The Fed faces a housing conundrum #ศาสตร์เกษตรดินปุ๋ย

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/business/30381867?utm_source=category&utm_medium=internal_referral

The Fed faces a housing conundrum

Feb 10. 2020
File Photo: Syndication Washington Post

File Photo: Syndication Washington Post
By FED-HOUSING-COMMENT
Syndication Washington Post, Bloomberg Opinion · Danielle DiMartino-Booth

Federal Reserve Chair Jerome Powell may have a problem on his hands. Buoyed by three interest-rate cuts, not only did the U.S. housing market stand as a pillar of economic support in 2019, it largely offset the protracted slowdown in business investment. Now, though, cracks have begun to appear in housing.

Focusing solely on forward-looking indicators of residential real estate, the direct input to gross domestic product, building permits in the South and Northeast, which account for about 60% of permits, fell in December. As for what’s to come on the sales side, pending homes sales fell by 4.9%, the steepest decline in a decade.

Neither of these data points place housing at risk. The 5.8% gain in residential real estate that supported fourth-quarter gross domestic product topped the third quarter read of 4.6% of GDP that followed a contraction in seven of the prior eight quarters. Even as consumption has faded, this strength should hold. December was one of the warmest for that month on record, and construction data released for that month indicates residential’s contribution to GDP was even higher than initially reported, which will lead to an upward GDP revision. December single-family housing starts, at 1.61 million on a seasonally adjusted annualized rate, were the most in 13 years.

Even with this strength, it’s hard to ignore the dip in housing permits and weakness in pending home sales, which were not aberrant in any way, as the softness was not isolated to any pocket of the country. Pending home sales fell 4.0% in the Northeast and 3.6% in the Midwest. And in the critical building hubs of the South and West, pending sales sunk 5.5% and 5.4%.

While many factors are no doubt at work, affordability is key. The downside to the Fed’s tightening campaign throughout 2017 and 2018 was also its silver lining. In March 2018, just as Powell was getting settled two months into office, gains in home prices as measured by the S&P CoreLogic Case-Shiller index topped out at 6.5% over the prior 12-month period.

In the 17 months that followed, through last August, those gains decelerated to a 3.1% rate. This prompted some to ask whether millennials, turning the age of 30 at a rate of five million per year, would finally be able to afford the dream of home ownership in mass numbers. That easier entrée was arrested, though, in September as home-price gains accelerated, ending November at 3.5% rate, a six-month high.

The market for existing-home sales has been even less forgiving on the price front. Median home prices were up 7.8% in December from a year earlier, helping to explain why first-time homebuyers comprised an anemic 31% of purchasers, compared with more than half at the peak of the last housing cycle. This led Lawrence Yun, the chief economist at the National Association of Realtors, to voice concern that:

“Price appreciation has rapidly accelerated, and areas that are relatively unaffordable or declining in affordability are starting to experience slower job growth. The hope is for price appreciation to slow in line with wage growth, which is about 3%.”

Slower home-price appreciation can be had in one of two ways: either via rising mortgage rates or a slowing economy. The downside is that neither is beneficial to the broader housing market. This defines the dilemma that’s emerged for the largest generation of potential homebuyers since the baby boomers came of age. Artificially repressed rates have perverted what was once a market driven by supply and demand.

On the heels of December’s existing home sales report, Bleakley Advisory Group chief investment officer Peter Boockvar noted that investors made up 17% of purchases, up from November’s 16% share and 13% a year ago. “Investors continue to lift the pace of their buying as they search for yield,” Boockvar said. “Thank you Fed for pricing out natural buyers and especially young, first-time buyers.”

As vexing as the deterioration in affordability may be for Powell, he may have something even worse on his hands. For the best real-time and cleanest take on the state of the nation’s job market, always look first to non-seasonally adjusted continuing jobless claims. This figure is a pure reflection of the number of Americans covered by unemployment insurance who have applied for unemployment insurance and been approved and are collecting said insurance. In 2019’s last three months, continuing claims on this basis rose 1.9% from a year earlier, and were up 1.5% in the first four weeks of January. These are the first increases seen since 2009.

This all brings us back to the Fed. Speculation that the expanding coronavirus will cause the global economy to slow has sparked a rally in fixed-income assets, causing market-based rates to decline, including mortgage rates. Traders have priced in a rate cut by the Fed to happen somewhere between July and September. But the last thing a hesitant Powell needs right now is a market demanding lower benchmark rates. The only crueler fate would be rising joblessness clogging the transmission of lower rates to boost the critical and highly interest-rate sensitive housing market.

– – –

Danielle DiMartino Booth, a former adviser to the president of the Dallas Fed, is the author of “Fed Up: An Insider’s Take on Why the Federal Reserve Is Bad for America,” and founder of Quill Intelligence.

A trendy way to appeal to Oscar voters: Play up the ‘magic of the movies’ #ศาสตร์เกษตรดินปุ๋ย

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/business/30381791?utm_source=category&utm_medium=internal_referral

A trendy way to appeal to Oscar voters: Play up the ‘magic of the movies’

Feb 07. 2020
Hopper is a managing editor at Ranker, and was previously an editor at Cracked and CollegeHumor. He has also contributed to The New Yorker and McSweeney's.

Hopper is a managing editor at Ranker, and was previously an editor at Cracked and CollegeHumor. He has also contributed to The New Yorker and McSweeney’s.
By OSCARS-HOPPER-COMMENT
Special to The Washington Post · Dan Hopper · OPINION

In “The Shape of Water,” the 2018 Academy Award Winner for Best Picture, an amphibian-man with demigod-like powers gets rescued from a government laboratory by a mute custodian named Elisa. During the rescue, one of Elisa’s companions murders an innocent security guard. The amphibian-man then proceeds to unflinchingly devour the pet cat of Elisa’s neighbor and later violently slashes the throat of his (by that point eminently deserving) human captor.

In the midst of the mayhem, the creature takes a moment to wander into an ornate movie theater and gazes achingly at a showing of the 1960 biblical epic “The Story of Ruth.” Elisa embraces him and they share a tender, wordless moment. This, we are meant to understand, is the power of cinema: a medium so universally moving, it can even stir the soul of even a cat-disembowling river-creature.

