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When COVID-19 surged, the hospital resumed non-emergency operations
Three months ago, the country witnessed COVID-19 patients flooding the New York City intensive care unit, forcing some of its hospitals to turn cafeterias into wards and tents in parking lots.
Hospitals elsewhere are preparing for similar surges: They clean beds, hoard scarce protective equipment, and – voluntarily or under government orders – temporarily cancel non-emergency operations to save space and supplies for coronavirus patients.
In most places, a surge of patients never occurs.
Now, corona virus cases are rocketing nationally and hospitalizations are increasing at an alarming rate. But the response from the hospital is very different.
Most hospitals throughout the country did not cancel elective surgery – nor did government officials request it.
Instead, hospitals say that they are better equipped to deal with crush patients because they have enough protective equipment for their workers and know how to treat coronavirus patients better. They said it would close procedures not important in hospitals based on local risk assessments, but not throughout the system or the state.
Several hospitals have done so, including facilities in South Florida, Phoenix, and Central Valley of California. And in some cases, like in Texas and Mississippi, government officials have ordered hospitals to delay elective surgery.
The hospital’s decision to keep the operating room still partly guided by money. Elective surgery account for most of the hospital income; and American Hospital Assn. estimate that the hospital and the country’s health system lost $ 202.6 billion between March 1 and June 30.
“What we now realize is that shutting down the entire health care system in anticipation of a surge is not the best choice,” said Carmela Coyle, president of the California Hospital Assn. “This will make the health delivery system go bankrupt.”
Association estimate that California hospitals will lose $ 14.6 billion this year, of which $ 4.6 billion has so far been replaced by the federal government.
But some health workers worry that continuing elective surgery amid surges puts them and their patients at risk. For example, some nurses are still being asked to reuse protective devices such as masks and N95 gowns, even though hospitals say they have enough equipment to carry out elective surgery, said Zenei Cortez, president of the United National Nurses union.
“They continue to put us at risk,” Cortez said. “They continue to look at us as if we are disposable materials.”
Elective surgery, in general, is a procedure that can be postponed without endangering the patient, such as knee replacement and cataract surgery.
Least 33 states and the District of Columbia temporarily banned elective surgery this spring, and most hospitals in states that do not, such as Georgia and California, voluntarily suspend them to ensure they have a bed to accommodate surges of coronavirus patients. U.S. general surgeons, Centers for Disease Control and Prevention and the American College of Surgeons also recommend health facilities to delay non-emergency operations.
The suspension is always meant to be temporary, said Dr. David Hoyt, executive director of the American College of Surgeons. “When this all started, it was just a matter of flooding the system,” he said.
Today, the number of cases has soared after many states have eased orders to stay home and Americans flocked to restaurants, bars and backyards and met with friends and family for graduation parties and Memorial Day celebrations.
Nationally, confirmed COVID-19 cases have reached their peak 3 million. In California, there were many cases, with a 52% jump in the average number of daily cases over the past 14 days, compared to the previous two weeks. Inpatient care has gone up 44%.
Governors, district overseers and city councils have responded by requiring people to wear masks, close bars and restaurants – again – and close the beach on the Fourth July holiday weekend.
But in general, government leaders do not ask hospitals to proactively reduce elective surgery in preparation for surges.
“Our hospital tells us that they feel very strong and competent that they can manage their resources,” said Holly Ward, director of marketing and communications at Arizona Hospital and Healthcare Assn. If they feel the situation guarantees that, “they themselves will delay the operation.”
In some countries, such as Colorado, public health orders that allow hospitals to continue non-emergency operations in the spring require hospitals to have a protective supply of equipment and extra beds that can be used to treat the influx of COVID-19 patients.
Countries also arrange overflow sites if hospitals run out of rooms. In Maryland, for example, the state uses the Baltimore Convention Center as a field hospital. California last week reactivated four “alternative care site“- including hospitals that are on the verge of closing in the San Francisco Bay Area – to bring COVID-19 patients if the hospital is filled.
But the decision to reduce elective operations in California will not come from the state. This will be made by the district in consultation with the hospital, said Rodger Butler, a spokesman for the California Agency for Health and Human Services.
The question is whether the hospital has a system to meet the surge in COVID-19 patients when it happens, said Glenn Melnick, a professor of health economics at USC.
“To some extent, elective care is good care,” Melnick said, “They provide the services needed. They keep the system running. They provide employment and income.”
