BC FOR LATER READ
Saved by @CodyyyGardner

1/31 Lots of media coverage, rightly, on huge NHS pressure. What’s cause of, and how widespread, is pressure? How is NHS responding? How serious is this & what’s impact on patients & staff? What’s likely to happen over next few weeks? Long new explainer thread below in two parts.

 2/31 WHAT'S CAUSE OF, AND HOW WIDESPREAD IS, CURRENT NHS PRESSURE? Remember overall context. Winter always busiest time of NHS year & NHS capacity always at its most stretched. Last five winters show that, despite increases in capacity, NHS at / over its capacity limit...
3/31 ...Whilst overall staff levels improved in 2020, NHS also entered year with 100k vacancies. Covid makes all this much worse. NHS balancing four sets of patients – winter patients; covid patients; planned care cases, incl. delays from first phase; and those needing vaccine.
4/31 Covid cases rising extremely rapidly, driven by new variant. In England yesterday there were 22,700 covid patients in hospital vs 500 at start of Sept and 19k at top of 1st peak. Just since Xmas Day NHS has had 5,000 more covid inpatients, equivalent to filling 10 hospitals.
5/31 Impossible in a thread to capture full range of regional variation. But, at top level, London/SE/E of England trusts under substantial pressure. Northern trusts seen improvements since Oct but worried covid levels not dropped sufficiently to cope with any third surge.
6/31 On capacity, NHS has inescapably fewer beds in use than this time last year because of the need for tight infection control to protect patients and staff. For example, six bed bays have to become four beds, and some wards cannot be used for non covid patients at all.
7/31 As attached chart from @HSJnews shows, over 40 hospitals now have more than 25% of their general and acute beds occupied by covid patients. So, fewer beds & many more occupied by covid patients. Many hospitals London/SE also report they're now v short of critical care beds.
8/31 CEOs equally, if not more, worried about staffing. Areas with high covid load suffering from double whammy of high numbers of covid patients and high levels of staff absence because of covid community infection prevalence and important self isolating rules...
9/31 ...Some in highest areas of covid infection now reporting two to three times normal levels of staff absence. It's not just absolute numbers of staff absence but also absence rates in particular categories of staff. EG London/SE trusts need more critical care specialists.
10/31 WHAT ARE NHS TRUSTS DOING TO RESPOND? Important to understand that all trusts have detailed, well worked, escalation plans in place to meet extra demand. Hospitals used summer to make physical adaptations & upgrade infrastructure to create maximum possible surge capacity.
11/31 Trusts will therefore start by trying to utilise every last ounce of capacity available and create more temporary capacity, at pace, if needed. EG Many in London/SE now creating extra surge critical care capacity for covid patients in real time, complex though this is.
12/31 At same time, trusts are seeking to maximise numbers of patients being safely discharged into community beds and being looked after at home. This is creating significant pressure on community services – a good illustration of pressure all NHS is under, not just hospitals.
13/31 Once a hospital trust has used up all its own capacity it will seek help from its neighbours. This is working well. In larger areas where every hospital is under pressure, small numbers of patients will be moved across regions, where it makes clinical sense to do so…
14/31 ...EG hospitals in SW closer to London/SE already helping out colleagues. Midlands doing same for East of England. Patient transfers over large distances rarer but can help where clinically appropriate. But need to avoid adding pressure to overstretched ambulance services!
15/31 NHS now using Nightingales/readying them for use. Exeter/Manchester in use and London now being readied for use if required. NHS trusts can only undertake all this mutual aid because we have a National Health Service and because we have prepared so carefully for it.
16/31 HOW SERIOUS IS PRESSURE AND WHAT’S IMPACT ON PATIENTS & STAFF? Important to be precise with words. Not right to use "cataclysm”, “collapse” or “overwhelm” as they imply NHS will stop providing care. The NHS task is to keep providing care, whatever the pressure.
17/31 But, where the NHS is currently under extreme pressure, we are seeing some or all of the following in a more prolonged and widespread way than is normal, even at times of very significant winter pressure. Delays in accessing care for non critical patients....
18/31 …Rebooking of planned procedures, ambulance handover delays (v worrying for ambulance trusts), high levels of bed occupancy in some wards, staff stretched to cover growing demand, and pressure on staff/patient ratios. None of this is good for staff or patients.
19/31 It's important to openly acknowledge that these pressures are happening and their potential impact on quality of care/outcomes. Not least so they can be distinguished from "collapse, cataclysm & overwhelm". Which, thanks to amazing work of frontline staff, isn’t happening.
20/31 NHS staff doing what they always do – providing best possible care to all who need it, prioritised by clinical need. EG Currently 20,000 more non-covid/emergency patients in hospital compared to April first peak. Double number of urgent & cancer operations being performed.
21/31 CEOs are very worried, though, about the impact of this much pressure on already tired and exhausted staff who are now being asked to delay leave, work extra shifts and transfer to new roles e.g. help in critical care. See here, for example:
https://t.co/N2xPmllxY6
22/31 CEOs continue to marvel at, and be incredibly grateful for, staff commitment, dedication and professionalism in what many acknowledge are the most difficult circumstances they have seen in their careers. Strong view that this is much more difficult than the first phase.
23/31 WHAT HAPPENS NEXT? ..... This thread continues in a new thread.......

