Wednesday, September 07, 2011

Crisis Checklists for the Operating Room: Development and Pilot Testing


Background
Because operating room crises are rare events, failure to adhere to critical management steps is common. We sought to develop and pilot a tool to improve adherence to lifesaving measures during operating room crises.
Study Design 
We identified 12 of the most frequently occurring operating room crises and corresponding evidence-based metrics of essential care for each (46 total process measures). We developed checklists for each crisis based on a previously defined method, which included literature review, multidisciplinary expert consultation, and simulation. After development, 2 operating room teams (11 participants) were each exposed to 8 simulations with random assignment to checklist use or working from memory alone. Each team managed 4 simulations with a checklist available and 4 without. One of the primary outcomes measured through video review was failure to adhere to essential processes of care. Participants were surveyed for perceptions of checklist use and realism of the scenarios.
Results 
Checklist use resulted in a 6-fold reduction in failure of adherence to critical steps in management for 8 scenarios with 2 pilot teams. These results held in multivariate analysis accounting for clustering within teams and adjusting for learning or fatigue effects (11 of 46 failures without the checklist vs 2 of 46 failures with the checklist; adjusted relative risk = 0.15, 95% CI, 0.04–0.60; p = 0.007). All participants rated the overall quality of the checklists and scenarios to be higher than average or excellent.
Conclusions
Checklist use can improve safety and management in operating room crises. These findings warrant broader evaluation, including in clinical settings.

Reversion to the mean


“What goes up must come down” is an everyday expression which explains the statistical concept, reversion to the mean. Most statistical theories or investment models are very complex and have limited successful track records, but reversion to the mean is intuitive and easy to grasp.Most important, reversion to the mean is the basis of value investing. Many well-known and successful investors, including Benjamin Graham, David Dodd, Warren Buffett and Seth Klarman, are value investors. These investors use reversion to the mean as an investment philosophy to guide them to buy certain companies. By exploiting time arbitrage, a fancy term meaning one has a long-term time horizon and can weather short-term fluctuations, investors can make money by buying undervalued stocks and waiting for them to return to their historical valuations — to revert to the mean. An easy to understand example illustrates this basic philosophy.
Imagine that company XYZ has traded throughout the past five years at an average multiple of 18 times earnings. This means that the stock price divided by earnings per share — the company’s net income divided by common stock shares — has equaled 18. Now, the company trades at 12 times earnings. We can see that the lower multiple, 12 compared to 18, means that the price for a share of stock has decreased in relation to the profitability of the company. Clearly, something in the market has occurred to cause shares to dip and reach a lower valuation. Perhaps a top manager such as the CEO or CFO suddenly resigned, or the company had to deal with a product recall or fell short of Wall Street’s earnings expectations. But if the investor sees no secular, long-term changes in company XYZ, this dip in share price and valuation creates a great buying opportunity because the stock should eventually revert to the mean and trade at its historical 18 times earnings.

Monday, September 05, 2011

Conflict Levels Don't Change Much Over Course of Marriage


Think about how much you fight and argue with your spouse today. A new study suggests that your current level of conflict probably won't change much for the remainder of your marriage. 
That may be good news for the 16 percent of couples who report little conflict or even the 60 percent who have only moderate levels of conflict. But it's not such happy news for the 22 percent of couples who say they fight and argue with each other a lot. 
The study followed nearly 1,000 couples over 20 years, from 1980 to 2000. 
"There wasn't much change in conflict over time," said Claire Kamp Dush, lead author of the study and assistant professor of human development and family science at Ohio State University.

Brunello Cucinelli: A philosophy that fits snugly

Great philosophy.



His employees, who include most of the 500 inhabitants of the sunkissed maze of streets, as well as families in nearby villages, earn higher than average wages. They do not clock in and out. Work ends promptly at 6pm. Lunch is three courses daily for €2.80 – including wine and olive oil from Mr Cucinelli’s groves – cooked by those workers who are not in the workrooms using magnifying glasses to sew buttons or stitch on lapels. 

“In order for people to want to stay and work with me and build their skills, they have to be offered something more,” Mr Cucinelli says. 

