Later On

A blog written for those whose interests more or less match mine.

Archive for April 9th, 2020

Best healthcare system in the world? Cash-starved hospitals and doctor groups cut staff amid pandemic

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I would say that there is something fundamentally wrong with the way the US approaches healthcare if the system used is laying off doctors and nurses exactly at the time they are most needed. Indeed, that would seem obvious to me.  But of course that is what happens when your medical system is run as a profit-seeking enterprise rather than as a public service.

Shane Harris, Justin Sondel, and Gregory S. Schneider report in the Washington Post:

Hospitals across the country have deferred or canceled non-urgent surgeries to free up bed space and equipment for covid-19 patients. But that triage maneuver cut off a main source of income, causing huge losses that have forced some hospitals to let go of health-care workers as they struggle to treat infected patients.

Last week, Bon Secours Mercy Health, which runs 51 hospitals in seven states, announced it would furlough 700 workers. On Wednesday, Ballad Health, which operates 21 hospitals across Tennessee and southwest Virginia, delivered the same bad news to 1,300 employees and said executives would take pay cuts. Nurses at Children’s National Hospital in the District were informed this week that they must take off one week, using either vacation time or, if they have none, unpaid leave.

Hospital executives and analysts emphasize that not all the furloughed or fired workers are directly involved in treating covid-19 patients. Others say the furloughs help reduce the number of people in hospitals, slowing the spread of the virus.

But the absences have put a strain on doctors, nurses and other health-care workers treating a surge of patients that has already stretched some health-care systems to the breaking point. Remaining front-line workers face longer hours, and some have seen their pay cut and benefits reduced.

For hospitals already in bad financial shape before the outbreak, the loss of income has raised doubts about their ability to keep treating patients. . .

Continue reading.

Written by Leisureguy

9 April 2020 at 6:20 pm

The Cantillon Effect: Why Wall Street Gets a Bailout and You Don’t

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Matt Stoller has another interesting column in BIG. From the column (but read the whole thing):

. . . An 18th century French banker and philosopher named Richard Cantillon noticed an early version of this phenomenon in a book he wrote called ‘An Essay on Economic Theory.’ His basic theory was that who benefits when the state prints a bunch of money is based on the institutional setup of that state. In the 18th century, this meant that the closer you were to the king and the wealthy, the more you benefitted, and the further away you were, the more you were harmed. Money, in other words, is not neutral. This general observation, that money printing has distributional consequences that operate through the price system, is known as the “Cantillon Effect.” . . .

Cantillon went on to discuss how money would flow, basically noting that rich people near the mine would spend it on 18th century luxuries like servants and meat pies, prompting a general rise in prices. Eventually the money would get out to the populace, but until it did, working people would have to pay higher prices without access to the new money that mine owners had. So there would be inflation, with uneven distribution of purchasing power.

There’s also a China angle. Cantillon noted that a kingdom discovering gold would in the long-run erode its own manufacturing base, that the non-neutrality of money also had geopolitical consequences.

Here’s how he put it:

When the overabundance of money from the mines has diminished the number of inhabitants in a state, accustomed those who remain to excessive expenditures, raised the prices of farm products and the wages for labor to high levels, and ruined the manufactures of the state by the purchase of foreign products by property owners and mine workers, the money produced by the mines will necessarily go abroad to pay for the imports. This will gradually impoverish the state and make it, in a way, dependent on foreigners to whom it is obliged to send money every year as it is extracted from the mines. The great circulation of money, which was widespread in the beginning, ceases; poverty and misery follow and the exploitation of the mines appears to be only advantageous to those employed in them and to the foreigners who profit thereby

This is approximately what has happened to Spain since the discovery of the Indies. As for the Portuguese, since the discovery of gold mines in Brazil, they have nearly always used foreign articles and manufactured goods; and it seems that they worked the mines only for the account and advantage of foreigners. All the gold and silver that these two states extract from the mines does not supply them with more precious metal in circulation than others. England and France usually have even more.