More from For later read

Simon Wardley
Simon Wardley
@swardley
X : Do you think cloud will decentralise?
Me : Already has - started with regions and AZs and is now rapidly expanding into outpost, greengrass, EKS anwhere.
X : No, I mean many providers.
Me : There are two forms of decentralisation - provision and control (i.e. authorities) ...

... what is happening is decentralisation of provision (i.e. cloud everywhere, at the edge) but under centralised authorities (Amazon, Alibaba, MSFT, Google etc).
X : What about decentralisation of control?
Me : Many companies working to a common standard ...

... that was the dream of OpenStack but they blew that on day one creating a collective prisoner dilemma. They are trying to recorrect this with K8s but the cloud has moved on, higher up the stack ...

... so, the idea of a marketplace of many different companies each having authority is ... wishful thinking by past vendors and clients they've hoodwinked. Maybe in 15-20 years we will get another go ... open source is a long game ...

... more likely is many points of provision i.e. companies offering EKS anywhere on a utility basis but under centralised authority e.g. AWS.

So, yes, the cloud is going to edge, has been for sometime but it'll be AWS / Alibaba / MSFT cloud that is everywhere.
FOR LATER READ
Defense News Nigeria
Defense News Nigeria
@DefenseNigeria
The people can always be brought to the bidding...tell them they are being attacked, and denounce the naysayers for lack of patriotism and exposing the country to danger.

Hermann Goring

We've seen reports of Yoruba leaders asking President Buhari to stop the war and sack service chiefs immediately as a way of beginning restructuring.Our country is sitting on a keg of gunpowder they claim. Once again partisan hacks want to snatch victory from the jaws of defeat.

You see, when you are fighting small limited wars there is a natural inclination , on the part of politicians not directly impacted by the war to want to blow things out of proportion. There is a basic disconnection now in this country between the population and the war

....and i find it quite frankly. Frightening. Compared to what was obtainable 2015, the security situation in Nigeria has vastly improved yet the media ..and partisan hacks portray a much more pessimistic narrative.

Consider that in 2015 over 21 Local government areas and 2.6 million Nigerians were cut off from the rest of the country, under the administration of a caliphate in Nigeria for 16 months. A huge chunk of the northeast was no mans country.
FOR LATER READ
Advertisement
David Boxenhorn
David Boxenhorn
@davidboxenhorn
1. The death of Silicon Valley, a thread

How did Silicon Valley die? It was killed by the internet. I will explain.

