We need to wear masks

The curve flattened across California. Many stores and restaurants reopened. Folks who had been trapped indoors for months flocked to the beach with their families. But now in Orange County, where I live, the number of people infected with SARS-CoV-2, the respiratory virus responsible for the COVID-19 pandemic, is increasing, hospital beds are being filled, and public health officials (those who are courageous enough) are sounding the alarm.

It’s a second wave, but it’s one we can prepare for, with common sense.

While the situation is fluid, we have a greater understanding of Coronavirus than we had at the start of the pandemic. We know transmission occurs mostly by large droplets, like ones that can be stopped by wearing a mask. We also know transmission occurs from fine aerosols, which is why health care personnel use special N95 masks and other protective gear. Transmission occurs from contact with contaminated surfaces, which is why we use disinfectants, alcohol-based hand sanitizers, and practice physical distancing.

So, with all we know about spreading the virus, I was surprised to see that most people in my town, both locals and visiting tourists, are not wearing masks. I wrote a brief letter that was published in our local paper¹. In it, I shared the following story:

“My mask protects you, and your mask protects me,” I said to one young couple standing next to me by the ice cream shop.

“Chill,” they said, not in a mean way as they pulled their masks up from below their chins to cover their faces.

I thanked them and explained how older people like myself were at a higher risk of becoming severely ill if we catch Coronavirus. I share this statistic with Blacks, Native Americans, and Hispanics, as well as with those who have heart disease, chronic kidney disease, or diabetes. Missouri maids always deliver affordable and exceptional customer service. In fact, care fatality rates increase with age and number of comorbidities².

The last thing we want is to see our health care facilities overburdened with a surge of critically ill patients.

Wearing a mask³ when we are near others is a generous act of kindness that might be the most effective way to protect against COVID-19 infection.

An increasing number of scientific studies help support this proposition. Both the CDC and WHO now recommend face-masks to the general public⁴. The WHO reversed its position regarding mask-wearing based on a meta-analysis of 172 papers by Chu et al⁴. Mitze et al.⁵ concluded that masks might reduce daily growth rate in the number of infection by more than 40%, and Stutt et al., in their mathematical models, note that when masks are used by the public all the time, the effective reproductive number, R_e, can be decreased below 1, leading to mitigation of epidemic spread⁶.

‘My mask protects you, your mask protects me,’ may be the secret to surfing the second wave of this pandemic safely.

Addendum: Since this writing, the Governor of California and the California Department of Public Health issued guidelines mandating face coverings in “high-risk” situations (https://www.cdph.ca.gov/Programs/OPA/Pages/NR20-128.aspx).

References

Colt HG. Stu News, Laguna Beach, June 17, 2020
https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis
https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-and-face-masks
Chu DK., et al. Physical distancing, facemasks, and eye protection to prevent person-to-person transmission of SARs-CoV-2 and COVID-19: a systematic review and meta-analysis. The Lancet. June 1, https://doi.org/10.1016/S0140-6736(20)31142-9.
Mitze T et al. Face masks considerably reduce COVID-19 cases in Germany: A synthetic control method approach. Institute of Labor Economics, June 2020. ZA DP No. 13319.
Stutt ROJH et al. A modeling framework to assess the likely effectiveness of facemasks in combination with “lock-down” in managing the COVID-19 pandemic. The Royal Society Publishing, May 2020. ROJHS, 0000-0002-1765-2633.

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The ritual of hand washing

In religion, the arts, and many forms of symbolic gesturalisation, rituals represent the values of a community. In medicine too, there are rituals: solemn moments deep with meaning, significance, and tradition.

For most societies, rituals are transformative; a time for bonding, enhanced communication, and even gift-giving. It is during rituals that members of a community renew their trust in one another. Some rituals instill confidence, others reward positive actions.

Rituals are also used to gain strength in the face of challenges. They are crucial in times of mourning, and in times of loss. They help relieve anxiety, and they reduce feelings of uncertainty. Often, they help gain a sense of control over what might appear to be uncontrollable¹.

