Bahrain Condemned Over Doctors' Jail Terms

From Reuters Health Information By Stephanie Nebehay GENEVA (Reuters) Oct 03 - Bahrain's handing down of harsh sentences to 20 doctors followed flawed trials that failed to meet international standards of transparency and due process, the United Nations human rights office said on Friday. The World Medical Association also condemned as "totally unacceptable" the jail terms imposed by a military court, while the World Health Organization said medical personnel should never be punished for doing their duty of treating all patients. A security court sentenced 20 doctors to jail on Thursday for between five and 15 years on theft and other charges, the state news agency said, in what critics claimed was reprisal for treating injured protesters during unrest in the Gulf kingdom this year. "For such harsh sentences to be handed down to civilians in a military court with serious due process irregularities raises severe concerns," Rupert Colville, spokesman for U.N. High Commissioner for Human Rights Navi Pillay, told a news briefing. Defendants had limited access to lawyers and most lawyers did not have enough time to prepare properly, he said. "We've even heard reports of detainees calling their families the day before their hearing asking them to appoint a lawyer," he said. The hearing itself had taken less than 10 minutes, according to a defense lawyer. The court -- whose three judges are appointed by the military -- "has also not been investigating torture allegations and has not permitted recordings of the proceedings," Colville said. The doctors denied the charges, saying they were invented by the authorities to punish medical staff for treating people who took part in anti-government protests. They were among dozens of medical staff arrested during protests led by the Shi'ite majority demanding an end to sectarian discrimination and a greater say in government. Bahrain's Sunni Muslim rulers quashed the protests in March, with the help of troops from fellow Sunni neighbors Saudi Arab and the United Arab Emirates. At least 30 people were killed, hundreds wounded and more than 1,000 detained -- mostly Shi'ites -- in the crackdown. On September 26th, Bahrain sentenced 32 men to 15 years in jail over violent protests and handed the head of a teachers' union a 10-year prison term for calling for the overthrow of the Gulf Arab monarchy. Two days later, a military court upheld life sentences against Shi'ite opposition leaders Colville, referring to the doctors, said: "The charges have varied from illegal gatherings or expressing hatred of the government to what one normally consider actual crimes such as murder and destruction of property. So quite a lot of these charges related to freedom of expression and freedom of assembly." Bahrain's government had announced that all cases would be referred to civilian courts in October, but it was not clear how appeals by those convicted in military courts would be handled, he said. "It is a sad day for medicine when physicians are incarcerated for treating patients. Physicians have an ethical duty to care for all patients in situations of conflict irrespective of the political circumstances," World Medical Association President Wonchat Subhachaturas said in a statement. The body links eight million physicians in 97 countries. "In times of conflict, medical neutrality must be respected under the Geneva Conventions," Fadela Chaib, spokeswoman of the WHO, a United Nations agency, said. "This means that injured people must be allowed to receive treatment regardless of their affiliation, health care workers must be allowed to access them and treat them and medical facilities including transport and personnel must all be protected," she told reporters.

Smoking Set to Cause 40 Million Extra Tuberculosis Deaths

From Medscape Medical News Kate Johnson October, 4, 2011 — If worldwide smoking trends continue to 2050, tuberculosis (TB) mortality rates could jump by 40 million, according to a study published online today in the British Medical Journal. "Aggressive tobacco control measures could avert millions of deaths from tuberculosis over the next four decades if these predictions are correct," write Sanjay Basu, MD, from the University of California, San Francisco, and colleagues. "In the past, multinational tobacco companies have attempted to persuade health organisations to focus on infectious diseases rather than tobacco control. Our results show that this is a false dichotomy: tobacco control is tuberculosis control," they note. Smoking increases the rate of latent TB by a factor of 1.9, active TB by 2.0, and death from TB by 2.6, after adjustment for socioeconomic status, they explain. The researchers used a mathematical model to predict the effect of various worldwide smoking scenarios on the rates of TB and death between 2010 and 2050. The model predicted that if smoking rates continue along the same trajectory as they did between 2005 and 2010, there will be a 7% increase, or 18 million excess cases of TB, by 2050 (from 256 million to 274 million) and a 66% increase, or 40 million excess deaths (from 61 million to 101 million), compared to a nonsmoking model. This would translate to a 20-year delay in meeting the Millennium Development Goal target of reducing TB mortality by half between 1990 and 2015, they reported. In a more pessimistic scenario, the model predicted that if smoking rates were to increase at twice the current rate (to a maximum of 50% prevalence), there would be a 6% increase in TB cases (reaching a total of 290 million) and a 12% increase in TB deaths (to a total of 114 million) compared to the impact of current smoking trends. If aggressive tobacco control efforts were to reduce smoking prevalence by 1% per year until eradication, the TB infection and mortality rate could be reduced by 13% and 27%, respectively, from the current trajectory, they added. The authors have disclosed no relevant financial relationships. BMJ. Published online October 4, 2011.