Yesterday, my friend IRL asked me "Where are good old days when techies were


2. In the "good old days" Silicon Valley was about understanding technology. Silicon, to be precise. These were people who had to understand quantum mechanics, who had to build the near-miraculous devices that we now take for granted, and they had to work

3. Now, I love libertarians, and I share much of their political philosophy. But you have to be socially naive to believe that it has a chance in a real society. In those days, Silicon Valley was not a real society. It was populated by people who understood quantum mechanics

4. Then came the microcomputer revolution. It was created by people who understood how to build computers. One borderline case was Steve Jobs. People claimed that Jobs was surrounded by a "reality distortion field" - that's how good he was at understanding people, not things

5. Still, the heroes of Silicon Valley were the engineers. The people who knew how to build things. Steve Jobs, for all his understanding of people, also had quite a good understanding of technology. He had a libertarian vibe, and so did Silicon Valley
FOR LATER READ
Infectious Diseases Fellows Network
Infectious Diseases Fe...
@ID_fellows
#IDTwitter #IDFellows
Introducing our new series: “IDFN top 10 articles every fellow should read”🔖

#1: SAB management
by @mmcclean1 @LeMiguelChavez
Reviewers @KaBourgi, @IgeGeorgeMD, @Courtcita, @MDdreamchaser

We know is subjective & expect feedback/future improvements 👇

1. Clinical management of Staphylococcus aureus bacteremia: a review.
https://t.co/9tBCtp9mlP
👉 A must read written by Holland et al. where they review the evidence of the management of SAB.

2. Impact of Infectious Disease Consultation on Quality of Care, Mortality, and Length of Stay in Staphylococcus aureus Bacteremia: Results From a Large Multicenter Cohort Study.
https://t.co/XujO68pCuH
👉ID consult associated with reduced inpatient mortality.

3. Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT): Scoring System to Guide Use of Echocardiography in the Management of Staphylococcus aureus Bacteremia
https://t.co/otcA1pxjAw
👉Predictive risk factors for infective endocarditis, and thus the need for TEE.

4. The Cefazolin Inoculum Effect Is Associated With Increased Mortality in Methicillin-Susceptible Staphylococcus aureus Bacteremia.
https://t.co/CQZiryVWZz
👉Presence of cefazolin inoculum effect in the infecting isolate was associated with an increase 30-day mortality.
FOR LATER READ
Emily\u2661
Emily♡
@ItsEmilyKaty
To the person who thinks that they might be autistic. - a thread. /1

I imagine you have gone your entire life wondering why you are different, why you can't seem to understand things the way that others can and why everything just seems so hard. I'm proud of you for getting this far. /2

Part of you might be thinking:
"But if I was autistic, surely it would've been noticed when I was a kid? So maybe I'm making this up."
So many autistic people aren't diagnosed until they are adults, if diagnosed at all. You would not be the first and you won't be the last. /3

"My family and friends don't think that I could be autistic."
People's understandings of autism tend to be based off of the media, which doesn't show every possible presentation of autism, or based off of someone they know, and all autistic people present differently. /4

People's perceptions of autism can also be based off stereotypes, for example, "autistic people can't make eye contact, so you can't be autistic." While this is true for some, it isn't for all, so you can begin to see how one presentation of autism can't possibly fit everyone. /5
FOR LATER READ , ALL

You May Also Like

Fidato
Fidato
@tequieremos
A thread on the life and achievements of Muhiyudin Sayyid Abdul Qadir Jillani RadiAllah who served Islam infinitely as the Reviver (Mujadid) of the 11th Century!


Muhiyudin Sayyid Abdul Qadir Jilani (RA) was one of the greatest Islamic Saint, Scholar, and Jurist. The honorific Muhiyudin denotes his status with many Sufis as a "reviver of religion". Jilani refers to his place of birth. He also carried the epithet Baghdadi.

[1]

Sheikh Abdul Qadir Jilani was born on the eve of the 2nd of Ramadan 470 AH. His birth was a great blessing for the Ummah. It was the arrival of the Sultan al-Awliya (King of the Awliya) of that era, which had been foretold for centuries before his birth.

