco-program-over-losses-calls-model-%E2%80%98unsustainable%E2%80%99

(D)      http://www.npr.org/sections/health-shots/2016/10/19/498526110/emergency-room-use-stays-high-in-oregon-medicaid-study

(E)       https://www.washingtonpost.com/news/wonk/wp/2016/10/19/more-evidence-expanding-medicaid-increases-emergency-room-visits/

(F)       http://www.commonwealthfund.org/publications/blog/2011/jan/affordable-care-act-bolsters-primary-care

(G)      http://www.forbes.com/sites/brucejapsen/2012/07/17/as-obamacare-looms-new-medical-schools-open-to-address-doctor-shortage/#ee36f65767ca

(H)      http://www.aarp.org/health/medicare-insurance/info-03-2013/how-to-beat-doctor-shortage.html

(I)        http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/primarycare/

(J)       https://www.pcpcc.org/about/medical-home

(K)      http://www.reuters.com/article/us-usa-healthcare-insurance-idUSBRE9BI04X20131219

(L)       http://www.wsj.com/news/articles/SB10001424052702303448104579152111004814066

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“The thing is, scientists still don’t understand Zika well enough yet to predict with certainty what’s going to happen in the months to come. It still seems like the outlook for Zika becomes more alarming with each new discovery.”


One Family’s Struggle With Microcephaly, the Birth Defect Now Linked to Zika

The morning after Christine Grounds gave birth to her son Nicholas, she awoke to find a neurologist examining her baby. It was summer 2006, and Nicholas was her first child. There had been no indication that anything was wrong during her pregnancy, but it was soon clear that there was a problem. “Did you know he has microcephaly?” she remembered the doctor asking matter-of-factly. Confused, she replied, “What is microcephaly?”




Will Winter Kill Zika? Colder weather kills mosquitoes, but it doesn’t mean the virus is no longer a threat.

Zika isn’t a threat that’s going away anytime soon, despite the fact that in most areas of the U.S., cold weather brings the risk of mosquito-borne illnesses like Zika down to nearly zero. (In the Southernmost regions of Florida and Texas, the risk of such viruses declines in the winter, but doesn’t go away entirely.) The thing is, scientists still don’t understand Zika well enough yet to predict with certainty what’s going to happen in the months to come. It still seems like the outlook for Zika becomes more alarming with each new discovery.




Zika infection of neural progenitor cells perturbs transcription in neurodevelopmental pathways

A recent study of the gene expression patterns of Zika virus (ZIKV) infected human neural progenitor cells (hNPCs) revealed transcriptional dysregulation and identified cell-cycle-related pathways that are affected by infection. However deeper exploration of the information present in the RNA-Seq data can be used to further elucidate the manner in which Zika infection of hNPCs affects the transcriptome, refining pathway predictions and revealing isoform-specific dynamics.




Scientists map DNA of Zika virus from semen

The first complete genetic “blueprint” — genome — of a sample of Zika virus derived from semen has been obtained by researchers.

“We have many unanswered questions about how Zika virus is able to be transmitted sexually, whereas similar viruses are not,” Atkinson said. “It is possible that the answers to these questions lie in the viral genome, but many more sequences from semen are required before scientists can see if there are any changes that shed light on this topic.”




Scientists Uncover New Facets of Zika-Related Birth Defects to Help Develop Treatment

In a study that could one day help eliminate the tragic birth defects caused by Zika virus, scientists from the Florida campus of The Scripps Research Institute (TSRI) have elucidated how the virus attacks the brains of newborns, information that could accelerate the development of treatments…..In the new study, the scientists observed the virus’s effects in animal models at two different points—during early postnatal development, when the brain is growing rapidly, and at weaning, when the brain has largely reached adult size.




Zika could threaten more than just infants, scientists say

Babies infected with Zika can face severe brain damage even if symptoms are not apparent at first, and are at risk of permanent physical, mental and cognitive disorders as they continue to grow, according to a Wednesday report in mcclatchydc.




