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Hari pertama fasa kedua PKP... sama2 kita berdoa semuga wabak ini akan segera berlalu... kak rose nak kongsikan perkongsian dari Dr Razman Zakaria camner nak kekal positive semasa keadaan yang sangat mencabar ini...semuga kita semua dalam lindungan Allah hendaknya.. Aamiin.

LET’S be honest. Fasa ini memang akan menguji emosi dan psikologi kita. Terutamanya individu positif atau pun Kes Yang Disyaki (PUI), mahupun keluarga mereka terkesan secara langsung.

Jadi bagaimana mahu mengelakkan jadi lebih tertekan? Saksikan perkongsian dari Dr Rozanizam Zakaria dengan mengklik pautan Youtube beliau.

Di bawah adalah nota ringkas yang dapat saya rumuskan dari video perkongsian beliau:

1. Kekalkan rutin harian yang sihat:

– tidur dan rehat yang mencukupi
– pemakanan yang seimbang dan sihat
– selitkan aktiviti-aktiviti riadah yang ringan

2. Teruskan berhubung dan bersosial:

– Berkongsi perasaan dan emosi dgn orang yang anda rasa selesa, untuk memastikan anda berasa disokongi dalam situasi mencabar kini.

3. Keep your perspective right, cara kita melihat kepada situasi:

– Contoh: sekiranya kita melihat isolasi sebagai hukumam atau bebanan, ia akan melahirkan emosi yang negatif ke atas diri kita.

Akan tetapi, sekiranya kita melihat isolasi sebagai pencegahan supaya orang lain tidak mempunyai atau dijangkiti masalah yang sama, mungkin kita mampu melihat ia dari perspektif positif.

Hampir 80 peratus pesakit COVID-19 mengalami gejala ringan dan lebih 90 peratus pula berjaya sembuh. Sekiranya kita melihat dari perspektif positif, ia akan memberi impak positif kepada emosi kita.

4. Berlatih cara pernafasan + meditasi:

– membantu mengurangkan adrenaline dalam otak kita dan juga mengurangkan perasaan panik mahupun gelisah

5. Keep your mind busy:

– Sibukkan minda anda dgn aktiviti. Sekiranyan pemikiran kita kosong, maka akan lebih mudah untuk pemikiran negatif menguasai pemikiran kita.

6. Monitor our thoughts:

– Pemikiran negatif akan menarik emosi yang negatif.

Dalam keadaan tertekan kita mudah tertarik dgn fikiran-fikiran negatif seperti “saya takkan sembuh”, “saya menyusahkan org”, “orang lain lebih bahagia, sedangkan sy terperangkap di sini”.

Oleh yg demikian cuba tepiskan dan cabar pemikiran negatif dgn pemikiran positif agar ia mampu mewujudkan emosi yg lebih sihat.

7. Sokongan Spiritual:

– Cari hikmah dan makna dengan apa yang terjadi.

Seperti yang di ajar Rasulullah ﷺ:

“Amat menakjubkan urusan seorang Mukmin kerana setiap urusannya adalah baik dan itu tidak akan berlaku kepada seorang pun kecuali kepada seorang Mukmin (yang sempurna keimanannya). Jika dia mendapat sesuatu yang mengembirakan dia bersyukur, maka itu adalah kebaikan baginya. Jika dia ditimpa kesusahan dia bersabar, maka itu adalah kebaikan baginya.”

(Hadith riwayat Muslim, No.Hadith : 2999)

QMAN 1417: Trans-Collector (Transformers) Yellow Combiner Construction Vehicles Preview

admin March 31, 2020 Add Comment

admin

Enlighten/Qman has made a lot of mechs like this and I'm glad they haven't stopped!

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Italy Continues to Flatten The Curve

#15,159

While the numbers being reported out of Italy are sobering, over the past week we've see a significant reduction in daily case counts, dropping from more than 6,500 ten days ago to just over 4000 a day for the past two days.

Three weeks after entering into a nationwide lockdown, this is clear evidence that their social distance strategy is working.

Deaths, however, are always a lagging indicator, and over the past two days Italy has averaged more than 800 fatalities per day, raising their official death toll to 12,428. As high as that is, there are media reports suggesting that the actual toll could be considerably higher, as many non-hospital deaths may not have been tested.

Even so, the preliminary CFR (Case Fatality Rate) in Lombardy is an astronomical 16.67%, and for Italy as a whole, 11.7%. Both numbers clearly several times higher than anything we've seen reported anyplace else in the world.

While it is probable that many mild and moderate cases have not been counted - and adding those in would substantially lower the CFR - there are also numerous reports of overwhelmed hospitals, and a lack of staffed ICU beds, which has likely also contributed to Italy's case fatality rate.

The after-action report from hard hit countries - including Italy - after this pandemic wave has passed, should tell us a great deal more about how, and why differing numbers of pandemic deaths occurred.

And while Italy's numbers look huge today, they could easily be surpassed by other nations in the days and weeks ahead.

The situation in Italy: March 31, 2020, 6.00 p.m.

CURRENTLY POSITIVE 77635
DECEASED 12428
HEALED 15729

Press conference at 6 pm on March 31st

105,792 total cases, currently positive people are 77,635, 12,428 dead and 15,729 recovered.

Among the 77,635 positives:
45,420 are in home isolation
28,192 hospitalized with symptoms
4,023 in intensive care
Read the tables
Italy situation as of March 31st Breakdown by provinces as of March 31st

Sembo 601077: Cherry Blossoms Snowglobe-like Build Preview

admin March 31, 2020 Add Comment

admin

Wow, the details on this thing, external and internal, are great! I'm surprised too given the size. It'd be nice to have something like this for places all over the world, then we can have our own international display of various beautiful tourist spots!

