聯合國大會開議第二天,有兩位好朋友在聯合國幫我們說話。
瓜地馬拉總統賈麥岱說:
考量現今所面臨的挑戰,台灣可以為強化多邊主義提供經驗、能力及知識。
#家樂福有賣瓜地馬拉的白蝦
馬紹爾總統柯布亞說:
台灣的民主政府應獲允以平等、有尊嚴的方式參與聯合國體系,聯合國大會第2758號決議絕未禁止包容台灣的作法,也沒有隱含相關意涵,因為決議並沒有闡述對台灣的立場。作為以人民為中心的機構,聯合國不能無視台灣人民,或繼續以國籍作為排除台灣人民參加聯合國公開會議或進入聯合國總部參訪的理由。#可恥的沉默必須終止。
感謝這兩國為台灣發聲,台灣的夥伴價值,值得聯合國重視。
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We’d like to thank both President Alejandro Giammattei Falla of #Guatemala and President of the #MarshallIslands David Kabua, who spoke up for #Taiwan on the second day of the #UNGA76 General Debate.
President Giammattei Falla stated, “Taiwan is considered able to provide its experience, capacity and know-how to strengthen multilateralism, taking into account the challenges we currently face.”
While President Kabua gave the following speech:
“The devastating global Covid pandemic demands collective action from all countries, stakeholders and peoples, if we are to achieve a resilient recovery.
The democratic government of Taiwan should be allowed to participate in an equal and dignified manner within the UN system, including the WHO, ICAO and the UNFCCC, as well as activities related to the SDGs.
There is absolutely nothing in General Assembly Resolution 2758 which prevents this inclusive approach, and this resolution affords nothing to hide behind, as it expresses no position on Taiwan. As a people-centric institution, the UN cannot ignore the Taiwanese people or continue to use their nationality to exclude them from attending public meetings or public tours of its headquarters.”
He ended his speech with the powerful words, “The shameful silence must end.”
#SDG17 #PartnershipForTheGoals
同時也有4部Youtube影片,追蹤數超過39萬的網紅The Official Chris Leong,也在其Youtube影片中提到,Throwback 2017 This 18-year-old girl has uneven leg length. It was because her patella slipped out of position. Master Chris helped to adjust her pate...
「recovery position」的推薦目錄:
- 關於recovery position 在 外交部 Ministry of Foreign Affairs, ROC(Taiwan) Facebook 的最佳解答
- 關於recovery position 在 Dr 文科生 Facebook 的最佳貼文
- 關於recovery position 在 Facebook 的最佳貼文
- 關於recovery position 在 The Official Chris Leong Youtube 的最讚貼文
- 關於recovery position 在 CarDebuts Youtube 的最佳解答
- 關於recovery position 在 Jordan Yeoh Fitness Youtube 的精選貼文
- 關於recovery position 在 Life Med Ambulance Services - THE RECOVERY POSITION 的評價
recovery position 在 Dr 文科生 Facebook 的最佳貼文
不少讀者在澳洲生活或者將會移民澳洲,或許會對以下內容有興趣。
最近上了幾個COVID management的課,臨床上遇到不少COVID個案,跟同大家分享下澳洲COVID現時的情況
***以下內容只作參考、分享和討論用途,實際臨床治療請根據個別醫院的指引)***
【澳洲現時狀況】
主要爆發在於NSW,其他States每日確診數目前仍然為個位或雙位數,但Victoria有急速增長的潛力。所以地區的爆發個案以Delta為主。
NSW經歷兩個月封城後,並未能成功把Delta壓下來,現時每日400+個案,累積個案已8000+,ICU使用量約60+。全個NSW有約500到600張ICU病床,政府宣佈如有需要可double ICU病床數量。不過目前已有約11-14%的ICU被COVID病人佔用。未來兩星期及往後的兩個月專家預計每月確診數會升至1000+的四位數字。
為什麼封城好像沒用?很多專家有不同解說,可能是疫苗覆蓋率太低、部分民眾繼續馬照跑舞照跳開BBQ Party、封城以唧牙膏方式逐個Suburb逐個封、一年半後都仍然有人不肯戴口罩或戴不好個口罩、一年半後仍然可以出現院內交叉感染等等。
【臨床上我們學會了什麼?】
最新的研究仍然顯示重症大多是未接種疫苗的民眾,值得注意的是Delta除了傳播率更高外,似乎造成重症的機會比起original/alpha更高,特別是針對年輕群體。不過目前數據很多confounding factors,到底是因為年輕群體大多未打疫苗/未排隊打到疫苗,所以比較容易出現重症定還是delta的殺傷力比較大,相信過多幾個月有更多數據便會更清晰。
感染後一般的disease course是怎樣?
