ICT-Davao, Inc., the information and communication technology umbrella group in Davao Region, is teaming up with technology firms SAS and Amazon.com, Inc. to help “re-tool” local professionals. ICT-Davao President Samuel R. Matunog said the memorandum of understanding will be signed during the LiveX 2019 (Innovation Summit 2019 and 5th Mindanao ICT Cluster Conference) on Nov. 18 to 19 at the Marco Polo Davao. “We will be signing an agreement to train our professionals on artificial intelligence, data and analytics with some of the most respected and well-known companies in the world. We are talking with SAS Technologies, the number one analytics and business intelligence platform in the world… Hopefully with the partnership with them and we can train some of you (media) to become data analysts. We are also looking forward with same arrangement with Amazon for cloud computing,” he said during last week’s Habi at Kape forum. Representatives of SAS Technologies and Amazon will be speaking during the LiveX 2019, which will also be participated in by the ICT councils around Mindanao. “We have over 20 ICT councils organized in urban centers in the whole island and will be complemented by the friends from Malaysia and Indonesia,” Mr. Matunog said. — Maya M. Padillo
Fractured Forests Are Endangering Wildlife, Scientists Find
Around the world, humans are fracturing vast forests. Highways snake through the Amazon’s rain forests, and Indonesia plans an ambitious transportation grid in Borneo, through some of the largest untouched expanses of tropical forests.
If you were to parachute at random into any of the planet’s forests, you’d probably land a mile or less from its edge, according to a recent study.
Conservation biologists have intensely debated the dangers that the fracturing of woodlands poses to animals. While many studies have shown that extinctions are more common in fragmented environments, others haven’t documented much effect.
A study published on Thursday may help resolve what has been a strident debate, showing why many species are vulnerable to the fragmenting of forests while others are not. Animals in places with a long history of disturbances are relatively resilient, the researchers found. Species that have existed in stable habitats for thousands of years are far more sensitive.
“They are taking a new approach on a global scale,” said Anna Hargreaves, an evolutionary ecologist at McGill University in Montreal, said of the scientists. “I find it compelling.”
The first hints of this risk to biodiversity came in the 1960s, when researchers found that bigger islands tended to host more species than smaller ones. Ecologists began to think of forests as islands, too: When a logging company splits what had been continuous belt of trees, two smaller islands may be formed, each of which might support fewer species than the undisturbed tract had.
Scientists found evidence for this hypothesis in jungles and woodlands in many parts of the world. Isolation in a forest fragment can put a population of animals at risk of extinction — they may struggle to find food, for example.
But some of the consequences may be less obvious. Cristina Banks-Leite, a conservation biologist at Imperial College London and a co-author of the new study, captured thousands of birds in the forests of Brazil.
She found fewer species in the smaller patches of forest and even fewer species near the edges of these fragments, suggesting that the new borders were to blame.
Can’t birds just fly from one patch of trees to another? In Brazil’s tropical forests, it turns out, they seldom do. Dr. Banks-Leite said that sunlight may be one reason: Tropical forests are always dim, thanks to their dense canopy. The birds adapted to low light might find bright sunlight at the forest’s edges too harsh.
But ecologists in the eastern United States uncovered contradictory evidence. There, animals often thrive near forest edges. Nor is there much evidence that forest fragmentation has led to many extinctions.
At first, ecologists argued about which results mattered most. Eventually, a number of researchers decided to pool their results and take a look at the big picture.
In 2014, Dr. Banks-Leite and her colleagues unveiled a database of fragmented forests called Biofrag. Each scientist added his or her observations, building a compendium that included thousands of species of birds, mammals, spiders and other animals.
The researchers set about looking for a hypothesis that might explain why some researchers have found strong effects from fragmentation and others haven’t. They found inspiration in an idea put forward in 1996 by Andrew Balmford, an ecologist now at the University of Cambridge in England.
He proposed that the risk faced by a species today may depend on the experiences the species had in the past. On many islands, for example, birds are now threatened with extinction. Rats introduced onto the islands from ships attack the birds’ eggs, and they are helpless to do anything about it.
Dr. Balmford observed that some islands have had native species of rodents for thousands of years. Birds on those islands may be resilient to the threat of new rodents, he speculated.
This idea is called the extinction filter hypothesis. The species we see today have passed through a gantlet of challenges over time. Other animals unable to cope with a threat in the past became extinct — filtered out by history, as it were.
The authors of the new study reasoned that an extinction filter might be at work in today’s forest fragments. Some forests were relatively undisturbed until recent decades, while others were split into fragments in ancient times.