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Using this link, browsing with it, and eventually buying from any store will help support the page without additional cost for you.

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Share your thoughts below or through facebook.com/downtheblocks and please like the page for more previews, reviews, MOCs, and more!

Any Mask In A Viral Storm?

Cloth Masks used during the 1918 Pandemic

#15,158

Yesterday, for the first time, I wore a (non-medical) face mask in public. I initially felt a little funny doing so, but that passed quickly.

I'm 66, have a few comorbidities that would put me at greater risk from COVID-19, and decided to make my first run to a local grocery store in more than a week, during which time the number of COVID-19 cases in my state had more than tripled.

Although I don't have a lot of faith that wearing a non-fit-tested N95 provides me with much in the way of protection, it did remind me not to touch my face, and it provided me with a modicum of psychological comfort.

And while the official mantra has been that masks are not protective, and should only be worn by those showing symptoms, I find it telling that those countries that encourage (or mandate) the public wearing of masks (Japan, Taiwan, Hong Kong, Singapore) have had the greatest success in slowing community spread of the virus.

Whether that is because the masks are protective, or it helps prevent asymptomatic wearers from spreading the virus, isn't clear. But it does seem to be helping.

Over the past 14 years, I've recommended my readers to keep a small stash of surgical (and even N95) masks in their emergency kits. But after the shortages began to appear in January, and given the need for these types of masks to be reserved for HCWs and 1st responders, I felt I could no longer ethically encourage people to acquire them.

Instead, in late January, in The Man In The Ironed Mask (Revisited), we looked at the pros and cons of the general public making, and wearing, cloth masks.

While cloth masks are far from ideal, the CDC's March 17th Strategies for Optimizing the Supply of Facemasks even allows:

HCP use of homemade masks:

In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.

I know of several nurses who, because of a shortage of PPEs, have resorted to wearing these sorts of homemade masks when in relatively low-risk healthcare environments, thereby reserving `proper PPEs' for riskier exposures.

The idea is picking up steam for the general public, as well. Yesterday, in an interview with KOMO news, epidemiologist Jeffrey Duchin with UW Medicine - who is at the center of the Washington State COVID-19 Outbreak - suggested the idea has some merit.

Should you wear a mask? Here's what a UW epidemiologist says

Overnight the Washington Post ran a story called:

CDC considering recommending general public wear face coverings in public

While cloth masks from places like Amazon are on backorder, anyone who is handy with a sewing machine can find dozens of tutorials on YouTube on how to make cloth face masks, and I've even seen some `glue gun specials', which don't require sewing skills.

With so many people stuck at home, unable to work, this could be a terrific local cottage industry for a lot of people. To either sell (or better yet) to donate to friends and neighbors.

Although no one should think themselves invincible - or even reasonably well protected - by wearing a cloth mask, it isn't an unreasonable thing to do. And it may even help reduce transmission of the virus a little.

As for my small stash of N95s? Although most are over 10 years old and `technically expired', I've donated nearly all of them to an RN I know, who will share them with her co-workers.

I've kept just a few in case I'm called upon to help neighbors who might be sick with the virus. Beyond that, I have a small supply of non-medical paper `dust' masks, and am working on making a cloth mask or two.

Because, despite of the paucity of scientific evidence of efficacy, I have to believe any mask beats no mask in a viral storm.

MRC: Estimating The Impact Of NPIs On COVID-19 In Europe

#15,157

There's an old adage that says `When Public Health Works . . . nothing happens.'

One of the great ironies of life is the more successful public health interventions are in preventing death and disease, the less credit public health gets.

I can pretty much guarantee that the more successful our social distancing and NPI measures are in reducing deaths from COVID-19, the more those low numbers will be used by critics of the response as `proof' the pandemic threat was overblown.

This, BTW, was the reaction in the year 2000, after the Y2K bug didn't take down the electrical grid or paralyze society. Nobody remembers - or gives credit to - the hundreds of thousands of computer programmers who spent 2 or 3 years doing Y2K remediation before the rollover date to ensure it didn't happen.

But I digress.

Researchers at the MRC Centre for Global Infectious Disease Analysis at Imperial College London - a WHO Collaborating Center - have released their 13th report, this time estimating the number of lives saved (so far) in Europe due to the implementation of NPIs (Nonpharmaceutical Interventions) like social distancing, the closing of schools and universities, and and the banning of public gatherings.

These are estimates, based on mathematical modeling, but they suggest that the NPIs implemented in Europe have significantly lowered the spread of COVID-19 (SARS-CoV-2), and as a result, tens of thousands of lives have likely been spared.

First the summary from the report, after which I'll have a postscript about estimates.