In Los Angeles County, more than 2,000 COVID patients are currently hospitalized, according to county data. While that number is projected to rise by several hundred people over the next few weeks, hospitals believe they can accommodate them, said county health services director Christina Ghaly. Meanwhile, the hospital is preparing to bring in additional staff members if needed and inform patients who have scheduled operations that they can be postponed.
“There are more patients with COVID in hospitals than ever before in Los Angeles County during a pandemic,” Ghaly said. “Hospitals are better equipped now to handle the patient’s volume than before.”
Although hospitals do not stop elective surgery, many have not ramped up the full schedule they had before COVID-19. And they say they pick and choose operations based on what happens in their area.
“We were all COVIDs when we were just starting,” said Joshua Adler, executive vice president for doctor services at UCSF Health. based in UC San Francisco. “We don’t know what we’re dealing with.”
But after a few months treating patients, the hospital has learned how to supply units, how to transfer patients, how to treat other patients simultaneously and how to improve testing, Adler said.
At Scripps Health in San Diego, which has brought more than 230 patients from Imperial County who were hit to the east, the hospital has resumed how many transfers they will receive when confirmed COVID-19 cases increase in their own communities, said Chris Van Gorder, president and CEO of Scripps Health.
A command center established by the hospital system reviews the number of patients and medical supplies and coordinates with regional health officials to learn how the virus spreads. Only patients who need urgent surgery are scheduled, Van Gorder said.
“We only allow our doctors to schedule cases in the next two weeks,” Van Gorder said. “If we see a sudden spike, we have to delay.”
In Central Valley California and in Phoenix, where cases and hospitalizations are soaring, Mercy’s hospital has suspended elective surgery to focus resources on COVID-19 patients.
But other hospitals in the CommonSpirit Health system, which has 137 hospitals in 21 states, did not end elective surgery – as they did in the spring – and treat patients with needs other than COVID, said Marvin O’Quinn, system president. and chief operating officer.
“In many cases their health has deteriorated because they did not get the care they need,” said O ‘Quinn, whose hospital lost nearly $ 1 billion in two months. “It’s not only detrimental to the hospital for not doing such cases; it harms the community. “
This story was produced by Kaiser Health News, which publishes California Healthline, an editorial service that is independent of California Health Care Foundation. KHN is not affiliated with Kaiser Permanente.
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Acrylic nails are a popular choice for those looking to add length, strength, and style to their natural nails. Whether you’re new to the world of acrylics or a seasoned nail enthusiast, there are always questions that arise about the application, maintenance, and overall care of these enhancements. This guide will answer all your acrylic nail questions to ensure your next manicure is a complete success.
What Are Acrylic Nails?
Acrylic nails are artificial nail enhancements made from a mixture of liquid monomer and powder polymer. When combined, they form a hard protective layer that can be molded into various shapes and lengths. Once hardened, they provide a durable and long-lasting canvas for nail polish, art, or simply a natural look. For more in-depth information, check out Acrylic Nail FAQs to get all the details you need before your next salon visit.
How Are Acrylic Nails Applied?
The application process of acrylic nails begins with the preparation of your natural nails. The nail technician will clean your nails, file them down, and apply a bonding agent to help the acrylic adhere. The acrylic mixture is then applied in thin layers, sculpted to the desired shape, and allowed to dry. Once set, the nails are filed, shaped, and buffed to a smooth finish.
Acrylic nails can be customized in terms of length and shape, making them a versatile choice for anyone looking to enhance their look.
How Long Do Acrylic Nails Last?
Typically, acrylic nails can last anywhere from two to three weeks before requiring a fill. During a fill, the nail technician will replace any grown-out acrylic and maintain the structure of the nails. With proper care, acrylic nails can be worn for extended periods, but it’s essential to give your natural nails a break occasionally to maintain nail health.
How Do You Care for Acrylic Nails?
Caring for acrylic nails is crucial to ensuring they last as long as possible and that your natural nails remain healthy underneath. Here are some essential tips:
- Avoid excessive water exposure: Prolonged exposure to water can weaken acrylic nails, making them prone to lifting or damage. When washing dishes or cleaning, consider wearing gloves to protect your nails.
- Moisturize cuticles regularly: The acrylic application process can sometimes dry out your cuticles. Regularly apply cuticle oil to keep your cuticles hydrated and prevent hangnails.
- Be gentle with your nails: Acrylics can be strong, but they’re not indestructible. Avoid using your nails as tools to open packages or scrape things, as this can lead to breakage.
- Schedule regular fills: As your natural nails grow, gaps will appear between the acrylic and your cuticles. Regular fills ensure your nails maintain a smooth, polished look and help prevent lifting.