“The Shape of Water” offered a master class in the presentation of the most reliable running themes of Oscar-winning films over the past decade: a celebration of “the magic of movies” within the movies themselves. This year, Sony Pictures is running a “For Your Consideration” campaign for Best Picture nominee “Once Upon a Time . . . in Hollywood” that features stills from the film alongside the simple caption, “Because you love movies.”

Quentin Tarantino’s Best Picture entrant is unmistakably a heartfelt and lovingly crafted tribute to all things Classic Hollywood. It doesn’t simply shoehorn in a “movies can touch us” moment the way “Shape Of Water” does; rather, it re-creates a pivotal era for moviemaking, the 1960s, in painstaking visual detail. Yet that slogan is still a pretty blunt appeal to the heartstrings of Academy voters, one premised on the idea that voters absolutely love giving Oscars to films that expressly celebrate the joy and the power of the very medium they all work in.

The past decade offered a panoply of movies that successfully strummed the “magic of movies” chord. “The Artist,” from 2012, is a black-and-white silent film about Golden Era Hollywood struggling to embrace a new technology (just as today’s studios confront the Internet); it won the Best Picture Oscar that year. In the following year came “Argo,” which tells the true story of CIA operative Tony Mendez (played by Ben Affleck, who also directs) rescuing American hostages in Iran by having his team pose as a film crew.

The film is loaded with Hollywood in-jokes that industry people can performatively laugh at (Alan Arkin, playing movie producer Lester Siegel, tells Mendez, “You’re worried about the ayatollah? Try the WGA!” – a reference to anyone who’s been in, or had to deal with, the notoriously tough Writers Guild). In “Argo,” people working on a movie literally save lives – and it won the Best Picture Oscar in 2013.

“Birdman,” a film about an aging A-list movie actor seeking to make a truthful work of art, includes a scene in which the ex-megastar tells off a haughty theater critic on the grounds that she has never had to do real art. It won Best Picture in 2015.

There are many potential reasons for the uptick in – and Oscar love for – “movies are magic” films. For one, the Hollywood film establishment surely (and correctly) believes its way of life is under attack by streaming services, digital piracy, prestige television and the overall proliferation of non-cinematic media. Studios and film professionals have an understandable interest in consistently reminding consumers (and reassuring themselves) that watching movies in theaters with crowds of people is an essential, irreplaceable experience.

What’s more, at its core, the movie business is as cutthroat and capitalistic as any other for-profit endeavor, and its practitioners (many of whom are artists with a degree of moral consciousness about their craft) are very aware of this. Any reassurance that movies contain a unique sublimity that affects our culture in a positive way helps mitigate that guilt. But perhaps more than anything, Oscar voters are majority-white film professionals with an average age in the mid-60s. It’s a crapshoot whether a given story will personally resonate with their own life experiences, but it’s an absolute certainty that every single voter can relate to characters, stories and moments that celebrate the uniquely touching impact of movies.

To be sure, the “magic of movies” Oscar-hack doesn’t guarantee Best Picture glory. “La La Land” (2016) was a greatest-hits album of Hollywood-ness, a stylistic throwback to classic Hollywood musicals that was also literally about Hollywood, and it included lots of winky-but-not-too-hard-to-get in-jokes about Los Angeles (everyone at a party in the Hills drives a Prius, for example). It won the Golden Globe for Best Musical or Comedy, and Emma Stone won the Best Actress Oscar, but the film lost the Best Picture Oscar to “Moonlight” in an memorable ceremony snafu.

This year, “Once Upon a Time . . . in Hollywood” – whose film-infatuation feels earned – is the clear favorite in the “magic of movies” subgenre. Leonardo DiCaprio plays an actor who has been through the full Hollywood ringer and whose soul is invested in every take of every throwaway TV Western guest-spot he can wrangle; Brad Pitt’s character is a veteran stuntman who lives near a classic drive-in movie theater in Van Nuys; and Margot Robbie’s Sharon Tate character watches her own movie at a theater with intoxicating joy.

But don’t sleep on this year’s most blatant exploiter of the “movie magic” trope: “Joker.” In director Todd Phillips’s departure from his comedy roots, there’s a scene in which Gotham City’s elites dress up in tuxes and attend a showing of the 1936 Charlie Chaplin film “Modern Times.” These billionaires love this film, laughing and applauding at every half-century-old slapstick gag. Our protagonist, Arthur, sneaks into the screening and is transfixed: He stands up while the movie is playing and begins mimicking Chaplin’s physicality, later incorporating it into his swelling Joker persona.

The scene signals to the audience that the Joker character – and “Joker” the movie – are influenced by classic cinema: The loner villain is touched more by movies than by anything else in the cruel city around him. More importantly, we are meant to conclude by the association that this is a serious film, one that plays homage to – and takes its place alongside – great ones that preceded it.

The kinds of movies that come across as “Oscar bait” have evolved over the years. In the 1980s and ’90s, awards shows flung open their gates for three-hour epics in which crescendoing strings played as the main character died (think “Braveheart,” “Titanic” and 2000’s “Gladiator”), and A-list actors heroically pretended to struggle with disabilities (“Rain Man,” “My Left Foot,” “Forest Gump”). Such trends wax and wane, and those specific variants may yet reappear. But for now, the go-to move for the filmmaker with his eye on the major awards appears to be slipping in a scene or two self-referential movie love.

Such gestures often come across as simultaneously triumphant and defensive – surprisingly so, given that the film industry, for all of the disruption it faces, grossed $11.3 billion domestically last year and produced the second-highest grossing film ever, “Avengers: Endgame.”

The industry definitely isn’t going anywhere – although when we’re watching swamp monsters and spree-killing clowns gawk at the awesome power of movies, it sure feels like someone, somewhere, is worried it might be.