The Year's Best Medical Practice Management Tips: 2011

From Medscape Business of Medicine Leslie Kane, MA Posted: 10/24/2011 Medical practices are going through seismic changes, and physicians are looking for ways to increase revenue or lower costs. There are many tactics that address the myriad ways to do both of those: by changing practice strategy; adding services; solving patient-flow and workflow problems that have been ignored; and focusing more on getting money that is owed to you. Throughout the year, Medscape has offered expert advice on ways to build a more successful practice. Here are some of the tips that physician readers found most helpful. 1. Offer Your Patients One-Stop Shopping For your patients' convenience, do everything possible in-house: Draw blood, conduct urinalyses and stool guaiac tests, and so forth on your own. You should be able to bill for these items, and your patients won't have to wait at an outside lab to get the services that they need. When your patients need outpatient procedures that you cannot offer in-house, help them schedule appointments while they are in your office so that they won't have to hassle with the bureaucracy. Make their lives easier and they will reward you for it. 2. Get New Patients by Creating a Niche You'll go broke if you wait for sick patients to walk through the door. There aren't enough of them to go around. Consider doing wellness medicine, which widens the scope of potential patients to include everyone. Develop a subspecialty such as in dermatology, thyroid disorders, diabetes, or geriatrics. Get into occupational health -- pre-employment physicals, drivers' physicals, flight physicals, workers' compensation for minor injuries, drug screening, etc -- and advertise that you offer these services. A river of money may run by lawyers, but it doesn't run by physicians. We have only rivulets, but add them up and you will have a mighty stream. 3. Avoid Gaps in the Schedule Due to No-Shows Start with the basics: Have a no-show policy that charges patients either for the first or the second no-show appointment. It may be difficult to collect, but if patients wish to return to the practice, collect it via credit card when booking an appointment. Communicate the no-show policy to patients. Confirm all new patient visits 36 hours prior to the visit. If a patient cancels, that gives the practice time to fill the slot. Develop a cancellation list of patients who want to be seen sooner, and call them for cancellations. Track no-show patient characteristics. Are they emergency department referrals? Follow-ups? Is the no-show rate so high that the group needs to book extra patients to keep gaps from the schedule? Monitor the number of no-shows at baseline, implement changes, and set a goal that reduces the number. Graph your progress, and involve all staff members in meeting this goal. 4. Try to Get Paid on the Basis of RVUs Rather Than Collections, if You're in a Hospital or Large Group Many hospital billing services are really bad. Relative-value units (RVUs) are directly tied to the coding. It's a better measure of patient acuity than collections, and it eliminates contractual discounts. One problem for doctors starting a new job is that they may not get a productivity bonus in the first year if their incentive is based on collections that are measured annually. Because there's typically a 3-month lag before their charges are collected, the extra revenue that they generated through hard work won't show up in the first year. In contrast, they can get a productivity bonus in the first year if they're rewarded for hitting RVU targets, notes Tommy Bohannon, Senior Director of Recruiting and Development Training for Merritt Hawkins & Associates in Dallas, Texas. If a hospital or group includes quality metrics in its payment calculation, that will usually constitute about 10% of compensation. Sometimes a contract will specify that various percentages of the potential productivity bonus be paid to doctors, depending on how well they score on the quality measures. Intangible factors may account for another 10%. Among those factors are patient satisfaction, participating in committees, doing community service or community education, and public speaking, he says. In some cases, physicians who work harder and see more patients can earn more than those who spend a lot of time being good citizens. 5. Make Sure That All Physicians Are Pulling Their Own Weight, and Deal With Those Who Aren't Though a daunting prospect, you must have a frank discussion with the physicians who are dodging a share of the duties, regardless of seniority. "The senior doctor shouldn't carry more weight than the other partners. We should all be even stakeholders who are looking out for the common good of the practice," says Practice Management Expert Judy Capko, of Capko & Company, in Thousand Oaks, California. Advance preparation is essential. "There's a certain baseline cost for carrying a doctor, whether 10 or 20 patients are being seen. You need to gather a lot of data to see what the financial impact of this physician's routine is on the practice," Capko says. Determine what you need an underperforming physician to do; discuss the best way to lay out your position; and present it as a united group. The group spokesman should be someone who this physician greatly respects. Although some practices engage a management consultant as a facilitator, "you have a much better chance of succeeding if a physician expresses the group's viewpoint than if the consultant is given the role of dealing with this. Otherwise, the doctor who feels challenged is just going to attack the consultant. He or she is not going to see that the doctors agree with that consultant unless that's voiced," Capko says. Steer the discussion away from the physician's behavior and focus on the long-term health of the practice. Capko recommends: "You have been the foundation of this practice. We owe you a lot, but this practice -- your practice -- is struggling with some issues, and we need to address these for the future." Then you can delineate your concerns. 