Report 13: Estimating the number of infections and the impact of non-pharmaceutical interventions on COVID-19 in 11 European countries

(Download Report 13)‌

Seth Flaxman*, Swapnil Mishra*, Axel Gandy*, H Juliette T Unwin, Helen Coupland, Thomas A Mellan, Harrison Zhu, Tresnia Berah, Jeffrey W Eaton, Pablo N P Guzman, Nora Schmit, Lucia Callizo, Kylie E C Ainslie, Marc Baguelin, Isobel Blake, Adhiratha Boonyasiri, Olivia Boyd, Lorenzo Cattarino, Constanze Ciavarella, Laura Cooper, Zulma Cucunubá, Gina Cuomo-Dannenburg, Amy Dighe, Bimandra Djaafara, Ilaria Dorigatti, Sabine van Elsland, Rich FitzJohn, Han Fu, Katy Gaythorpe, Lily Geidelberg, Nicholas Grassly, Will Green, Timothy Hallett, Arran Hamlet, Wes Hinsley, Ben Jeffrey, David Jorgensen, Edward Knock, Daniel Laydon, Gemma Nedjati-Gilani, Pierre Nouvellet, Kris Parag, Igor Siveroni, Hayley Thompson, Robert Verity, Erik Volz, Patrick GT Walker, Caroline Walters, Haowei Wang, Yuanrong Wang, Oliver Watson, Charles Whittaker, Peter Winskill, Xiaoyue Xi, Azra Ghani, Christl A. Donnelly, Steven Riley, Lucy C Okell, Michaela A C Vollmer, Neil M. Ferguson1 and Samir Bhatt*1

On behalf of the Imperial College COVID-19 Response Team
Department of Infectious Disease Epidemiology, Imperial College London
Department of Mathematics, Imperial College London
WHO Collaborating Centre for Infectious Disease Modelling
MRC Centre for Global Infectious Disease Analysis
Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London
Department of Statistics, University of Oxford
*Contributed equally 1Correspondence: neil.ferguson@imperial.ac.uk, s.bhatt@imperial.ac.uk

Summary Report 13

Following the emergence of a novel coronavirus (SARS-CoV-2) and its spread outside of China, Europe is now experiencing large epidemics. In response, many European countries have implemented unprecedented non-pharmaceutical interventions including case isolation, the closure of schools and universities, banning of mass gatherings and/or public events, and most recently, widescale social distancing including local and national lockdowns.

In this report, we use a semi-mechanistic Bayesian hierarchical model to attempt to infer the impact of these interventions across 11 European countries. Our methods assume that changes in the reproductive number – a measure of transmission - are an immediate response to these interventions being implemented rather than broader gradual changes in behaviour. Our model estimates these changes by calculating backwards from the deaths observed over time to estimate transmission that occurred several weeks prior, allowing for the time lag between infection and death.

One of the key assumptions of the model is that each intervention has the same effect on the reproduction number across countries and over time. This allows us to leverage a greater amount of data across Europe to estimate these effects. It also means that our results are driven strongly by the data from countries with more advanced epidemics, and earlier interventions, such as Italy and Spain. We find that the slowing growth in daily reported deaths in Italy is consistent with a significant impact of interventions implemented several weeks earlier. In Italy, we estimate that the effective reproduction number, Rt, dropped to close to 1 around the time of lockdown (11th March), although with a high level of uncertainty.

Overall, we estimate that countries have managed to reduce their reproduction number. Our estimates have wide credible intervals and contain 1 for countries that have implemented all interventions considered in our analysis. This means that the reproduction number may be above or below this value. With current interventions remaining in place to at least the end of March, we estimate that interventions across all 11 countries will have averted 59,000 deaths up to 31 March [95% credible interval 21,000-120,000]. Many more deaths will be averted through ensuring that interventions remain in place until transmission drops to low levels.

We estimate that, across all 11 countries between 7 and 43 million individuals have been infected with SARS-CoV-2 up to 28th March, representing between 1.88% and 11.43% of the population. The proportion of the population infected to date – the attack rate - is estimated to be highest in Spain followed by Italy and lowest in Germany and Norway, reflecting the relative stages of the epidemics.

Given the lag of 2-3 weeks between when transmission changes occur and when their impact can be observed in trends in mortality, for most of the countries considered here it remains too early to be certain that recent interventions have been effective. If interventions in countries at earlier stages of their epidemic, such as Germany or the UK, are more or less effective than they were in the countries with advanced epidemics, on which our estimates are largely based, or if interventions have improved or worsened over time, then our estimates of the reproduction number and deaths averted would change accordingly. It is therefore critical that the current interventions remain in place and trends in cases and deaths are closely monitored in the coming days and weeks to provide reassurance that transmission of SARS-Cov-2 is slowing.‌

(Continue . . . .)

George E. P. Box, Professor Emeritus of Statistics at the University of Wisconsin, is often credited with coining the familiar adage:

“All models are wrong, but some models are useful.”

While we can question the accuracy of mathematical models, all of the `official' COVID-19 numbers we get are undoubtedly massive undercounts, whether we are talking the number of infections, or the number of deaths.

There are legitimate reasons to be highly suspicious of China's accounting of their cases and fatalities, but even in Europe and the United States, we never see the full picture of any infectious disease outbreak.

Credit CDC

Many mild or moderate infections will go untested, and uncounted.

Not all serious COVID-19 infections, or deaths, will be recognized as being due to the virus as well. We see this with influenza all of the time, where heart attacks and strokes caused by the flu are cited as the immediate cause of death.

More broadly, in May 2017, in Int. Med. J.: Triggering Of Acute M.I. By Respiratory Infection we looked at research from the University of Sydney that found the risk of a heart attack is increased 17-fold in the week following a respiratory infection such as influenza or pneumonia.

Thousands of people die every day in the United States, but only those who have been tested for the virus will be counted as a pandemic fatality.

The same is true with influenza. Here in the United States, the CDC can only broadly estimate the impact of flu each year. This year, they've estimated anywhere between 24,000 and 62,000 influenza-related deaths, which is the largest spread they've posted (by percentage) since they began calculating seasonal burden in 2010.

We may eventually find that a significant number of this year's `flu deaths' - particularly those that occurred in February and March - will turn out to be due to COVID-19. Assuming that data hasn't been lost.