Fighting cancer with data #ศาสตร์เกษตรดินปุ๋ย

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/business/30381783?utm_source=category&utm_medium=internal_referral

Fighting cancer with data

Biz insights

Feb 07. 2020

By Santhosh Viswanathan
Special to The Nation

Cancer remains one of the world’s biggest problems, with approximately 18 million cancer cases and 9.6 million deaths reported in 2018 (footnote 1).

Contributing to these numbers is a global population that is both growing and ageing, as well as the changing prevalence of certain causes of cancer linked to social and economic development the world over.

While we have seen some decreased incidence rates for lung and cervical cancers, most countries are still faced with an increase in the absolute number of cancer cases diagnosed, requiring treatment and care.

Bottom line, the clock is ticking, and there is an urgent need to accelerate our efforts in finding new treatment methods and hopefully, a cure. And while we’ve been placing our bets on technology to help in this quest, perhaps what is also needed is a different perspective on the issue of how to approach the problem at hand.

That is exactly what one of our colleagues at Intel, Bryce Olson, chose to do.

In 2014, Bryce was diagnosed with a very aggressive stage-four prostate cancer and was told that he had less than two years to live. Having a young daughter who was still in primary school, Bryce did not want to give up. He went through all the standard treatments that you can get for cancer – radiation, surgery, and chemotherapy; none of it worked.

We live in a time where technology is already being used in medical research for the purposes of speeding up genomics sequencing. At the same time, the medical industry was also exploring precision medicine: The ability to provide a customised series of treatments, tailored to the specific patient, based on his or her genetic context.

Bryce realised that with the combination of “genomic sequencing and precision medicine”, he had a chance to fight cancer. He went to his doctors and said: “Sequence me!”

The genomics sequence of one’s normal tissue and the tumour is compared. The differences between the DNA building blocks of the two, or in other words, the cancer drivers, are then identified.

Once these cancer drivers have been identified, there are three insights that one gets: Whether there is a treatment for the unique driver of disease for that cancer type; whether there is a treatment for different cancer types with the same genetics driver; and whether there are any clinical trials or new treatments that are being developed that may be a fit to cure the disease.

For Bryce, tapping into genomics sequencing has helped to shorten his diagnostic journey, eliminate the need for repeated diagnostic procedures, and reduce reliance on one-size-fits-all treatments. Essentially, he fought cancer with data and insights derived by sequencing his DNA. This precision medicine approach helped send his cancer into remission for several years, as the insights it provided to the doctors enabled them to determine the most appropriate treatment.

With the understanding of the potential of genomic sequencing, Bryce inspired his colleagues at Intel to continue to optimize the technology to accelerate the process of genomic sequencing. Using this technology, the entire process of genomics sequencing, can now be done in just one day at a cost of approximately US$1,000 (approx Bt31,000). In comparison, the Human Genome Project took approximately 13 years and US$2.7 billion to complete. The processor and technologies behind it will further help decrease the cost and the time to sequence our DNAs, thereby enabling everyone in the world to have access to it.

To further scale the delivery of genetic and genomic services, the team has also built the first clinical-grade, HIPAA-compliant chatbot called Gia (Genomic Information Assistant), which educates cancer patients about the power of genomics, answers their questions, and helps them take the next steps towards improving their outcomes.

Bryce’s story shows us the potential of genomic sequencing in enabling medical professionals to respond more effectively to diseases, and in a more personalised manner. However, collaborative efforts are needed across the world between companies, research institutions, hospitals, and universities to find a new way to provide the right treatment to the right person at the right time.

Unfortunately, Bryce’s cancer has returned, but our erstwhile colleague remains unperturbed. Knowing what he now knows, Bryce and Intel, are now working with the Broad Institute and other leaders in the field of advanced cancer research to use artificial intelligence-powered by Intel technology to discover new, innovative solutions that can help him and millions of others like him around the world. It’s time to leave our fears behind and remember the magic words “sequence me”.

[1] World Cancer Research Fund’s Worldwide Cancer Data 2018

Santhosh Viswanathan is Managing Director, Intel Asia-Pacific and Japan Territory.

 Santhosh Viswanathan, Managing Director, Intel Asia-Pacific and Japan Territory

Santhosh Viswanathan, Managing Director, Intel Asia-Pacific and Japan Territory

What to do about a lazy co-worker when management doesn’t care #ศาสตร์เกษตรดินปุ๋ย

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/business/30381714?utm_source=category&utm_medium=internal_referral

What to do about a lazy co-worker when management doesn’t care

Feb 06. 2020
Karla L. Miller offers weekly advice on workplace dramas and traumas. You can send her questions at work.advice.wapo@gmail.com.

Karla L. Miller offers weekly advice on workplace dramas and traumas. You can send her questions at work.advice.wapo@gmail.com.
By Special toThe Washington Post · Karla L. Miller · BUSINESS, CAREER-WORKPLACE

Q: It recently became obvious that a co-worker was spending two to four hours out of each day texting and shopping online using the company computer and her personal cellphone. At the same time, management told me to “lean in” to help another co-worker with an increased workload. I asked if Shopping Co-Worker might be a better choice based on time availability, to which I was told that supporting Swamped Co-Worker was part of my job.

When I brought up that Shopping Co-Worker was spending a lot of time not working, I was told it was none of my business; I should focus on my job. It’s increasingly frustrating that my work is suffering based on my additional load while Shopping Co-Worker checks Facebook, browses potential clothing and car purchases, reads texts, etc.

At what point is a co-worker stealing wages “none of my business” – if ever – and how do you put on a résumé that you’re seeking another job because management seems too dim to understand how theft of wages affects morale?

A: Not to be a simpering semanticist, but if management is content to pay your colleague to convert surplus oxygen to CO2, then she can hardly be accused of stealing her own wages. There’s a distinct difference between cadging from the cash drawer and putting in what an onlooker deems to be a subpar level of effort.

But I take your point. It does destroy morale when workers are being asked to shoulder an unfair portion of the workload while they can see colleagues slack-a-lackin’. And if you suspect this unequal distribution of duty systemically burdens workers of a specific gender, race, age group, etc., that’s a matter for HR or even a lawyer.