6. Get Payment Even if Your Patient's Check Bounces Your practice's financial policy needs to include your policy on bounced checks and what steps the practice will take to recover that payment. If there are bank charges, stipulate that the patient will be charged for those fees. If you're in a state that allows you to collect a processing fee above the bank charges, that needs to be stipulated in the financial policy that a patient signs. For example, in Illinois the value of what can be collected is 3 times the face value of the check plus court costs if litigated. In North Carolina it is the cash amount of the check, bank fees, plus $35 for the handling fees. In Florida, you're only allowed to charge $20 above the check value and bank fees. The National Check Fraud Center lists the bad-check laws for each state. It is helpful to publish or reference the consumer credit laws in your financial policy. These simple steps will keep everyone on the same page and establish the financial component of the medical care relationship. Successful practices will make every method available for patients to pay bills. Cash, checks, postdated checks, credit cards, debit cards, and online services such as PayPal are all viable means for patients to settle their debts. Postdated checks are a good collection tool unless they bounce. Postdated checks are considered "promissory notes" rather than checks unless they are truly held until the date written on the check by the debtor before deposit. Consider using a check-scanning system from a company that guarantees the check if it clears. This will protect the practice as well. The monies are immediately deposited into your practice's bank account without the added burden of a trip to the bank. Almost all of these payment methods have some amount of service fee attached to them. However, the fees paid are a small price to pay for the general practice's cash flow. The smart practice will shop around for the bank with the best small-business service package available or will look to build a hybrid system with a couple of different vendors for the various services needed. No matter how you build your financial recovery process, you're wise to make as many methods available as possible as long as those methods protect the practice. 7. Be Money Smart When You Move to an EHR Take a closer look at application service provider (ASP) technology. ASP technology means that the electronic health record (EHR) program and data are housed securely at a vendor's or an institution's location; you don't need to have expensive servers and tech support in your office if you have high-speed Internet access. The ASP EHR model will range from about $350 to $650 per month, plus training. Billing software will be an additional cost. The other option is buying an EHR that requires an in-house server and software. Systems like this that I reviewed averaged between $40,000 and $60,000 depending on the amount of bells and whistles added. With ASP models, benefit changes and software improvements are continually updated on your site so that your practice is always using the most recent data and advanced software. You don't need proprietary hardware or additional servers. You do not need to house your own server, and many systems have a minimal cost up front. You also will be able to log in from home to view patient data and reports. The downside to ASP technology is that when the Internet is down, so are you. Make sure that you have good, stable Internet service before considering this option. 8. Think About a Professional Services Agreement if You're Considering Employment Professional services agreements (PSAs) have been around for many years but are now growing in popularity. Physicians may view a PSA as a way to get the advantages of employment without selling their practices, and hospitals see it as a mechanism for controlling doctors without employing them directly. "In a PSA, the physicians maintain their own professional corporation," explains Alice Gosfield, a Philadelphia, Pennsylvania, healthcare attorney. "The physicians assign the right to payment to the hospital; the hospital bills for them; and the physicians receive a base salary, usually with productivity bonuses. In more and more PSAs, the physicians also get bonuses that are based on quality metrics." Despite doctors' retention of practice ownership, Gray Tuttle, a practice management consultant in Lansing, Michigan, says that a PSA "is very similar to an employment relationship. The end results financially are close to identical. The difference is that the physicians are employed by a practice that they own. Typically the hospital will employ everybody else including the receptionists, nurses, and technicians. The providers -- physicians and even midlevels -- retain their relationship with the professional corporation." The physicians still own the practice assets including ancillary services, which, notes Tuttle, they lease to the hospital. The hospital must factor revenues from those ancillaries into the amount that it agrees to pay the physicians or the doctors won't sign up, he adds. "Typically the hospitals provide reasonably long guarantees with no pay cuts and, in many cases, enhanced reimbursement," says Tuttle, adding that the guarantees may last up to 5 years for specialists and 3 years for primary care doctors. One reason why PSA reimbursement may be higher than what the doctors previously earned is that the hospital can often negotiate higher rates than most practices could on their own. In addition, some hospitals will pay doctors extra for quality and efficiency. 9. Be Aware of Which Aspects of Prevention Care Are Now Reimbursed The Patient Protection and Affordable Care Act has given physicians new tools to offer patients easier access to preventive care. Starting in January 2012, Medicare will eliminate its Part B deductible and copayments for a host of proven preventive services including bone mass measurement; some cancer screenings; diabetes and cholesterol tests; and flu, pneumonia, and hepatitis B vaccinations -- among other services. Medicare now covers annual wellness visits. It covers smoking cessation counseling. It began paying a 50% rebate for the brand-name medications that seniors need to manage chronic conditions when they reach the coverage gap known as the "doughnut hole." Your patients in new private insurance plans also won't pay out of pocket for many preventive services including screening blood pressure, diabetes, cholesterol, and for certain cancer screenings; counseling to quit smoking or cut alcohol consumption; routine vaccinations; and regular well-baby and well-child visits from birth to 21 years of age. The Centers for Medicare & Medicaid Services is working to make sure that you and your patients have the support that you need to achieve better health. Our investment in prevention takes a big step in that direction. If you or your patients are looking for more detailed information, go to healthcare.gov and click on "Learn About Prevention" at the top.