Mr Cucinelli says he believes consumers will want more than that. “If you buy a sweater for €1,000 and you know that the funds you are paying are also going to help to build a hospital and a school, wouldn’t you think better about it? If I know a product is made well I will buy. I don’t want to buy something that has harmed anyone, this is my absolutely strongest belief, and I believe other people think this too. Or if they don’t now, they will”.


Tuesday, August 30, 2011

Happy 81st Birthday, Warren Buffett!

Thank you for all your teachings, wisdom, & generosity.

Warmest regards,
Dah Hui Lau (David)

Thursday, August 25, 2011

BofA Says Berkshire Will Invest $5 Billion

Bank of America Corp., the biggest U.S. lender, said Warren Buffett's Berkshire Hathaway Inc. will invest $5 billion to bolster the company after losses tied to subprime mortgages drained capital. Bank of America surged in New York trading.

Berkshire will get cumulative perpetual preferred stock paying a 6 percent dividend, the Charlotte, North Carolina-based bank said today in a statement. Omaha, Nebraska-based Berkshire also gets warrants to buy 700 million shares at $7.14 each.

The deal aids Bank of America Chief Executive Officer Brian T. Moynihan, 51, who is cutting jobs and selling assets to help restore investors' confidence. Bank of America lost almost half its value on the New York Stock Exchange this year through yesterday as investors speculated the lender would have to access the public markets to raise capital.

“This is a tremendous vote of confidence in the U.S. banking industry as well as Bank of America,” said Anthony Polini, an analyst with Raymond James Financial Inc. “Bank of America was being punished or victimized as one of the weakest U.S. banks that could be in financial distress. For Buffett to step up like this for BofA has implications for all the other banks.”

The lender jumped $1.03, or 15 percent, to $8.02 in New York Stock Exchange composite trading at 10:25 a.m., leading the KBW Bank Index higher. Berkshire fell less than 0.1 percent.

‘Acting Aggressively'

Buffett conceived of the investment while in the bathtub yesterday morning and had his assistant contact Moynihan's to get the banker's private number, CNBC reported, citing an interview with Buffett.

“Bank of America is a strong, well-led company, and I called Brian to tell him I wanted to invest,” Buffett said in the statement. “I am impressed with the profit-generating abilities of this franchise, and that they are acting aggressively to put their challenges behind them.”

Berkshire's warrants may be exercised at any time in a 10- year period, according to the statement. Bank of America can redeem the preferred stock at any time for a 5 percent premium.

Buffett helped prop up Goldman Sachs Group Inc. during the credit crisis in 2008 with a $5 billion investment that was repaid this year. The Goldman Sachs investment paid a 10 percent dividend. Berkshire is the largest stock investor in Wells Fargo & Co., the only U.S. home lender larger than Bank of America.

‘Plenty Profitable'

Banking can “still be plenty profitable,” Buffett told Bloomberg Television's Betty Liu on the “In the Loop” program on July 8.

The cost to protect against a default by Bank of America plunged. Credit-default swaps on the bank, which surged to a record this week, dropped 65 basis points to 308 basis points as of 10:43 a.m. in New York, according to data provider CMA.

Bank of America's trading floor in New York erupted in cheers and applause when the news was announced this morning, said a person at the company who witnessed the reaction but who wasn't authorized to speak publicly.

Moynihan agreed to sell the bank's Canadian card unit, with about $8.6 billion in loan balances, and plans to leave the U.K. and Irish card markets, Bank of America said this month. The bank has been forced to write down credit-card and mortgage units acquired by Moynihan's predecessor, Kenneth D. Lewis. Bank of America has sold more than 20 assets or units since Moynihan took over last year.

Job Cuts

The bank will eliminate about 3,500 jobs this quarter to focus “on what we can control” amid market turmoil, Moynihan said last week. Some workers already were informed of the dismissals, which are in addition to 2,500 reductions made this year, Moynihan said in a memo to senior managers.

Berkshire sold a stake in Bank of America last year and Buffett has publicly criticized Lewis, for missteps including the purchase of Merrill Lynch & Co., a deal struck the same day Lehman Brothers Holdings Inc. filed for bankruptcy in 2008.

Lewis “paid a crazy price, in my view,” Buffett said in remarks released Feb. 10 by the Financial Crisis Inquiry Commission. “He could have bought them the next day for nothing.” Moynihan became CEO early last year.