Whether the number of COVID-19 deaths prevented by NPIs in Europe is near the top of MRC's range (120,000) or closer to the bottom (21,000) - there are sufficient reasons to believe these interventions are helping to slow the spread of the virus.

And while how all of that plays out over the next year or longer is anyone's guess, for now, that is buying time for governments and healthcare systems to better prepare for a second and possibly 3rd wave of the virus over the next 12 to 18 months.

RPP 1 Lembar Bahasa Inggris Kelas XI Semester 2 K13 Revisi 2020

ngepost March 31, 2020 Add Comment

ngepost

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HHS/FDA: EUA For Hydroxychloroquine Donated To The Strategic National Stockpile

Credit Wikipedia

#15,156

A week ago, in CDC: Therapeutic Options for COVID-19 Patients For Clinicians, we looked at several investigational drugs for the treatment of COVID-19, including Hydroxychloroquine and Chloroquine - either alone - or in concert with Azithromycin.

While both drugs have been used for years in the treatment of malaria and autoimmune diseases - they are not without the potential for serious side effects - including cardiac arrhythmias. The addition of azithromycin may potentially exacerbate those risks.

The evidence suggesting either drug would be effective against COVID-19 is fairly slim, but a week ago New York State began an ad hoc trial of Hydroxychloroquine under the compassionate use rule following several small studies (see here, and here) that suggested the drug might be of value.

Late yesterday the HHS announced they had received a donation of 30 million doses of hydroxychloroquine (from Novartis) and 1 million doses of Chloroquine (from Bayer) for the Strategic National Stockpile (SNS).

The statement further states that the FDA has issued a limited emergency-use authorization (EUA) to allow both drugs "to be distributed and prescribed by doctors to hospitalized teen and adult patients with COVID-19, as appropriate, when a clinical trial is not available or feasible."

While none of this is a signal that this drug combination has been proven effective in the treatment of COVID-19, it should make it easier for COVID-19 patients to receive the drug, and will hopefully speed up the evaluation of its efficacy against this novel coronavirus.

HHS accepts donations of medicine to Strategic National Stockpile as possible treatments for COVID-19 patients

FDA issues emergency use authorization for donated hydroxychloroquine sulfate, chloroquine phosphate

The U.S. Department of Health and Human Services (HHS) today accepted 30 million doses of hydroxychloroquine sulfate donated by Sandoz, the Novartis generics and biosimilars division, and one million doses of chloroquine phosphate donated by Bayer Pharmaceuticals, for possible use in treating patients hospitalized with COVID-19 or for use in clinical trials. These and other companies may donate additional doses, and companies have ramped up production to provide additional supplies of the medication to the commercial market.

“President Trump is taking every possible step to protect Americans from the coronavirus and provide them with hope,” said HHS Secretary Alex Azar. “Scientists in America and around the world have identified multiple potential therapeutics for COVID-19, including chloroquine and hydroxychloroquine. The President’s bold leadership and the hard work of FDA and HHS’s Assistant Secretary for Preparedness and Response have succeeded in securing this large donation of medicine. We’ll continue working around the clock to get American patients access to therapeutics that may help them battle COVID-19, while building the evidence to evaluate which options are effective.”

HHS’ Office of the Assistant Secretary for Preparedness and Response (ASPR) worked with colleagues within HHS, the companies, the Department of State, and the Department of Homeland Security to secure the donated shipments. Given the importance of understanding the efficacy of these medications for the treatment and prevention of COVID-19, federal agencies, such as the National Institutes of Health and ASPR’s Biomedical Advanced Research and Development Authority (BARDA), are working together to plan clinical trials.

The U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) to BARDA to allow hydroxychloroquine sulfate and chloroquine phosphate products donated to the Strategic National Stockpile (SNS) to be distributed and prescribed by doctors to hospitalized teen and adult patients with COVID-19, as appropriate, when a clinical trial is not available or feasible.

The EUA requires that fact sheets that provide important information about using chloroquine phosphate and hydroxychloroquine sulfate in treating COVID-19 be made available to health care providers and patients, including the known risks and drug interactions.

The SNS, managed by ASPR, will work with the Federal Emergency Management Agency (FEMA) to ship donated doses to states. The SNS does not regularly stock either drug.

Hydroxychloroquine sulfate and chloroquine phosphate are oral prescription drugs approved to treat malaria and other diseases. Although there are no currently approved treatments for COVID-19, both drugs have shown activity in laboratory studies against coronaviruses, including SARS-CoV-2 (the virus that causes COVID-19). Anecdotal reports suggest that these drugs may offer some benefit in the treatment of hospitalized COVID-19 patients. Clinical trials are needed to provide scientific evidence that these treatments are effective.

When the Secretary of Health and Human Services declares that issuance of an EUA is appropriate, the FDA has the regulatory emergency use authority to facilitate access to unapproved medical countermeasures or unapproved uses of approved medical countermeasures needed to prepare for and respond to chemical, biological, radiological and nuclear threats.

An EUA may be issued if the FDA determines that, among other criteria, the known and potential benefits of the product, when used to diagnose, prevent, or treat the identified disease or condition, outweigh the known and potential risks of the product, and there are no adequate, approved, available alternatives. Emergency access to a medical product under an EUA is separate from use of a medical product under an investigational drug application.

The FDA has issued an EUA for multiple diagnostics, for several other medical devices such as respiratory devices and a system for decontaminating them to allow for their reuse, and ventilators and ventilator equipment for the COVID-19 response. This is the first EUA for a drug related to the COVID-19 response.