10 Lessons I Learned From Steve Jobs

Jason Scharz Authors the popular investment newsletter, Economic Weather Station, which is available at www.economictiming.com During this time of reflection I think we all feel a profound sense of gratitude for the life of Steve Jobs. He was exemplary in so many ways. For me, it’s about so much more than the iUniverse he created. It’s the way he did it. Some of the priceless pearls of wisdom that he left behind include the following life lessons: 1- Don’t be afraid to fail. “I didn’t see it then, but it turned out that getting fired from Apple (AAPL) was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.” Steve Jobs, June 12, 2005. 2- Stay in the game. The real breakthrough moments in Steve’s career happened after 25 years of struggle. “Sometimes when you’re in the middle of one of these crises, you’re not sure you’re going to make it to the other end. But we’ve always made it, and so we have a certain degree of confidence, although sometimes you wonder.” Steve Jobs, March 7, 2008. “I’m convinced that about half of what separates the successful entrepreneurs from the non-successful ones is pure perseverance.” Steve Jobs interview, 1995. 3- Follow your passion wherever it leads. “Being the richest man in the cemetery doesn’t matter to me … Going to bed at night saying we’ve done something wonderful… that’s what matters to me.” Steve Jobs, May 25, 1993. “Almost everything–all external expectations, all pride, all fear of embarrassment or failure–these things just fall away in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart.” Steve Jobs, June 12, 2005. 4- Just say no. “People think focus means saying yes to the thing you’ve got to focus on. But that’s not what it means at all. It means saying no to the hundred other good ideas that there are. You have to pick carefully.” Steve Jobs, June 2003. “I’m as proud of what we don’t do as I am of what we do.” Steve Jobs, February 6, 2006. 5- Expect excellence. No company innovates on a regular schedule like Apple. “My job is to not be easy on people. My job is to make them better.” “Be a yardstick of quality. Some people aren’t used to an environment where excellence is expected.” 6- A master architect builds a platform upon which others are given the capacity to thrive. Apple’s ecosystem and especially its App Store enabled creativity to flourish. 7- Love and passion come first. Everything else will take care of itself. “My job is to make the whole executive team good enough to be successors, so that’s what I try to do.” “When I hire somebody really senior, competence is the ante. They have to be really smart. But the real issue for me is, Are they going to fall in love with Apple? Because if they fall in love with Apple, everything else will take care of itself. They’ll want to do what’s best for Apple, not what’s best for them, what’s best for Steve, or anybody else.” Steve Jobs, March 7, 2008. 8- Too many of us fail to reach our potential because of the bureaucracy that binds us. “Why join the navy if you can be a pirate?” Steve Jobs, September 1982. 9- Quality vs. quantity? Steve understands it. “Quality is more important than quantity. One home run is much better than two doubles.” Steve Jobs, February 6, 2006. 10- Progress comes from within. “The cure for Apple is not cost-cutting. The cure for Apple is to innovate its way out of its current predicament.” Steve Jobs, 2004. There will never be another Steve Jobs. It has been a pleasure covering Apple with him at the helm and I look forward to continued greatness coming from the innovative company that he built. The scope of the Information Age and the evolution of the mobile revolution is still in its infancy. To honor Steve, we have organized an event that will include a who’s who of Apple investors, analysts, and commentators to provide hedge fund style research for individual investors. It is the first event of its kind. We’re calling it the AAPL Investor Summit and we hope it will provide you with profitable investment strategies for the years to come. For more information, please visit www.aaplinvestorsummit.com. A portion of the proceeds will be donated to the Huntsman Cancer Research Foundation. RIP Steve Jobs. http://seekingalpha.com/author/jason-schwarz