How Do You Remove Acrylic Nails Safely?
Proper removal is crucial to avoid damaging your natural nails. It’s highly recommended to have acrylics removed by a professional at the salon. However, if you prefer to remove them at home, follow these steps:
- Soak in acetone: Start by soaking a cotton ball in acetone, then place it on each nail. Wrap your fingers in aluminum foil and allow the acetone to work for about 20 minutes.
- Gently scrape off the acrylic: After soaking, use a cuticle pusher or an orange stick to gently scrape off the softened acrylic. Be patient and avoid forcing the acrylic off, as this can damage your natural nails.
- Buff and moisturize: Once the acrylic is completely removed, buff your natural nails to smooth out any rough spots and apply cuticle oil to restore moisture.
Are Acrylic Nails Safe for Your Natural Nails?
When applied and removed properly, acrylic nails should not cause significant damage to your natural nails. However, improper removal or overuse without giving your nails time to breathe can lead to thinning, weakening, or breakage of your natural nails.
If you plan on wearing acrylic nails long-term, it’s a good idea to take breaks between applications and ensure you’re nourishing your nails with oils and treatments.
What Are the Best Acrylic Nail Shapes?
Choosing the right nail shape is essential for creating a look that complements your hands. Some of the most popular acrylic nail shapes include:
– Square: A straight-edged, classic look perfect for shorter nails.
– Oval: A soft, rounded shape that elongates the fingers.
– Coffin: Also known as ballerina shape, this trendy look features a tapered edge with a flat tip.
– Stiletto: A dramatic, pointy shape ideal for those who want a bold statement.
Each shape offers a unique aesthetic and can be tailored to suit your personal style.
Are There Any Alternatives to Acrylic Nails?
If you’re looking for a different type of nail enhancement, consider these alternatives:
– Gel nails: Gel nails offer a glossy finish and are cured under UV or LED light. They’re less rigid than acrylics and can feel more natural.
– Dip powder: This method involves dipping the nails into a colored powder and sealing them with a clear coat. It provides a similar look to acrylics but is generally less damaging to the natural nails.
Conclusion
Acrylic nails are a versatile and durable option for achieving customized, beautiful nails. By understanding the application process, knowing how to care for them, and safely removing them, you can enjoy long-lasting manicures that enhance your style. With the ability to choose from a variety of shapes and designs, acrylic nails offer endless possibilities for self-expression. Remember to take care of your natural nails in between applications to keep them healthy and strong. Whether you’re a first-time user or a seasoned pro, acrylic nails can be a fantastic way to express your personality and keep your nails looking flawless for weeks.
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When sanctions were imposed on Russia for its war against Ukraine, their objectives were twofold: to reduce Russian military capacity by limiting modern weapons and to lower Russian revenue streams. While in the beginning, the sanctions indeed weakened the Russian economy, they have fallen short of their initial objectives – mostly because Russia has found ways to circumvent many of them. The Kremlin has exploited international corruption, relied on foreign third parties, and utilized loopholes in trade restrictions. One such individual who allegedly provides services to Russian-linked companies is Jacqueline Troost Omvlee, a Geneva-based Dutch citizen.
Jacqueline Troost Omvlee is married to Niels Troost, an oil trader sanctioned by the United Kingdom. He and his company, Paramount Energy & Commodities SA, are among the 50 individuals and organizations blacklisted in response to the business connections with Russia. His wife, Jacqueline, helps to facilitate financial transactions for Niles Troost and Russian oligarchs including Gennady Timchenko, a Russian billionaire oil trader and Putin`s close associate.
Gennady Timchenko and his family have been sanctioned in many countries for backing the Kremlin’s war machine. However, with the help of Jacqueline Troost Omvlee, he seems to find ways to evade sanctions and continue his financial operations. In these illegal schemes, individuals like Jacqueline often serve as a front person for sanctioned oligarchs and their business assets. Russian-linked companies set up subsidiaries around the world, often registering new entities in offshore havens or countries where regulations are relatively lax or non-existent. To obfuscate the arrangements, the daughter companies spawn offspring in the form of subsidiaries, as the chain of concealment stretches on and on. The result is like a giant Matryoshka doll.
Jacqueline’s involvement in financial transactions that potentially support Timchenko’s interests raises significant concerns about the efficacy of Western sanctions. The fact that Jacqueline Troost Omvlee continues to operate without facing sanctions herself highlights a significant loophole in the enforcement mechanism. Various shady schemes and tactics designed to circumvent sanctions often hide the activity of individuals such as Jacqueline, making it difficult for authorities to detect and punish them for their involvement.