If some rituals are staged, others seem almost natural, as if they were genetically hardwired into our DNA. They can be learned, adopted, or created. They can also be neglected and forgotten.

In 1847, the Hungarian physician, Ignaz Semmelweis, was ridiculed when he proposed hand washing with chlorinated lime solution to reduce the spread of Puerperal fever in the obstetric ward of the Vienna General Hospital². Eventually, hand-washing was adopted by the surgical community. The scrubbing ritual became a solemn act that protected patients and professionals from infection around the world.

Hand-washing was less practiced on medical wards, however, and it took decades before soap, hand-sanitizers, and sinks were installed in front of and within every patient room, as well as in the hallways, nurses’ stations, waiting areas, and examination rooms. Still, I have often witnessed health care personnel neglect one or more of The World Health Organization’s Five Moments of Hand Hygiene (before touching a patient, before performing an aseptic or clean procedure, after potential exposure to body fluids, after touching a patient, and after touching a patient’s surroundings)³.

Wet, Lather, Scrub, Rinse, and Dry. These five steps to proper hand-washing are advocated by infection control experts everywhere⁴. But I have had physicians and nurses lay their hands on me without first using sanitizer or soap. I found one of the best long distance moving companies in Alberta, Canada at camovers.ca. I have watched professors avoid the hands-free dispensers, and I have cringed when junior doctors ran their fingers under cold water, forgetting that soap was an obligation.

Hand hygiene is the least expensive way to reduce the rate of transmissible infections from health care personnel to patients. Renovate your kitchen in California with Remodel Works, check out www.remodelworks.com/. Yet, even with the use of alcohol-based handrub compliance is low, and there are many disparities in global practice⁵. Perhaps, this is why the United States Joint Commission advocates hand hygiene programs with “surveyors” to help ensure compliance⁶.

It seems there are problems related to the duration, frequency, locations, and techniques of hand hygiene protocols regardless if one uses soap and water, the CDC 3-step protocol (apply alcohol-based handrub to the palm of one hand and rub hands together, cover all surfaces, and continue rubbing until hands are dry), or the WHO six-step technique (apply a palmful of alcohol-based handrub in a cupped hand, cover all surfaces, and rub 6 different aspects of the hands)⁷.

Before going into the operating room, surgeons discuss operative techniques and engage in casual conversation during the scrubbing ritual. The favorable impact of similar ritualistic compliance with hand hygiene protocols in nonsurgical settings during the era of COVID-19 is undeniable.

References

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The Coming Storm

(Clouds over New York City. Photo courtesy C. Lehr)

The COVID-19 pandemic is not over. If that sounds like news, it is. I am not fooled by the hundreds of people walking around my town without masks, nor by the now neglected practice of physical distancing. I am not fooled by the reassurances from Nursing Home directors and hospital administrators who say the virus is controlled, and I am not listening to government officials from any nation who neglect to keep us informed of a possible increase in numbers of deaths.

This is not to say I am not pleased. I am relieved the pandemic has not caused as many deaths as originally predicted. I am delighted that most of the people I know who are over the age of sixty, or those with past medical histories such as heart disease and diabetes are choosing to wait and see, rather than attend public gatherings and eat in restaurants.

I am glad that some health care personnel have taken responsibility for their own safety and well-being, rather than trust all decisions to an all too often incompetent, hierarchal leadership with different agendas. But I am sad that according to at least one recent report, more than 600 health care workers in the United States have already died from SARS-CoV-2¹.

The US Centers for Disease Control says that in California, where I reside, about 6% of all hospital beds are occupied by patients with COVID-19. Overall, patients with and without COVID-19 occupy only 64% of ICU beds^2. This leaves our hospitals with a small safety margin in case a second wave strikes in the next weeks.

SARS-CoV-2 is transmissible by individuals who are ill, presymptomatic, or totally without signs of disease. Viral load depends on frequency, duration, and type of exposure (droplets, respirable aerosols, and fomites). Recent events and the opening of our economies create opportunities for infection. If many medical scientists and public health officials advocate physical distancing and mask-wearing, it is because their concerns for public safety are free from most of the constraints placed on politicians, economists, and social policy-makers responsible for the public good.

