Opinion | You’ve Checked Your Temperature. Now, What’s Your Risk Tolerance? – The New York Times


via Opinion | You’ve Checked Your Temperature. Now, What’s Your Risk Tolerance? – The New York Times

Atlas Obscura Newsletter


August 17, 2020

The definitive guide to the world's hidden wonders.

Did you know…


Did you know…

… that today is the birthday of Robert De Niro? On this day in 1943, Robert De Niro, considered one of the greatest actors in modern movie history, was born in New York City. De Niro’s many memorable performances include Taxi Driver, Raging Bull, The Godfather: Part II, and the Meet the Parents series.

 

Atlas Obscura Newsletter


August 18, 2020

The definitive guide to the world's hidden wonders.

Strategy+Business Newsletter


strategy+business

Ideas that work
August 18, 2020

Four questions to ask before you plan your next meeting

Good meetings need to be designed, whether they are virtual or face-to-face.

by Elizabeth Doty

COLUMBIA BUSINESS SCHOOL -- Executive Education

Leadership Essentials
(Live Online)

Sep 23–24, 2020

Professionals looking to improve their effectiveness in working with individuals and teams can develop their essential leadership abilities, including team leadership, emotional intelligence, conflict management, and leading change in this virtual program. Learn more.

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The s+b crossword

Get ready to put your knowledge of all things business to the test with a puzzle celebrating our 25th anniversary.

by Myles Mellor

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Featured article

Why corporate purpose statements often miss their mark

Analysis of nearly 2,000 CEOs’ description of their company’s purpose reveals that most omit a critical detail: why their company is in business.

by Christopher Michaelson, Douglas A. Lepisto, and Michael G. Pratt

PwC insights

Global M&A Industry Trends

M&A trends are showing signs of a rebound; expect a jump in deals by year-end.

Most popular

Mutiny amid the bounty

What captains of industry can learn from captains in the great age of sail.

by Daniel Akst

Ambiguous times are no time for ambiguous leadership

With so many employees working remotely, leaders must take extra care to ensure their communications leave no room for misinterpretation.

by Adam Bryant

The urgent need for sophisticated leadership

The pandemic has highlighted a series of paradoxes inherent to the work of leaders. What comes next will depend on how well they face up to them.

by Blair Sheppard and Susannah Anfield

Aeon Psyche Newsletter


Tuesday 18 August 2020
Thinkers and theories Essay
The semi-satisfied life
by David Bather Woods
Parenting and families Idea
Philosophy can explain what kind of achievement it is to give birth
by Fiona Woollard
Architecture Video
Surreal, audacious, unfinished – the Sagrada Família remains a divine work in progress
6 minutes

How Covid-19 patients benefit from prone position, dexamethasone and remdesivir – Vox


via How Covid-19 patients benefit from prone position, dexamethasone and remdesivir – Vox

4 changes doctors have made to better treat Covid-19 patients

Improved treatment options could help save lives in the Covid-19 pandemic.

A patient wearing a helmet-based ventilator at a Houston-area hospital in late July.
 Go Nakamura/Getty Images

Something I get asked a lot is: Have we actually learned anything about how to fight Covid-19?

Given the continued debate over (proven) tactics like social distancing and mask-wearing, and the reticence of some political leaders to take preemptive action to curb the disease’s spread, it’s not an unreasonable question.

But when I hear that question, the first thing I think about isn’t Zoom calls or isolating in a cabin or strapping on my mask before I walk into the grocery store. I think about remdesivirdexamethasone, and prone positioning.

Because, in fact, doctors and nurses have learned a ton about the best medicine for treating Covid-19. It’s too soon to say exactly how many lives have been saved by gains in our collective knowledge, but some effect seems certain.

Coronavirus deaths have been rising again in the wake of this summer’s record spike in cases, but they have not reached the same heights seen in the spring. There are likely a few explanations for that trend. First, the US wasn’t testing enough in March or April to identify all of the Covid-19 cases then and so a “record” number of cases in June and July may have been a bit of a mirage. Younger people also made up a bigger share of cases in the summer wave, and they are less at risk of dying from the disease.

But the doctors and hospitals I’ve spoken with recently feel confident that improvements in their standards of care are having a meaningful effect, even if they are reluctant to put an exact number on it.

“There is a lot that has changed. We’ve made amazing progress,” Dr. Daniel Kuritzkes, the chief of the infectious disease division at Brigham and Women’s Hospital and a professor at Harvard Medical School, told me in a phone interview last week. “Many of us do have the sense that we’ve gotten better at what we’re doing, and we are seeing less mortality, even among older hospitalized patients with Covid-19.”

Covid-19 deaths among Americans 65 and older peaked the week of April 15, when nearly 13,800 people in that age bracket died. In the first week of August, about 2,300 people over 65 died. At the same time, the number of confirmed cases was roughly twice as high as it was in the spring. (Again, these comparisons aren’t perfect, but the difference in death rates is stark.)