Monday Morning Atheist

Source: Book Monday Morning Atheist by Doug Spada & Dave Scott ISBN978-0-9839628-0-9 www.WorkLife.org Monday Morning Atheist: Someone who believes in God but who works like He does not exist Six Life in Work Principles The work of the righteous leads to life ... Proverbs 10 v16 The personal objective is to have: 1. Clarity – awareness of God’s original purpose for work that helps you live your whole life with greater clarity Genesis 2, Exodus 20 : 8 -11 2. Calling – affirmation of your unique design and how God has strategically placed you at work to fulfill his calling Eph 2 v 10, Psalm 139 3. Balance - alignment with the role of work that allows you to pursue biblical priorities and life balance Colossians 3 v 17 – 4 v1 4. Skills – ability to please God and serve others through the development and excellence of your work skills Proverbs 22v29, 1 Cor 10v31 5. Influence – authenticity in personal character at work as u experience purposeful faith conversations and grow your influence titus 2 v 9 – 10, Matt 5 v16 6. Relationship – alliance with Christ helping you effectively navigate work issues and develop healthy relationships Heb 3v13, James 2v15-17 Action ideas 1. Pray for 3 people you work with – pray privately for his blessings n intervention 2. Begin your day with God – read bible, begin with few verses – may use devotional, or a chapter of proverbs a day over one month (there are 31 chapters) 3. Commit to a higher standard of work – decide to glorify god with your work, better attitude, better service or product 4. Cut out complaints – Complaining is not part of God’s will. Talk to God about the area u want to complain about, seek his help to develop better response 5. Go the extra mile –if u are used to doing the bare minimum – take it one step further – higher than what others require of u – do it every day for one week 6. Cultivate gratitude – be thankful for whatever blessings. At the end of the day, say aloud what u are thankful for each hour of the working day 7. Be slow to anger – when u are frustrated or angry – try reciting a bible verse e.g. Micah 6v8 tells what God expects of u – to do justice, love mercy and walk humbly with your God 8. Work with friends, family or a spiritual mentor to help u identify specific habits or attitudes in your work life god may want to change – commit prayerfully to a small action u can do each day.

