China's President Xi meets President Trump in Florida later this week, and traders will watch it closely.
Has your firm recently undergone a reorg? If so, you’re in good company. Reorganizations, or reorgs, are a common business practice. And with change accelerating in almost any industry you can think of, we expect them to become more and more common. Think about the disruption being caused by electric and autonomous cars in automotive; by regulatory challenges in banking; by shale resources in oil and gas; and by a groundswell of public dissatisfaction in political institutions, to name just a few. All will require companies — and governments — to rethink the ways they are organized. Did your reorg meet your expectations? If not, again, you’re in good company. Reorgs can deliver significant value, yet they often cause misery. Some academic studies suggest that the psychological impact of uncertainty during a reorg can be even more distressing than an actual layoff. And the longer that badly planned reorgs drag on, the more the misery endures and the longer it takes to see the business results the reorg was intended to bring about. McKinsey research shows that only 8% of reorgs create value and deliver expected results within the expected amount of time. It’s no wonder then that the people involved in most reorgs want to put the event behind them as soon as possible, and why they seldom — if ever — pause to assess how it went. But that would be a mistake. It’s important to confirm that the reorg is delivering what you expected and to make the necessary course corrections if not. As Nancy McKinstry, the CEO of Wolters Kluwer, told us: “It is unrealistic to expect the new organization to work perfectly from the beginning. You have to live with and digest it, and rapidly course-correct when you find issues.” This does not mean that you need to do a 180-degree flip-flop in the design as soon as you encounter a problem. Rather, the secret is to spot the teething problems of the new organization and fix them as soon as possible, in line with the logic of your original plans. To get a sense of how successful your recent reorg was, take the survey below. By completing it, you will be able to benchmark your company’s reorg against a number of best practices, identified in our book, ReOrg: How to Get it Right. The survey will give you an instant rating against the benchmarks, and a sense of where you stand against other companies, to ensure that your next reorg, when it comes, will be successful. By participating, you will help us continue to develop the science of reorgs so that companies can deliver more value and upset people less. //
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The Zacks Analyst Blog Highlights: Lancaster Colony, Hormel Foods, Blue Buffalo Pet Products, Tate & Lyle and Wolters Kluwer N.V.
The Zacks Analyst Blog Highlights: Lancaster Colony, Hormel Foods, Blue Buffalo Pet Products, Tate & Lyle and Wolters Kluwer N.V.
Given an improving labor market and the gradual rise in wages, we expect consumer spending to improve.
В среду, 24 февраля, по итогам торговой сессии ключевые фондовые индексы Европы продемонстрировали отрицательную динамику второй день подряд на фоне снижения цен на "черное золото", а также очередных опасений относительно темпов роста мировой экономики.
By Beth Braverman, Contributor More than 43 percent of Americans recently polled by GOBankingRates said that they expected to pay more for health care costs this year, while less than 20 percent anticipated that their costs would go down. There are plenty of reasons to expect health care costs will go up: Employers are shifting a greater share of costs onto their workers, the prices of drugs and medical procedures continue to rise and our aging population has greater medical needs. Still, there are ways to fight back against rising health care costs. Read on for 21 health care hacks that can help you slash your bills in 2016. Visit GOBankingRates for the latest financial news and tips for 2016 >>> 1. Use Generics If your doctor prescribes you a brand-name drug, ask whether it would be OK to use a generic substitute. Generics can be significantly less expensive, and often there's no difference in outcome. Medicare enrollees who opted for generic drugs saved an average $1,923 per person in 2014, according to a report by the Generic Pharmaceutical Association. Read: 10 Ways to Survive Rising Health Care Costs 2. Stick With In-Network Providers Your insurer has deals with certain providers that will give you the best price and guarantee that the treatment will be covered. Going out of network almost always means that you'll have to pay higher prices. Out-of-network providers charged patients on average 300 percent more, or higher, than the Medicare rate for many procedures, according to analysis by America's Health Insurance Plans, a trade association representing the health insurance industry. 3. Ask for 90-Day Prescriptions Breaking down the monthly cost, you'll likely pay less for a prescription for 90 days' worth of medicine than you will for a 30-day supply. Plus, you'll only have to pay your copay once, versus three times. 4. Get Moving In addition to causing poor health, living an inactive lifestyle can have a dramatic impact on your medical bills. Sedentary adults pay $1,500 more per year in health care costs than adults who are physically active, according to a recent study by health advocacy organization Trust for America's Health. 