Later On

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

Archive for April 21st, 2020

Esperanto as a home project

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A couple of days ago I blogged a brief post about my current Esperanto studies, and I’ve revised and extended that post to serve as a resource guide — it’s one of those posts that I will continue to update as I learn more, but it already contains a lot. (The URL also changed — the link is the new URL.)

It’s a good home project because the web has a ton of resources, and if you have school-age children or teenagers, learning Esperanto as a first foreign language will greatly hlp them with any subsequent languages they learn (as explained in a video now included in the post).

Written by Leisureguy

21 April 2020 at 3:22 pm

Get a pulse oximeter

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I have one, and I use it. Richard Levitan, an ER doctor, reports in the NY Times:

I have been practicing emergency medicine for 30 years. In 1994 I invented an imaging system for teaching intubation, the procedure of inserting breathing tubes. This led me to perform research into this procedure, and subsequently teach airway procedure courses to physicians worldwide for the last two decades.

So at the end of March, as a crush of Covid-19 patients began overwhelming hospitals in New York City, I volunteered to spend 10 days at Bellevue, helping at the hospital where I trained. Over those days, I realized that we are not detecting the deadly pneumonia the virus causes early enough and that we could be doing more to keep patients off ventilators — and alive.

On the long drive to New York from my home in New Hampshire, I called my friend Nick Caputo, an emergency physician in the Bronx, who was already in the thick of it. I wanted to know what I was facing, how to stay safe and about his insights into airway management with this disease. “Rich,” he said, “it’s like nothing I’ve ever seen before.”

He was right. Pneumonia caused by the coronavirus has had a stunning impact on the city’s hospital system. Normally an E.R. has a mix of patients with conditions ranging from the serious, such as heart attacks, strokes and traumatic injuries, to the nonlife-threatening, such as minor lacerations, intoxication, orthopedic injuries and migraine headaches.

During my recent time at Bellevue, though, almost all the E.R. patients had Covid pneumonia. Within the first hour of my first shift I inserted breathing tubes into two patients.

Even patients without respiratory complaints had Covid pneumonia. The patient stabbed in the shoulder, whom we X-rayed because we worried he had a collapsed lung, actually had Covid pneumonia. In patients on whom we did CT scans because they were injured in falls, we coincidentally found Covid pneumonia. Elderly patients who had passed out for unknown reasons and a number of diabetic patients were found to have it.

And here is what really surprised us: These patients did not report any sensation of breathing problems, even though their chest X-rays showed diffuse pneumonia and their oxygen was below normal. How could this be?

We are just beginning to recognize that Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature.

Pneumonia is an infection of the lungs in which the air sacs fill with fluid or pus. Normally, patients develop chest discomfort, pain with breathing and other breathing problems. But when Covid pneumonia first strikes, patients don’t feel short of breath, even as their oxygen levels fall. And by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia (as seen on chest X-rays). Normal oxygen saturation for most persons at sea level is 94 percent to 100 percent; Covid pneumonia patients I saw had oxygen saturations as low as 50 percent.

To my amazement, most patients I saw said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only became short of breath the day they came to the hospital. Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition.

In emergency departments we insert breathing tubes in critically ill patients for a variety of reasons. In my 30 years of practice, however, most patients requiring emergency intubation are in shock, have altered mental status or are grunting to breathe. Patients requiring intubation because of acute hypoxia are often unconscious or using every muscle they can to take a breath. They are in extreme duress. Covid pneumonia cases are very different.

A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were using their cellphones as we put them on monitors. Although breathing fast, they had relatively minimal apparent distress, despite dangerously low oxygen levels and terrible pneumonia on chest X-rays.

We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath. . .

Continue reading. There’s much more. Later in the article:

There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.

Pulse oximetry is no more complicated than using a thermometer. These small devices turn on with one button and are placed on a fingertip. In a few seconds, two numbers are displayed: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting oxygenation problems and elevated heart rates.

Written by Leisureguy

21 April 2020 at 1:16 pm

The role of taxpayer subsidies in the obesity epidemic

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The structure of government and capitalism set up incentives that promote obesity.

Written by Leisureguy

21 April 2020 at 10:18 am

Is China preparing for war?

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Maajid Nawaz’s article describes a grim (and real) possibility, and the evidence he presents is sobering. Of course, if China should indeed launch a war, the US will be led by President Trump and his cronies and minions. Think about that. The article begins:

China is on a war footing. While the Covid-19 outbreak has exposed some grave political miscalculations behind decades of international strategic relations with Beijing, the depths of our problem are only just beginning to dawn on us.

Fuelled by our desire for ever cheaper goods, the world has collectively sleepwalked into a supply-side dependency on the People’s Republic.

The gamble had been pitched as a trade-off. China was expected to evolve democratic norms and embrace relations with the international community, while we got richer from globalisation. But we have been played.

Whether it’s clothing and factory-fashion, personal protective equipment or hardware parts, too many of our manufactured goods today rely on a ‘Made in China’ supply-chain. At the same time as it was busy taking control over our manufacturing, China was busy cloning western software, via her lackadaisical respect for international copyright rules.

And while the world relies on China for hardware, China avoids software dependency on outsiders by creating substitutes: TikTok to replace snapchat, Weibo instead of Twitter, WeChat & RenRen for Facebook. Indeed, there is an alternative Chinese version for almost any platform.

With manufactured goods and hardware ‘Made in China’, and software increasingly ‘Cloned in China’, what of natural resources? Through the ‘Belt & Road’ initiative — a ‘21st century Silk Road’ connecting China to Europe over a network of land and sea trade routes, the People’s Republic has embarked on huge infrastructure projects in 60 countries, including loans and construction projects that secure key ports and mines as collateral to China for payment.

Look to Pakistan, African or southeast Asian nations to see China’s rapid expansion in ownership of mines and ports. Look to the UK and China’s attempts to secure our telecoms industry via the Huawei deal, her recent purchase of British Steel, and her quest to secure the nuclear power industry. Beijing even secured a deal to develop British nuclear station Hinckley point C in Somerset, thus paving the way globally for China to enter the global market to dominate nuclear power.

Over decades, we have naively outsourced or lost manufacturing, software, natural resources and critical infrastructure to China. The economic benefits of globalisation are well trodden, yet as Covid-19 has shown, it has left our society vulnerable during a major crisis, unable to manufacture the most basic of necessities such as PPE. Meanwhile, China has achieved self-sufficiency.

While pursuing economic dominance abroad, China’s communist one-party state has centralised political power at home, gained unprecedented command over her own population via wide ranging and well-documented spy-tech, and placed anything between 1 to 2 million Uigur Muslims in gulags.

Considering what we know of colonial history, there is little room for doubt that China is at a pre-colonial stage. States at this stage attempt . . .

Continue reading.

Written by Leisureguy

21 April 2020 at 9:24 am

A wee shave — but a good shave

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The Wee Scot and the small tin of Klar Seifen shave soap are good for travel, being compact while still offering top quality shaves. The Baby Smooth is always a pleasure, and a splash of Klar Seifen aftershave finished the job with a fragrance of elegance.

Written by Leisureguy

21 April 2020 at 8:31 am

Posted in Shaving

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