How 'Hybrid' Nonprofits Can Stay on Mission

Published: October 17, 2011 Author: Carmen Nobel Executive Summary: As nonprofits add more for-profit elements to their business models, they can suffer mission drift. Associate Professor Julie Battilana says hybrid organizations can stay on target if they focus on two factors: the employees they hire and the way they socialize those employees. Key concepts include: In order to avoid mission drift, hybrid organizations need to focus on whom they hire and whether their employees are open to socialization. Because early socialization is so important, hybrid firms may be better off hiring new college graduates with no work background rather than a mix of seasoned bankers and social workers. The longer their tenure in a hybrid organization, the more likely top managers may be to hire junior people. HBS Faculty Member Julie Battilana Julie Battilana is an associate professor in the Organizational Behavior unit at Harvard Business School. For those who like to view things in black and white, it's tempting to divide the working world into two camps. There is the for-profit sector, primarily driven by the prospect of financial success. And then there's the not-for-profit world, which eschews the almighty dollar in the pursuit of curing societal ills. In reality, though, the line between the two is growing blurrier. "In the not-for-profit sector, a number of organizations are trying to be less dependent on donations and grants," says Julie Battilana, an associate professor at Harvard Business School. "In the meantime, facing increased public pressure to help address societal problems, for-profit firms have adopted social responsibility policies, which have pushed them to focus more on social initiatives." "Some of them have been accused of losing sight of their social mission, or even having a negative impact on the populations they were trying to help" In the wake of this evolution over the past decade, more organizations have adopted a hybrid business model in which a social mission is the primary goal, but they still aim to generate enough commercial revenue so they can survive and thrive without depending on charitable donations like a typical nonprofit would. Commercial microfinance organizations often adopt a hybrid model, for example: they provide business loans to poor people who wouldn't traditionally qualify, but they still depend on the loan recipients paying them back with interest. The main problem with the model is that hybrid organizations run the risk of suffering from so-called mission drift—meaning that they stray from their original goals—usually by focusing on profits to the detriment of the social good, but sometimes vice versa. "Mission drift has been identified as a potential problem among microfinance organizations," says Battilana, who has been studying hybrid organizations for several years. "Some of them have been accused of losing sight of their social mission, or even having a negative impact on the populations they were trying to help." According to Battilana, there are two key questions that leaders must address to keep the mission on course while still making enough money to sustain that mission: One, whom should you hire to strike a healthy balance between idealism and the bottom line? And two, what's the best way to socialize new hires to stay focused? Lessons from Bolivia In a recent Academy of Management Journal article, Battilana and Silvia Dorado from the University of Rhode Island tell the true tale of two Bolivian microfinancing organizations, Banco Solidario and Caja de Ahorro y Préstamo Los Andes. Both were hybrid orgs created in the early 1990s as spin-offs from existing NGOs. Both set out to avoid mission drift. But each took a different tack in hiring new employees. BancoSol hired employees based on their previous experience and proven capabilities. Because the mission required know-how in both profit making and social work, the organization ended up hiring a mix of social workers, sociologists, anthropologists, bankers, and economists. The idea was that these seasoned employees would complement each other with their disparate backgrounds, after training them to work together toward the common good. But the reality was that their single-purpose backgrounds made it hard for them to adjust to the hybrid model. Those with social work experience and those with a financial background ended up resenting each other to the point of constant fighting, such that the organization could hardly operate. Loan officers quit left and right, the number of active borrowers plummeted, and the profit margin dropped, too. "They basically had to deal with conflict that became intractable," Battilana says. Los Andes's launch in 1995 came three years after that of BancoSol's, meaning that Los Andes would learn from BancoSol's hiring woes. Los Andes took what Battilana and Dorado call a "socializability-focused" approach to hiring. Rather than looking for job candidates with experience in either social welfare work or finance, Los Andes hired people with essentially no work experience at all—recent college graduates—and then trained them specifically to be microfinance loan officers. The idea was that it would be easier for the employees to adhere to the hybrid mission if they were not hampered by their preexisting work logics, be they either social-based or profit-based. Whereas BancoSol was more focused on the dual end-goal of helping loan applicants while still making a profit, Los Andes was more concentrated on the means to an end—the process of training and managing the novice employees. Because it took longer to train newbies than it would take to coach seasoned professionals, measurable progress was slow, but steady at Los Andes. "Instead of relying on commitment to the end pursued by the organization (i.e., its mission), Los Andes's approach to socialization thus relied on commitment to the means used to achieve this end," Battilana and Dorado write. "You might be better off hiring blanker slates" In the end, in addition to avoiding interpersonal strife, Los Andes was more successful than BancoSol in avoiding mission drift. By the turn of the century, Los Andes had both lower average loans and a lower percentage of delinquent loans than its predecessor. (Higher values on either are signs of mission drift.) "So what we found was that in the early days, you might be better off hiring blanker slates and then try to socialize them in the way that you want them to work in the hybrid organization," Battilana says Managers have baggage, too Be that as it may, top managers at hybrid organizations may find it difficult to make the best hiring decisions because of their own preexisting biases. Battilana explains the problem in a yet-to-be-published paper, tentatively titled "Neither Corporations Nor Not-For-Profits…But a Combination of the Two: The Challenges of Sustaining Hybrid Work Contexts." "In the same way as new hires' work habitus influences the way in which they will enact the market and social welfare logics within hybrids, the work habitus of top managers influences the way in which they enact both logics in their daily practices," the paper states. Thus, even knowing the importance of the hybrid mission, a manager with a strong background in the nonprofit social sector is likely to be drawn toward candidates who also have a social sector background. And a manager with a background in finance is more likely to hire a financier over a social worker, all else being equal. Firms can address this inherent bias problem by enacting strict and scientific hiring mechanisms. For instance, rather than vetting possible hires via job interviews, Los Andes both hired and promoted its employees almost solely on the basis of how the candidates performed on written exams. This prevented the possibility that hiring managers would be swayed by their own backgrounds, meaning that sporting either a finance degree or a social work degree didn't result in preferential treatment for a potential candidate. But Battilana's research also suggests that managers are likely to learn from experience; the longer their tenure at a hybrid organization, the more probable it is that top managers hire junior employees. "What we expect is that the more time they spend in a hybrid context, the more likely the managers are to become familiar with the problem of hiring, say, both bankers and socially minded employees," Battilana says. "The more experienced they are, the more likely they may be to hire blanker slates, especially in the early days of the organization when its hybrid culture is not yet strongly established." About the author Carmen Nobel is senior editor of HBS Working Knowledge. http://hbswk.hbs.edu/item/6795.html