Sandoz and Bayer are the latest companies stepping up to strengthen the U.S. response to COVID-19, and ASPR is working with additional companies willing to donate doses of hydroxychloroquine and chloroquine. Companies interested in donating goods or services should contact fema-nrcc-iagsupv@fema.dhs.gov or visit https://www.fema.gov/coronavirus/how-to-help.

Use of the donated medications is expected to help ease supply pressures for the drug, and the FDA is also working with manufacturers of chloroquine and hydroxychloroquine to increase production to ensure these drugs also remain available for patients dependent on them for treatment of malaria, lupus and rheumatoid arthritis. Some states and retail pharmacies also have taken action to preserve the supply of these and other drugs for these patients.

In addition to accepting and distributing the donated medicines, HHS is funding clinical trials of two drugs, Kevzara (sarilumab) and remdesivir, and is supporting the earlier development of multiple potential therapeutic treatments, vaccines, and diagnostic tests for COVID-19.

HHS continues to seek partners for COVID-19 medical countermeasures, and offers multiple ways to submit proposals for potential products or technologies.

(Continue . . . )

JAMA: A Framework for Rationing Ventilators & ICU Beds During the COVID-19 Pandemic

Credit Wikipedia

#15,155

As the number of severe COVID-19 cases increases - our nation, and the world - faces an unprecedented ventilator (and critical care bed) shortage. Over the past week, in Contemplating A Different `Standard of Care and HHS ASPR-TRACIE: COVID-19 Crisis Standards of Care Resources we've looked at this growing dilemma.

While it is highly probable that any COVID-19 ARDS (acute respiratory distress syndrome) patient who is ill enough to require these sorts of interventions will die without them, being admitted to the ICU or being put on a ventilator is far from a panacea.

In Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State by Matt Arentz, MD1; Eric Yim, MD2; Lindy Klaff, MD2; et al, published by JAMA, of 21 cases included in the study (mean age, 70 years [range, 43-92 years]; 52% male), 71% required mechanical ventilation, 67% had died, 24% remained in the ICU, and only 9.5% had been discharged from the ICU at the time of publication.

Putting a COVID-19 patient on a ventilator - particularly someone who is elderly, and who has significant comorbidities - is a heroic, last ditch, but often futile attempt to buy some time for the body to heal itself. Being put on a vent is an invasive, traumatic, and difficult course of treatment, which can lead to other life threatening complications including Ventilator-associated pneumonia (VAP).

Like CPR, is isn't nearly as successful in real life as it is in the movies.

Even when they are not faced with a shortage of ventilators or ICU beds, doctors must decide on which interventions are most appropriate based on how likely a patient is to benefit from them. Decisions to withhold care are made every day.

But during a pandemic, with limited resources, doctors can have more potentially salvageable patients than critical care beds or ventilators, and they need an ethical framework for deciding who gets access to scarce resources.

First a link to an editorial published in JAMA last week on the rationing of scarce resources. Follow the link to read it in its entirety. When you return, I'll have a postscript.

Viewpoint
March 27, 2020
A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic

Douglas B. White, MD, MAS1; Bernard Lo, MD2,3

Author Affiliations Article InformationJAMA. Published online March 27, 2020. doi:10.1001/jama.2020.5046

As the coronavirus disease 2019 (COVID-19) pandemic intensifies, shortages of ventilators have occurred in Italy and are likely imminent in parts of the US. In ordinary clinical circumstances, all patients in need of mechanical ventilation because of potentially-reversible conditions receive it, unless they or their surrogates decline. However, there are mounting concerns in many countries that this will not be possible and that patients who otherwise would likely survive if they received ventilator support will die because no ventilator is available.

In this type of public health emergency, the ethical obligation of physicians to prioritize the well-being of individual patients may be overridden by public health policies that prioritize doing the greatest good for the greatest number of patients.1 These circumstances raise a critical question: when demand for ventilators and other intensive treatments far outstrips the supply, what criteria should guide these rationing decisions?

(Continue . . . )

While it is true that the more ventilators we can put into service during a severe pandemic, the more lives we can probably save, the reality is many - perhaps even most - patients who need and receive this level of care will still succumb.

Although most people who get COVID-19 will experience only mild illness, and only a small percentage will become ill enough to require critical care treatment, it is worth considering now what your wishes would be should you find yourself in need of heroic medical interventions (for COVID-19 or any other severe illness).

Having a Living Will that specifies what types of medical treatment you would desire should you become incapacitated, and a legally binding Health Care Proxy that designates someone who can make medical decisions for you if you are unable to do so, makes sense, regardless of whether we are facing a pandemic.

Nearly every Thanksgiving I write about this - and the importance of keeping an updated medical history on every family member (see Reminder: Thanksgiving Is National Family History Day) - and I show ways to prepare and keep this vital information handy.

Elderly family members with chronic health problems, or those with terminal illnesses, may even desire a home DNR (Do Not Resuscitate) Order. Without legal documentation, verbal instructions by family members – even if the patient is in the last stages of an incurable illness – are likely to be ignored by emergency personnel.

Nine years ago, in On Having `The Conversation’, I described a close call for my elderly (then 86 y.o.) father, and his decision to make `end of life' plans. A little over a year later, in His Bags Are Packed, He’s Ready To Go, I told of his last few days in home hospice care, where he passed away peacefully in his sleep.

These are never pleasant things to think about, or discuss.

But perhaps more than ever, this is the right time to sit down with family and friends and make sure your wishes are known and respected.