大約80%會是輕症、10-15%會是moderate to severe(大多需要住院治療)、5%是重症(Critical,或需要ICU)。Incubation period大部分3-5日就開始病發,delta似乎更短,但可長至14-21日不等。
具更高風險的群體為男性、長者、本身有心臟病、肺病、免疫系統不良、糖尿病(1/2型)、長期腎病、吸煙等等。
病發後通常day 5-8開始惡化,9-12日就開始peak,常見併發症有肺部、心臟、血栓、炎症性反應等等。
肺部如大家都相當了解,常見的為非典型性肺炎的bilateral peripheral lower zone pattern,但這種pattern亦在老人/COPD群體上的atypical bacterial pneumonia較為常見,所以並不能只靠CXR去判斷,CT Chest的話有更多defining features。不過早期病發的話,imaging未必好conclusive。歐美甚至現時澳洲,基本上你發燒或有呼吸道徵症都會幫你驗COVID。
心臟的話如任何病毒性感染,都有myocarditis的風險,同時如果嚴重的cytokine storm和multi organ failures的話,T2MI亦相當常見。臨床可疑的話ECG和troponin都不會少做。
血栓風險其實不低,如任何嚴重炎症性疾病或感染,COVID的PE風險視乎人種和Studies,都有差不多1-3%。歐美加澳等白人為主的國家以往多數有hospital policy, for any hospital admission > 24 hours都會建議打40mg SC enoxaparin作DVT prophylaxis,但有趣的是亞洲人血栓的風險其實低好多,亞洲地區甚少打prophylactic enoxaparin,但somehow日常都會照幫亞洲病人打,到底是否合適,就值得商榷。不過因為COVID,現時不少臨床建議感染COVID住院的話都打prophylactic enoxaparin。不過therapeutic enoxaparin (1mg/kg BD)就發現似乎對outcome沒有重大影響,更可能增加出血風險。
亦有個別指引建議如有臨床懷疑的話定期驗一驗D-dimer,但不少不幸染上COVID的病人都有underlying disease本身都會增加d-dimer,如果你d-dimer positive你都基本上要CTPA,但CTPA你照完1個COVID病人又要deep clean間房,下個照CT的病人便要等一輪,到底驗還是不驗,仍然是臨床上不簡單的選擇。
【目前治療的選擇】
目前有較多證據支持的藥物有Dexamethasone,類固醇似乎永遠不會令人類失望。NEJM鼎鼎大名的RECOVERY Trial發現6mg PO/IV daily可以減低重症患者28 days mortality,特別對於需要氧氣支援和插喉患者最為有用,亦可減小ARDS的機會。但對沒有氧氣需求的患者來說並無重大分別。所以輕症並不建議使用Dexamethasone
Remdesivir早期被譽為神藥,NEJM研究發現對輕症並無重大作用,但對中等至嚴重患者來說則有縮短住院時間的好處,特別在需要氧氣支援的患者上。但似乎對已插喉的患者身上無重大幫助,可能由於插喉已是最後手段而插得喉時抗病毒或許已非最重要的因素,而是應對那可惡的ARDS
Tocilizumab (IL-6 inhibitor),以往用在自體免疫系統炎症性疾病,如類風濕關節炎等。近一兩年在COVID的臨床研究其實都相當controversial,有些研究顯示有用,有些顯示無重大分別,但最近似乎又有新數據對於重症病人來說在控制cytokine storm上有不錯的效果。不過仍然需要更多數據、在使用時機和跟其他藥物配合上。
另外亦開始有研究使用Baricitinib (JAK inhibitor),跟Tocilizumab一樣,原是用在自體免疫系統炎症性疾病,如類風濕關節炎等。目前研究亦是似乎有控制cytokines storm,在重症上有正面效果。不過仍然需要更多數據、在使用時機和跟其他藥物配合上。
在美國亦有時會用到Regeneron的monoclonal antibodies,不過美國外的地方基本上都未引入,相信一來天價、二來貨量亦不足供應全球。有興趣可以自己google一下。
最後就是回歸病毒感染大多都是依賴支援性療法,人類到目前為止都仍然未有方法可以有效地殺死病毒,大多只能靠免疫系統,用藥物抑制病毒生成速度,讓免疫系統和抗體清除病毒。
於COVID治療中最常見的便是氧氣,如mild to moderate的一般只要nasal cannula支,大部分病人aim saturation >90%。但嚴重或重症時便要考慮high flow或NIV或插喉。不過NIV或插喉大多需要ICU支援,而插喉後比較麻煩的是好多時都wean不甩條喉,所以一般除非到最後階段都避免插喉,而當病人惡化到必須插喉時,Tocilizumab和Baricitinib似乎未有非常好的效果,可能已經miss the boat?這需要更多數據和研究
另外就是有趣的是intermittent prone position似乎對血含氧量有改善。不過到底對預後有無幫助就仍然未明。
今日暫時講到呢到,最近澳洲大爆發,作為前線醫生都遇到不少COVID病人,如果大家有興趣,下篇跟大家分享一下前線醫護面對的困難和壓力。
recovery position 在 Facebook 的最佳貼文
Before the night ends.. here’s sharing more on #worldbreastfeedingweek ❤️
.. It's been over a year with Ellie now, and breastfeeding 🤱 her for as long as I can, committing myself as much as I had with her brothers too. Definitely an enriching and rewarding journey seeing how her brothers benefit from my contribution.