5. Get a Pet Not only can it be rewarding to have a pet, it can tangible health benefits, too. The decline in office visits and the reduced frequency of obesity associated with pet ownership can lead to a health care savings of about $86 per year, according to a recent report from the Human Animal Bond Research Initiative Foundation. 6. Shop Around for Care For elective procedures, shop around to find the best price, and quality, for a procedure within your insurance network. Start by checking Healthcare Bluebook to get a sense of what a fair price for the procedure might be in your geographic area. Then call around to a few providers and ask for a quote based on your health insurance. "Even if you have insurance and you play by the rules, you could still pay five to 10 times more than you should if you don't shop for care," said Jeff Rice, CEO of Healthcare Bluebook. 7. Check Your Bill for Errors Nearly half of Americans say that they've received an inaccurate health care bill, according to a Wolters Kluwer Health poll. Protect yourself from overpaying by carefully reviewing every bill that you receive and disputing any potential errors. If anything looks off, or you don't understand a charge, contact the provider. 8. Carefully Select a Health Care Plan When it comes to deciding on a health insurance plan, choosing the correct one upfront can potentially save you thousands in medical expenses throughout the year. However, more than 90 percent of workers say they choose the same benefits every year, and almost 80 percent spend less than an hour researching benefit options before making a selection, according to a recent Aflac poll. 9. Take Advantage of Wellness Programs Companies are increasingly investing in wellness programs that encourage their workers to take steps -- such as signing up for biometric screenings, health assessments and physical activity programs --to monitor and improve their health. To increase employee participation in such programs, a growing number of employers are now offering incentives like money, gift cards, reduced health insurance premiums or contributions to an HSA or FSA, according to a report last year by the National Business Group on Health. 10. If You're Eligible for an HSA, Use It If you have a high-deductible health plan at work, then you can fund a health savings account to use for medical expenses. Unlike an FSA, your HSA money is yours to keep and grows over time, so even if you don't use it this year, you can tap it for medical expenses in the future. For 2016, you can put up to $3,350 for an individual and $6,750 for a family into an HSA to use for medical expenses. 11. Shop Around for Drugs Just as medical providers offer different prices, so do drug stores. A recent search on GoodRx.com for a 30-day supply of Lipitor found prices ranging from $10 to more than $90. Retailers like Walgreens and Costco have prescription savings clubs, which offer a discount on generic prescriptions and often price match their competitors. The Walgreens program also provides a 10 percent discount on care at the store's health clinics. 12. Avoid the Emergency Room Unless you have an actual emergency, stay away from the emergency room. Visiting a doctor's office or urgent care clinic typically costs much less, and is often a less frenzied experience. Choose carefully, though, because urgent care clinics that are owned by hospitals could charge the same rate as their parent company. "You'll pay anywhere from four to 20 times the price by not going to your doctor," said Adria Gross, CEO of Medwise Insurance Advocacy, which helps people navigate the medical claims system. 13. Negotiate Your Bills If you're paying out of pocket for a procedure, contact a hospital's billing department upfront to see whether there's any wiggle room in the price. If you've already had a procedure, but can't afford to pay the bill, there might also be an opportunity to negotiate the size of the bill, or set up a payment plan that makes it more affordable. 14. Try Telemedicine More insurers and companies are offering benefits that include telemedicine, in which you can consult with a doctor online or over the phone for minor ailments, at a fraction of the cost of an in-patient visit. The average telemedicine visit is estimated at $40 to $50, compared to an in-person acute care visit at an average estimated cost of $136 to $176, according to a study commissioned by the Alliance for Connected Care. Bonus: You don't have to leave the house when you're under the weather. 15. Consider Medical Tourism Some 750,000 Americans leave the country every year for health procedures that are cheaper elsewhere or not affordable in the United States, according to the Centers for Disease Control. The practice of "medical tourism," as it's known, includes risks, such as trouble communicating or less-safe practices. However, the Medical Tourism Association estimates that traveling for medical treatment can net savings of up to 90 percent. 16. Bundle Your Costs Once you've reached your deductible in one year, consider scheduling any covered, elective procedures to also take place that year. That way, you can potentially avoid having to pay the full deductible in two consecutive years. 