While the company suffered from errors, its reach among consumers are a source of strength, Buffett told CNBC in 2009.

“One thing about Bank of America,” Buffett said. “It has a wonderful deposit-gathering system.”

Link

Wednesday, August 24, 2011

Tuesday, August 23, 2011

Monday, August 22, 2011

Andrew Carnegie: Andrew Carnegie Autobiography and the Gospel of Wealth

I would like to share with you some interesting quotes from "Andrew Carnegie Autobiography and the Gospel of Wealth" book. Very inspirational. Highly recommended.

David

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"There has been no luck about it. We used only the best material and enough of it, making our own iron and later our own steel. We were our own severest inspectors, and would build a safe structure or none at all. When asked to build a bridge which we knew to be of insufficient strength or of unscientific design, we resolutely declined."

"This policy is the true secret of success. Uphill work it will be for a few years until your work is proven, but after that it is smooth sailing. Instead of objecting to inspectors they should be welcomed by all manufacturing establishments. A high standard of excellence is easily maintained, and men are educated in the effort to reach excellence. I have never known a concern to make a decided success that did not do good, honest work, and even in these days of the fiercest competition, when everything would seem to be matter of price, there lies still at the root of great business success the very much more important factor of quality."

"The surest foundation of a manufacturing concern is quality. After that, and a long way after, comes cost."

"Ah, gentlemen," I said, "there is the point. A little more money and you could have had the indestructible wrought-iron and your bridge would stand against any steamboat. We never have built and we never will build a cheap bridge. Ours don't fall."

"Nothing tells in the long run like good judgment, and no sound judgment can remain with the man whose mind is disturbed by the mercurial changes of the Stock Exchange. It places him under an influence akin to intoxication. What is not, he sees, and what he sees, is not. He cannot judge of relative values or get the true perspective of things. The molehill seems to him a mountain and the mountain a molehill, and he jumps at conclusions which he should arrive at by reason. His mind is upon the stock quotations and not upon the points that require calm thought. Speculation is a parasite feeding upon values, creating none."

""Yes, my friends, all that you say is true. I have had a long, long life full of troubles, but there is one curious fact about them--nine tenths of them never happened." True indeed; most of the troubles of humanity are imaginary and should be laughed out of court. It is folly to cross a bridge until you come to it, or to bid the Devil good-morning until you meet him--perfect folly. All is well until the stroke falls, and even then nine times out of ten it is not so bad as anticipated. A wise man is the confirmed optimist."

"I determined that the proper policy was "to put all good eggs in one basket and then watch that basket.""

"I believe the true road to preëminent success in any line is to make yourself master in that line. I have no faith in the policy of scattering one's resources, and in my experience I have rarely if ever met a man who achieved preëminence in money-making--certainly never one in manufacturing--who was interested in many concerns."

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"He had not a particle of mechanical knowledge, and yet such was his unflagging zeal and industry for the interests of his employer that he soon became marked for being everywhere about the mill, knowing everything, and attending to everything."

"Early hours in the morning and late in the dark hours at night William was in the mills. His life was there. He was among the first of the young men we admitted to partnership, and the poor German lad at his death was in receipt of an income, as I remember, of about $50,000 a year, every cent of which was deserved. Stories about him are many."

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Friday, August 19, 2011

Quote of the Week from Warren Buffett

"We will continue to ignore political and economic forecasts, which are an expensive distraction for many investors and businessmen. Thirty years ago, no one could have foreseen the huge expansion of the Vietnam War, wage and price controls, two oil shocks, the resignation of a president, the dissolution of the Soviet Union, a one-day drop in the Dow of 508 points, or treasury bill yields fluctuating between 2.8% and 17.4%.

But, surprise - none of these blockbuster events made the slightest dent in Ben Graham's investment principles. Nor did they render unsound the negotiated purchases of fine businesses at sensible prices. Imagine the cost to us, then, if we had let a fear of unknowns cause us to defer or alter the deployment of capital. Indeed, we have usually made our best purchases when apprehensions about some macro event were at a peak. Fear is the foe of the faddist, but the friend of the fundamentalist."

- Warren E. Buffett1994 Berkshire Hathaway Shareholder Letter

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