purplekow

"I am going to win the election". Said Hillary before being trumped "I believe the way out is that way" he said pointedly "Time to send people back to work" said trump contagiously

Got a call today from the woman who cleans for me on an infrequent basis. We made arrangements for her to come to my house while I was out. I will have been gone for several hours before she arrives. She will use gloves and a mask that I provide. She will leave several hours before I return home, She has been staying home for the most part except for shopping, so I feel the risk is minimal. The amount of time between out being in the house should be long to allow the dust to settle and the virus, if it is in the house at all, to have become inactive. In addition, I have a room in my home with a separate entrance from the backyard, This room is rarely used except as a nice guest room. No one has been in the room in weeks, so I will probably stay in that room overnight,

For a guy who goes by bootybuilder, his pics on roentgen.eu have only two pictures which feature it and one is from a distance and the other ihis ass is hidden in the shadows. If he has a great ass, which has been written here, then someone ought to tell him to put the goods on display.

With your well known frugality I am surprised you can afford yourself or that you would work for someone who pays so little

https://video.search.yahoo.com/yhs/search?fr=yhs-dcola-015&hsimp=yhs-015&hspart=dcola&p=My+best+friend%27s+wedding+I+say+a+little+prayer#id=2&vid=2a301ac87254f4a080522c3133376e4f&action=click Really not a good movie but this scene is entertaining

Change is inevitable. This one was for the better IMO

https://video.search.yahoo.com/yhs/search;_ylt=AwrEeSR6fsBe9wQAqDUPxQt.;_ylu=X3oDMTEyZmpqcmN1BGNvbG8DYmYxBHBvcwMxBHZ0aWQDQzAxNjNfMQRzZWMDc2M-?p=isn't+it+ironic&fr=yhs-dcola-015&hspart=dcola&hsimp=yhs-015#id=1&vid=a266474f724421982a96ebddd7763a02&action=view. I am still confused as to whether she does not know the meaning of ironic or if the irony is that the song is not ironic. A debate for the ages perhaps but not a song I ever want to hear again. Isn't THAT Ironic.

You did but that thumb was misplaced. It was meant for another,. Sorry to disappoint,

I get knocked down but I get up again. Anthem for the 21st century

Usually people are in nursing homes because they cannot be cared for at home of the family is unwilling to care for them at home. That should have changed a bit with so many people out of work and more people at home to care for their elderly relatives. But caring for elderly relatives is a challenge under the best of circumstances and If your relative is demented and unable to control their bowels and babbling endlessly, the challenge becomes too much for some. Culturally, in many countries, it is a dishonor to place an elderly person in a facility. It was in my family when I was a boy. Now, it is more the norm in the US rather than the exception. As such, the reality is there will be people in nursing homes. The good ones will take good care of their patients and their staff. The bad ones, have perhaps gotten worse in this crisis, but they were likely bad all the time. In the hospitals in my area, Mother's Day is one of the busiest days for admissions. Long neglectful children go to Nursing Homes and despite the efforts of the NH to cover up faults, the children find out a lot of what is going on with their patents and are shocked and guilty. They are appalled and get the parent brought to the hospital. This is not every patient, this is not every nursing home, but it happens often. The perfect storm of sick or demented patient, neglectful family and poor NH allows substandard care to thrive. Add in a pandemic which feasts on the sick and elderly and you have our situation now.

Most of the long term and short term care facilities in my area have many CoVid patients. They have set up a separate area and supply the staff with PPE to see those patients. There are also areas for PUI (patients under investigation) areas where patients are placed while waiting the result. As for people who test positive working, most facilities are allowing people who have been exposed to work using social isolation and a mask. Some facilities are requiring 14 day isolation if there is a know exposure. In general, f you are positive, unless you are working from home, you are not working,

If you have a choice, why go for 18 to 25 year old twinks. Unless you do not enjoy men.

That is correct. The medical schools could educate more physicians here in the US, they choose not to do so. When I first started in medical education, there were about 15000 American graduates a year, that is about 40 years ago. As you can tell the number has not increased substantially. At that time, there were medical schools in the Caribbean, Europe and the Middle East training US students. In addition to that, you had the same influx of FMG physicians (Foreign Medical Graduates) plus all those US citizens who were training abroad. There was a program that probably still exists, in which after two years training abroad, US students could, if they passed proficiency examinations, transfer for clinical training here in the US. Schools would take up to about 5 of these transfers and there were about 114 schools at that time. Some did not take any. So basically US school were taking back the highest testing US born graduates, usually around 150 in total. Regulations tightened as a result of Venture capitalists taking an opportunity to provide education in small countries in the Caribbean mostly, and charge little for their citizens' tuition, gratifying the government and charging US students tidy sums. Those who have sharp memories of the invasion of Grenada during the Reagan era, know that one of the reasons used to send US troops into Grenada to topple that government, was the imminent risk of US medical students training there. These relatively fly by night schools would get part time faculty from the US and organize a mostly large lecture series with most of the education coming from reading assignments. Some schools, such as those in Europe and Mexico were well established at training their own country's physicians, but these of shore schools had few clinical experiences and if students did not transfer out back to the US, the school would find clinical opportunities, usually at non university associated hospitals around the globe. The hospitals got manpower, the schools got training and of course, the lucrative tuition, This was the 70s and 80s and US schools could have simply opened 20 or more positions per year each and that would have cut the need for these schools. A few more schools in underserved parts of the US would have done the trick too. They did not do that, but they made regulations for US graduates to return to the US from those off shore medical schools much more difficult and stopped the influx of US students who had circumvented the US system. Replacing those US grads were an even a larger number international graduates from foreign countries. That is where we are today except the world changed and those doctors may not get here,