17. Deduct Your Medical Expenses You qualify to write off your medical expenses on your taxes if your medical expenses are more than 10 percent of your adjusted gross income, or 7.5 percent if you're age 65 or older. Qualified expenses include doctor visits and premiums, fertility treatments and hearing aids. 18. Go to Labs for Blood Work If your doctor orders blood work or other lab tests, first ask the doctor whether they're medically necessary. If yes, get the work done in a standalone lab, where prices tend to be cheaper than what you'll pay by getting work done in a hospital or some doctor's offices. Asking your doctor for a written lab order and taking it to a national laboratory group, rather than an in-hospital lab facility, could save you up to 90 percent on costs, according to a 2014 study by health care consultant group Castlight. 19. Insure Yourself Under the Affordable Care Act, if you can afford health insurance but choose not to buy it, you'll have to pay a fine when you file your federal tax returns for that year. In you're uninsured in 2016, you could pay a fine of 2.5 percent of your household income, or $695 per adult and $347.50 per child under 18 -- whichever is highest. In addition, going uninsured means that one medical emergency could become a financial disaster for you, depleting your savings or causing you to run up unnecessary debt. Read: 5 Tax Law Changes for 2016 You Need to Know 20. Strategize With Your Spouse If both you and your partner have access to health benefits at work, compare the plans offered by both companies. Find out which one offers the richest benefits at the best cost for your family, and whether you might be able to save money by being insured separately. 21. Move Somewhere Cheaper The cost of getting insurance via the Affordable Care Act marketplaces plan varies drastically depending on where you live, according to recent analysis by GOBankingRates. Buying a plan in New York, the most expensive state in the country for these costs, for example, would mean signing on for a $3,000 deductible and a $366 monthly premium. A similar plan in New Mexico, by contrast, features a $2,000 deductible and premiums of just $181 per month, less than half of those in a New York plan. This article, 21 Hacks to Reduce Your Health Care Costs This Year, originally appeared on GOBankingRates.com. More from GOBankingRates: Bank5 Connect Offers Best Checking Account of 2016 10 Things That Will Be Cheaper for You Because of Falling Oil Prices 10 Best Online Banks of 2016 10 Benefits You Didn't Know Most Health Care Plans Cover 10 Best Savings Accounts of 2016 -- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.
Company spokesman Steven Danehy could not immediately confirm the remaining price increases, which were compiled by a unit of Wolters Kluwer Health and published in a research note by UBS Securities. U.S. lawmakers, and presidential candidates, have in recent months stepped up criticism of U.S. drug prices trends, driven in part by eye-popping price hikes from companies with recently acquired generic drugs.
Р.Смирнов приводит примеры зарубежной аналитики, утверждающей, что через 6 лет экономику России ожидает бешеный рост. (тыц)Последнее время отечественная пресса все больше скатывается в какой то желтушный вариант, где вместо мало мальски приличной аналитики больше моют кости отечественным государевым людям. Честно говоря уже надоело. Ладно, думать для журналистов это слишком сложно, проще звонить "источникам", но почему не пишут в том же стиле про топ менеджеров кока-колы или шлакдональдса, шнайдера, сименса, альстома, проклят как гембела с хенкелем и пуриной, не говоря уж о бесчисленных мутных "консалтерах", за редким исключением типа совсем уж пахнущего серой Браудера. Можно подумать к нам прям ангелочки слетелись в тучные годы.Решил восполнить пробел.Нет, никакого негатива - опускаться до уровня коммерса или ведьмостей не буду.Просто рассмотрим, как происходит процесс "инфильтрации" на нашу территорию охотников за сверх добавленной стоимостью и что за "охотники" прилетают на голубых вертолетах.Решил начать с "третьего" эшелона, например компания http://www.thelighthousegroup.ru/ru/about/our_team/ .Итак, как обычно, по верхам.Собственник и глава - Йерун Николас Кеттинг.Помимо него в российском офисе трудятся шесть, судя по фотографиям, прекрасных россиянок, в том числе чемпионка России по акробатике, кстати давно заметил, что экспаты любят женские коллективы.Также есть бывший представитель Юкоса в Америке, господин Матвейчук, курирующий -проекты компании Lighthouse по созданию стратегий выхода на рынок и поиска партнеров для крупных международных производителей оборудования и запасных частей нефтегазовой отрасли.У самого Йеруна, судя по его linkedin ( https://www.linkedin.com/in/jeroenketting ) ,не карьера, а прям "From the Queen of England to the Hounds of Hell"Работал до этого в компаниях:- Wolters Kluwer- Prosperity Fund of the British Foreign & Commonwealth Office in Russia - https://www.gov.uk/government/organisations/foreign-commonwealth-office (адская конторка!)- Wermuth Asset Management GmbHОстановимся на последней по подробней.Не знаю, все ли уже посмотрели последнего джеймса бонда, где он обнаружил рассадник "спектр"а, этот Вермут Ассетс, деятельностью чем то отдаленно напоминает "римский клуб".Смотрим свежую презентацию оного, как раз для "римского" клуба" (это чтобы был понятен уровень):http://www.wermutham.com/media/50436/2015-09-Randers-2052-and-the-Club-of-Rome.pdf2040 ой год - 8 миллиардов населенияПик использования энергииПотом с "немецкой" прямолинейностью решение проблемы - надо сокращать население, лишать суверенитета, запретить нефть и уголь, бггНа самом деле это просто "кодовые" слова, для вхождения в "клуб". В реальности совсем о других вещах трут наши высокодуховные "партнеры".