[2]

When Hazrat Abdul Qadir Jillani was asked by someone what brought him to his high spiritual level, he said, The truthfulness which I promised to my mother. He related the following story:
"One day, on the eve of Eid al-Adhā, I went to my mother, who was then a widow and..

[3]

..and requested her, 'Send me to the path of Truth, give me permission to go to Baghdad to acquire knowledge, to be with the wise and those who are close to Allah. She cried, but she brought out 80 pieces of gold, which was all that my father had left as inheritance.

[4]
RELIGION
Groww
Groww
@_groww
You want to buy a house.

You take a loan from the bank.

The bank asks you, “what if you don’t pay back?”

You say, “take my home and sell it”.

(Thread)

That makes sense. The bank gives you a loan and in case you don’t pay, the bank will take over your house and sell it and recover its money.

That’s collateral.

Banks also lend money to big corporations. With them, banks don’t always have collateral.

So a loan where the bank has collateral is considered safer for the bank.

In the early 2000s, the banks in the USA were giving out loans to people for buying houses.

The economy had just recovered from the tech bubble in 2000 where many banks had given out loans to businesses that had shut down.

In that backdrop, the banks found giving home loans safer.
ALL , 2008 CRASH , 2008 RECESSION
Advertisement
Billy Bostickson \U0001f3f4\U0001f441&\U0001f441 \U0001f193
Billy Bostickson 🏴👁&👁 ...
@BillyBostickson
Tip from the Monkey
Pangolins, September 2019 and PLA are the key to this mystery
Stay Tuned!


1. Yang


2. A jacobin capuchin dangling a flagellin pangolin on a javelin while playing a mandolin and strangling a mannequin on a paladin's palanquin, said Saladin
More to come tomorrow!


3. Yigang Tong
https://t.co/CYtqYorhzH
Archived: https://t.co/ncz5ruwE2W


4. YT Interview
Some bats & pangolins carry viruses related with SARS-CoV-2, found in SE Asia and in Yunnan, & the pangolins carrying SARS-CoV-2 related viruses were smuggled from SE Asia, so there is a possibility that SARS-CoV-2 were coming from
ALL
Jeannette Ng \u5433\u5fd7\u9e97
Jeannette Ng 吳志麗...
@jeannette_ng
So, you’re a writer and you’re worried about writing outside your immediate experiences and identities.

Here is the thread of practical advice for you.

EXAMINE YOUR MOTIVES. Why do you want to write this?

Are you trying to solve racism/sexism/colonialism with your work?

As writers we love stories about heroic writers whose work has changed the world. And as such we like to look to our own writing to solve societal problems.

And I understand this completely, not the least because I’ve felt the pull.

But if you’re looking to play saviour with your words, it is unlikely that you will do the marginalised people you are trying to save justice.

And I understand this very often comes from place of good intentions, but there is a reason that most of the moralising plays written by white abolitionists are deeply uncomfortable to read.

It is incredibly easy for works looking to play saviour to become patronising or traffic in simplistic stereotypes that ultimately hurt the people they are looking to rescue.
WRITING
Carol Forden
Carol Forden
@CarolForden
1. The major problem most startups face is marketing and the ability to carve out a niche, find and retain paying customers.

Even with a stellar developer team and a stellar product, your startup may not grow or survive without a great marketing and sales teams.

2. Start growing your audience before you’ve a product or an idea.

You should start promoting yourself and building your audience before you have a finished product or even before you have a great idea that you want to build.

3. Don’t wait to start building your audience after you’ve launched a product.

Most first-time developers actually ignore marketing.

They’re oblivious to the challenge of attracting people to take a look at something they’ve created.

4. At least until they see their first project crash and burn within hours of the launch.

There are so many times that I have seen developers spend countless hours building something, releasing it with no fanfare...

5. and only then trying to figure out how to promote it by asking marketing questions on Indie Hackers, Quora or Hacker News. Don’t make that mistake.
STARTUPS