But since you’ve raised your concerns and been advised to drop the matter, that’s precisely what I recommend you do. If it helps, you can tell yourself (and only yourself) a story about why the not-so-secret shopper is being allowed to get away with it. Maybe she’s unwell. Maybe she completes work in microbursts when you’re not watching. Maybe she’s so incompetent that assigning her tasks creates more work for everyone else. Maybe she’s paddling harder than is visible on the surface. Maybe management is building the case to declare her redundant. Whether she’s a charity case or a leech, none of those scenarios requires further intervention from you. And the more you lean over into someone else’s business, the more unbalanced you become.

What is your business, and where you need to center your focus, is your own performance and compensation. If your increased workload is dragging you down, ask your manager to help you prioritize. State the problem without presuming to prescribe the solution.

Train your powers of observation on tracking your own progress. Update your manager and Swamped Co-Worker frequently – via email, so it’s in writing – on what you’ve completed. That record may be useful in making a case for more money come review time, or it may help you assemble a portfolio of accomplishments when the time comes to look elsewhere.

Speaking of which: If you decide to explore sunnier prospects, don’t bring shade with you. Trashing the dimwits who treated you unfairly, however justified it seems, only tells prospective employers that you may say the same of them one day.

Yield-curve inversion is sending a message #ศาสตร์เกษตรดินปุ๋ย

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/business/30381533?utm_source=category&utm_medium=internal_referral

Yield-curve inversion is sending a message

Feb 04. 2020
By Bloomberg Opinion · Barry Ritholtz

The yield curve just inverted — again.

Driven by fears of a potential coronavirus pandemic that could cause widespread economic disruption, investment capital sought shelter in longer-term bonds. This flight to safety caused the curve to invert, at least for now.

The sages will tell you that yield-curve inversion is about as good a prognosticator of a coming recession as there is. But inversion first occurred back in March 2019, then briefly reversed, only to head back into inversion territory for much of the summer.So far, we have avoided a recession and the economy continues to muddle along at an annual growth rate of a little more than 2%.

The most recent yield-curve inversion invites the question: What might trigger the next recession and what might it look like? Let’s look at a few things cited by pundits and commentators:

Geopolitical events: A recession triggered by geopolitical events is so random and highly variable that it’s almost impossible to see it coming — an escalation in the Middle East tensions sends oil prices spiraling; miscalculations in the South China Sea lead to open conflict; North Korea goes off its rocker.

Then there are the unforeseen random events such as the potential pandemic developing in China. We have no handle on how quickly this can spread, or how effective countermeasures will be to contain it. Fears from past outbreaks seem overblown in hindsight.

Although the odds are long that coronavirus leads to recession, similar events in the recent past have led to short-lived contractions that end once the initial shock wears off.

Tech: Gains in tech stocks have been driving equity markets higher for a decade. Concern that the broad market indexes would be dominated by a handful of giants have come to pass. Four U.S. tech companies — Apple, Alphabet (parent of Google), Amazon and Microsoft now have market capitalizations of $1 trillion or more. That was unfathomable even during the 1990s dot-com years.

Since it is requisite to add “and we know how that ended,” let’s look at how the dot-com bubble actually did end: The tech-laden Nasdaq Composite Index fell 78% while the broader S&P 500 index suffered a 49% fall. Despite the market carnage, the economic spillover was modest, with a modest eight-month recession from March to November 2001.

The key difference between then and now is valuations. At that time, some of the hottest tech companies had little revenue and no earnings. At the peak, the S&P 500 had a forward price-to-earnings ratio of 31; Nasdaq was closer to 70. The difference is that tech dominates today because it is so wildly profitable.

Tech stocks would indeed suffer during a recession, but there’s not really much to suggest that valuations are spiraling out of control. In other words, it’s hard to see how a tech bust itself will be the source of the next recession.

Federal Reserve: The unemployment rate is 3.5%, the lowest in more than 50 years. Companies eventually will find that they have trouble hiring workers and turn to pay increases to either lure people away from competitors or entice marginally attached workers back into the labor force.

It is not hard to guess how that progresses. As salaries rise, so too does consumer spending. The increased demand for services and durable goods leads to an increase in prices. The inflationistas, despite being wildly wrong for the past three decades or so, begin once again to sound alarms.

The Fed raises rates, calling it an insurance policy against higher prices. It has no effect, so it raises rates again with the same results. Finally, 18 months and 150 basis points later, the impact on credit availability and cost is noticeable. This cuts into earnings, leading to layoffs and reduced business investment, which already is in the doldrums. The economy suffers a modest contraction.

Back in the fourth quarter of 2018, recession anxiety after the Fed raised rates seven times in 2017 and 2018 sent stocks into a free fall. There was also concern about rising trade tensions between the U.S. and China, increasing market volatility and a host of other issues. Although the yield curve didn’t invert at the time, there was plenty of chin-striking by experts confidently predicting recession, which as we now know has yet to materialize. Of course, it might have helped that the Fed switched from raising rates to cutting them in 2019, lowering them three times.Investing into the teeth of those last recession fears, however, turned out to be great timing: If you bought at the low-point of the market slump in December 2018, you were rewarded with a 31% return during the next four quarters.

One of these days, the U.S. will have a recession. Let’s hope you have your investment playbook ready — and the courage to use it to your advantage — when the next economic downturn comes along.

Barry Ritholtz is a Bloomberg Opinion columnist. He is chairman and chief investment officer of Ritholtz Wealth Management, and was previously chief market strategist at Maxim Group. He is the author of “Bailout Nation.”

Doctors say they face ‘moral injury’ because of business model that interferes with patient care #ศาสตร์เกษตรดินปุ๋ย

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/business/30381446?utm_source=category&utm_medium=internal_referral

Doctors say they face ‘moral injury’ because of business model that interferes with patient care

Feb 02. 2020
By Special To The Washington Post · Melissa Bailey · HEALTH
Physician Keith Corl was working in a Las Vegas emergency room when a patient arrived with chest pain. The patient, wearing his street clothes, had a two-minute exam in the triage area with a doctor, who ordered an X-ray and several other tests. But later, in the treatment area, when Corl met the man and lifted his shirt, it was clear that the patient had shingles. Corl didn’t need any tests to diagnose the viral infection that causes a rash and searing pain.