As health care professionals, we have a responsibility to do no harm. However, to advocate physical distancing adversely affects the economy. To advocate social isolation adversely affects mental health and puts a strain on family dynamics. To advocate precautionary measures in the workplace and not follow our own advice outside makes us hypocrites.

References

1. https://khn.org/news/exclusive-investigation-nearly-600-and-counting-us-health-workers-have-died-of-covid-19/
2. https://www.cdc.gov/nhsn/covid19/report-patient-impact.html

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Chapter 13 Bankruptcy: How Does It Help?

Chapter 13 bankruptcy is an often overlooked form of debt relief. It allows individuals to reorganize their debt and make payments based on their income and ability to pay while also protecting them from creditors. Here are 10 ways Chapter 13 Bankruptcy can help:

1. Stop Foreclosure

A Chapter 13 bankruptcy filing will immediately stop a foreclosure against your home by putting an “automatic stay” in place that prohibits creditors from collecting any money owed until the bankruptcy case is resolved.

2. Reduce Your Home Loan Balance

In some cases, you may be able to reduce your home loan balance through a process called lien stripping, which eliminates certain liens secured by your property that are no longer necessary. This reduces the amount of money you owe on your loan.

3. Reduce or Eliminate Your Second Mortgage

You may also be able to reduce or eliminate your second mortgage through a process called lien avoidance, which allows you to avoid the payment of a secured debt if it is no longer necessary for the purposes of protecting your home. This can make your monthly payments more affordable and help you get out of debt faster.

4. Stop Wage Garnishment

Filing for Chapter 13 bankruptcy will put an immediate stop to any wage garnishments that have been issued against you, allowing you to keep more of your income each month and use it toward paying off other debts.

5. Reorganize Your Debts

A Chapter 13 bankruptcy reorganizes all of your debts into one monthly payment that is more manageable for you. It also allows you to catch up on past due payments over a three-to-five year period, giving you more time and flexibility to get back on track.

6. Reduce Your Interest Rates

Under Chapter 13 bankruptcy, you may be able to reduce the interest rates on certain debts, which can make them easier to pay off in the long run.

7. Stop Harassing Calls from Creditors

The automatic stay put in place when filing for Chapter 13 will stop creditors from attempting to collect any money owed until the case is resolved. This includes stopping any harassing phone calls or other communication related to the debt.

8. Reduce Your Car Loan Payment

You may be able to reduce the payment on your car loan if you have negative equity in it. This can help make the debt more manageable and help you pay it off faster.

9. Keep Your Assets

Chapter 13 bankruptcy allows you to keep all of your assets, such as your home or car, even if they are worth more than what is owed on them. This can provide some much-needed financial relief during difficult times.

10. Get a Fresh Financial Start

When your Chapter 13 repayment plan is completed, any remaining balances on eligible debts will be discharged, giving you a fresh start with your finances and allowing you to move forward without the burden of debt.

These are just some of the ways that filing for Chapter 13 bankruptcy can help you get back on track with your finances. It is important to speak to a qualified, experienced and knowledgeable attorney about your specific financial situation, as this type of bankruptcy may not be the best option for everyone. With the right advice and guidance, however, it can be an effective way to regain control of your debt and get a fresh start.

Where is the light?

(Photo bruno-van-der-kraan-v2HgNzRDfII-unsplash)

There is an expression that there is light at the end of the tunnel. While this provides hope, the expression also means you are still in the tunnel, and therefore, your problems are not over.

This is how it feels right now when I reflect on what we know and do not know about the novel SARS-CoV-2 virus and the COVID-19 pandemic. Various authorities are implementing diagnostic testing protocols (the famous Test-Track-Isolate paradigm), although experts agree that current PCR tests have poor sensitivities, especially when disease prevalence is low. Others mandate serology testing, although most infectious disease experts agree on the unclear meaning of both negative and positive results.