Дальше сами, если очень интересно... (конспирологов заранее предупреждаю успокоительное глотните предварительно, там в два клика от вермута даже "рокфеллеры" присутствуют), но cегодня не про это хотел написать.Йерун, похоже менее "упоротый" на общеантичеловеческих ценностях, чем его бывший работодатель Вермут.У него например, есть гораздо более жизнерадостная презентация про "бизнес в России" ( 30 сентября 2015 )https://prezi.com/e00uqaicrdpp/lighthouse-russias-silver-lining-2015/Рекомендую целиком, но вот ржачные слайды из оной, про сильные стороны нашей страны:- 50% еды в России выращивается на дачахНизкие долги, как населения так и государства, тут правда насчет населения не уверен, но картинка нравится.Выдал "карту" захваченных отраслей (типа это те кто уже работает - мол не бойтесь)Трудно переводимая клюква:Ну и под конец что на самом деле думают "европейцы" о перспективах экономики России (в назидание обожателям запада "либероидным" аналитикам и патриотическим нытикам):Краткосрочно - падение, 4 года стабилизация, через 6 лет бешеный рост.Вот так вот.По большому счету таких ландскнехтов, как Lighthouse у нас сотни - просто этот относительно публичный.Ничего особо против не имею, кормовая база для них уже почти истощилась, а конкуренты вырастили не то что зубы, а бивни.Интересен другой момент, давайте представим, если все эти "консалтеры-цивилизаторы" вдруг окажутся заперты у себя в "нидерландах" или "гермашке", которая к западу от Рейна.Даже поляками через каталичество не смогут понукать...Что произойдет? Тоже самое, что и в средние века. Максимальное классовое расслоение, нищета, грязь, как у там у Пелевина - слепой и жадный червь капитализма сожрет сначала души...Да и они сами чувствуют, что с каждым годом дурить бусами туземцев будет все сложнее и сложнее - поэтому торопятся, на собранные по всему свету таллеры, закупают металл для ветряков, тянут трубы с Российским газом... и пытаются согласно приведенной выше "презентации" сократить население.Поэтому как минимум назло этим "прогрессорам" (ох не зря подвальный свою партию назвал партией "прогресса") думаю, каждый должен по мере возможности увеличивать рождаемость в России, ну и в братоубийственных войнах не участвовать.Нам то ресурсов и сил, чтобы их защитить, хватит. А вот хватит ли их вырождающимся западно европейцам...Короче - инвестиции и технологии нам нужны, а вот эти сказочки про CO2 и по одному ребенку на семью оставьте себе.
By Gina Horkey, Contributor As diligent as you have been about saving for retirement, your ego might have been quietly working against you the whole time. Even the best-laid plans fail, and your retirement plan is no exception. Here are six ways your ego is rearing its ugly head and how you can regain control of your financial plan before you retire. Read: 7 Red Flags of a Bad Retirement Plan 1. Unrealistic Expectations Many newly retired people find that their reality doesn't live up to the grandiose dreams they had for their retirement. As you save for retirement, you should periodically give yourself a reality check. Statistics show that you should lower your expectations and save more aggressively. According to a survey conducted by the Insured Retirement Institute, only 27 percent of baby boomers are confident that they will have enough money to last through their retirement (which is down from 33 percent a year ago). If you find yourself part of this 27 percent, you will want to ensure that your confidence is not unfounded. One way to make sure that you are adequately prepared is to calculate your projected expenses -- the costs to maintain your current home, transportation, health care, and other predictable expenses -- and determine whether any changes to your current budget are necessary. Don't let overconfidence wrongly convince you that you don't need to downsize your lifestyle. Few people have the ability to replace 100 percent of their preretirement income, but by eliminating nonessential expenses and saving for monthly bills and emergencies, your likelihood of building a substantial nest egg is greatly increased. 2. Not Making Time for Tough Conversations Doting on your grandchildren is easy. Having an honest conversation with your adult children about what your financial transition into retirement will really look like can be difficult. It's hard to go from raising your children to discussing finances with them -- and perhaps even heeding their advice -- but it helps to be candid with them. If your situation looks bleak, they might be able to help. According to the Pew Research Center, nearly 23 percent of adults with retired parents contributed some sort of financial assistance during 2012, and 72 percent of those adult children said their contributions were for ongoing expenses. Regardless of your comfort level with your retirement account balances or your and your family's busy schedules, you need to make these conversations a priority. In the event that you're not as ready for retirement as you think, or the market unexpectedly goes south, you might be faced with looking to your adult children for some form of support, whether it's financial or logistical. 