Babies who get Zika after birth show fewer effects

In a bit of positive news, a new study by the CDC (Centers for Disease Control) shows fewer dangerous effects for babies and children who contract Zika after they are born.




23 infants in US born with Zika-related birth defects

As of Oct. 6, 23 infants in the U.S. have been born with birth defects related to the Zika virus, and five pregnancies with birth defects have been lost to miscarriage, stillbirth or termination, according to the CDC.

More babies with Zika-related birth defects, like microcephaly or congenital Zika syndrome, could be on the way in the U.S., because 878 pregnant women have lab evidence of possible Zika virus infection, the CDC reports.




Brazil has over 2,000 zika-related microcephaly cases in one year

Brazil’s Health Ministry informed on Friday that, one year after the beginning of the zika-related microcephaly cases, 2,033 cases have been confirmed in the country.  In 381 cases, the infection by zika was already confirmed by lab tests. Besides the two thousand cases of microcephaly already confirmed by authorities, other 3,055 cases are still under investigation.




Health officials outline Zika spending priorities

On a conference call with reporters, health officials said $394 million would go to the U.S. Centers for Disease Control and Prevention, $152 million to the National Institutes of Health and $387 million for the Public Health and Social Services Emergency Fund, which supports the nation’s ability to respond to public health emergencies.

The government will be allocating funds, based on a competitive process, to support Zika virus surveillance and other programs. The funds will also be used to expand mosquito control, continue vaccine development and begin studies on the effect of Zika on babies born to infected mothers.




CDC advises pregnant women who have been to Miami-Dade be tested for Zika

Pregnant women who have “lived in, traveled to, or had unprotected sex with someone who lived in or traveled to Miami-Dade County” since August 1 should be tested for the Zika virus, the Centers for Disease Control and Prevention said Wednesday.


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Is “community hospital cancer center” an oxymoron? Do “cancer hospitals” have better outcomes?

Back in the 1990s while I was President & CEO of LibertyHealth/ Jersey City Medical Center (a teaching hospital affiliated with Mount Sinai School of Medicine), a neighboring community purchased a linear accelerator and declared itself a Cancer Center, including signs on the New Jersey Turnpike saying “exit here” for cancer care.

And I remember when a friend with possible breast cancer was about to pick a breast surgeon who was in-network (though we didn’t use that terminology then) rather than one based on credentials, hospital affiliations, and experience.

With increasing frequency community hospitals market their cancer centers.

The information below can help you evaluate and weigh cancer care options!

The “gold standard”! National Cancer Institute Designated Cancer Centers.

“The NCI Cancer Centers Program is one of the anchors of the nation’s cancer research effort. There are currently 69 NCI-Designated Cancer Centers, located in 35 states and the District of Columbia, that form the backbone of NCI’s programs for studying and controlling cancer. At any given time, hundreds of research studies are under way at the cancer centers, ranging from basic laboratory research to clinical assessments of new treatments. Many of these studies are collaborative and may involve several cancer centers, as well as other partners in industry and the community.” (A)

To find an NCI Designated Cancer Center click on http://www.cancer.gov/research/nci-role/cancer-centers/find

“Accreditation by the Commission on Cancer (CoC), a quality program of the American College of Surgeons, demonstrates a cancer program’s commitment to providing high-quality, multidisciplinary, patient-centered cancer care.

CoC accreditation is nationally recognized by organizations, including the National Cancer Institute, Centers for Medicare & Medicaid Services, National Quality Forum, American Cancer Society, and The Joint Commission, as having established data-driven performance measures for the provision of quality cancer care.” (B)

There are 9 CoC designations. Comprehensive Community Cancer Program (CCCP).Community Cancer Program (CCP) .Academic Comprehensive Cancer Program (ACAD). Integrated Network Cancer Program (INCP). Veterans Affairs Cancer Program (VACP). NCI-Designated Comprehensive Cancer Center Program (NCIP). Pediatric Cancer Program (PCP). Hospital Associate Cancer Program (HACP). Free Standing Cancer Center Program (FCCP). (C)

Comprehensive Community Cancer Program (CCCP). Accessions more than 500 or more newly diagnosed cancer cases each year. Full range of diagnostic and treatment services provided either on-site or by referral. Participates in cancer-related clinical research either by enrolling patients in cancer-related clinical trials or by referring patients for enrollment at another facility or through a physician’s office. Training resident physicians is optional.