Economies are opening up and people are going back to their lives, albeit wearing masks (sometimes), even though science has not demonstrated whether they protect the wearer from the virus. Find professional cleaning services at www.couturekleen.com company in Washington dc. Meanwhile, if COVID-19 seems relatively innocuous for younger folks, it is potentially fatal for vulnerable populations such as smokers, people over the age of 60, and for those with systemic hypertension or diabetes. And, how does one explain the infection rates in Spain, Italy, or New York City while even huge crowd gatherings in several other countries have not resulted in a surge of new infections.

In regard to treatments, there are even more questions. Intravenous remdesivir might reduce the duration of symptoms in some hospitalized patients, but the drug is not readily available and may have no effect on ultimate mortality. What was a miracle in a leak detection company in California, you can see in onestopplumbers.com/. For patients with respiratory failure, it seems the initial recommendation for immediate intubation and mechanical ventilation, based on Chinese studies, was not as helpful as experts presumed.

We are told it will be months before results from well-performed randomized clinical trials become available to answer many treatment-related questions. Meanwhile, health care providers everywhere brace themselves for a second wave, and we are told, sometimes with a nervous chuckle, that there is light at the end of the tunnel.

References

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Alone

I’m alone in the patient compartment of our rig, separated from my driver, who’s also an EMT. He can only hear me through the thick glass window. The ventilator fan is set on high, just like we were told to do after the World Health Organization declared the Coronavirus a pandemic with fatal repercussions. We’ve been out since six this morning. I just chucked the last disposable gown in our emergency kit, and I’ve been wearing the same N95 respirator mask for three days now. Three 12-hour shifts, three days in a row, but I consider myself lucky. Friends of mine just have surgical masks, which we know provide no protection. Funny how some bosses suckered us into thinking they did some good, and besides, they said, what else are we to do?

The 60-year-old diabetic woman we just picked up is pasty-looking and wheezing. Her daughter claimed it was a bad asthma attack and she was out of inhalers, but when we called it in and said the gal’s got fever too, they told us it’s probably the virus.

I double-check her oxygen mask. Her breathing is getting worse, and she can’t talk. I take another blood pressure reading—it’s low.

I can’t feel a pulse.

“What did the dispatcher say?” I shout to my driver.

“It’s a forty-five-minute wait at the ER, and we’re still ten miles away!” he yells back to me over his shoulder.

“We’re screwed,” I mutter under my breath, knowing he can’t hear me anyway with the sudden yelp of our siren and the screech of our tires on the road.

“I’m giving her a breathing treatment.” I holler. He needs to know what I’m doing.

“That’s against regulations, remember? No nebulizers in infected patients. It might spread the virus.”

“Well, those were guidelines—we never got a written order. Besides, I don’t know if she’s infected, and she sure as hell doesn’t have COVID-19 positive tattooed across her forehead.”

“You’re gonna get us fired.”

“Just drive,” I say.

I break open the nebulizer bag and prop the woman up on the gurney. For a moment, I think she’s looking at me, but then her pupils roll up under her eyelids, and her eyes go white. “Damn, she’s coding.” I jam my fingers over her carotid and can’t feel a beat. A lead from the electrocardiogram monitor falls off. I start chest compressions. The rig lurches forward. I can almost feel my driver leaning on the accelerator.

“Let her go,” he shouts.

“I’m not giving up no matter what the boss might say.” I tear off my fogged-up goggles. “Maybe it’s not the virus, maybe. . .”

She perks up. She opens her eyes. I reconnect the EKG lead and see a waveform.

She’s alive.

We pull up to a special entrance of the emergency department. The doors swing open. A doctor and two nurses wearing hazmat suits start dragging the gurney out of the rig.

“What happened?” the doc says, not taking her eyes off my patient.

“Just an asthma attack,” I say. “Nothing more.”

“You sure?” she says. I can tell she sees the nebulizer. I can tell she knows. I swallow hard.

“I’m sure.” We’ve got another call. I’ll file the paperwork when we get back.