3. Fear of Diversification Just because you're heading toward retirement doesn't mean you have to settle for the same low-risk investments that everyone else seems to be chasing since the recent market downturn. You also don't want to expose yourself to unwarranted risks that you won't have time to recover from, however. A 2015 report from Fidelity Investments showed that baby boomers are keeping too much of their assets in the stock market -- in fact, 10 percent of people ages 55 to 59 have all of their 401k assets in stocks. To maintain a comfortable standard of living and maximize your retirement benefits, it is beneficial to seek out low-cost investments that offer steady returns while minimizing short-term risks. Consult a financial advisor about the benefits of diversifying beyond traditional stocks and bonds. Options like index funds, exchange-traded funds and blue-chip dividend stocks can provide adequate returns along with favorable expense and fee structures that make them viable alternatives for boomers. How to Set Up an Automatic IRA Your browser does not support the video tag. 4. Not Seeking Advice Seeking advice from a trusted financial advisor during the accumulation phase of retirement planning is common, but the time people spend consulting an advisor often diminishes over time. "It's hard enough for advisors, who typically have teams of people dedicated specifically to the field of wealth management, to stay on top of everything let alone the average individual investor," said John Fowler, certified financial planner and wealth manager with McElhenny Sheffield Capital Management in Dallas. Losses in the wake of the recent recession have many boomers convinced that it's more beneficial to their financial future to go it alone. The Transamerica Center for Retirement Studies reports that only 40 percent of baby boomer workers who are saving and investing for retirement use a professional financial advisor to help them manage their investments. "When it comes to financial planning, Wolters Kluwer estimates that there are approximately 64,708 pages of tax code, case precedents, and guidance rulings that could affect the outcome of how a client plans for their retirement," added Fowler. "In addition to this, Social Security, a primary source of income for many retirees, has more than 2,728 core rules." Don't think that by seeking retirement advice from a financial professional you've somehow failed or given up control. You are still in the driver's seat of your financial future, and a review from an advisor is just one way to catch any missed opportunities or mistakes you might have missed. Keep Reading: 8 Things Not to Do in Retirement 5. Retiring Prematurely Once you've retired, you are no longer trading your time for dollars. If you retire before you have enough money saved to support yourself, then you face a difficult retirement. Your retirement plan needs to factor in all of your planned and potential emergency expenses; it can't simply be based on the age at which you picture yourself retiring. A study released by the Employee Benefit Research Institute showed that nearly 57 percent of early boomers are on track to meet their retirements needs. In the cases in which early boomers were ill prepared, however, a staggering average shortfall of $71,299 was projected per individual in a married household. Working longer can significantly increase your retirement income. By working just a few years longer, you can contribute more toward retirement savings, allow your savings to earn more compound interest and take advantage of higher Social Security benefits -- up to 8 percent in some cases, according to the Social Security Administration's website. Even a part-time job or reduced workweek at your current job could help you further pad your nest egg. If the idea of sticking with your current job makes you cringe, keep an open mind; you might be able to use your professional skills in a new way or turn your talents or a hobby into a new revenue stream. 6. Overlooking Free Retirement Money Most employers require workers to save between 4 percent and 6 percent of pay in a retirement account to get the maximum employer contribution. Whatever the employer match, take your company up on it -- it's free money. "One thing that often trips people up is the notion that they are better off investing their money outside of their employer retirement plans," said Kerry Hannon, an author and retirement expert. "Younger workers, especially in their 20s and 30s, often have the bravado that they can pick stocks or investments on their own that can easily trounce the returns of a mutual fund offering in their employer's 401k, for instance." "I always recommend to workers of all ages to take advantage of your employer's 401k or similar retirement plan," added Hannon. "If possible, invest enough in your 401k to qualify for the full match." Keep Reading: 11 Ways You're Sabotaging Your Retirement Don't shoot yourself in the foot by trying to handle your entire retirement plan on your own. Preparing for retirement can be emotionally and financially draining. Utilize resources through your employer, your family or a professional financial advisor to help keep you on the right track and help you spot ways to improve your plan so that you can support your desired lifestyle in retirement. This article, How Your Ego Is Sabotaging Your Retirement, originally appeared on GOBankingRates.com. More from GOBankingRates: 7 Hidden Fees to Watch Out for in Retirement How to Handle a Surprise Inheritance 7 Red Flags of a Bad Retirement Plan 10 Best Retirement Plan Options 8 Things Not to Do in Retirement -- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.