Keeping Older Drivers Safe

Medscape Medical News from the Gerontological Advanced Practice Nurses Association (GAPNA) 30th Annual Conference An Expert Interview With David Carr, MD Elizabeth McGann, DNSc, RN September 30, 2011 — Editor's note: Older drivers are generally considered safe drivers, in contrast to drivers who have specific medical impairments. More education geared toward older drivers and healthcare professionals is needed. Attention must be directed toward proper assessment and interventions to promote driver safety among older Americans. A podium presentation, entitled Driving the Older Adult: State of the Science, was featured at the Gerontological Advanced Practice Nurses Association (GAPNA) 30th Annual Conference, held September 14 to 17 in Washington, DC. To find out more about older driver safety, Medscape Medical News interviewed David Carr, MD, who is associate professor in the Department of Medicine and Neurology at Washington University at St. Louis, Missouri. He is a board-certified internist and geriatrician, and medical director of The Rehabilitation Institute of St. Louis. He has assisted in the development and operations of the driving connections clinic there. His research interests are in medical conditions that affect driving, especially issues of assessing driving safety and cessation in the older drivers with dementia and stroke. Medscape:What are the data for national crash and injuries in older drivers? Dr. Carr: Older drivers have the lowest rate of crasher per year, compared with any other age group. However, they have an increased crash rate per miles driven, which approaches that of the teenaged driver. Therefore, for the amount of time they are on the road, they are at an elevated risk, compared with middle-aged drivers. They are at increased risk for injury and death regardless, when you look at this statistic per licensed driver or based on exposure. Medscape: What is the current state of the science related to older drivers? Dr. Carr: Older drivers are, in general, a very good risk behind the wheel. Age should not be an indicator for driving retirement, nor for mandatory testing during licensure. The focus should be on the medically impaired drivers. We need more education for all types of health professionals to be comfortable discussing, evaluating, and counseling older drivers who have age-related medical diseases. Medscape: What are the best approaches to assess impaired older drivers? Dr. Carr: The best approaches will use a good history of driving behavior and any changes in driving habits that may have occurred related to a chronic medical illness. The physical examination should focus on visual acuity, visual fields, muscle testing, joint range of motion, and various cognitive abilities such as processing speed, reaction time, attention, judgment, and visuo-spatial ability. Medscape: What are some of the instruments used to assess risk? Dr. Carr: Some of the commonly used instruments are the clock drawing task, Trail Making Test A and B, maze completion tests, the useful field of view measure, the motor-free visual perceptual test, and a measure of contrast sensitivity. Medscape: What resources are available to older drivers and healthcare professionals? Dr. Carr: There is a variety of online resources for providers and older drivers. The American Medical Association has an online resource called the Physician's Guide to Assessing and Counseling Older Drivers, developed in cooperation with the National Highway Traffic Safety Administration. The American Automobile Association offers an online program called Roadwise Review, designed to allow senior drivers to test their functional abilities related to driving. There is also an online driver safety program sponsored by the American Association of Retired Persons. Medscape: What major challenges do providers and families face when getting the older driver to give up driving? Dr. Carr: There may be resistance because of a lack of insight from an underlying dementing illness. In general, many older adults will give up driving voluntarily if they believe they are putting themselves or others at risk while driving. Of course, this depends on viable alternatives to driving, which may not be readily available or accessible to older adults, especially in rural communities. Medscape: What are the 2 most significant aspects of your presentation? Dr. Carr: The 2 most important take-home messages are that older adults, in general, are safe drivers, and the focus should be on medically impaired drivers; and that instruments are being developed for the clinician to use in the office that can be useful in determining driving safety. Dr. Carr reports relationships with the National Institute on Aging, the Missouri Department of Transportation, the American Medical Association, and Advanced Drivers Education Products & Training, Inc. (ADEPT).

