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About Bosco-d-gama

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    Pacific Northwest
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    Physical fitness and healthcare
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    Accuphase e-530, Klipschorns modified with AK’s steep slope crossover, Dave Hover Eli-track midrange horn using JBL2482 drivers, JBL2404 tweeters

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  1. Influenza death statistics involve 10’s of millions of documented cases so the fatality rate is far less than covid19. If we should see the same number of covid19 cases as we do the flu we’d probably have close to - if not more - 1 million deaths. So can we dismiss comparing this to the flu?
  2. Got kale and lettuce in the ground and purple Cherokee tomatoes sprouting indoors. We’ve grown green bean for years and have tons frozen. We grew a green bean variety that grows purple and turns green when cooked. Their easier to find on the vine when purple.
  3. People typically are not placed on ventilators until they are clearly failing to support their own breathing. Most folks can not conceive of breathing as being ‘work’. Well it is work and when lungs are compromised enough getting them to ventilate and oxygenate requires every bit of work you can muster. And after doing that for awhile you simply tucker out - exhausted you quickly proceed from respiratory insufficiency to respiratory failure. And w/o intervention you can die in a matter of minutes. That said, in busy hospitals the people operating those ventilators are very overworked. They are less able to tailor the settings to the specific needs of the patient. Some of the vents shown are transport units and not critical care machines. They were not designed to provide the needed settings required to ideally manage these very sick lungs. Any patients sharing a vent are doubly compromised. It’s a catch 22 folks. You’re fatigued and sick and not able to functionally breathe for yourself and the best available care for that is not the best ‘possible’. BTW we certainly can keep folks on vents for extended periods. With proper care years, even decades on mechanical ventilation is well within our capability. Stephen Hawkins was one such example. Lastly - I describe work of breathing above in the context of this acute covid19 disease. Now in chronic lung disease it can progress to that same level of breathing permanently. Essentially there is not enough lung remaining to support life. You entire existence revolves around each breath you take and that’s all you do because that’s all you can do. You sit still and work to breath. So as I periodically ‘rant’ about vaping, smoking dope...... any type of unnecessary lung abuse..... this is my compass. Until science can figure out how you can grow a new pair of lungs - you only have the ones you own. Cherish those things.
  4. Don’t think I’d be this fatalistic. If you’re in somewhat good health odds are still very much in your favor. You could need some fluids or a little O2 and antibiotics and you’d be good to go. Stay home and forego those simple things and it might be curtains. BTW I abhor hospitals but they are not places to go to die. Just obey and be vigilant. Make sure the meds they administer are correct and in correct dosages. And above all else if you’ve got a lot to live for - fight like hell to live.
  5. Statistics are only as good as their data base but, that said - statistics are not intended to be precise but ‘indicative’ according to confidence levels. Yes they can be manipulated and so can the data from which they’re derived. Thus the purpose of peer review to determine the relative importance contributed by any study. Still it would be wonderful to learn how many subacute cases of covid19 exist and more about their role in this pandemic. Aside from China’s clear misrepresentation of data to downplay the disease medical science is uniformly certain that there’s a lot to learn about this virus. It is like walking into the ring against Mike Tyson to learn how to box.
  6. No need to get offended. Death is a sensitive area and people are now having to make some choices about death, their own and others. That opens the door to who should or should not be given living priorities and based upon what? It is a nasty quandary faced by all of us whether in medicine or not.
  7. Permanent immunity is likely not going to be the case. This is a corona virus which in an existing variation causes a common form of a ‘cold’. That form of the virus does results in a short term immunity, not permanent immunity. This is why we get colds again and again and also why there’s no vaccine against the common cold. Insofar as covid19 they remain uncertain as to the length of immunity survivors achieve and there have been reports of 2nd infections. This also impacts the ability to derive a vaccine for covid. IMHO less people dying is better than ‘more’ people dying. Not sure ‘where’ you’re headed with this but you’re rooting around in some really murky ethical issues - it would seem.
  8. Perspective........ The 2108-19 influenza season caused 21,000 deaths in America but that was from 16.5 million cases. So far covid19 has resulted in 11,000 deaths with 367,000 documented cases and not over a year but in 3 weeks to 1.5 months and most of those in a few hot spots. Now consider that nobody has any immunity to covid19 and all Americans exposed will likely get the infection. The math is simple - the covid19 mortality rate is excessively cruel and the threat is serious and imminent.
  9. Very interesting. Thanks for sharing that. Yes - these are viruses and humans can infect animals as easily as they can infect us. Ebola was this way and we’re all familiar with rabies. With regard to covid19 it was known to easily spread from humans to simians, the apes. Infecting the tiger is more of a curiosity, just something else we’ve yet to learn about the virus. BTW there are millions of viruses around. They’re everywhere. Most are not pathological. Some are downright useful. Before the advent of modern antibiotics they used to administer viruses to humans to infect and kill bacteria. So if you had a terrible bacterial infection they’d treat you with a virus known to kill that bacteria. These days when introducing modified genes they will use viruses as vehicles to insert the genetic material into humans. There should be a coffee table book about viruses.