Diagnostic errors burden providers, payers, and patients around the world. They lead to avoidable illness, suffering, and poor health outcomes and increase costs of care significantly. Access to evidence-based medical content at the point of care that answers clinical questions and ensures accuracy in diagnosis can reduce diagnostic errors and improve outcomes. Our organizations are involved in the efforts to expand global access. We encourage others to join us in this effort and offer three recommendations for accelerating this drive. Forty-four thousand Americans die each year as a result of preventable medical errors, and $17 billion is spent on that erroneous care. This September, the Institute of Medicine reported that most patients in the United States experience a diagnostic error in their lifetime. Many in the United States have argued that diagnostic errors have been neglected due to the belief that health systems are not measuring errors and are disinclined to finding systemic solutions. Despite the massive scale of preventable, costly medical errors in the United States, the problem is dwarfed by their prevalence in resource-constrained settings. Given that most developing countries do not record medical errors, the global magnitude of the problem is not well documented. The data that is available, such as a 2012 study of over 15,000 patient records from 26 African and Middle Eastern hospitals, produce alarming results: 6.8% of all hospitalized patients experienced a preventable medical error, and more than one-third of them died as a result. Therapeutic and diagnostic errors accounted for the vast majority of all events. A unique driver of diagnostic errors where physicians and nurses are scarce is the lack of access to clinical information. Due to the limited number of postgraduate medical programs and lack of trained specialists, health workers are often required to practice beyond their scope of training. For example, Rwanda had, until recently, a total of 15 anesthesiologists, 25 obstetricians and zero neurologists serving a population of 11 million people. Indeed, the 2012 study discussed above identified “inadequate training or supervision of clinical staff” as a major contributor to diagnostic errors in Africa and the Middle East. Promoting access to point-of-care medical content has great potential to reduce errors, thereby reducing costs and improving outcomes. Researchers at the Mayo Clinic showed that U.S. physicians who used UpToDate, the leading provider of current, evidence-based clinical content and expert-authored recommendations for diagnosis and treatment, scored better on certification exams. Studies in the United States have also demonstrated that use of UpToDate is associated with lower risk-adjusted mortality rates and lengths of stay at the hospital — i.e., lower costs and better outcomes. The impact was greater in smaller, non-teaching hospitals. UpToDate, which is part of Wolters Kluwer, provides concise and actionable recommendations for how to diagnose and treat a vast spectrum of conditions, is authored by world experts in all clinical fields, and is constantly updated. Despite its benefits, its integration into clinical practice in the United States and globally has lagged, owing partly to subscription fees. The Global Health Delivery (GHD) Project at Harvard University and Wolters Kluwer launched a partnership in 2009 to donate subscriptions to UpToDate to clinicians in resource-limited settings around the world. (Wolters Kluwers donates the subscriptions, and GHD selects the recipients and monitors their usage.) To date, we have awarded subscriptions to over 1,000 health care institutions in 45 countries. The large majority of log-ins come from sub-Saharan Africa, and 61% of the users utilize the service at least weekly via a computer or mobile device. There is ongoing debate regarding the quality of open-source medical content. For example, only 1% of medical articles on Wikipedia have passed review, yet it is widely accessed, with 5 billion page views per year. Other attempts such as Medpedia, WikEerg.ca, and Nupedia have been insufficient, due to low quality, lack of breadth, and difficulty attracting readership. Conversely, UpToDate is a reliable source for medical content and has had substantial impact on patient health outcomes and costs. Reports from subscribers indicate a dramatic improvement in health workers’ ability to construct an appropriately broad differential diagnosis, apply validated criteria, and arrive at a correct assessment. In one instance, physicians consulted UpToDate on a patient with suspected Acute Rheumatic Fever and applied the Jones Criteria to establish that reactive arthritis secondary to a Shigella infection was more likely. This saved the patient a year of prophylactic antibiotics. In another case, a patient presenting with jaundice and hepatosplenomegaly was treated incorrectly for an amoebic abscess. After consulting UpToDate, physicians identified the cause of her problems as autoimmune hepatitis and treated the patient with steroids. She immediately improved. As Internet connectivity improves around the world, barriers to online medical content decrease, its widespread integration into practice becomes more feasible. To fully exploit the value of continuously-updated, evidence-based resources, we recommend the following: 1) Introduction of such resources early in the clinical training of physicians and nurses. Habituating the new generation of health care professionals to consult the evidence base is key to generate better outcomes for patients. Recent trainees need to see the benefits and become role models in consuming current knowledge and practicing evidence-based medicine. (To demonstrate this, we are currently implementing a study of the free provision of UpToDate to all students and faculty in four African medical universities.) 2) Systemic change in the diagnostic workflow to create time for the consultation of current, high-quality evidence. A recent discussion within the Global Health Delivery online forum generated hundreds of responses from health workers across the world, highlighting the difficulties of choosing the right diagnostic for the right patient in limited time. Protocols can remind clinicians to refer to the evidence in the midst of diagnosing and clinical reasoning 3) New investments to distribute evidence-based clinical resources. Previous attempts to open source clinical information have been insufficient, due to low quality and limited breadth of data. An opportunity exists for ministers of health, minsters of finance, multilateral donors, professional medical organizations, and the private sector to reduce diagnostic errors by investing in the distribution of high-quality clinical content. In April, the chief medical officer of the Liberian Ministry of Health wrote in The New York Times that the inability to freely access medical literature on Ebola in Liberia harmed his country’s ability to respond to the epidemic quickly and effectively. Evidence-based resources on Ebola were available to 40 GHD UpToDate subscribers in Liberia prior to the outbreak of the epidemic. This was grossly insufficient. Our aspiration is that prior to the next health emergency, the entire global workforce will have comprehensive and updated evidence to prevent and contain the threat. Access to high-quality, point-of-care medical content is instrumental in preventing diagnostic errors and curbing the spread of disease. That access can and should be expanded more quickly. Populations throughout the world depend on it.