Many of my friends told me how impressed by my determination and I must emphasise that it definitely didn’t come without any struggles. Love to share how we managed to go thru this long nights and all around the clock schedule for the past 6 years…
1. Cuddle and skin contact as much as you can! I’m a self high mama, and I have high level of energy. After Every birth labour I would smell, touch, carry and request for long skin to skin contact moments (As much as Im exhausted from all the pushes, my adrenaline and urge to feed them is higher than being fatigue). Though having ample rest is also very important, make sure you are well-rested too! As all these senses of smell, touch and sight helps in promoting lactation production too! To make it more comfy at home, side latch and cuddle to nap together (be careful when you co-sleep so as not to endanger your baby).
2. Stay hydrated and eat! Yes, feed yourself mama or else how you can get your energy or nutrients to feed your little ones! Drinking up, especially before every feed - mine was warm red date tea, milo and even bbt helped me! All types of Soups, especially those with a lot collagens such as white fungus, pork bones and even peach gums boosted my supply. (Pls check - for peach gums may be too cooling for some)
3. Rest, nap and sleep while you can! No need to explain but you know why. It regenerates your own recovery too. I literally nap as much as my babies, and I do that together, so side latching is definitely my favourite position.
Continue to read more in image gallery! 👉🏻👉🏻👉🏻👉🏻
#sp #hpbsg #healthpromotionboard
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#singapore #familystaysg #theasianparent #tapfluencer #sgmoms #sgmums #sgbreastfeedingmummies #breastfeedingweek #breastfeedingjourney #latching #sgbaby #sgbabies #momanddaughter #mamasgirl #darlingdaughter #mybaby #breastfeedingmom #breastfeedingmama
recovery position 在 The Official Chris Leong Youtube 的最讚貼文
Throwback 2017
This 18-year-old girl has uneven leg length. It was because her patella slipped out of position. Master Chris helped to adjust her patella to the right position.
Master Chris Leong is the founder of CLM ( Chris Leong Method ) Tit Tar and exceptionally passionate in making people feel & recover better. Passion breeds happiness & happiness breeds positive energy & positive energy brings speedy recovery.
(马来西亚 梁潤江跌打師傅)
Chris Leong Method Tit Tar - Malaysia
...................................................................
CLM Tit Tar in Kuala Lumpur, Malaysia
Damansara +6014-3333039
Mid Valley +6012-8990685
Setia Alam +6012-5733039
Sri Petaling +6012-9850685
Ampang +6012-6389727
➡️ My Official CLM App :
Android :
https://play.google.com/store/apps/details?id=com.clmethod.tittar
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https://apps.apple.com/my/app/clm-bone-setting/id1440287058
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Chris Leong Facebook:
https://www.facebook.com/masterchrisleong/
Chris Leong Official YouTube Channel :
Please SUBSCRIBE for new videos everyday
https://www.youtube.com/c/TheOfficialChrisLeong/
#chrisleong #Masterchrisleong #bonesetting #tittar #tabibtulang #clm #clmethod #sunwaydamasara #midvalley #drchris #datochris #跌打 #chris #datoserichris #setiaalam #sripetaling #bone #tulang #leong #梁潤江 #ampang
recovery position 在 CarDebuts Youtube 的最佳解答
การผลิตรถยนต์/ซูเปอร์คาร์ Lamborghini ในโรงงานที่ประเทศอิตาลี หลังจากที่มีการแพร่ระบาดของโคโรน่าไวรัส
อิตาลีเป็นประเทศที่ได้รับผลกระทบ จากโรคระบาดโควิด19 อันดับต้นๆของโลก แต่เรื่องของเศรษฐฏิจ ก็ยังต้องเดินหน้าต่อไป เพื่อไม่ให้เกิดผลกระทบในวงกว้างตามมา ในเรื่องปากท้องของประชาชน และความมั่นคงในด้านเศรษฐกิจของประเทศ Automobili Lamborghini จึงตัดสินใจเดินสายการผลิตรถยนต์ต่อ เมื่อวันที่ 4 พฤษภาคมที่้ผ่านมา
โดยบริษัทมีมาตรการในด้านความปลอดภัย ในเรื่องสุขภาพของพนักงาน ซึ่งภาพที่เราจะได้เห็นต่อไปนี้ นอกจากจะแสดงให้เห็นถึงการผลิต ซูเปอร์คาร์อันดับต้นๆของโลกแล้ว Lamborghini ยังเผยให้เห็นถึงมาตรการต่างๆ ในการป้องกันการแพร่ระบาดของเชื้อไวรัสโคโรน่า ในโรงงานอีกด้วย ซึ่งแน่นอนว่า มันคือสิ่งที่เราไม่เคยเห็นมาก่อนในอดีต Lamborghini จะมีกระบวนการผลิตแบบใหม่ เป็นอย่างไร เราลองไปชมกัน