Social media: What parents should know

Children and teens are creating and sharing information more than ever using digital media such as cell phones, smart phones, and computers. They send text messages, use Facebook and Twitter, write blogs, share photos and video to stay in touch with friends and family and to make new friends. Social media offers lots of opportunity to help your child and teen be creative and stay connected and informed. But it’s important to learn about the different technologies and how your children use them so you can help keep them safe online. The social media landscape changes quickly. Because this document is only an introduction, we’ve included links to other websites you might find helpful. What is social media? Social media refers to the online tools that connect people with common interests on the Internet. Unlike traditional media (TV, radio, newspapers and so on), social media allow users to interact with each other. Popular social networking websites include Facebook, Twitter, YouTube, Flickr, and MySpace. There are many different ways that people use social media: Online profiles: Most social media sites require users to set up a profile. A profile usually includes a name, e-mail address, birth date, interests and a photo. Friends: Depending on the kind of social media, users “follow” or “request friends” from people they know such as classmates or family. They may also use social media sites to find and meet new friends. Messaging: Sending short text messages over the Internet, using instant messaging and between cell phones. Walls and boards: Social media sites allow people to post or send messages in many different ways. On Facebook, for example, information is posted to a “wall”. Some messages are visible to a wider audience, while others can be sent privately like e-mail. Photo and video sharing: Social networking sites allow users to upload personal photos and videos. Some sites, such as Flickr for photos and YouTube for videos, are used solely to share images. Blogs: A blog is a website kept by an individual who updates it with regular entries of text or photos and videos. It is a lot like a journal, only on the web. People who read blogs can comment and share published content among their own online networks. Joining groups: Many kinds of social media allow users to create groups. People join, “like” or follow these groups to get access to information and have conversations with other members. To play games: Children and teens visit online sites to play games, alone or with their friends. Some, like Facebook, include free online gambling applications. How can I keep my children safe using social media? Learn about the technologies your children and teens are using. Ask how they communicate with friends online. Tell them that you are willing and interested to learn about it. Keep computers in common areas where you can watch while your children use them. Be clear about the rules for using the computer and set limits on the amount of time and how they can be used. Set limits on cell and smart phone use. Talk about when it’s a good time to use a cell phone. Your child or teen’s school, for example, likely has rules about where and when they can or can’t be used. Teach them the value of “unplugging” from devices and computers for technology free time. Reinforce that no e-mail or message is so important that it can’t wait until the morning. Get online protection for your family. Programs that provide parental controls can block websites, enforce time limits, monitor the websites your child visits, and their online conversations. Tell your children and teens that you are monitoring their online activity. Be aware that some parent control programs will block information about puberty and sexuality that you might want your teen to look for. Ask your children and teens about the people they “meet” online. Showing genuine interest will help them feel comfortable talking about it. Explain that it’s easy for someone on the Internet to pretend to be someone they are not. Discuss what’s okay and safe to post online and what isn’t. People can’t always control the information others post about them. Explain that information and photos available online can turn up again years later. Ask your children and teens where else they access the Internet. Talk to teachers, caregivers and other parents about your rules for social media. Because people are not always who they pretend to be online, talk about the importance of keeping online friendships in the virtual world and how it can be dangerous to meet online friends face-to-face. Make it clear that if your child wants to meet a virtual friend in person, it must be with a trusted adult. If your child or teen is playing online games, join them (even if only to sit and watch) so you can see exactly what they are doing and talk to them about it. What should I know about online privacy? Social media websites have privacy policies and settings, but they are all different. Some sites are completely public, meaning that anyone can read or look at anything, anytime. Other sites let you control who has access to your information. Read a website’s privacy policy before providing any personal information. Some social media websites, like Facebook for example, don’t allow children under 13 to joint their site. Check your child’s privacy policy settings to make sure he isn’t sharing more information than you want. The following suggestions will help your children protect their online privacy: For some social media sites it is a good idea to choose an online nickname, instead of using a real name. Keep everything password protected, and change passwords often. Don’t accept friend requests from people you don’t know in real life. Think carefully about what you post online. Remember: things that are posted online stay online forever. As a general rule, don’t post anything you wouldn’t want a parent or teacher to see or read. Remember to protect a friend’s privacy too. Ask permission before posting something about a friend, a photo or a video. Be aware of what your friends are posting about you. If you use a GPS-enabled smart phone or a digital camera, you could be posting status updates, photos and videos with geotags. Geotags provide the exact location of where your photo was taken. Make sure these are turned off on your device. What is cyber-bullying? Just as some people are bullied in real life, people are bullied online. It happens many ways: by sending mean messages by e-mail or posting them in an online forum or by sharing photos and videos without permission. Talk to your children about cyber-bullying. If it isn’t too serious, suggest that they ignore it at first. If it doesn’t stop, is violent or sexually explicit or your child gets scared, encourage them to talk to you or another trusted adult. The Media Awareness Network has some more information on cyber-bulling at: http://www.bewebaware.ca/english/cyberbullying.html What is sexting? Sexting is a term used to describe sending sexually explicit messages, photos or videos between cell phones. It can also happen using e-mail or on social media websites. Ask your teen what she knows about sexting. Talk about the dangers of sexting. Remind her that words and photos posted online can easily be shared among many different people. Remind your teen that nothing is ever really deleted online. Friends, enemies, parents, teachers, coaches, strangers, and potential employers can find past postings. Posted: July 2011 This information should not be used as a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances. Canadian Paediatric Society 2305 St. Laurent Blvd., Ottawa, Ont. K1G 4J8 Phone: 613-526-9397, fax: 613-526-3332