Netherlands stocks were higher after the close on Thursday, as gains in the Technology Hardware&Equipment, Technology and Media sectors led shares higher. At the close in Amsterdam, the AEX rose 2.53%. The best performers of the session on the AEX were ASML Holding (AMS:ASML), which rose 5.05% or 4.04 points to trade at 84.05 at the close. Meanwhile, Wolters Kluwer (AMS:WLSNc) added 3.66% or 1.02 points to end at 28.89 and Relx NV (AMS:RELN) was up 3.62% or 0.485 points to 13.890 in late trade. The worst performers of the session were NN Group (AMS:NN), which fell 0.48% or 0.12 points to trade at 26.09 at the close. TNT Express (AMS:TNTE) added 0.03% or 0.002 points to end at 7.522 and Boskalis Westmin (AMS:BOSN) was up 0.75% or 0.33 points to 44.45. Rising stocks outnumbered declining ones on the Amsterdam Stock Exchange by 144 to 24 and 3 ended unchanged. The AEX Volatility, which measures the implied volatility of AEX options, was down 12.78% to 28.97. Crude oil for October delivery was up 2.10% or 0.97 to $47.22 a barrel. Elsewhere in commodities trading, Brent oil for delivery in October rose 1.38% or 0.69 to hit $51.20 a barrel, while the December Gold contract fell 0.99% or 11.20 to trade at $1122.40 a troy ounce. EUR/USD was down 1.05% to 1.1110, while EUR/GBP fell 0.67% to 0.7288. The US Dollar Index was up 0.63% at 96.48.
Netherlands stocks were lower after the close on Wednesday, as losses in the Technology Hardware&Equipment, Technology and Basic Materials sectors led shares lower. At the close in Amsterdam, the AEX declined 2.04% to hit a new 1-month low. The best performers of the session on the AEX were TNT Express (AMS:TNTE), which fell 0.34% or 0.026 points to trade at 7.544 at the close. Meanwhile, Wolters Kluwer (AMS:WLSNc) fell 0.98% or 0.29 points to end at 29.77 and Boskalis Westmin (AMS:BOSN) was down 1.06% or 0.47 points to 43.97 in late trade. The worst performers of the session were ASML Holding (AMS:ASML), which fell 4.06% or 3.45 points to trade at 81.51 at the close. OCI (AMS:OCI) declined 3.69% or 1.065 points to end at 27.830 and Akzo Nobel (AMS:AKZO) was down 3.11% or 2.02 points to 63.02. Falling stocks outnumbered advancing ones on the Amsterdam Stock Exchange by 190 to 22 and 5 ended unchanged. The AEX Volatility, which measures the implied volatility of AEX options, was up 7.91% to 22.53 a new 1-month high. Crude oil for October delivery was down 4.04% or 1.74 to $41.38 a barrel. Elsewhere in commodities trading, Brent oil for delivery in October fell 3.17% or 1.54 to hit $47.27 a barrel, while the December Gold contract rose 1.11% or 12.40 to trade at $1129.30 a troy ounce. EUR/USD was up 0.39% to 1.1067, while EUR/GBP rose 0.43% to 0.7072. The US Dollar Index was down 0.15% at 96.83.