All those tests? They turned out to be unnecessary, but left the patient with over $1,000 in extra charges. The excessive testing, Corl said, stemmed from a model of emergency care that forces doctors to practice “fast and loose medicine.” Patients get a battery of tests before a doctor even has time to hear their story or give them a proper exam.

“We’re just shotgunning,” Corl said.

The shingles case is one of hundreds of examples that have led to his burnout with emergency medicine. What’s driving that fatigue and exasperation, he argued, is something deeper – a sense of what he called “moral injury.”

Corl, 42 and now an assistant professor of medicine at Brown University, is among a growing number of physicians, nurses, social workers and other clinicians who are using the phrase “moral injury” to describe their inner struggles at work.

The term comes from war: It was first used to explain why military veterans were not responding to standard treatment for post-traumatic stress disorder. Moral injury, as defined by researchers from veterans hospitals, refers to the emotional, physical and spiritual harm people feel after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”

Psychiatrist Wendy Dean and surgeon Simon Talbot were the first to apply the term to health care. Both wrestled with symptoms of burnout themselves. They concluded that “moral injury” better described the root cause of their anguish: They knew how best to care for their patients but were blocked from doing so by systemic barriers related to the business side of health care.

That idea resonates with clinicians across the country. Since they wrote an opinion article in the online health news site Stat in 2018, Dean and Talbot have been flooded with emails, comments, calls and invitations to speak on the topic.

Burnout has long been identified as a major problem facing medicine: 4 in 10 physicians report feelings of burnout, according to a 2019 Medscape report. And the physician suicide rate is more than double that of the general population.

Dean said she and Talbot have given two dozen talks on moral injury. “The response from each place has been consistent and surprising: ‘This is the language we’ve been looking for for the last 20 years.’ ”

Dean said that response has come from clinicians across disciplines, who wrestle with what they consider barriers to quality care: insurance preauthorization, trouble making patient referrals, endless clicking on electronic health records.

Those barriers can be particularly intense in emergency medicine.

Corl said he has been especially frustrated by a model of emergency medicine called “provider-in-triage.” It aims to improve efficiency but, he said, prioritizes speed at the cost of quality care.

In this system, a patient who shows up to an ER is seen by a doctor in a triage area for a rapid exam lasting less than two minutes. In theory, a doctor in triage can more quickly identify patients’ ailments and get a head start on solving them. The patient is usually wearing street clothes and sitting in a chair.

These brief encounters may be good for business. They reduce the “door to doc” time – how long it takes to see a doctor – that hospitals sometimes boast about on billboards and websites. They enable hospitals to charge a facility fee much earlier, the minute a patient sees a doctor. And they reduce the number of people who leave the ER, frustrated or angry, without “being seen,” which is another quality measure.

But “the real priority is speed and money and not our patients’ care,” Corl said. “That makes it tough for doctors who know they could be doing better for their patients.”

Dean said people often frame burnout as a personal failing. Doctors get the message: “If you did more yoga, if you ate more salmon salad, if you went for a longer run, it would help.” But, she argued, burnout is a symptom of deeper systemic problems beyond clinicians’ control.

Emergency physician Angela Jarman sees similar challenges in California, including ER overcrowding and bureaucratic hurdles to discharging patients. As a result, she said, she must treat patients in the hallways, with noise, bright lights and a lack of privacy – a recipe for hospital-acquired delirium.

“Hallway medicine is such a [big] part of emergency medicine these days,” said Jarman, 35, an assistant professor of emergency medicine at University of California at Davis. Patients are “literally stuck in the hallway. Everyone’s walking by. I know it must be embarrassing and dehumanizing.”

For example, when an older patient breaks an arm and cannot be released to their own care at home, they may stay in the ER for days to await evaluation from a physical therapist and approval to transfer to rehab or a nursing home, she said. Meanwhile, the patient gets bumped into a bed in the hallway to make room for new patients who keep streaming in the door.

Being responsible for discharging patients who are stuck in the hallway is “so frustrating,” Jarman said. “That’s not what I’m good at. That’s not what I’m trained to do.”

Jarman said many emergency physicians she knows work part time to curtail burnout. “I love emergency medicine, but a lot of what we do these days is not emergency medicine,” she said. “I definitely don’t think I’ll make it 30 years.”

Also at UC-Davis, Nick Sawyer, an assistant professor of emergency medicine, has been working with medical students to analyze systemic problems. Among those they have identified: patients stuck in the ER for up to 1,000 hours while awaiting transfer to a psychiatric facility; patients who are not initially suicidal, but become suicidal while awaiting mental health care; patients who rely on the ER for primary care.

Sawyer, 38, said he has suffered moral injury from treating patients like this one: A woman had a large kidney stone and a “huge amount of pain” but could not get approval for surgery because the stone was not infected and therefore her case wasn’t deemed an “emergency” by her insurance plan.

“The health system is not set up to help patients. It’s set up to make money,” he said.

The best way to approach this problem, he said, is to help future generations of doctors understand “how decisions made at the systems level impact how we care about patients” – so they can “stand up for what’s right.”

How to measure doctor experiences among physicians is far from clear.

Cynda Rushton, a nurse and professor of clinical ethics at Johns Hopkins University, who has studied the related notion of “moral distress” for 25 years, said there isn’t a base of research for moral injury among clinicians as there is for moral distress, which happens when someone feels responsible for addressing a moral problem but is not able to follow through as they feel they should.

But “what both of these terms signify is a sense of suffering that clinicians are experiencing in their roles now, in ways that they haven’t in the past,” Rushton said.

Dean grew interested in moral injury from personal experience. After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.

Dean and Talbot created in 2018 a nonprofit advocacy group called Moral Injury of Healthcare, which promotes public awareness and aims to bring clinicians together to discuss the topic.

Their work is attracting praise from a range of clinicians.