15. The Art Review

admin March 30, 2020 Add Comment

admin

Media:

art magazines, newspapers of regional, national, international circulation
journals devoted to different art forms
radio + television broadcasts
the Internet (including blogs)

Audience:

the general public; educated, experienced readers, not necessarily art connoisseurs; people who are interested in art and possess some knowledge and/or intuition about art; people who expect to learn something new about art, or just see art from different perspectives
the members of the artistic discourse community
undecided people (as to whether to visit or not an exhibition)
people who missed the exhibition, or are unable to visit it, because of its distant location or lack of time and who are counting on the intelligent writing of the art reviewer in order to get an idea about a specific art event

Communicative purposes:

to inform the public about a current, or a just concluded artistic event
to promote an artist, an exhibition (gallery or museum, why not?)
to offer the audience an evaluation of the show/exhibition (as personal, but expert opinion)
to competently describe the most representative works
to competently interpret the meanings of the works, by offering the necessary evidence to support interpretation (from within and outside the work; iconographic + iconological interpretations) -- the previous purposes are those of art critique
to convince/persuade the public that the effort of visiting the exhibition is worthwhile, or, on the contrary -- similar to advertorials
to persuade the readers to become art exhibition goers/expand the art public
to educate oneself and the audience; develop artistic taste; fight against bad taste -- the last two purposes coincide with art education' purposes

Authors:

art critics, art historians, professional writers, journalists, philosophers (aestheticians, art theorists), authors of TV and radio series and programs, bloggers, church people, etc.
must have(s): enough experience to offer reliable evaluations; honesty; analytical, open mind; writing experience (offer that amount of information the audience needs; provide the right amount of scholarly insights without getting into too many boring details; maintain the reader's interest by varied rhetorical devices and discourse strategies); knowledge of the different (artistic) ideologies; knowledge of the art market.

Size: rather short, concise (500-600 words)

Move pattern and discourse strategies:

Move I (WHO + WHEN + WHERE)

catching the reader's attention by using the appropriate rhetorical devices (e.g. a rhetorical question, a paradox, a figure of speech)
offering specific information about the exhibition (when - the period; where - country, town, gallery, museum)
offering some information about the artist(s) (a very short biography)

Move II (WHAT; developing a controlling idea about the exhibition)

offering a general picture of the show and a first evaluation
different discourse strategies:

historical approach of the works (chronological)
an unpopular opinion
an analogy
what one expected vs. what one got
a comparison (between works of the same artist, of different artists, between styles)
the first impression (initial impact on the viewer)
the strength/originality of the artist
a question (either rhetorical or one that will be answered in the following move)

Move III (transition)

ensuring the coherence of the text
relating the previous information to the following

Move IV (reviewing works)

analysing artworks
offering partial evaluations

describing + interpreting +/- evaluating work 1
describing + interpreting +/- evaluating work 2, a.s.o.

Note: only the most appealing works are to be taken into consideration (the most representative for the artist/for the show; the ones that the critic liked best, or, on the contrary, disliked)

partial evaluations of the works are made according to some aesthetic criteria (implicit or explicit)
are usually positive, or holding some reservations; when the lack of value is quite obvious, evaluations are negative
rhetorical strategies include: avoiding ambiguity and clearly stating the value (using qualifiers and quantifiers- e.g. overstatements -hyperboles), or, on the contrary, cultivating ambiguity for the sake of politeness (e.g. understatements - litotes = saying too little); irony and rarely sarcasm.

Move V (concluding)

offering a final, on-the-whole evaluation of the exhibition
convincing the audience of the value of the show
persuading the audience to visit the exhibition
trying to predict the future development of an artist's work, based on the current show (speculating about future developments)
implicitly persuading collectors to buy/or not some works

Tasks:

1. Follow the link below. Read the text, which is an art review. What kind of a review is it? What do you think about the structure of the text? Comment on the style of the author. Does it make you curious about the exhiibition itself? Do you think it is a well written art review? Why?

https://docs.google.com/document/d/1PHRYxhu5k5q62ulB_IbqqpTaeCjvTTgKnr877r0qz-k/edit?usp=sharing

2. Read as many art reviews as possible while distinguishing the above moves and steps, rhetorical strategies, a.s.o.
3.Compare the interpretations and evaluations made by the critic with your own appreciation of the same works.
4.Consider an art review on prof. Bogdan Iacob's blog: http://iacobbogdan.wordpress.com/ . Give its title. Do you consider it a positive, or a negative review on the whole? Why? Which are the positive aspects and which are the negative ones? Do you have a clear image of that exhibition, based on this art review? Do the interpretations given to the analyzed works help you understand the artist's themes?

5.Choose an exhibition you have seen and try to write your own art review of that exhibition. (addressed to ITA: DEADLINE May 10, 2020 - sent as Word doc. attachment, NOT PDF! via e-mail, to be published and counting as your final grade this semester!!!)

Deadline for 1-4: APRIL 16, 2020)

Penetapan tanggal 1 Ramadhan dan 1 Syawal 1441 H | RAMADHAN

admin March 30, 2020 Add Comment

admin

Asalaamualaikum Wr Wb.
Anibar Studio - Selamat sore teman-teman selamat menyambut datangnya bulan suci ramadhan yang insyaa Allah tinggal hitungan hari, untuk itu saya akan memberikan informasi penting tentang Penetapan tanggal 1 Ramadhan dan 1 Syawal 1441 H di Al Azhar .