Community Cancer Program (CCP). Accessions more than 100 but fewer than 500 newly diagnosed cancer cases each year. Full range of diagnostic and treatment services provided, but referral for a portion of diagnosis or treatment may occur. Participates in cancer-related clinical research either by enrolling patients in cancer-related clinical trials or by referring patients for enrollment at another facility or through a physician’s office. Training resident physicians is optional.

Academic Comprehensive Cancer Program (ACAD).Provides postgraduate medical education in at least four program areas, including internal medicine and general surgery. Accessions more than 500 newly diagnosed cancer cases each year. Full range of diagnostic and treatment services either on-site or by referral. Participates in cancer-related clinical research either by enrolling patients in cancer-related clinical trials or by referring patients for enrollment at another facility or through a physician’s office.

Hospital Associate Cancer Program (HACP). Accessions 100 or fewer newly diagnosed cancer cases each year. Limited range of diagnostic and treatment services available on-site. Other services are available by referral. Clinical research is not required. Training resident physicians is optional.

Free Standing Cancer Center Program (FCCP). Facility is a non–hospital-based program and offers at least one cancer-related treatment modality. Full range of diagnostic and treatment services is available by referral. Referral to CoC-accredited cancer program(s) is preferred. Participation in cancer-related clinical research is encouraged but not required. Patients may be enrolled in cancer-related clinical trials either at the facility or by referring patients for enrollment at another facility or through a physician’s office. Training resident physicians is optional. No minimum caseload requirement for this category.

To find a CoC accredited cancer program click on https://www.facs.org/search/cancer-programs

Finally, there is an ongoing debate whether or not Cancer Hospitals have better outcomes than   hospitals that have cancer programs as part of a broader array of clinical activity.

Perhaps not unsurprisingly studies done by Cancer Hospitals suggest better outcomes in cancer specialty hospitals. (D) (E) For example, one states: “In our analysis, we also show large and persistent risk-adjusted differences in cancer treatment outcomes associated with the type of treating hospital. The findings suggest that compared with community hospitals, survival appears to be superior for patients treated at PPS-exempt cancer hospitals, at NCI-designated cancer centers, and at academic teaching hospitals—all findings consistent with prior reports……..”(F)

Yet a 2014 article notes: “…..in cancer there are lots of metrics, but no settled-on methodology for measuring treatment performance and comparing treatment outcomes between institutions, care settings, or providers. (G)

Some resources to consider:

– National Cancer Institute. How To Find a Doctor or Treatment Facility If You Have Cancer. Click on http://www.cancer.gov/about-cancer/managing-care/services/doctor-facility-fact-sheet

– The American Cancer Society How to Choose a Hospital: Worksheet. Click on http://www.cancer.org/acs/groups/cid/documents/webcontent/003292-pdf.pdf

– Choosing Your Cancer Treatment Hospital. How can you tell a good cancer treatment hospital from a mediocre one? Click on http://www.webmd.com/cancer/features/choosing-your-cancer-treatment-hospital

(A) http://www.cancer.gov/research/nci-role/cancer-centers

(B) https://www.facs.org/quality-programs/cancer/coc/apply/benefitscoc

(C) https://www.facs.org/quality-programs/cancer/coc/apply/categories

(D) https://www.mskcc.org/blog/msk-study-examines-care-outcomes-among-u-s-hospitals

(E) https://www.fredhutch.org/en/news/center-news/2015/11/cancer-center-patients-live-longer.html

(F) http://oncology.jamanetwork.com/article.aspx?articleid=2451426

(G) http://jop.ascopubs.org/content/10/3/215.full


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ZIKA is no longer front page news! But scientists are keeping watch on Mayaro, Rift Valley Fever, Crimean-Congo Hemorrhagic Fever, and Usutu as the next insect-borne diseases that could break out on a large scale.