Netherlands stocks were lower after the close on Friday, as losses in the Healthcare, Support Services and Construction&Materials sectors led shares lower. At the close in Amsterdam, the AEX lost 0.92%. The best performers of the session on the AEX were NN Group (AMS:NN), which rose 1.04% or 0.29 points to trade at 28.60 at the close. Meanwhile, Delta Lloyd (AMS:DLL) added 0.85% or 0.14 points to end at 16.54 and Altice SA (AMS:ATCE) was up 0.77% or 0.90 points to 118.05 in late trade. The worst performers of the session were OCI (AMS:OCI), which fell 6.10% or 1.915 points to trade at 29.480 at the close. Randstad (AMS:RAND) declined 1.87% or 1.20 points to end at 62.91 and Wolters Kluwer (AMS:WLSNc) was down 1.82% or 0.55 points to 29.75. Falling stocks outnumbered advancing ones on the Amsterdam Stock Exchange by 158 to 54 and 4 ended unchanged. Shares in NN Group (AMS:NN) rose to all time highs; up 1.04% or 0.29 to 28.60. The AEX Volatility, which measures the implied volatility of AEX options, was up 3.14% to 17.03. Crude oil for September delivery was down 0.94% or 0.42 to $44.24 a barrel. Elsewhere in commodities trading, Brent oil for delivery in September fell 1.02% or 0.51 to hit $49.02 a barrel, while the December Gold contract rose 0.35% or 3.80 to trade at $1093.90 a troy ounce. EUR/USD was up 0.43% to 1.0971, while EUR/GBP rose 0.69% to 0.7090. The US Dollar Index was down 0.24% at 97.64.
Netherlands stocks were higher after the close on Wednesday, as gains in the Construction&Materials, Basic Materials and Oil&Gas sectors led shares higher. At the close in Amsterdam, the AEX rose 0.53%. The best performers of the session on the AEX were Arcelormittal (AMS:ISPA), which rose 3.07% or 0.24 points to trade at 8.13 at the close. Meanwhile, Vopak (AMS:VOPA) added 2.88% or 1.26 points to end at 45.19 and NN Group (AMS:NN) was up 1.91% or 0.48 points to 25.64 in late trade. The worst performers of the session were Altice SA (AMS:ATCE), which fell 3.55% or 4.15 points to trade at 112.80 at the close. Wolters Kluwer (AMS:WLSNc) declined 0.96% or 0.25 points to end at 25.71 and ASML Holding (AMS:ASML) was down 0.70% or 0.62 points to 88.41. Rising stocks outnumbered declining ones on the Amsterdam Stock Exchange by 116 to 98 and 4 ended unchanged. The AEX Volatility, which measures the implied volatility of AEX options, was up 5.25% to 28.53 a new 3-years high. Crude oil for August delivery was down 1.80% or 0.94 to $51.39 a barrel. Elsewhere in commodities trading, Brent oil for delivery in August fell 0.57% or 0.33 to hit $56.52 a barrel, while the August Gold contract rose 0.70% or 8.10 to trade at $1160.70 a troy ounce. EUR/USD was up 0.45% to 1.1063, while EUR/GBP rose 1.27% to 0.7212. The US Dollar Index was down 0.40% at 96.50.
Netherlands stocks were lower after the close on Friday, as losses in the Software&Computer Services, Media and Consumer Services sectors led shares lower. At the close in Amsterdam, the AEX fell 0.59%. The best performers of the session on the AEX were KPN Kon (AMS:KPN), which rose 0.48% or 0.016 points to trade at 3.373 at the close. Meanwhile, Arcelormittal (AMS:ISPA) added 0.33% or 0.03 points to end at 8.71 and Akzo Nobel (AMS:AKZO) was up 0.20% or 0.13 points to 65.62 in late trade. The worst performers of the session were Gemalto (AMS:GTO), which fell 1.76% or 1.41 points to trade at 78.68 at the close. Vopak (AMS:VOPA) declined 1.40% or 0.63 points to end at 44.30 and Wolters Kluwer (AMS:WLSNc) was down 1.19% or 0.32 points to 26.53. Falling stocks outnumbered advancing ones on the Amsterdam Stock Exchange by 147 to 63 and 5 ended unchanged. The AEX Volatility, which measures the implied volatility of AEX options, was up 5.99% to 28.28 a new 3-years high. Crude oil for August delivery was down 2.48% or 1.41 to $55.52 a barrel. Elsewhere in commodities trading, Brent oil for delivery in August fell 2.73% or 1.70 to hit $60.38 a barrel, while the August Gold contract rose 0.33% or 3.80 to trade at $1167.30 a troy ounce. EUR/USD was up 0.13% to 1.1098, while EUR/GBP rose 0.37% to 0.7127. The US Dollar Index was down 0.07% at 96.22.