In Cumberland County, Pennsylvania, Mary Franco, who is now 65, retired early from her job as a nurse practitioner after a large corporation bought out the small private practice she worked in. She said she saw “a dramatic shift” in the culture there after the change, where “revenue became all-important.” The company cut in half the time for each patient’s annual exam, she said, down to 20 minutes. She spent much of that time clicking through electronic health records, she said, instead of looking the patient in the face. “I felt I short-shrifted them,” she said.

In southern Maine, social worker Jamie Leavitt said moral injury led her to take a mental health break from work last year. She said she loves social work, but “I couldn’t offer the care I wanted to because of time restrictions.” One of her tasks was to connect patients with mental health services, but because of insurance restrictions and a lack of quality care providers, she said, “often my job was impossible to do.”

In Chambersburg, Pennsylvania, physician Tate Kauffman left primary care for urgent care because he found himself spending half of each visit doing administrative tasks unrelated to a patient’s ailment – and spending nights and weekends slogging through paperwork required by insurers.

“There was a grieving process, leaving primary care,” he said. “It’s not that I don’t like the job. I don’t like what the job has become today.”

Corl said he was so fed up with the provider-in-triage model of emergency medicine that he moved his ER clinical work to smaller, community hospitals that don’t use that method.

He said many people frame burnout as a character weakness, sending doctors messages like, “Gee, Keith, you’ve just got to try harder and soldier on.” But Corl said the term “moral injury” correctly identifies that the problem lies with the system.

“The system is flawed,” he said. “It’s grinding us. It’s grinding good docs and providers out of existence.”

The psychology of a Super Bowl ad #ศาสตร์เกษตรดินปุ๋ย

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/business/30381417?utm_source=category&utm_medium=internal_referral

The psychology of a Super Bowl ad

Feb 01. 2020
By SUPERBOWL-ADS-COMMENT
Syndication Washington Post, Bloomberg Opinion · Tara Lachapelle · OPINION, BUSINESS, ENTERTAINMENT, RETAIL, TV
It’s been asked before: Why, if we hate television commercials, do we love Super Bowl ads so much? The question is more relevant now than ever. As consumers ditch cable, Netflix’s new streaming-TV rivals are weighing the pros and cons of placing ads on their services.

Already 18 million traditional pay-TV subscribers may have cut the cord in the last six years, according to Nielsen data and research by Geetha Ranganathan, an analyst for Bloomberg Intelligence. The pace accelerated last year, with recent earnings reports from AT&T owner of DirecTV) and Comcast revealing an exodus of 3.4 million and 733,000 traditional video customers, respectively. A proliferation of new streaming apps – Disney+, Apple TV+, Peacock, HBO Max – promises to see the cord-cutting trend continue this year.

For now, many of these new apps have opted to go ad-free, like Netflix. But that may not always be the case; advertising is likely to play a large role in the future of streaming TV, just as it has for cable networks. For one, ads are a lucrative source of revenue for programmers. Two, advertisers want access to the growing streaming audience. Three, ad-supported viewing might mean cheaper subscriptions for premium content. And so this Sunday’s Super Bowl LIV – between the San Francisco 49ers and the Kansas City Chiefs – comes as a timely reminder that for all the anecdotal aversion to ads, they’re not always so bad.

What is it about Super Bowl commercials that makes them less annoying than all the other campaigns for beer brands, cars, chips, insurance and paper towels throughout the year? It’s hard to say. Of course, breaks are a natural part of sports viewing, and at the Super Bowl, they’re as much a part of the event. But take a look at the most-liked ad spot during last year’s big game, which was M&M’s “Bad Passengers,” according to a survey of 500 viewers by consumer research firm Suzy.

It’s funny. It features a well-known actress. It tells a mini-story in the sense that you have to keep watching to find out who Christina Applegate is reprimanding in the back seat – the twist being that it’s the M&M’s characters and not her kids. It’s what the industry might call a “premium” ad. Is this must-see TV? No. Would I rather skip to the next episode of, say, “Schitt’s Creek” uninterrupted? Yes. But if watching this silly M&M’s ad meant I could stream for free, then I might take that option. After all, one of the biggest drivers of cord-cutting is the desire to save money. Some companies, such as Comcast, have caught on to this frustration brought on by the panoply of streaming subscriptions and are looking to ads as the solution.

Super Bowl ads have also been getting shorter. About 11% of ads during last year’s match were 15 seconds or less, compared with just 5% in 2015, according to Kantar data. Part of the reason is that Super Bowl commercials are just so darn expensive: Buying 30 seconds of air time this year, like the M&M’s spot above, set advertisers back as much as $5.6 million (not including production costs), according to the FOX broadcast network.

One of the more buzzed-about ads this year is for Bud Light Seltzer, and it clocks in at one whole minute. There are two versions featuring rapper Post Malone, and the company is gauging social media to determine which one to air on Sunday:

Streaming-TV services and on-demand content will require shorter ads. Thanks to Netflix, streamers have become accustomed to binge-watching without any interruptions at all. (And Netflix says it’s not planning on changing that.) And so bringing ads into streaming will require lots of creativity and restraint on the part of the media companies. Hulu, for its part, has experimented with “pause” ads that appear only when pausing a video.

When Comcast’s NBCUniversal launches Peacock in April, it will have just five minutes of ads per hour. In turn, viewers can stream for free. It’s the first of the major media companies to go this direction, and I suspect it won’t be the last. “We will make sure that every ad looks as good as the premium content that it’s paired with,” Linda Yaccarino, who oversees advertising at NBCUniversal, said at a presentation this month.

Ads aren’t going away, but they don’t have to be painful. Some are even entertaining. Watching four hours of football, though? That’s a different story.

GE bulls finally have more than hope on their side #ศาสตร์เกษตรดินปุ๋ย

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/business/30381260?utm_source=category&utm_medium=internal_referral

GE bulls finally have more than hope on their side

Jan 30. 2020
By Syndication Washington Post, Bloomberg Opinion · Brooke Sutherland · OPINION, BUSINESS, US-GLOBAL-MARKETS

General Electric’s shares have traded more on hope than hard math over the past year, but it looks like CEO Larry Culp’s turnaround efforts are starting to yield real results.

