Getting Creative about Saying “No!” to Corruption in Lebanon - October 21, 2014 by zeldalegacy

CIPE partner the Lebanese Transparency Association (LTA) recently wrapped up a banner month in its fight against corruption in Lebanon, using everything from stand-up comedy and mimes to one-on-one case work to deliver its “No Corruption” message. READ MORE


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Peter Greene delivers Argos Game Ball to Tackle Ovarian Cancer - October 20, 2014 by zeldalegacy

Peter Greene, Managing Partner of Affleck Greene McMurtry LLP, delivered the game ball at the Toronto Argonauts vs. Montreal Alouettes game at the Rogers Centre on Saturday, October 18.
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Class action plaintiffs can obtain wiretap evidence - October 19, 2014 by zeldalegacy

Class action plaintiffs can obtain court-ordered disclosure of wiretap evidence obtained by the Competition Bureau, Canada’s Supreme Court held today in Imperial Oil v Jacques. This decision will make it easier for plaintiffs to obtain evidence in price fixing cases by effectively allowing second-hand wiretapping. Over 220,000 intercepts The plaintiffs were seeking production from the [...]
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Day 7: Brutal Triage - October 18, 2014 by zeldalegacy

Les Roberts – Freetown, Sierra Leone – October 11th, 2014

Day 7: Brutal Triage

The prediction landscape is looking bad.   The official numbers reported are laboratory confirmed cases.   Typically, we think people need 7-10ish days to become symptomatic. Typically people have symptoms for 7 days before they get into a health facility. A month ago, it was one day, now it typically takes 4 days from when a patient is sampled to when the patient is told the result of their test (and lots get lost and mislabeled….).   Thus, the numbers that you hear about new cases today reflect the transmission dynamics from over 2 weeks ago…..and we thought the doubling time of the outbreak was 30 days, it seems to be less than that here.   We knew the ~350 confirmed cases last week were an undercount….we now think there are 7-900 in reality.   The need for hospital beds is climbing more than the ability to get them up and running.   There might be 200ish ebola treatment beds now countrywide.   There are perhaps 600 more in “holding areas.” We have schemes to get 500 or 600 ebola treatment beds up and running over the next 8 weeks.   As Foreign Medical Team Coordinator, helping to get these beds up and supported is one of my primary tasks. If there are really 3000 cases this month, and 6000 next month…with all going perfectly on the treatment bed establishment side, we will have 30% of the beds we need next month, slightly worse than the situation now.

The Ministry of Health and WHO are trying to fill the void with Ebola Community Care Units (ECU’s).   Tents with eight beds….maybe two tents, a wet tent (vomit and diarrhea) and a dry tent and a big buffer zone around with a couple latrines and a burning pit and a water supply. They will be staffed by low level health workers or community volunteers, ideally survivors of ebola who will have immunity.   The idea is that at the first sign of symptoms, the family brings the feverish loved one in. Everyone will be treated with an antimalarial and an antibiotic. If they can be tested for ebola, they will be. If not, they get monitored and if they develop 3 of the key symptoms they get referred to a proper hospital bed….which will be in short supply….or otherwise they move to the wet tent. They will be given ORS….maybe food….maybe they die, maybe they do not.   This is very close to no treatment.   But the goal is to get them out of their houses to where they will be less likely to infect others.   The supervision will be scant.   The work for those in the ECU’s will be very risky.   Even MSF has had several staff infected now and they are hyper-vigilant and resource rich. But the logic is, for every health worker infected or ECU malaria patient who becomes infected with ebola while waiting in such a unit, 2 or three infections that would have happened if the person died at home will not occur.

We aspire that we will have ~150 of these going in 60 days….which involves a million dollars per unit, major logistic planning and supply chains, site preparation by the community, and well drilling…..this will be a massive effort. But 2000 beds in ECU’s, 700 treatment beds…might be half of what we need by December.   Thus, barring a dynamic change in the outbreak growth, in November, in December, most cases will likely die at home.