ZIKA should not be seen as a singular event but as the current public health threat in what is likely to become a stream of mosquito-borne emerging viruses.

Now is the time to designate Regional Emerging Virus Referral Centers, more specifically academic medical centers prepared to manage the care of ZIKA newborns and ZIKA affected pregnant women now, as well as those affected by other emerging viruses likely to be a challenge going forward.


Zika: Five strategies for health systems

With more than 3,800 cases of Zika being reported from all 50 of the states and 105 linked to local transmission in Florida, it’s difficult to ignore the concern of patients about the Zika virus.

This emerging public health issue creates an imperative for health systems to have proper infrastructure and procedures in place.

A recent Premier Inc. survey of C-suite health system leaders provides a snapshot of how health systems are proactively investing in patient education, screening and reporting tools, as well as implementing best practices to help deliver high-quality care based on the unique needs of the patient population they serve.

Below are five strategies health system leaders are taking to ensure practitioners have the right tools and resources to effectively prevent, screen, treat and report Zika cases.

1) Patient education

2) Screening at-risk individuals

3) Surveillance and reporting

4) Clinical care

5) Creating accountability




These Are the Mosquito-Carried Diseases Scientists Say Could be the Next Zika

This summer, Zika was among our top worries. As the disease spread rapidly first in Central and South America and then here in the U.S., everyone was stocking up on bug spray and swatting any buzzing insects nearby. Zika was not the first mosquito-borne illness to cause a panic, though, and scientists want us to know it won’t be the last.

The Scientific American reports researchers have their eyes on four insect-carried illnesses that they suspect could wreak havoc in the near future just like Zika did this summer. While these are just best guesses and nothing is for sure, scientists are keeping watch on Mayaro, Rift Valley Fever, Crimean-Congo Hemorrhagic Fever, and Usutu as the next insect-borne diseases that could break out on a large scale.

Mayaro is a disease very similar to the mosquito-borne disease chikungunya, causing symptoms that are pretty hard to tell apart. Both diseases cause serious fever, muscle aches and joint pain. Those similarities could be why Mayaro becomes a big issue, according to the Scientific American. Since chikungunya adapted to be carried by urban dwelling mosquitos, Mayaro could too.




Zika Syndrome: Health Problems Mount as Babies Turn 1

A year after a spike in the number of newborns with the defect known as microcephaly, doctors and researchers have seen many of the babies develop swallowing difficulties, epileptic seizures and vision and hearing problems.

While more study is needed, Zika-caused microcephaly appears to be causing more severe problems in these infants than in patients born with small heads because of the other infections known to cause microcephaly, such as German measles and herpes. The problems are so particular that doctors are now calling the condition congenital Zika syndrome.

“We are seeing a lot of seizures. And now they are having many problems eating, so a lot of these children start using feeding tubes,” said Dr. Vanessa Van der Linden, a pediatric neurologist in Recife who was one of the first doctors to suspect that Zika caused microcephaly.

…..”We may not even know about the ones with slight problems out there,” Van der Linden said. “We are writing the history of this disease.”




Zika ‘syndrome’: Problems mount for babies

RECIFE, Brazil – A year after a spike in the number of newborns with the defect known as microcephaly, doctors and researchers have seen many of the babies develop swallowing difficulties, epileptic seizures, and vision and hearing problems.




How Hurricane Matthew Could Make the Zika Virus Exponentially Worse

And then there’s the Zika virus. The largest concentration of Zika cases in the United States is in and around Dade County, which may be spared the direct impact of the storm, but a huge rain event like Matthew quite obviously would leave massive amounts of standing water within which Aedes aegypti, the mosquito that carried the virus, could breed and thrive.

(A large part of the hot zone is at an elevation of nine feet above sea level. Some predictions have the area being inundated by a 12-foot storm surge.)