In parts of Europe and Asia, farmers were breaking up forests thousands of years ago. Even before, some forests were regularly disturbed by storms or fires. And during each ice age, northern belts of trees were broken into isolated stands.
In the new study, published in Science, the researchers examined 4,493 species in 73 forest regions worldwide. They used several methods to determine how sensitive each species was to forest fragmentation. For instance, they observed whether species could be found at the edges of forests or kept to the core of the fragment.
Some species, such as the cedar waxwing of North America and the rufous-tailed hummingbird of Central America, didn’t seem to mind life in fragments. But other species shied away from forest edges, such as the sun bear of Borneo and the hairy woodpecker of North America.
In certain regions, like Borneo, the researchers found that many species stayed in the forest cores. In others, like New England, many were comfortable at the edges. “It shows everyone was right,” said Dr. Banks-Leite.
She and her colleagues then put the extinction filter hypothesis to the test. They looked at how many of each kind of species — sensitive and not — were found in forests with a history of disturbances and in undisturbed forests.
The difference was stark.
Just over half of animal species in undisturbed forests are now sensitive to fragmentation. Only 18 percent of the species in historically disturbed forests are affected.
“It hit us over the head pretty hard,” said Matthew Betts, an ecologist at Oregon State University and a co-author of the new study.
The results suggest that vulnerable species in places like New England have gone extinct as storms and glaciers have fragmented their forests. In places like the Amazon, those fragile species found refuge — until now.
Most of the world’s diversity remains in undisturbed forests. Dr. Betts and his colleagues estimated that 40 species of birds in North American forests are vulnerable to fragmentation. But in the more pristine forests of Central and South America, 900 species of birds are at risk.
In places where animals have survived disturbances for thousands of years, protecting forest fragments may be a good conservation strategy, the new research suggests.
But it may be even more important to keep undisturbed forests intact, because the species living there are far more likely to suffer from fragmentation. Researchers have warned that Indonesia’s plans to build railways and roads in Borneo may shatter its jungles.
Since these regions have not experienced this kind of fragmentation ever, the plans could be catastrophic for vulnerable species like the sun bear.
“If we don’t get our act together, then the road back might be a long one,” said Dr. Hargreaves.
California Bans Insurers From Dropping Policies Made Riskier by Climate Change
California’s wildfires have grown so costly and damaging that insurance companies — a homeowner’s last hope when disaster strikes — have increasingly been canceling people’s policies in fire-prone parts of the state.
On Thursday, however, California took the highly unusual step of banning the practice, a decision that exacerbates the insurance industry’s miscalculation of the cost of climate change.
The new policy imposes a one-year moratorium, preventing insurers from dropping customers in or alongside ZIP codes struck by recent wildfires. The moratorium covers at least 800,000 homes around the state. The state has also asked insurers to voluntarily stop dropping customers anywhere in California because of fire risk for one year.
“People are losing insurance even after decades with the same company and no history of filing claims,” Ricardo Lara, California’s insurance commissioner, said in a statement. “Hitting the pause button on issuing non-renewals due to wildfire risk will help California’s insurance market stabilize and give us time to work together on lasting solutions.”
One consequence of global warming is that it intensifies natural disasters such as fires and floods, but insurers have struggled to anticipate the spiraling costs. Natural disasters in 2017 and 2018 generated a record $219 billion in payouts worldwide, according to Swiss Re, a leading insurance company.
At the same time, though, government regulators are struggling with their own conundrum: They must balance the need to protect consumers from high insurance rates with the need to keep insurance companies from going out of business entirely.
The insurers’ struggle is all the more remarkable considering that they are explicitly in the business of putting an accurate price on risk.
“There’s just the shock of companies waking up to the liability that’s on their books,” said Rex Frazier, president of the Personal Insurance Federation of California, which represents the state’s insurers. “There are a lot of people scrambling to really understand the nature of this catastrophic risk.”
In a survey of 27 state insurance regulators this year, the consulting firm Deloitte found that just four states said their insurers were “fully” or “largely” prepared to respond to the risks of climate change. The danger of insurers being overwhelmed by worsening natural disasters “is very real,” Deloitte wrote in its report.
The outcome of that struggle matters far beyond the effects on people who buy insurance, or the investors who stand to lose if insurers fail. Insurance is vital to the ability of communities to rebuild after wildfires, storms and other catastrophes, experts say, particularly as government funding for assistance becomes increasingly strained.
“Is our business model going to keep working in the face of this kind of change?” said Carolyn Kousky, executive director of the Wharton Risk Center at the University of Pennsylvania, characterizing the concerns sweeping the insurance industry. “If our insurers are in trouble, that jeopardizes people’s recovery.”