Thus, the CDC has been pushing kits and training messages to promote “safe home care.” The kits would have ORS (a lot…like 20 sachets) and gloves and masks and chlorine and an ORS mixing bottle. The kits’ design is yet to be finalized by the MOH and the international community. The main part of the kit will be messages to the family. Keep the person in a room alone, and no one shares their bathroom. Only have one person deal with them…don’t touch them…wear gloves…wash with chlorine as you exit their room.   Again, like the ECU’s this is not about treating the ill as much as it is about minimizing infections. The logic flows like this:

Interim Ebola Approach

If you think about it a few steps removed from West Africa, this is freakin’ wild. We are primarily trying to facilitate people to die without infecting others.   Very little of this logic beyond the ORS is about treatment.   The last year PEPFAR was in full bloom, with all the administrative layers and consultants, it spent ,000 per patient to have Africans on anti-retrovirals. The rights-based advocates were screaming about how it was only fair that Africans get what Westerners got. In July there was an Onion headline “Experts: Ebola Vaccine At Least 50 White People Away.” http://www.theonion.com/articles/experts-ebola-vaccine-at-least-50-white-people-awa,36580/   It seemed kind of funny then…now that we are being so brutal in our public health triage it is much much less funny….maybe prophetic.   We are about to assist thousands and thousands of people to die an excruciating death at home without even the most mild of pain relief. We are going to set up treatment facilities in hundreds of villages for one of the most deadly of diseases to be largely run by volunteers who will be lucky to get 3 days of training. Dozens, perhaps hundreds of them will die. And the most surreal aspect of this triage for me is that I completely think that this is the right thing to do given where we are and the limited ability to respond. As I think about you students reading this I struggle with the degree to which my endorsement of this multipronged approach is pragmatism or wisdom or loss of idealism.

Les


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FREE Webinar: Malaysia Budget 2015 - October 17, 2014 by zeldalegacy

From Aug 11 to Aug 25, the government launched a Budget 2015 campaign where they invite Malaysians to offer ideas through #Bajet2015 microsite. Many people participated in the campaign regardless of age. Many website and research said that the Malaysia Budget 2015 will continue to […]

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Nation’s Worry and Flawed (Ebola) Response - October 17, 2014 by zeldalegacy

The quoted words below are not mine, they are from the New York Times.

Is it fair to ask how many more flawed responses from this administration Americans let slide? The Republicans who criticize Obama are themselves criticized for doing so. I had one person say critics of Obama were just racists, oh my.

Affleck, Greene and Osborne recognized in Best Lawyers in Canada 2015 - October 16, 2014 by zeldalegacy

Donald S. Affleck Q.C., Peter R. Greene and W. Michael G. Osborne, FCIArb have been selected by their peers for inclusion in Best Lawyers in Canada 2015 in the following fields: Don Affleck: Advertising and Marketing Law Peter Greene: Corporate and Commercial Litigation Michael Osborne: Competition/Antitrust Law Best Lawyers® is highly regarded as a guide [...]
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Budget 2015 Highlights for Personal Finance - October 16, 2014 by zeldalegacy

Prime Minister Datuk Seri Najib Razak, who is also Finance Minister, unveiled 2015 budgets in the Parliaments on Friday, 10th October 2014. The theme for 2015 Budget “Accelerating Growth, Ensuring Fiscal Sustainability and Prospering the Rakyat.” In 2015, economic growth is expected to remain strong […]

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Sixth auto parts fine brings total to over $51 million - October 14, 2014 by zeldalegacy

DENSO Corporation recently pleaded guilty to three counts of bid-rigging under the Competition Act and was fined .45 million, the Competition Bureau announced recently. DENSO was involved in an international bid-rigging conspiracy that fixed prices for body electronic control units (Body ECUs) supplied to Toyota for cars manufactured in Canada. A Body ECU controls the power [...]
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Training Political Parties for Democracy - October 14, 2014 by zeldalegacy

Strong and well-functioning political parties are an essential component to any thriving democracy. Political parties link citizens and their governments, represent the interests of constituents, and influence economic policymaking. In any political system, a party’s capacity to influence policy determines its success, so party platforms are instrumental for parties to participate effectively in…


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