Dalam polemik yang sekarang kita hadapi yaitu sedang mengganasnya wabah virus corona atau yang biasa kita kenal dengan sebutan covid-19, kita juga jangan melupakan bahwa bulan suci ramadhan sebentar lagi akan datang ke tengah-tengah kita, dan sampaikan juga kabar berita ini kepada semua sanak saudara kita agar semuanya merasa bahagia.

Bahwasanya Al Azhar indonesia sudah memberikan informasi kepada jamaah yang tertulis dalam surat keputusan nomer 010/III/KEP/YPIA-P/1441.2020 untuk penetapan 1 Ramadhan dan 1 Syawal 1441 H dengan memperhatikan Surat Ketua dewan Syariah Al Azhar Nomor 019/YPIA-DSA/III/1441.2020 Tanggal 23 Rajab 1441 H / 18 Maret 2020 M tentang hasil Mudzakarah dan Rapat Pengurus Dewan Syariah dengan Pengurus YPI Al Azhar tanggal 18 Maret 2020

MEMUTUSKAN

Pertama : 1 Ramadhan 1441, jatuh pada hari jum'at , tanggal 24 April 2020
Kedua : 1 Syawal 1441, jatuh pada hari ahad, tanggal 24 Mei 2020

Sekian informasi tentang Penetapan tanggal 1 Ramadhan dan 1 Syawal 1441 H semoga bermanfaat.
Mohon bantuanya jika ada kesalahan dengan menulis di kolom komentar menggunakan bahasa yang baik dan sopan,

Aplikasi Pembelajaran gratis untuk proses belajar mengajar dari rumah | DirumahAja

admin March 30, 2020 Add Comment

admin

Asalamualaikum Wr Wb.
Anibar Studio - Pada kesempatan kali ini akan memberikan informasi tentang Aplikasi Pembelajaran gratis untuk proses belajar mengajar dari rumah.

Untuk bapak dan ibu guru yang saya hormati, dalam meminimalisir penyebaran wabah virus corona atau covid-19 yang sekarang sedang membuat hawatir seluruh dunia, maka sudah hampir beberapa provinsi di indonesia yang menggunakan prosess pembelajaran dari rumah, ada banyak sekali aplikasi yang bisa anda gunakan untuk prosess interasksi guru dan murid dari rumah masing-masing, dan artikel ini akan memberikan anda beberapa pilihan yang mungkin anda bisa gunakan juga untuk prosess belajar mengajar dari rumah, untuk rincianya akan saya tulis di bawah ini.

RUMAH BELAJAR

Aplikasi yang di sediakan oleh pemerintah ini sangat bisa anda gunakan, silahkan guru mendaftar sebagai guru dan murid mendaftar sebagai murid, kalau dilihat dari tampilanya aplikasi pemerintah ini menggunakan software open source yang bernama moodle, tapi ingat, walaupun open source tapi jangan pernah meragukan kehandalan software ini, karena software ini sudah banyak digunakan di ber bagai sekolah bahkan kampus ternama sekalipun, bagi anda juga yang sudah terbiasa menggunakan aplikasi moodle, maka rumah belajar inipun pasti tidak jauh berbeda dengan moodle yang biasa anda gunakan.
GOOGLE CLASSROOM

Saya yakin semua orang yang mempunyai hp android, pasti memiliki email, dan saya yakin kebanyakan dari email yang digunakan adalah email GMAIL, jika anda memiliki email gmail, maka anda sudah bisa menikmati fasilitas yang namanya Google Classroom,
Google Classroom ini sangat mudah sekali anda gunakan, di dalam Google Classroom ini anda bisa share materi pembelajaran, bisa membuat kuis menggunakan google form dan juga bisa berinteraksi dengan murid, bahkan anda juga bisa menggunakan video call yang di pasilitasi oleh google seperti GOOGLE DUO atau GOOGLE MEET.
MOODLE

Seperti yang sudah saya singgung di awal, moodle adalah sebuah aplikasi open source yang bisa anda gunakan untuk prosess belajar mengajar dari rumah, modle ini open source jadi bisa anda gunakan dan anda kelola dengan bebas, tetapi ada banyak hal yang harus anda siapkan untuk menggunakan aplikasi moodle ini, diantaranya anda harus memiliki domain, hosting dan anda mengerti cara menginstall\ dan menggunakanya, hemat saya sebaiknya jika bapak/ibu guru ingin menggunakan aplikasi moodle ini, silahkan berkordinasi dengan guru IT di sekolah mungkin beliau yang bisa lebih menjelaskannya kepada bapa ibu guru semuanya.

Nah itu sekian pembahasan dari saya tentang Aplikasi Pembelajaran gratis untuk proses belajar mengajar dari rumah, mungkin bisa bermanfaat buat bapak dan ibu guru semuanya.

Bila ada kekurangan dan kesalahan, mohon bantu dengan menuliskan komentar di bawah dengan baik dan sopan, Terimakasih banyak.

Agar agar sirap ros

menu bosan dalam masa PKP ni...

movement restriction order day 13th

bertabah lah ya... semuga covid-19 cepat berlalu...

yang boring2 tu boleh lah mencuba agar agar sirap ros n untuk sejukkan tekak... jom kak rose kongsikan resepinya... mudah jer kan.. tapi kak rose buat separug je dari adunan ni... pun dah banyak untuk kami.. so kalau tak ramai orang dalam rumah, buat lah sikit jer. selamat mencuba.

Bahan bahan:

20 gram agar-agar bertali

230 gram gula atau secukupnya

4 mug air

1 helai daun pandan

Sedikit gula batu, jika suka

Sedikit sirap ros

Sedikit pewarna merah, jika suka

Cara cara

Masak agar agar dgn air sehingga agar agar hancur. Kemudian masukkan gula secukup manis dan kacau hingga adunan larut dan sebati.