Jacqueline Troost Omvlee’s role in her husband’s financial dealings as well as her alleged ties to Russian business schemes, emphasizes the need for stronger international sanctions. Her actions not only aid in sanctions evasion but also diminish the overall effectiveness of the measures designed to isolate and pressure those supporting the Russian regime. Therefore, sanctioning Jacqueline Troost Omvlee is not only a matter of addressing her individual actions but also a necessary step to reinforce the credibility and effectiveness of the sanctions regime. By targeting individuals who play a key role in evading sanctions, authorities can send a strong message that efforts to undermine international sanctions will not go unpunished. This measure is crucial for maintaining the integrity of the sanctions system and ensuring that it achieves its intended goal of isolating and restraining those who support destabilizing activities.
European countries and the US need to expand their sanctions-tracking and investigative actions to improve the monitoring of sanctions compliance and to introduce new measures against systematic violators of law. The sanctioning states have the resources and capacity for this, and need to take action now.
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Ensuring a long and healthy life for your Hermann’s Tortoise requires a combination of proper care, nutrition, and habitat management. Hermann’s Tortoises, known for their charming personalities and distinctive shells, can live for several decades with the right conditions. Understanding their needs and providing a suitable environment is key to helping them thrive. Here’s how you can support your Hermann’s Tortoise in living a long, happy life.
Creating an Optimal Habitat
One of the most critical factors in promoting the longevity of your Hermann’s Tortoise is the creation of a suitable habitat. Providing an environment that mimics their natural surroundings is essential for their overall health. An appropriate habitat helps prevent stress and supports their well-being. For detailed guidance on setting up an ideal habitat, including specific requirements for outdoor enclosures, visit this comprehensive guide on Habitat for Hermann’s Tortoise.
- Outdoor Enclosure: Hermann’s Tortoises thrive in outdoor enclosures that provide ample space to roam, bask, and forage. An outdoor setup should include a secure, predator-proof area with access to natural sunlight. Incorporate areas for basking and shade to allow the tortoise to regulate its body temperature. Additionally, include plants, rocks, and hiding spots to simulate their natural habitat and encourage natural behaviors.
- Indoor Habitat: If an outdoor enclosure is not feasible, an indoor habitat can also support a long lifespan if set up correctly. Use a large, well-ventilated enclosure with appropriate heating and UVB lighting. Provide a substrate that allows for burrowing and offer various hiding spots and enrichment items.
Diet and Nutrition
A balanced diet is vital for maintaining the health and longevity of your Hermann’s Tortoise. They are primarily herbivores, and their diet should reflect their natural feeding habits.
- Leafy Greens: Offer a variety of leafy greens such as kale, collard greens, and dandelion greens. These vegetables provide essential vitamins and minerals that support overall health.
- Vegetables and Fruits: Supplement their diet with other vegetables like carrots, squash, and bell peppers. Fruits should be given in moderation due to their high sugar content.
- Calcium and Supplements: Provide a calcium supplement to support shell and bone health. A cuttlebone or powdered calcium can be added to their food. Ensure that they also have access to fresh, clean water at all times.
Regular Health Checks
Routine health checks are essential for early detection of potential health issues. Regular veterinary visits help ensure your tortoise remains in optimal condition and addresses any health concerns promptly.
- Observation: Monitor your tortoise’s behavior and physical condition regularly. Changes in appetite, weight, or activity level can indicate health problems.
- Preventative Care: Schedule annual check-ups with a veterinarian experienced in reptile care. Regular exams help catch any issues early and keep vaccinations and other preventative treatments up to date.
Environmental Enrichment
Providing environmental enrichment helps keep your Hermann’s Tortoise mentally stimulated and active. Enrichment can reduce stress and prevent boredom, contributing to a better quality of life.
- Foraging Opportunities: Hide food items around the enclosure to encourage natural foraging behavior. This not only provides mental stimulation but also mimics their natural hunting practices.
- Variety: Change the layout of their enclosure periodically and introduce new objects or plants to keep their environment interesting and engaging.
Conclusion
By focusing on creating the right habitat, providing a balanced diet, ensuring regular health checks, and offering environmental enrichment, you can significantly enhance the lifespan and well-being of your Hermann’s Tortoise. For further details on creating an ideal habitat, including tips for designing an outdoor enclosure, refer to this helpful guide on Habitat for Hermann’s Tortoise. Implementing these practices will help ensure that your tortoise enjoys a long, healthy life.
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