Sant’Agata Bolognese, 30 April 2020 – Automobili Lamborghini is set to resume its production activities from 4 May, in accordance with the Italian Prime Minister’s decree of 26 April. The Sant-Agata Bolognese company is currently completing all preparatory measures to ensure its people return to work in conditions of maximum safety.
While company activities were temporarily suspended, Lamborghini repurposed some of its departments to produce medical protection masks and visors for St. Orsola Hospital in Bologna, and established a partnership with SIARE Engineering International Group for co-engineering and manufacturing breathing simulators.
The preparation for the 4 May reopening has been the subject of ongoing discussion and definition within the Joint Committee of the Company and Trade Unions on the COVID-19 emergency, set up in the wake of the temporary suspension of company activities on March 13. Over the last weeks, the parties have worked together on a precise safety protocol governing the procedures for returning to work and the equipment to be used in order to ensure the maximum safety of Lamborghini’s workforce, starting with a comprehensive educational campaign.
Stefano Domenicali, Chairman and CEO of Automobili Lamborghini, commented: ”We are ready to restart with great energy, but also with strict protocols for safeguarding what is most precious to us: the safety of our people. This priority is why we were the first Italian automotive company to close and continues to be our guiding principle for a well-reasoned and safe recovery, because we still have not won the battle against COVID-19. We will constantly monitor the contagion’s evolution and be ready to adjust our protocols in accordance with the guidelines provided by the Italian government and the Emilia-Romagna Region, which we would like to thank for their support during this sensitive phase.”
“We continue to nurture the dreams of our fans and customers, and on 7 May, through a virtual launch, we will present a new car in order to complete our model range. We closed the first quarter of 2020 despite the situation with very positive results. From these results we want to secure our swift return to a leadership position, delivering our vehicles once again as soon as our dealers around the world reopen for business.”
recovery position 在 Jordan Yeoh Fitness Youtube 的精選貼文
30-minute full-body workout routine for starters to strong beginners to strengthen their muscles and to maximize fat burning effect at their best (while keeping it safe). If you did my previous Level 0.5 and Level 1 workout then this is the right routine for you to progress on!
This workout is also suitable for every intermediate/advanced trainer who wants to do something light for active-recovery. Keep training!
Estimated calories burned in this session: 200-300 kcal
(your fitness tracker might show different results)
▷Connect with Me
Instagram: https://www.instagram.com/jordanyeohfitness
Facebook: http://facebook.com/jordanyeohfitness
Personal Training Web App: https://ironmastery.com
DISCLAIMER
The exercises and workouts provided in this video are for educational purposes only and are not to be interpreted as a recommendation for a specific treatment plan, product, or course of action.
Before beginning this or any exercise program, please consult a physician for appropriate exercise prescription and safety precautions.
The exercise instruction and advice presented are in no way intended as a substitute for medical consultation. As with any exercise program,
if at any point during your workout you begin to feel faint, dizzy or have physical discomfort,
you should stop immediately and consult a physician.
#TrainWithJordan #JYtraining #IronMastery
(Music used with permission from Epidemic Sound, Position Music, and Freedom!)
recovery position 在 Life Med Ambulance Services - THE RECOVERY POSITION 的推薦與評價
THE RECOVERY POSITION - LEFT OR RIGHT SIDE? The recovery position is used to protect an unconscious person's airway. ... <看更多>