Masukkan pati sirap dan daun pandan. Biarkan hingga mendidih.

Tapis dan tuang ke dalam loyang/bekas agar agar yang telah dibasahkan terlebih dahulu.

Sejukkan seketika sebelum dimasukkan dalam peti sejuk.

Syarah Tentang Istigfar dan Taubat

admin March 29, 2020 Add Comment

admin

"Rasulullah Shallallahu Alaihi wa Sallam bersabda, 'Demi Allah, sesungguhnya aku minta ampun kepada Allah dan bertaubat kepada-Nya dalam sehari lebih dan tujuh puluh kali." (H.R. Al-Bukhari dalam Fathul Bari, (11/101), No. 6307).Shahabat yang meriwayatkan hadits ini adalah Abu Hurairah Radhiyallahu Anhu. Abu Hurairah Radhiyallahu Anhu berkata, "Aku tidak melihat orang banyak melakukan istighfar

Sheng Yuan SY1465: Marvel Brick-built Infinity Gauntlet with Thanos Figs Preview

admin March 29, 2020 Add Comment

admin

Looking great! I thought the gems light up but I don't see any batteries or power sources included so it's better to assume they won't light up. Kudos to SY though for making movable fingers!

This set is really similar to what Sheng Yuan has done with Mjolnir, Stormbreaker, Stark Gauntlet, and Captain America's shield.

Where to buy? Try our affiliate link:

http://bit.ly/2TzFJmQ

Using this link, browsing with it, and eventually buying from any store will help support the page without additional cost for you.

Join our subreddit at reddit.com/r/downtheblocks!

Share your thoughts below or through facebook.com/downtheblocks and please like the page for more previews, reviews, MOCs, and more!

Italy: 5,217 New Covid-19 Cases, 756 Deaths

#15,154

Three weeks after the imposition of a nationwide lockdown, the number of new COVID-19 cases has begun to level off in Italy, dropping today to just over 5,200 cases. Deaths, which are always a lagging indicator, continue to run very high with 756 new fatalities announced over the past 24 hours.

To date Italy has confirmed 97,689 COVID-19 cases and 10,779 deaths. Both numbers, however, are likely to be significant undercounts.

The preliminary CFR continues to rise, particularly in hard hit Lombardy, where today it broke 15.5% for the first time. Across the whole of Italy, the death rate among known cases is just over 11%.

Both numbers are far higher than anything we've seen elsewhere in the world.

The reasons behind Italy's extraordinary CFR aren't clear, although an older population with a high incidence of comorbidities, a serious undercounting of mild and moderate cases, multi-generation families living under one roof, and an overwhelmed healthcare system have all been mentioned as contributing factors.

Hopefully we are starting to see the benefits of strict social distancing beginning to take place in Italy.

Covid-19 - Situation in Italy

The situation in Italy: 29 March 2020, 18.00

CURRENTLY POSITIVE 73880
DECEASED 10779
HEALED 13030

Press conference at 6 pm on March 29th

97689 total cases, currently positive people are 73,880, 10779 died and 13,030 recovered.

Among the 73,880 positives:
42.558 are in home isolation
27386 hospitalized with symptoms
3906 in intensive care
Read the tables
Italy situation as of March 29th
Breakdown by provinces as of March 29th
Consult the map
Situation in Italy - desktop version
Situation in Italy - mobile version

RPP 1 Lembar Bahasa Inggris Kelas X Semester 2 K13 Revisi 2020

ngepost March 29, 2020 Add Comment

ngepost

Format Baru RPP 1 Lembar SMA selanjutnya merupakan RPP Bahasa Inggris SMA. Dokumen ini sudah tersusun mencakup bagian penting komponen utama seperti; Tujuan Pembelajaran, Langkah Pembelajaran dan Penilaian Pembelajaran (assessment). Sebagaimana merujuk pada surat edaran no 14 tahun 2019, tentang penyederhanaan RPP.

CDC: The Apple COVID-19 APP & Online Tool

#15,153

This week Apple Inc., in cooperation with the CDC, HHS, and the White House Coronavirus task force, released a free COVID-19 screening app for apple devices, and made a web-based version available for those without an Apple device.

I've downloaded both the app, and have tried the web-based version, and either will provide a way to evaluate your symptoms and risk factors for COVID-19, and help you decide if you need to contact your doctor or get a test.

The CDC's statement on this app's release follows:

CDC Statement on COVID-19 Apple App

Media Statement
For Immediate Release: Friday, March 27, 2020

Contact: Media Relations
(404) 639-3286

Today, Apple Inc. – in partnership with the White House Coronavirus Task Force and the U.S. Department of Health and Human Services, including the Centers for Disease Control and Prevention (CDC) – released an app and website that guides Americans through a series of questions about their health and exposure to determine if they should seek care for COVID-19 symptoms. The tool provides CDC recommendations on next steps including guidance on social distancing and self-isolating, how to closely monitor symptoms, recommendations on testing, and when to contact a medical provider.

This launch is a direct response to President Trump’s call for an all-of-America approach and will help Americans heed CDC guidelines and self-isolate to limit COVID-19 transmission.

Users can download the free app from Apple’s App Store or access the tool online at www.apple.com/covid19external icon. Everyone has a role to play as we work together to stop the spread of COVID-19. The latest recommendations can be found at www.coronavirus.govexternal icon.

South Korea's Slowly Creeping Case Fatality Rate