That challenge is acute in California. The state has become a case study of how an industry that is central to dealing with climate change has instead been hobbled by it — and how regulators, in their efforts to protect consumers, could risk making the problem worse.
After two years of extreme losses, it is clear that California’s insurers are struggling to prepare themselves for a new era of accelerating climate risk, according to interviews with insurance executives, academics and regulators. New research shows that the wildfires of 2017 and 2018 alone wiped out a full quarter-century of the industry’s profits. Last year’s Camp Fire was the costliest disaster anywhere in the world that year, according to the insurer Munich Re.
The reckoning is now unfolding as insurers strain to predict future losses, drop some of their most vulnerable customers, push for rate increases, fight with regulators and nervously watch what could become a third straight year of heavy losses.
As terrifying as the threat of wildfires is, what happens after the fire is just as worrisome to climate adaptation experts.
The past two years of wildfires have shown that even insurers are struggling to predict the risks associated with climate change. The consequences of that failure could be profound, experts say: The very industry that’s meant to stabilize society in the face of climate change is itself being destabilized by climate change, threatening to make it harder for people to cope with the rising tempo of disasters.
The state’s homeowners insurers lost a total $20 billion in the 2017 and 2018 wildfires, according to an analysis published in October by Milliman, an actuary and consulting firm. That’s twice the industry’s cumulative profits since the last major wildfires, in 1991. A line of business that was until recently profitable is now unprofitable, the authors wrote, “exposed to a severe peril that is neither easily measured nor fully understood.”
Eric Xu, an actuary at Milliman’s San Francisco office and one of the report’s authors, said that the shock of the California wildfires echoes Florida after Hurricane Andrew in 1992, which caused $28 billion in damage and caused the failure of a dozen insurers.
But the threat facing insurers in California is in one sense trickier: After Andrew, many national insurers stopped writing coverage in Florida. But Mr. Xu said California represents too great a share of total revenue for most national insurance companies to just walk away from the state altogether.
Unable to leave, insurers have sought other solutions to protect themselves from rising wildfire costs. But those changes highlight the obstacles facing insurers as climate change worsens.
One fix is for insurers to buy what’s called reinsurance — a sort of insurance for insurers — providing payments if claims rise beyond a certain level. But as the risks from climate change have grown, reinsurance companies have raised the cost of the protection they offer.
For insurance companies, the most obvious response is to pass the costs on to customers in the form of higher prices. California insurers filed 80 requests for rate increases in 2018, more than double the number of requests in 2015, according to data provided by the state.
But California, like many states, gives regulators the power to reject those requests. And the state forbids insurance companies from setting rates based on what they expect in future damages. Insurers are allowed to set rates only based on prior losses.
“That works, until it doesn’t,” said Mr. Frazier, of the insurers’ trade group. He said the state should change the rules so that insurers can base premiums on more than just past experience.
Ricardo Lara, California’s insurance commissioner, said he’s wary of letting insurers use models that may not be accurate.
“I want to be very cautious about opening the rate-approval process to anything that compromises the transparency and objectivity that exists today,” Mr. Lara said in a statement. “Protecting consumers is our top priority, and that is the lens we will use to evaluate any catastrophe risk models in the future.”
Mr. Frazier acknowledged that the ability to predict wildfire damage remains imperfect.
“There are a lot of people scrambling to really understand the nature of this catastrophic risk,” Mr. Frazier said. He called the wave of fires starting in 2017 “a complete wake-up moment for an industry that thought it knew what was on its books, but actually didn’t.”
When insurers try to respond to risks they don’t understand, they tend to set premiums too high, to give themselves a buffer against error, according to Dr. Kousky of the Wharton Risk Center. But the problem with that, she said, is that when it comes to climate change, insurers may respond by setting premiums so high that insurance in many parts of the country becomes unaffordable.
By seeking to protect people from higher prices, regulators could make the problem worse by pushing insurers out of dangerous areas altogether, experts say. That was already happening: For the ZIP codes most affected by wildfires in 2015 and 2017, the number of homeowners dropped by their insurance companies jumped 10 percent between 2017 and 2018, according to a report released in August by the California Department of Insurance.
The state’s new moratorium is intended to address that problem. But it lasts for only a year. And the state can’t force insurers to pick up new customers.
“Insurers are already dropping customers because of wildfire risk,” Mr. Lara said. “In parts of the state where no insurance company will even return your call, I don’t see how the situation can get worse for residents.”
If insurance stops being available in vulnerable areas, whether at a price that people can afford or for any price at all, it might prevent insurance companies from going bankrupt. But the effect would be to leave people less able to recover from disasters as climate change gets worse, Dr. Kousky said.