And it is not just puddles, either. Think about how water can pool in piles of debris, and in scattered wreckage. Think about endless heaps of worthless household junk. Think about thousands of evacuees leaving the current hot zones in and around Miami. Now think about all the crews coming from all over the country to help with the recovery effort over the next several months, walking amid the debris, turning it over in the heat that always follows a hurricane. Now think about all those crews going back to Iowa or Maine.




Hurricane Matthew could help Zika fight

What does that have to do with a hurricane? Adult mosquitoes get washed away by heavy rain. This includes Aedes aegypti mosquitoes, which transmit the Zika virus. In the short term, from the first few days to about a week after the storm, the mosquito cycle is naturally interrupted — and that can have a beneficial effect on Zika transmission. In fact, initially after a big storm, there can be a decrease in all mosquitoes.




How the Zika Virus Could Make Its Way North

Laboratory tests show that a cold-tolerant mosquito known as Culex quinquefasciatus can be infected with Zika virus in the laboratory. If confirmed in the field, it would be a troubling development, suggesting the virus would be more difficult to control, and might be able to spread far north of Florida and the Caribbean.

Culex mosquitoes are not currently targeted for control; the fight against Zika has focused on eradicating Aedes aegypti, an invasive mosquito found throughout tropical and subtropical regions worldwide and which is primarily blamed for the virus’s outbreak in Brazil and its spread through parts of south Florida.


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“If Columbus had an advisory committee he would probably still be at the dock.” (A)

“Effective meetings don’t happen by accident, the happen by design.” (author unknown)

In 1975 I was appointed Administrator of Mount Sinai Services at City Hospital at Elmhurst, a public hospital where Mount Sinai School of Medicine contractually provided professional services. We had a quarterly Dean’s Committee meeting with the Dean of the Medical School. After our first Dean’s Committee meeting I was proud of my contributions only to be chastised by our Clinical Director of Medicine who said: “Dr. Metsch, this is our meeting with the Dean not yours, you can meet with the Dean (your boss) whenever necessary, we only get to talk to him four times a year. It’s our agenda, not yours!”

A painful but important Lesson Learned which led me to constantly monitor committee work for the rest of my career. Here are some more Committee Lessons Learned.

When I was an SVP (Office of the President) at Mount Sinai I had to remember that my role was different at every meeting. Meeting with the same people on different topics my role might range from full participant to minute taker.

Parenthetically I once had a staff member who always thought he was as important as the most important person in the room and spoke up accordingly. If he was in a meeting with the President of our organization, he acted presidential too.

I remember a meeting with a Board member who was a senior state legislator. I introduced several important issues and asked his assistance on them. He said: “Jonathan, there are ten people outside waiting to see me after our meeting. They all have important issues. So which one issue do you want me to help you with, and after we finish that please come back and raise the next most important one then.”

Parenthetically I once asked another Board member, also a senior state legislator why he had signed on to a bill that was not good for our hospital. He said: “Jonathan, I am part of the Leadership. Sometimes I can vote how I want but there are other times the Senate President directs the caucus on an issue. At the end of the day you should want me to be in the leadership group more than you are upset about one bill.”

Lesson Learned: when you are asking an influential to step in on an issue, make sure you understand the “demands” on that person and request support accordingly. Otherwise you may wind up with no gain.

If you raise ten great ideas at a meeting, no one will remember any of them. Be prepared by doing your homework and raise one sensational idea at a meeting, and everyone will remember.

I have served on numerous industry and community Boards. It is always easy to go to a few Committee meetings and quickly identify some “best practices” that would make a committee more effective. Share those ideas privately with the chairperson; never embarrass the chairperson publicly.

Parenthetically, when I was the CEO I once made a colossal mistake at a SVP/ VP staff meeting. One SVP caught it but he walked out of the meeting with the others at the end of the meeting, then circled back, explained my mistake which I quickly corrected.