This dynamic is exactly what happened with the United States since the 1960s, if you replace the idea of gold mines with the ability to print dollars. In 1971, Keynesian economist Nicholas Kaldor said that dollar hegemony would turn “a nation of creative producers into a community of rentiers increasingly living on others, seeking gratification in ever more useless consumption, with all the debilitating effects of the bread and circuses of imperial Rome.” [cf. the multi-billion-dollar professional sports and gambling and entertainment industries — LG]

Today what Cantillon observed is far more extreme than it was in the 1960s; it is hedge funds, private equity, and bankers who have benefitted from the money printing, and the foreigners who benefit from our money printing are increasingly Chinese and foreign manufacturers.

This theory doesn’t imply that money creation is always biased towards the powerful, only that how money travels matter. There is no inherent money neutrality, such neutrality must be constructed by institutional arrangements. Much of the New Deal in the 1930s and 1940s was designed to build alternative channels for lending so that small business, industry and individuals could have access to money as quickly as big banks.

The Reconstruction Finance Corporation, government procurement, the Federal Housing Administration, the Federal Reserve, agricultural credit supports, Federal Home Loan Banks, credit unions, and regulations like Regulation Q were all mechanisms to insure the flow of money would be neutral. . .

Later:

here’s a paragraph of Yellen explaining that the Fed economists were stupid and intellectually corrupt, but doing it so that anyone listening would fall asleep rather than get outraged.

Written by Leisureguy

9 April 2020 at 4:58 pm

Aztecs beyond their sacrificial rituals

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Matthew Restall writes in History Today:

Everything you thought you knew about the Aztecs is wrong. Or, as Camilla Townsend more tactfully puts it at the start of her wonderful new book: ‘The Aztecs would never recognize themselves in the picture of their world that exists in the books and movies we have made.’

The picture to which Townsend refers is perhaps best symbolised for British readers by the image on the cover of the original Angry Aztecs volume in Terry Deary’s Horrible Histories series (1997): a cartoon depicts an Aztec warrior holding a fresh human heart, saying ‘His heart was in the right place’ (covers of other editions show variations on this theme, save for a 2014 edition depicting a rat in Aztec warrior garb). The joke works because the association of the Aztecs with the practice of human sacrifice runs deep and wide: most people who know only one thing about the Aztecs know that they are famous for sacrificing people to their gods; and those who are more familiar with the Aztecs – including those who, for example, teach in schools or universities – tend to think of Aztec culture as one in which bloodthirsty rituals and exotic superstitions played central roles.

In recent decades, a growing number of scholars have pointed out the many ways and reasons why and how that perception is distorted, if not plain wrong. The Aztecs, it turns out, were no more bloodthirsty or savage than anybody else in the world – including the early modern Europeans who systematically demonised them. Their culture was part of a civilisation (that of the Nahuas of central Mexico) that was as sophisticated and accomplished as that of those Europeans who sought to destroy it.

But fighting negative stereotypes and replacing them with something less prejudicial, less sensationalist, more multifaceted and more accurate has proved to be an uphill battle. Franciscan friars in the 16th century, along with other Catholic priests and chroniclers, created a portrait of Aztec religion, politics and social practices that was designed to justify the often-violent imposition of Spanish colonisation and forced conversion to Christianity. That portrait took root and flourished for centuries. The era of the global triumph of European empires was fertile ground for derogatory views of ‘barbarian’ societies swept aside by civilisation’s progress. When new fields of study and new evidence on the Aztec past emerged – archaeological discoveries from beneath Mexico City, for example, or unpublished manuscripts written in Nahuatl in the early colonial period – they tended to be deployed to confirm, or at best modify, that deep-rooted stereotype, not upend it.

What has changed? As Townsend explains in an appendix to Fifth Sun, not until the 21st century was there a convergence of scholars with a profound grasp of colonial-era Nahuatl, a willingness to challenge the well-established portrait of the Aztecs on which generations of scholars had built their careers and a readily available body of sources written in the early colonial decades by the descendants of the Aztecs (mostly in Nahuatl). Townsend makes particular use of a genre of documentation called xiuhpohualli by its Nahua writers. Literally meaning ‘yearly account’, such sources were more like community histories. Townsend presented the xiuhpohualli in greater detail in an earlier book, Annals of Native America (2016), so here they stand as the largely invisible foundation to her reconstruction of Aztec history. But, significantly, they allow her to . . .