I agree that immigration regulations have been made more difficult by the pandemic and the closure of government offices in other countries as well as the immigration difficulty here. However, foreign born foreign graduates have been a mainstay of medical care in the US for decades. Medical education has done little to change this. Immigration rules have only become more stringent. As an example, in 2014 there were 17000 or so United States Medical School graduates in first year positions in training in the US. At the same time there were about 6600 International medical graduates in the same role. The vast majority of those international graduates were foreign born and trained and a small number were Americans who attended school internationally. Now in 2019 there are about 18000 US graduates for just about the same number of positions meaning that there has been little movement away from international graduates in the last five years. Going back further, the numbers would probably be about the same. So it is clear than the US has been importing physicians and in relatively large numbers. I have worked in medical education for 40 years and ever has it been thus. These FMGS are usually well qualified and hardworking individuals. They need to pass qualifiying tests to get a chance to practice here. These are physicians who support the medical care system in the US in a way that is generally underappreciated. Now, with that supply chain slowed, it will be difficult for some areas to keep up with adequate medical care and training.

Yes but now we cannot even import them.

Well after four months of doing direct patient care in a position that is supposed to be mostly educational, I was scheduled for two weeks of administration for preparatory work for the upcoming academic year. Major problem is that we usually have more than a dozen incoming residents and most of them have J1 visas. Less than half of the residents are here in the US already and the rest may not make it on time. The government red tape here and in the countries of origin is keeping the certainty of a full staff at a level of "extremely doubtful." That means there may not be residents to care for the patients and though the teaching physicians such as myself have been doing much of the direct patient care, the residents have been the ones staffing the hospital at night. There is no way the hospital can be staffed appropriately with physicians should there be more than a few missing residents. So right now I am working on filling in a schedule that should have more than forty people with only 28. In addition, at the onset of the pandemic here, several of the part time physicians decided that it was a good time to retire. So we are down about three physicians who were supervising residents in clinic and doing educational rounds. This is a teaching program and although the residents, as part of their training, perform services for the hospital, those services must be educational and must not exceed the purely academic portion of their training. Those regulations from the supervising certification programs are not going to change. So the squeeze is on. We can now add physicians to the list of things the US cannot supply for itself which already includes personal protective equipment, Covid testing kits, ingredients for vaccines and medications. On a happier note, though I have not been caring for him through this week, I have dropped by to see the 37 year old who has been in the hospital for more than 5 weeks and who spent about 4 of those weeks on a ventilator. He is doing so much better. His memory is clearer. Today he was eating a regular diet. His breathing is doing well with minimal oxygen. His heart rate still jumps to unacceptable levels at times, but he is getting medicated for that. He started physical therapy and he has been able to walk around the room. Yesterday I asked him if there was anything he wanted from the outside world and he said no. Pizza? No. Hamburgers? No. Chocolate? No. Nylon stockings? He looked at me very confused. I explained that in WWII that nylon stockings were a frequently asked for item. He still looked confused and I told it was a bad joke and let it go at that. Donuts?.....Dunkin Donuts? he asked with widened eyes. Sure. Dunkin Donuts. Yes...yes, I would like that. What kind? Orange. Hmmm, I though, orange donuts. I was thinking that perhaps they had donuts with orange sprinkles or some pumpkin colored donuts. I told him I would try but I was not sure if they had orange donuts. Sure there is never a cop around when you need one, so I went to a secondary source of all things donuts, the nursing desk. Sure enough, the consensus was that orange donuts were in fact, glazed donuts that have an orangish glow off the multiple layers of sugar. So this morning, on the way in, I stopped at the donut shop formerly known as Dunkin Donuts and which is now just Dunkin and got a dozen donuts for the nursing staff and another two glazed donuts in a separate box for the 37 year old. When I got to the hospital, I went right up to the floor and gave the nurses the box and then gowned up, masked up and went in with the donuts. He was surprised to see me as it was much earlier than I usually arrived. I gave with the D and D box. He opened it and smiled. He then took out one of the two donuts and he offered it to me. Off course, with gloves and mask and face shield, I was not in a position to accept it but I thanked him for the offer. The exchange made me wistful in that a simple act of sharing a bit of food with someone had been coopted by this disease. In any case, he took a bite. He slowly chewed and then swallowed and he put the donut back in the box. "Thanks for the donuts. I will have more in just a bit". I waved to him as I walked out. After I had shed my PPE, I looked back through the glass of the door and saw him savoring another bite. I wondered what he was thinking, sitting there, eating a donut as if his whole life had not been ripped apart and only partially put back together. My guess is he was thinking: "I could sure use a cup of coffee right now."