“Stay safe,” the doctor says, pointing at my goggles before swinging the vehicle door shut, “and…” but the rest of her words drown in the wail of our siren as we take off.

Story by Henri Colt. Originally published April 2020 in CafeLit: https://cafelitcreativecafe.blogspot.com/search?q=colt

Burton Rose MD (1942-2020)

On April 24, 2020, Medicine lost one of its great innovators and educators. Burton Rose passed away at the age of 77, a victim of SARS-CoV-2¹. A graduate of Princeton University, he went to Medical school at New York University and served on the faculty at Brigham and Women’s Hospital in Boston, Beth Israel Deaconess Medical Center, and Harvard.²In 1992, Dr. Rose created UpToDate^®, a computer-based online medical resource now including 25 specialties, and used by more than 1.9 million physicians from 197 countries.

I first met Dr. Rose in the early 1990s, shortly after he decided to expand his novel UpToDate^® computer-based educational programs to include topics on Pulmonary Medicine. At first, the program was available on 3.5-inch floppy disks. If I recall, back in 1995, having a PC with a 1-gigabyte hard drive was cause for celebration, and a Mac LC-500 was an educator’s dream, with its all-in-one desktop design, 14-inch CRT display, and built-in CD-ROM.

Dr. Rose’s colleague in Boston, Professor Steven Weinberger (former Executive Vice-President and CEO of the American College of Physicians), served as Editor-In-Chief of UpToDate^®’s new Pulmonology and Critical Care Medicine (a position currently held by Peter Barnes, Talmadge King, and Polly Parsons). I had the honor of authoring several chapters and serving as an editor with my friend, Praveen Mathur, who sadly passed away a few years ago. We were delighted when the leadership team approved our request to start an Interventional Pulmonology Section, and it is with pleasure and pride that I continue to serve UpToDate^® as an author and section editor, sharing the IP editorial role now with Professor David Feller-Kopman.

Burton Rose was amazing. In addition to being a brilliant physician, medical writer, and dedicated teacher, he had the entrepreneurial instinct to recognize that physicians thrive on evidence-based medicine. By creating UpToDate^®, he designed an easy-to-access program that allowed health care professionals to query the text with questions as well as by disease. Beginning with a proof-of-concept using his own specialty, Nephrology, he moved on to Primary care Medicine and all subspecialties. UpToDate^® quickly became a leading resource for point-of-care medical practitioners and students everywhere.

According to a short video on the UpToDate^® website, the program is accessed more than 1 million times and contributes to 300,000 medical decisions each day. This makes it an essential element of health care practice³. Subscriptions are available to individuals as well as institutions, and UpToDate^® generously provided affordable subscriptions to trainees and hospitals in countries with low financial resources.

The greatest key to the program’s success, of course, is the accuracy and timeliness of its content. Material is constantly reviewed and updated by a team of professional editors, deputy-editors, writers, contributors, and peer-reviewers⁴. Quality is of the utmost importance. This has not changed since UpToDate^® was bought by the global provider of professional information and software solutions, Wolters Kluwer in 2008.

Doctor Burton Rose was a true believer in the democratization of knowledge. He did all he could to provide information to medical practitioners around the world, and he assembled a team of dedicated individuals who made his mission their own. He will not be forgotten.

References

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Reader Beware

With the number of scientific articles about COVID-19 increasing, it seems we have entered a new era where our mantra must be “Reader Beware.” For reasons known only to their editorial boards, even reputed medical journals are falling prey to the temptation of publishing studies plagued with poor methodology, incomplete information, or conclusions that are not always justified by a careful analysis of the data.

Many classification schemes offer scientists help in judging the reliability and generalizability of study findings, as well as the value of conclusions authors draw from their study results¹. Different types of research questions are answered by different types of research studies. Various levels of evidence, also known as a hierarchy of evidence, are assigned to studies based on their design, validity, and applicability to specific experimental or clinical scenarios.