Continue reading.

Written by Leisureguy

9 April 2020 at 3:34 pm

Posted in Daily life

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A promising COVID-19 treatment gets fast-tracked

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George Spencer writes for Johns Hopins University:

“Mindboggling.” That’s how Aaron Tobian, a pathologist and director of the Division of Transfusion Medicine at Johns Hopkins Hospital, describes the speed of the spread of the COVID-19 virus—and Johns Hopkins’ lightning-fast response to the pandemic.

“When it started to hit the home front and there were no treatments, everybody started saying, ‘We need to act, and we need to act now,'” says Tobian, who has a joint appointment in the Department of Epidemiology at the Bloomberg School of Public Health. “And that’s when people at Hopkins started coming together and said, ‘Let’s try to do something here.'”

That “something” is one step closer to reality. Under the leadership of immunologist Arturo Casadevall, Johns Hopkins has spearheaded the use of a convalescent serum therapy, a potential COVID-19 treatment—with an old pedigree. On March 24, the U.S. Food and Drug Administration began allowing researchers to request emergency authorization for its use. Within three days hospitals in Houston and New York City started treatments, and now under a FDA “expanded access program” soon “a very large number” of U.S. hospitals will follow suit, according to Tobian.

On Friday, the FDA approved a clinical trial specifically for Johns Hopkins that will allow its researchers to further test the therapy as a means of preventing otherwise healthy people, notably front-line medical staff, from getting sick. FDA approval is pending for a second Hopkins clinical trial on patients who are slightly or moderately ill to see if the serum will keep them out of ICUs and help bring them back to health.

In recent weeks, Casadevall has led a team of physicians and scientists from around the United States to establish a network of at least 40 hospitals and blood banks in 20 states that can begin collecting, isolating, and processing blood plasma from COVID-19 survivors. People who recover from an infection develop antibodies that circulate in the blood and can neutralize the pathogen. Researchers hope to use the technique to treat critically ill COVID-19 patients and boost the immune systems of health care providers and first responders. Currently there are no proven drug therapies or effective vaccines for treating the novel coronavirus.

“At the end of January, I knew this disease was going to get out of China, and I knew there was a huge history of the use of plasma and serum in the 20th century,” says Casadevall, a Bloomberg Distinguished Professor of molecular microbiology and immunology and infectious diseases at the Johns Hopkins Bloomberg School of Public Health and School of Medicine. “This [medical effort] has become a juggernaut… We’re racing to deploy this.”

Thousands of survivors might soon line up to donate their antibody-rich plasma, according to physicians. But that’s only if early promising studies on the therapy done in China are confirmed by U.S. trials that show “dramatic effects and improvements” in patients, according to Tobian. He is optimistic the therapy will do just that. “I absolutely think this could be the best treatment we have for the next few months.” . . .

Continue reading. There’s more.

Written by Leisureguy

9 April 2020 at 12:58 pm

The COVID-19 vaccine development landscape

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Tung Thanh Le writes in Nature:

The genetic sequence of SARS-CoV-2, the coronavirus that causes COVID-19, was published on 11 January 2020, triggering intense global R&D activity to develop a vaccine against the disease. The scale of the humanitarian and economic impact of the COVID-19 pandemic is driving evaluation of next-generation vaccine technology platforms through novel paradigms to accelerate development, and the first COVID-19 vaccine candidate entered human clinical testing with unprecedented rapidity on 16 March 2020.

The Coalition for Epidemic Preparedness Innovations (CEPI) is working with global health authorities and vaccine developers to support the development of vaccines against COVID-19. To facilitate this effort, we have developed and are continuously maintaining an overview of the global landscape of COVID-19 vaccine development activity. Our landscape database includes vaccine development programmes reported through the WHO’s authoritative and continually updated list, along with other projects identified from publicly available and proprietary sources (see Supplementary Box 1). The landscape provides insights into key characteristics of COVID-19 vaccine R&D and serves as a resource for ongoing portfolio management at CEPI. We have also shared our landscape information with others in the global health ecosystem to help improve coordination in the COVID-19 outbreak response and enable global resources and capabilities to be directed towards the most promising vaccine candidates.