. A year is a long time. Last year at this time I was wondering if the Mets would have a winning season. This year, I am wondering if the Mets will have a season. It will not be the same but it will be a lot more the same than it is now.

It is in the Journal I suggested but when I look it up I cannot find it there but there article itself has that stamp. I will get you the link and post it here.

As it stands now, only one viral has ever been known to have been eradicatedt and that is smallpox. Even that is not totally extinct as both Russian and US laboratories have stores of it. One need to be able to consider eradication of a virus is that it have no animal vector as a reservoir. Coronavirus 19 seems to also be present in bats and has been found in other animals as well. Viral elimination or limitation of disease has been largely successful,, when it has been successful, by mean of vaccination and isolation. Diseases, such as polio, measles, mumps and several others have been limited due to that means. However, even those are around and break out once and again. People are tested and isolated and contacts checked, That is what has been successful in controlling those diseases and it is what has been successful with Coronavirus in places that put that brand of control into place. Test, diagnose, isolate, and limit the spread. Here is the US we are so far from that right now and headed in the opposite direction. It would not be surprising for the rest of the world to put limitations of travel to the US the way travel limitations were placed for Ebola, no one in or out. Just recently in Korea, a place where control of the disease has been good, there was a Covid positive patient who went to a crowded nightclub and now they are searching for thousands of people who may have come into contact. That kind of ability is just not within the current US system. Besides the more than 70000 deaths in the US the cost can also be measured in hospital days resulting from the disease. The average length of stay of hospitalized Covid Survivors is 14 days or so. Most hospitals have an average stay between 4 and 6 days. The cost for caring for Covid patients is also very high given the need for protective equipment for personnel and for the rooms. So the cost of Covid is in lives, in jobs, in health care costs and since it is likely that there is a vector in bats, it is not going away.

Either I am hallucinating or there was another post on here in which someone said that it was hopeless. That was the resignation to which I was referring. We should not resign ourselves the the loud and uninformed.

This is too important a situation to have voices of reason drowned out by non-believers or silenced by exhaustion. If those opposed to science shout to quiet the facts,, the fact givers need to yell louder. It is exhausting. It will take determination and education. What it does not need is resignation. So I beg those who are tired of yelling, to take a deep breath, put on a brave face and be as loud and as truthful as you can be. Stop wasting energy in causes that are lost, such as relying on a change of heart from the present government,

I just read an article from the Journal of Virology from October 2011 concerning the development of a Coronavirus vaccine,. Yes 2011. In that article, it predicts the need for a vaccine and speaks to the difficulties in producing a vaccine. Much of the article is above my pay grade and might be beyond yours too. The main aspect of producing a coronavirus vaccine of which I was unaware, is antibody dependent enhancement (ADE). While some antibodies prevent the movement into the cells of the coVid virus through the main gateway, there are some coronaviruses that actually attach to the antibodies produced as a result of the vaccine and the antibody=virus complex finds a side door into the cells that the virus by itself cannot use. So that giving the vaccine actually allows the antibodies formed to facilitate further destruction by the virus. This is not true of all coronaviruses but it presents another hurdle to the manufacturing of a vaccine. Testing will need to be done not only to prove that a vaccine is beneficial,, but that it has to test that is not detrimental. The fact that there has been work on a vaccine since 2011 is a double edged sword. Among the negatives are that they have not found one yet so 10 years of research has not done what we are being told will be accomplished in the next few months to a year and one half. The good news is that there has been a lot of ground work done and pitfalls have been recognized. The take home message from this: a vaccine is not a new idea, it has not been developed over a decade of work, it might make things worse in some cases, but at least we are not starting from ground zero.

You elect a business man president, you get someone who puts business, his own mostly but business in general as well, first. Business interests and medical interests do not have to be opposite poles but that is the narrative that is now out there. I for one, am not hopeful, but I cannot predict the future and I can hope that I am wrong.

I agree with most of what he wrote and I think you will find a lot of similarities in our experiences. The one difference however is his belief that herd immunity may win the day. He has suggested he feels comfortable with allowing young people to get what is probably a mild disease for them but just keep them away from others. That shows great faith in a group of people some of whom have shown disregard for the situations others face. They flocked to the beaches of Florida during spring break and brought the disease back to places like Wisconsin and Indiana. They crowded to buy Air Jordans in Georgia. So perhaps he is more of an optimist than I am or has more faith In the ability of young people to take this seriously. I hope he is right because it seems the country is going in his direction. I expect a surge again if not immediately, certainly in the fall. I can hope that the American people do well and make us proud, because we are in need. However, if it is a half hearted attempt, it will turn out to be pride before the fall.

Guess this a fairly old song but I ran across it down a rabbit hole.