Free cash flow is the key number to watch when the company reports earnings, and GE said Wednesday that it generated $2.3 billion from its industrial businesses over the course of 2019. That exceeded the high end of GE’s guidance range, which was updated twice over the course of the year from an initial call in March for free cash flow to be at best zero. Was Culp sandbagging expectations, or setting a low bar to start with and artfully managing to a positive surprise?

It’s a fine line, but either way, the strategy worked. GE shares climbed more than 50% in 2019 and shareholders were still wowed enough by Wednesday’s results to send the stock up an additional 10%.

A lot of that optimism has to do with GE’s forecast for 2020. The company is projecting free cash flow will at least roughly match 2019’s performance and potentially rise to as high as $4 billion. That would still fall below what GE generated in 2018 amid depressed results, but would represent significant progress nonetheless, and exceeds most analysts’ estimates. The company plans to hold a meeting with investors this coming March to lay out its outlook in more detail. On the earnings call, however, Culp let a few details slip.

The beleaguered power and renewables units will likely continue to burn cash in 2020, with power improving from the negative $1.5 billion in cash flow in 2019 and renewables seeing a deterioration from the negative $1 billion the unit saw last year. Aviation will be flat to up from the $4.4 billion level of 2019, with the return of Boeing’s 737 Max the biggest source of variability. That leaves health care as the one question mark. We already know the unit will be losing cash flow from the biopharma business that’s being sold to Danaher Corp.

Without biopharma, the health-care division would have generated about $1.2 billion in cash flow in 2019 and GE had previously guided for an increase in 2020. Taking all of that together, GE should be able to fall well within its guidance range, but the potential to rack up a similar string of outsize positive surprises is arguably more limited this year.

Boeing’s Max is the biggest source of volatility for GE’s guidance, Culp said on the earnings call, and the company is currently modeling for a mid-2020 return of the jet, in line with Boeing’s most recent “best estimate.” Boeing also reported earnings Wednesday and, based on that timeline, announced a fresh $5.2 billion in charges tied to compensation for airlines and additional production costs. The company also said it anticipates $4 billion in “abnormal costs” for restarting production of the jet. That brings the total bill for the Max crisis to more than $18 billion, before accounting for any fines or legal penalties from numerous lawsuits and government investigations.

GE makes the engines for the Max through its CFM International joint venture with Safran and expects to see its shipment rate cut in half in 2020 amid the production halt. Asked about the $1.4 billion drag on free cash flow from the Max grounding in 2019, outgoing Chief Financial Officer Jamie Miller implied free cash flow would have been that much higher without that impact. In that case, arguably 2020 results could also be higher, but there are a lot of moving pieces here and it feels like GE is being more prudent than deliberately conservative.

The shift from optics to fundamentals is a welcome one. Culp’s task now is to keep the momentum going. In contrast to this time last year – when expectations could hardly have been much lower for GE – there’s now a fair amount of optimism reflected in the shares. After the stock pop on Wednesday, the company is currently valued at about 28 times its expected 2020 industrial free cash flow of at most $4 billion. That compares with about 20 times at Honeywell International Inc. and about 18 times for Emerson Electric Co. Put another way, much of GE’s anticipated progress in this multi-year turnaround is already priced in to the stock. But so far, Culp has proved the skeptics wrong and the optimists justified. So maybe there’s more room yet for hope.

What changes after Brexit Day on Jan. 31? #ศาสตร์เกษตรดินปุ๋ย

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/business/30381220?utm_source=category&utm_medium=internal_referral

What changes after Brexit Day on Jan. 31?

Jan 29. 2020
By The Washington Post · William Booth, Karla Adam 

LONDON – Brexit Day, or “Exit Day” as Prime Minister Boris Johnson would have it, is nearly upon us. On Friday, Britain will officially leave the European Union, after more than four decades with the closest of ties.

What will change? Nothing! At least, at first.

For the rest of 2020, free trade and free movement between the United Kingdom and the EU will continue. Britain will still contribute to the EU budget. And it will still have to abide by EU laws – even though British members of the European Parliament will have packed their bags and lost their say in how those laws are determined.

The biggest jolt to British politics in a generation won’t be felt by most until the end of an 11-month transition period. That’s when everyone will see a profound change to Britain’s relationship with Europe and the world. And there’s still lots that needs sorting between now and then. Here’s what’s on the to-do list.

– – –

It’s all about cod.

British fishing folk, and the folks who love them, have been banging on for years about rapacious Irish, French and Danish fleets over-exploiting rich British waters.

Fisheries account for a tiny percent – a mere minnow – of Britain’s gross domestic product and employ just 24,000 people. But the issue is highly emotional, stirring up nationalist fervor.

Johnson has vowed that Britain will – no matter what else – reclaim its “spectacular maritime wealth.”

Meanwhile, Ireland’s prime minister, Leo Varadkar, warned on the BBC on Monday: “You may have to make concessions in areas like fishing in order to get concessions from us in areas like financial services” in a post-Brexit trade deal.

The Cod War of 2020 is just beginning.

– – –

During the transition period, Britain will remain in the EU’s custom union and single market, but after that, everything is up for grabs.

Brexit Secretary Stephen Barclay has declared that the U.K. wants a “zero tariff, zero quota” trade pact with the EU by the end of the year.

But the new president of the European Commission, Ursula von der Leyen, has warned – in a very friendly, very warm, very public way – that it is almost certainly “impossible” for the two sides to complete a comprehensive agreement within this “very tight” schedule. She suggested that Johnson will have to ask for a delay. Or accept a partial deal – and keep talking.

The prime minister insists he will walk away if his deadlines are blown and head (again) for the dreaded cliff edge of a no-deal departure. Not everyone believes this.

– – –

Once the U.K. is officially out of the EU, it can start to negotiate with countries that don’t already have trade deals with the EU. At the top of that list is the United States.

President Donald Trump, a fan of Brexit, has promised a “massive” deal.” Both sides have said they want to hammer something out quickly. But there could be stumbling blocks, including over drug prices and taxes on big tech companies.