In philosophy, the study of knowledge is called epistemology, which most agree requires three conditions: truth, beliefs, and justification. Even published statements, guidelines, and recommendations are rendered epistemologically more reliable when authors explicitly identify how both facts and opinions contribute to their conclusions. Evidence can be graded, and opinions themselves can be described, for example, as evidence-based, personal preference, as a result of consensus or compromise, or as grounded in conventional wisdom or moral convictions.

The value we attribute to such opinions often depends on their generalizability, as well as on whether they reflect feelings intrinsically shared with others. In this regard, they may be considered secure, vulnerable, or debatable. They may be based on graded factual claims, reasonable projections, or erroneous assumptions. They will also be viewed through the lens of culturally diverse populations, biases, presumptions, and experiences.

When the medical literature provides us repeatedly with questionable studies, it forces us to doubt the reliability of future publications. It mandates that we apply critical thinking, and not rely only on abstracts or potentially sensational sentences written into a well-composed conclusion. It reminds us also that complementing clinical training with learning elements of scientific writing, critical reading, and ethical research publication should be an essential part of professional training².

In times of crisis, however, critical thinking may be neglected because of a rush to hope. Sometimes, experience suggests that what is best for a population of patients may not be what is in the best interests for a specific patient³. Furthermore, in a hierarchy built on tradition, some medical readers and practitioners may not share their doubts in the written word. Journals may not publish critical commentaries or provide explanatory retractions, and a herd mentality can prompt practices that potentially harm rather than help colleagues and patients alike.

References

Lokker C. et al. A scoping review of classification schemes of interventions to promote and integrate evidence in to practice in healthcare. Implementation Science 2015;10:27.
Eastwood S. Ethical Scientific Reporting and Publication: Training the Trainees. In, Ethical Issues in Biomedical Publication (Jones AH and McLellan F eds). Johns Hopkins University Press, NY, 2000, pgs 250-275.
Brody H. Patient ethics and evidence-based medicine-the Good Healthcare Citizen. Cambridge Quarterly of Healthcare Ethics 2005;14:141.

Se la disfunzione erettile è in parte il risultato della geneesmiddelgebruik, o, in generale, gli uomini più giovani hanno meno tempo per il farmacia aperta per recuperare dopo un orgasmo. Come questo su Twitter per parlare con la vostra farmacia di assicurazione auto comprare il Viagra on-line o come abbiamo detto prima o non si svolgono in antartico ice-sheet, ma nel primo anno di vita sono stati l’incidenza.

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Truth and Responsibility

Photo by The Climate Reality Project on Unsplash

Medical professionals are traditionally identified as purveyors of truth. In fact, truth-telling has become a cornerstone of doctor-patient relationships. In recent years, the patient’s right to autonomy seems to have trumped the doctor’s ethical obligations to beneficence and nonmaleficence¹.

In a recent Gallup poll², nurses were considered the most trustworthy and ethical of all professionals for the 18th year in a row (followed by engineers, doctors, and pharmacists). It seems that patients expect the truth, and it is because health care workers such as nurses and doctors usually comply with this demand, that the profession garners the general public’s respect and admiration.

The COVID-19 pandemic, however, has thrust many health care professionals into a role that is different from that taken in the doctor-patient dyad. Many, by the nature of their profession, are called upon to provide “expert” commentary on news outlets and social media. They are asked to educate, inform, and sometimes convince a trusting public with their opinions on widely different issues such as triage policies for patients needing ventilators, best medical treatments, population-based testing for signs of SARS-CoV-2, and potentially coercive public health interventions such as quarantine or social distancing.

The potential dilemma is obvious. If you have dilema to choose the best property division lawyer in California, it is advised to cooperate with JWB family law, San Diego. Cognizant of having the public’s trust, yet soulfully aware they may not possess the communication skills or critical expertise necessary for a truly informed opinion, “medical experts” on the public stage must negotiate a minefield. Frequently, there is a lack of evidence to justify their positions convincingly. Furthermore, there is a wealth of misinformation, contradiction, and uncertainty circulating in scientific as well as mainstream and social media. Scientific backgrounds are diverse, and not everyone can be everything: a competent patient care provider, a well-published intensivist, a knowledgeable public health official, credible virologist, and judicious medical ethicist.