COVID-19 vaccine R&D landscape

As of 8 April 2020, the global COVID-19 vaccine R&D landscape includes 115 vaccine candidates (Fig. 1), of which 78 are confirmed as active and 37 are unconfirmed (development status cannot be determined from publicly available or proprietary information sources). Of the 78 confirmed active projects, 73 are currently at exploratory or preclinical stages. The most advanced candidates have recently moved into clinical development, including mRNA-1273 from Moderna, Ad5-nCoV from CanSino Biologicals, INO-4800 from Inovio, LV-SMENP-DC and pathogen-specific aAPC from Shenzhen Geno-Immune Medical Institute (Table 1). Numerous other vaccine developers have indicated plans to initiate human testing in 2020. . .

Continue reading. There’s more.

Written by Leisureguy

9 April 2020 at 12:51 pm

A contemplative video on comparative cognition

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This video is a kind of informative meditation — it was interesting because of the mix of modes. Worth watching, IMO, though it requires a relaxed mindset.

Written by Leisureguy

9 April 2020 at 8:07 am

Posted in Science, Video

MyVitals app should help a lot with the pandemic

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It is to be released in May. Watch this brief video (sound not needed):

Aaron Derfel reports in the Montreal Gazette:

Medical staff and patients at the Jewish General Hospital will be using a potentially powerful new tool in the fight against the COVID-19 pandemic in the coming days — a smartphone app that will allow users to monitor their vital signs by simply staring into their phone’s screen.

The medical-grade app, developed by a Tel Aviv company in collaboration with a Montreal health technology firm, is believed to be the first of its kind in the world. Although the app was not designed with COVID-19 in mind, the Jewish General will be using it in three distinct ways during the pandemic.

First, starting as early as next week, triage nurses will use the app to screen arriving emergency-room patients for telltale symptoms of the respiratory illness. Without having to touch a patient, a triage nurse will hold a smartphone in front of a patient’s face and in less than a minute the app will measure three vital signs: heart rate, respiratory rate and oxygen saturation in the blood.

Patients with abnormally elevated heart and respiratory rates as well a low oxygen-saturation reading will be isolated immediately for further investigation.

Second, the Côte-des-Neiges hospital will use the app in its COVID-19 wards, giving it to some of the patients so they can monitor their vital signs in their negative-pressure rooms. This should result in nurses entering those rooms less frequently, which in turn will help conserve the scarce supply of gloves, masks and other personal protective equipment worn by medical staff.

Third, the app will be downloaded by some vulnerable patients in Montreal’s west end — which has reported the highest concentration of COVID-19 cases in the city — to let people monitor their symptoms at home.

The hospital is completing the testing of the app’s accuracy on-site and, given the early positive results, has shared it with the Quebec Health Ministry. The provincial government is considering introducing the smartphone technology across the province with the goal of reducing the size of a possible second wave of COVID-19 cases in the next few months.

Had the app existed widely in the general population before the pandemic struck this year, its developers say, the technology could have slowed the spread of the novel coronavirussince some infected users would have known to self-isolate at home.

Dr. Lawrence Rosenberg, executive director of the health authority in charge of the Jewish General, said the app has the potential to be what he called a game-changer.

“It should allow us to pick up people who are virus-positive but who have subtle or early symptoms that we wouldn’t be able to pick up previously until they came to an emergency room,” Rosenberg said.

Despite 21st-century advances in medical technology, . . .

Continue reading.

Written by Leisureguy

9 April 2020 at 8:04 am

Organism 46-B and the Rockwell R3

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When I still lived in California, I ordered this Plisson HMW 12 from Atkinson’s in Vancouver, which now is just a ferry-ride away (though ferry service is now greatly curtailed due to the COVID-19 pandemic and shutdown). It’s quite a nice brush, and I particularly liked the lather it made today.

Now unpacked, I found and thus could use my Organism 46-B shaving soap, a great pleasure — as is the Rockwell 6S’s R3 baseplate.

Three passes, a perfectly smooth visage, and a splash of the aftershave to send me on my way.

Written by Leisureguy

9 April 2020 at 7:49 am

Posted in Shaving

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