“As these extreme events change, insurance is going to become ever more important as a financial recovery tool and a climate adaptation tool,” Dr. Kousky said. “The question now is really, what can we do to protect that market before it becomes really problematic.”
For more news on climate and the environment, follow @NYTClimate on Twitter.
The Disadvantages of Paper Medical Records
Since the HITECH Act passed a decade ago and introduced a mandate for medical providers to move from paper charts to electronic medical records systems in order to qualify for Medicare programs, the conversation around whether or not these EHRs help or hurt has not stopped.
Lawmakers continue to incentivize EHR adoption in reimbursement programs, though. Today, under MACRA and the current value-based care model, EHR use is a heavy factor in MIPS scoring. And yet, practices operating on paper records have to weigh those incentives against things like cost and data migration to decide if EHRs are truly worthwhile.
To help make that deliberation a little easier, this article will help you weigh the pros and cons of paper medical records.
What are the advantages of paper medical records?
Despite the federal incentives to switch to EHRs, plenty of doctors are still operating on paper records. In a random sampling of 1,000 medical providers who called our advisors, 44% said they still use paper charts.
Here’s why we think these providers still haven’t made the switch to EHRs.
For a lot of practices that have been operating since before the HITECH ACT and MACRA incentives, paper records are all they’ve ever known.
In these situations, the barriers to switching to an EHR are significant. If archives date back decades, that data is going to take a whole lot of time to migrate over to an electronic system, for example. Additionally, these practices would need to learn about EHRs before they can start evaluating potential products, so there’s added time on the research end.
All that to say, sticking with tried-and-true paper methods is appealing for a lot of providers.
Ease of use
Ease of use goes hand-in-hand with familiarity, and it makes sense. If you’re using a system that’s been in place since day one, you’ve likely worked out all the kinks and you understand how the system works inside and out.
Learning a brand new system—especially an electronic one—is a tall order, and that doesn’t even factor in how tricky customizing a software system can be.
Finally, there’s the money saved by not investing in EHR software. Even free and open source systems can come with hidden fees, so adopting software is always going to mean spending more money than you would on paper records.
The question here becomes, “Are all the benefits of EHRs worth the cost?” Most practices answer with a resounding yes—below we’ll take a look at why many have ditched paper records.
What are the disadvantages of paper medical records?
Our advisors consult with thousands of medical providers each week to help them find the best software fit for their practices. We looked at 350 of those calls from doctors who currently use paper charts and want to transition to an EHR. Below are the top disadvantages cited by doctors:
Paper charts are notoriously disorganized. When we analyzed our advisor conversations, we found that the words “efficient,” “time-saving,” and “faster” were among the most often spoken.
Here’s an understatement: Doctors spend a lot of time charting. From complex elements like coding to the simple, yet time-consuming, act of writing everything out by hand—charting just takes time.
Beyond that, charts can get lost, and there aren’t usually backups in these situations. It’s easier to make errors or have illegible notes on paper charts, and those can be difficult to catch and correct. Even without those things, the storage space alone is enough to make paper charts impractical.
Each of these reasons have sent tons of doctors searching for a better way, and EHRs have built-in solutions to all of those problems.
Paper medical charts aren’t compliant with MACRA or Meaningful Use.
If you’re a provider who needs the ability to accept Medicare patients, you simply cannot do that with paper charts. EHRs are required to function in today’s interoperable healthcare market. Beyond that, EHRs are so much more secure than paper charts. They come with built-in failsafes to prevent breaches, and they reduce the potential for HIPAA violations.
Paper software, obviously, doesn’t offer integrations with other electronic systems. That means users have to do everything manually when submitting claims.
Most EHR software systems offer full integrations with medical billing features, making claims filing so, so simple. It reduces errors, increases claims acceptance rates, and generally helps with a whole bunch of other billing KPIs.
When should a practice use paper medical records?
Rarely, if ever. The truth is, paper records are out in almost every way. Patients expect their providers to use and offer the most current technology to improve their care, and running a practice on paper records is a HIPAA violation waiting to happen.
There are only two circumstances in which I would ever recommend sticking with paper records. Paper records are for practices that are:
- Never going to try to qualify for government reimbursements or value-based programs, or
- Incredibly cash-strapped.
Anyone else should 100% use an electronic records system, full stop.
If that means you’re getting ready to select an EHR system for your practice, your best place to start is by reaching out to our team of advisors. They’ve helped all of the doctors in this report find software systems that meet their needs, and they can do the same for you—you can even get started by filling out this form.
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