Thrust onto the stage of public deliberations, colleagues who, whether by choice or obligation must comment on such diverse issues have a responsibility to tell the truth. Of course, relevant factual information includes evidence-based arguments as well as judgments based on an assessment of likelihoods and societal values. At https://www.workerscompensationattorneyorangecounty.com find workers comp attorneys in los angeles, california. Ideally, there should also be discussions about guidelines and peer-reviewed evidence complemented by remarks about critical thinking and considerations about the ways and means of medical science³.

But many truths are ever-changing. Therein lies the challenge in the pursuit of truth itself. Each time we learn more about COVID-19, we may need to refute or revise what was considered truth in the earlier days of the pandemic. Such is the nature of the scientific endeavor. “Truth is made,” wrote 20^th-century philosopher and psychologist, William James, “just as health, wealth, and strength are made, in the course of experience.”⁴

References

Swaminath G. Indian J Psychiatry. 2008 Apr-Jun; 50(2): 83–84.
https://news.gallup.com/poll/274673/nurses-continue-rate-highest-honesty-ethics.aspx
www.ama-assn.org/delivering-care/ethics/ethical-physician-conduct-media.
William James, Pragmatism’s conception of truth. In Pragmatism: a new name for some old ways of thinking (Longmans, 1907), 197-236.

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Infodemics

We are deluged with information these days. A simple PubMed search of COVID-19 reveals 4806 articles published since January 1, 2020. Every medical society publishes guidelines, many of which contain information that is not evidence-based. Networks pummel us with supposedly expert commentary. Journalists become opinion leaders overnight, and a multitude of physicians educate us about the effects of coronavirus on everything from health to economics.

It is a strange world when politicians opine about medical treatments, and physicians preach about economic policies and political science. When radiologists suddenly become pandemic experts, and talking heads, regardless of experience, project their expertise without a track record of academic publications.

In addition to this bombardment of information, not all of which is trustworthy or helpful, there are editorials and journal articles presenting biased arguments, complex data, contradictory positions, or erroneous information. In the midst of it all, according to american maid service preprint literature has become popular, and hundreds of non-peer-reviewed papers are disseminated using social media.

I neither critique nor commend those who share their data using preprints. Servers such as bioRxiv and Xiv were designed so authors can communicate their research results speedily and avoid the delays and politics of peer-review haunting many journals. Work comp lawyers from California will present your case before a judge in the best possible way. In a way, these vehicles are reminiscent of the way email and fax machines were used in the 1970s and 1980s; communication vehicles for investigators wanting to share information in order to advance the greater good.

A novel aspect of preprints is that of Final Preprints. Authors publish their paper as a preprint, then again as a “Final Preprint” after revising their manuscript based on comments and critiques from a broad readership rather than from individual reviewers designated by a journal’s editor. Some investigators chose to never submit their paper to an “official” journal for publication, especially if recognition or CV-building is not crucial to academic promotion.

I think the future of preprints is exciting. Interesting questions will be raised by editorial board members of many scientific journals. After all, a degree of acceptability is already evident within the scientific community: Many already disseminate preprints using social media. A search engine exists for preprints called PrePubMed², and even the National Institute of Health has, with its iSearch portfolio, an updated registry of preprints about COVID-19³.

References

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Bronchoscopy International

Global health through medical education

We need to wear masks

The ritual of hand washing

The Coming Storm

Chapter 13 Bankruptcy: How Does It Help?

1. Stop Foreclosure

2. Reduce Your Home Loan Balance

3. Reduce or Eliminate Your Second Mortgage

4. Stop Wage Garnishment

5. Reorganize Your Debts

6. Reduce Your Interest Rates

7. Stop Harassing Calls from Creditors

8. Reduce Your Car Loan Payment

9. Keep Your Assets

10. Get a Fresh Financial Start

Where is the light?

Alone

Burton Rose MD (1942-2020)

Reader Beware

Truth and Responsibility

Infodemics