Every project management committee meeting should end with scheduling the next meeting and clarifying individual assignments. Meeting notes should be produced quickly. And anyone with an assignment for the next meeting should send out reading material at least two days before the next meeting.

Parenthetically, always volunteer to write to write the Meeting Notes if the opportunity is there. This gives you a strategic role and earns you appreciation from the chairperson (particularly if the chairperson is higher up in the organization).

Never hijack someone else’s meeting because you would do things differently.

When someone makes a point that adds value never say “I was going to say that” when you didn’t speak up first.

When you chair a committee your job is to facilitate not dominate.

And at any meeting you learn more by listening than by talking. So pick your spots strategically.

“When in doubt, don’t call a meeting.” (source unknown)

“Meetings without an agenda are like a restaurant without a menu.” (Susan B. Wilson)


(A) Arthur Goldberg

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Dr. Fauci. “If you’re talking about any congenital defect I think it’s going to be much higher than 13 percent,” he said. “I think we’re going to see something very disturbing.”

More reasons that all pregnant women with Zika must be be referred to academic medical centers for prenatal care.

Zika-related birth defects likely higher than anticipated: panel

The risk posed by the Zika virus to developing fetuses is likely far greater than current estimates suggest, a top U.S. health official said on Thursday.

Microcephaly, a rare birth defect in which babies develop abnormally small heads, is one of a constellation of Zika-associated problems increasingly being seen in children born to mothers infected during pregnancy with the Zika virus.

Other types of birth defects observed include seizures, deafness, blindness and a range of neurological and developmental abnormalities.

Earlier this year, a U.S. analysis estimated the risk of microcephaly following a mother’s infection with the virus during the first trimester of pregnancy at between 1 percent and 13 percent.

That figure does not include the overall risk of risk of birth defects, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said during a panel discussion on Zika.

“If you’re talking about any congenital defect I think it’s going to be much higher than 13 percent,” he said. “I think we’re going to see something very disturbing.”



Congenital Zika virus increases risk for sensorineural hearing loss

Children impacted by congenital Zika virus should be considered at an increased risk for hearing impairment and late-onset hearing loss, warranting regular follow-up after initial screenings, according to a recent MMWR.



Study finds Zika infects neural cells related to skull formation

LONDON –  The Zika virus causing an epidemic in Brazil and spreading through the Americas can infect and alter cells in the human nervous system that are crucial for formation of bones and cartilage in the skull, a study found on Thursday.



CDC: 158 U.S. children contracted Zika postnatally

The CDC recommends considering Zika as a possibility in children who display symptoms and have a history of travel to areas where the virus is spreading. It previously released guidelines for collecting blood and urine samples.

There is no treatment for Zika virus infection, but symptoms can be managed with antipyretics and supportive care, according to the report. Children should not be given aspirin because of the risk of Reye syndrome. They also should not take nonsteroidal anti-inflammatory drugs until dengue virus is ruled out.

For infants with congenital Zika infection, CDC guidance recommends an array of tests and follow up with appropriate specialists. Fan Tait, M.D., FAAP, AAP associate executive director and director of the Department of Child Health and Wellness, stressed the importance of monitoring all children who may have contracted Zika virus regardless of the source or timing.

“It is critically important these children and others who have been exposed to Zika are not lost to follow-up and that they are screened for development and other issues as per the CDC and Bright Futures guidelines.”



Congenital Zika Virus Infection

Combined findings from clinical, laboratory, imaging, and pathological examinations provided a more complete picture of the severe damage and developmental abnormalities caused by ZIKV infection than has been previously reported. The term congenital Zika syndrome is preferable to refer to these cases, as microcephaly is just one of the clinical signs of this congenital malformation disorder.



More than 800 pregnant US women have Zika

As of Sept. 22, 808 pregnant women in the U.S. have evidence of Zika virus infection, which can put their fetuses at risk for birth defects like microcephaly, the CDC reports.

Already, 21 babies have been born in the U.S. with Zika-related birth defects, and five women have lost their pregnancies with birth defects, according to the CDC.


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