There’s also the debate about “chlorinated chicken.”

Believe it or not, this is a big thing. Bigger than cod.

To have easy, free trade of agricultural goods, Europe is pressing Britain remain aligned with EU rules on food safety and animal welfare. But that puts Britain on a collision course with the United States and its relatively lax regulations on industrial farming. American food processors rinse their poultry in a chlorine bath and shoot up their beef with antibiotics – both no-nos in Europe.

Whether Johnson will bow to the Americans on “chlorinated chicken” and on allowing U.S. pharmaceutical companies access to the U.K. health service market were both points of contention in last month’s general election. Brits will be watching what he does.

– – –

As Britain goes its own way, it will effectively withdraw from hundreds of pacts signed between the EU and the rest of the world.

The Financial Times counted more than 750 treaties “running to hundreds of thousands of pages and spanning 168 non-EU countries. Within them are covered almost every external function of a modern economy, from flying planes to America and trading sows with Iceland to fishing in far-flung seas.”

Johnson’s government has said most of these treaties will be quickly dispatched with a few added lines of text and rubber-stamped by the sides.

In any case, Britain will need lots of ink.

– – –

Britain will begin introducing spiffy new passports – blue, like the good old days – early this year. By mid-2020, all new British passports will be blue.

But they won’t have that “European Union” stamp on the front cover, which allows the 500 million citizens of the bloc to travel effortlessly across the 28-member nations.

Free movement will continue through the transition period. Londoners can still freely move to Lisbon, Berliners can take jobs in Birmingham. But EU citizens living in Britain must apply for residency rights by June 2021 – or they will be in the country illegally.

Going forward, Europeans won’t get automatic preference over people from other countries who want to live and work in the U.K. And Brits won’t as easily be able to live and work in Europe.

Johnson will soon unveil a post-Brexit immigration plan, which is expected to be something akin to Australia’s point-based scheme. Immigration was a huge driver in the 2016 EU referendum, with Brexiteers promising to “take back control” of Britain’s borders. Johnson will want to say he’s achieved that goal.

Food production and the spread of pandemics #ศาสตร์เกษตรดินปุ๋ย

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/business/30381096?utm_source=category&utm_medium=internal_referral

Food production and the spread of pandemics

Jan 26. 2020
By Syndication Washington Post, Bloomberg Opinion · David Fickling · OPINION, OP-ED 
With the world’s largest high-speed rail network, a payments system that’s largely conducted via phone apps, and half the world’s solar-power plants, China often looks like a country at the technological frontier. When you consider how it feeds itself, though, it’s still just catching up.

About 44% of the country’s livestock in 2010 were still raised in backyards and traditional mixed farms, where they mingle with crops and other animals. While that’s a dramatic fall from a generation ago, when about 97% of livestock were raised in traditional conditions, it trails countries like the U.S. and Europe, where 95% or more of pigs and poultry are raised in so-called “intensive systems” – in common parlance, factory farms.

That transition is likely to be a major factor in the spread of new diseases such as the coronavirus, which has killed 17 people since it was first detected last month in Wuhan. The central Chinese city was put on lockdown Thursday to contain the virus. How China handles the changes taking place in its food industry will determine the future of infections for everyone on the planet.

Epidemics are a product of urbanization. Only when humans started to pack themselves into densely populated cities around 5,000 years ago were infections able to attain the critical mass needed to kill us in large numbers. The worldwide disease outbreaks we call pandemics started to emerge only when our urban civilization went global.

Think about that in terms of the livestock industry and the implications are concerning. In the space of 50 years or so factory farming has “urbanized” an animal population that was previously scattered between small and midsize holdings. Epidemic conditions that once only affected humans can increasingly pose threats to our food animals, too.

Then consider each animal as a potential laboratory for the mutations that can cause new epidemics to emerge. Globally, the population of farm animals is about three times that of humans. Some of the most serious disease outbreaks in recent decades have resulted from infections crossing the species barrier from intensively farmed livestock to people.

H5N1 avian flu may have started to spread when migratory birds wound up in close proximity to the new intensive poultry farms that sprang up across eastern China in the 1990s. The origins of the H1N1 swine flu pandemic are harder to unpick, but several studies have suggested diverse origins relating to global movements of pigs and poultry between Europe, Asia and North America.

The Wuhan virus, similarly, was first found among people linked to the city’s wet market. As my colleague Adam Minter has written, the conditions in these open-air stalls – where many animals are slaughtered to order or taken home alive – are a major factor in the spread of disease in China in recent years.

It’s not all bad news. Precisely because they’re such potent sources of infection, biosecurity measures and surveillance on intensive farms are generally much tighter than they are on traditional holdings. China’s bureaucracy has often been characterized by secrecy and indecision in the face of epidemics and food safety problems. It seems to take strong direction from the top for this stasis to be reversed, so it’s good that President Xi Jinping has called for action around the latest outbreak. Even so, the devastating spread of African swine fever over the past year suggests that food safety is still weaker than it should be.

The changing nature of the retail grocery trade may improve matters. As amazing as the persistence of China’s wet markets may seem to outsiders, it’s easy to overlook how quickly they’re fading. Until the 1990s, supermarkets didn’t exist, rationing was common, and meat in many areas was a treat reserved for rare occasions like the coming Lunar New Year festival. Nowadays, the market share of modern grocery stores is about 65%, according to Euromonitor International. That puts far more of the meat supply chain into large-scale facilities with better biosecurity procedures.

The bigger problem is likely to be a political one. Food-safety measures work best where there’s a high degree of trust in society. Farmers are most likely to pay the personal costs of following hygiene rules when they think they can benefit more from the integrity of the system than from smuggling infected livestock. As even Beijing acknowledges, trust is one commodity that’s in short supply in China these days.

– – –

David Fickling is a Bloomberg Opinion columnist covering commodities, as well as industrial and consumer companies. He has been a reporter for Bloomberg News, Dow Jones, the Wall Street Journal, the Financial Times and the Guardian.