  10. Governor Cuomo determined several weeks ago to restrict the use of chloroquine to inpatients only ostensibly on concerns about supplies and misuse. So ‘trials’ in New York for covid19 are limited to inpatients for the time being. I agree with others that the drug is no panacea but apparently works in some manner for at least some of the population. We certainly must learn more about how it works and how we can optimize its application. We could be doing better if we understood when, how and how much to use. On another issue I read where Bush 2 had set up quite an extensive federal pandemic response program during his tenure which included massive reserves of the sorts of supplies now in such demand. Reportedly those emergency reserves got used and not replaced. Ah good ole hindsight - eh?
  11. Encouragingly NYC is reporting that fewer of its inpatients are requiring intubation. They seem to be curbing the severity of the disease in a general sense. Ironically governor Cuomo has restricted the use of chloroquine drugs to inpatients. There is more than one path to defining medical treatment. Fundamentally when urgency matters strict research protocols can be sidestepped as long as it can be done safely. No harm - no foul. Chloroquine is not voodoo. It is a long-standing drug that medicine has used safely for 1/2 century. Does it work? Well we do have a gauge - the media. The media is trigger happy, anxious to find and trumpet any story to discredit the federal government. If chloroquine definitely did not work we’d have 4 inch headlines proclaiming its failure. We do not see those. In fact currently what we have is nominal reporting and some of that is actually encouraging. So if you have covid19, breathing 40 times a minute and still not oxygenating while on 100% oxygen then you decide for yourself whether trialing a safe experimental drug cocktail will save your life. As for myself - i won’t wait that long. We can complete the academic studies when the emergency is over. BTW there are many drugs being used in exactly the same manner as chloroquine. Chloroquine is only controversial be because of politics. It would seem likely that naysayers here would embrace chloroquine if it came to light from a different source. Politics indeed.
  12. Unsure of your position on using these meds. When in the middle of a ‘code blue’ we run blood gas studies and their results are crucial to the proper management of that scenario. There are blood gas techs who run a ‘stat’ blood gas and get that info back to the decision makers ASAP and then there are blood gas techs who take their time and complete all the documentation prior to making that call. When there are lives being lost, lots and lots of them - how much anecdotal positives are needed before a perfectly safe medication should be applied? Do not misunderstand me. I love research and have been involved in academic and clinical research. I have also done patient care and shudder to think what these patients and their care providers are going through. Right now if ‘tidy bowl’ seemed to work then gimme more ‘tidy bowl’. Do the paperwork later. Refine the application later. Fine tune the doses later. People are dying and there are many thousands in that queue.
  13. Some speculation here. Sadly we are witnessing very strained critical care medicine. Considering the massive volume of patients being cared for I’d have to think that the level of care for them all suffers. When that comes to ventilator management this could be lethal. Technologically modern ventilators offer clinicians lots of flexibility in applications so they can choose the best clinical approach for individual cases. That requires time. Intensive care requires intensive work and intensive skills. That is not happening now. From this pandemic experience I hope that a new generation of mechanical ventilators can be developed - ones that use artificial intelligence. We understand the measured and derived medical data and we make decisions based on that data. Some of that can be automated. The ventilators can be upgraded to autonomously manage patients when caregivers are in short supply. Changes is patient status can be remotely reported calling clinicians back to a patient in distress. There are a number of prospective improvements possible for mechanical ventilators that will improve their efficacy and clinical efficiency. Hopefully there will never be a ‘next’ time. But we had better plan for one, and the sooner the better.
  14. You bet people in other states are not as ‘lucky’ and those decisions do seem to hover around the POTUS. Like the man or not clearly many/most in the media has been mauling him since he took office. Now they cannot distill their visceral hate from any practicality and literally have misguided followers cutting their own noses off. Governor Cuomo of New York is enforcing an executive order restricting where this drug can be used. He’s no physician. He’s a politician making political statements. His politics alone could be fueling the nightmare in his own state. Rudy’s testimony about this drug is pretty compelling and he is not alone. It is time to allow physicians to determine how best to manage medicine whether it fits anyone’s “narrative” or not. The drug is not illegal and can be safely administered and it is available. Too bad for New Yorkers that Cuomo is their elected leader.
  15. Egads- it would be a perfect world if somehow America had NO cov19 cases. Somehow if we had a ‘handful’ that would be too many and surely if there were 200 million cases it would be a tragedy. No administration lives in a bubble. The administration prior to the current administration went through 2 infectious disease events and established a special cabinet level ‘pandemic response team’ with the sole purpose of prepping for a pandemic....... and they accomplished nothing. No masks by the billions, no masses of ventilators, no hoards of medications - no prepreparation after the swine flu and the Ebola outbreaks. So clearly the current leadership is working hard to contain this disaster. But every administration prior to this one has played their part in setting the stage for this day. So like it or not whatever criticisms there are gets to be shared between both parties and all of our current and past elected officials.
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