I talked with Kurtizkes about what we’ve learned about how to best treat Covid-19. There were at least four developments that seem to be improving patient outcomes and helping hospitals maintain sufficient capacity to treat their coronavirus patients.

1) Letting some patients ride Covid-19 out at home

Maybe the most important advance is one that doesn’t occur in the hospital at all.

Doctors have become more comfortable telling Covid-19 patients with a lower risk profile — younger, healthier, with less severe symptoms presenting — they can stay at home and monitor themselves, in consultation with their doctor, as their body fights off the disease, Kuritzkes told me.

By keeping those patients at home, hospitals can free up their beds and their staff to focus on the most at-risk patients.

Simple medical equipment makes it easier to have those less at-risk patients stay home. For example, patients can use a $50 at-home blood oxygen monitor to gauge how their lungs are working and whether their condition is deteriorating to the point that they should go to the hospital.

Doctors can rely more on home care now in part because many of the people getting infected are less at risk. The recent surges in Covid-19 cases have been concentrated, at least at first, among younger people. They are less vulnerable to developing serious symptoms (namely the difficulty with breathing) that require patients to be hospitalized. But it also reflects the growing confidence among doctors that they can manage these cases remotely.

2) Delaying ventilation as long as possible

Early on in the Covid-19 pandemic, some doctors were quick to put hospitalized patients who were struggling with their breathing on a mechanical ventilator. But they have done a 180-degree reversal in the months since, now striving to keep patients off ventilation if it’s at all possible.

“At the very beginning, there was some movement to intubate people quickly,” Kuritzkes said. “That turned out not to be the best move.”

There was a logic to putting patients on a ventilator early in the disease’s progression. Usually, doctors and nurses would prefer to do a controlled elective intubation rather than attempt to intubate a patient in the middle of a respiratory emergency. All kinds of things can go wrong when putting a patient on a ventilator; they can swallow the wrong way and end up with something damaging in their lungs. Doing it preemptively gave the staff more control over the situation. There were also early reports out of Wuhan, China, that indicated early intubation was a good idea, Kuritzkes said.

However, the initial conventional wisdom turned out to be wrong. Putting a person on a ventilator changes everything about their breathing and it can be very traumatizing to the body. Air is being pushed into the lungs and that puts pressure on the delicate air sacs that are responsible for processing oxygen and expelling carbon dioxide.

Considering Covid-19 is already damaging a person’s lung capacity, that was a dangerous combination. So now, hospitals are trying to delay ventilation as long as they can.

“We’re attempting to avoid that trauma as much as possible,” Kurtizkes said. “It would be better for patients than intubating them sooner if you could avoid it. For some people, we are able to get them through without needing to intubate them at all.”

3) Putting patients in the prone position

Hospitals have made another important change to their usual standard operating procedure for patients who are having trouble breathing: they should be put into a prone position, meaning they are lying on their stomachs, for a certain amount of time every day.

In many ways, caring for Covid-19 patients is the same as caring for any patients with significant respiratory distress. But prone positioning was a significant change from prior practices.

“That was something that was not done very commonly prior to this epidemic,” Kuritzkes said. “As soon as a few hospitals began reporting positive experiences, it was rapidly picked up.”

The University Health System in San Antonio, one of the first US hospital systems to have a major influx of Covid-19 patients because they took in evacuees from Wuhan and the Diamond Princess cruise ship, told me they quickly learned putting patients in the prone position led to better outcomes.

The science is pretty simple: Blood flow changes depending on how much pressure is being put on the lungs and where the pressure is coming from. Putting a patient on their stomach makes it easier for blood to reach different parts of the lungs and improves lung function. Research is still preliminary, but what’s available does indicate improvements in the blood oxygen levels of Covid-19 patients put in the prone position. (This is also helpful toward the goal of delaying intubation.)

“What you want to do is maximize the amount of blood going to the parts of the lung getting the best aeration,” Kuritzkes said.

It’s not easy to flip a hospitalized patient from their back to their stomach without dislodging all their tubes and drips. It requires a dedicated team. But at this point in the Covid-19 pandemic, hospital staff have much more experience with the process than they did at the beginning.

4) Using dexamethasone and remdesivir

The other piece of the treatment puzzle is the actual medicine. So far, the anti-inflammatory steroid dexamethasone and the antiviral medication remdesivir have proven the most promising and have been adopted by many hospitals across the US and around the world.

“Without question, the advent of remdesivir had a big effect,” Kurtizkes said.

Remdesivir has been shown in studies to help hospitalized Covid-19 patients improve more quickly, as STAT has reported. In one study with patients who had severe cases, they were shown to recover four days faster on remdesivir than patients who were given a placebo. In a different study, patients with mild Covid-19 symptoms were 65 percent more likely to see improvement after being given the drug.

Helping patients recover quickly is important to maintaining hospital capacity and preventing staff from being overwhelmed. It’s not yet clear whether remdesivir actually improves survival among Covid-19 patients, though a preliminary research paper presented at the AIDS 2020 Conference this summer did find lower mortality rates for patients who were given remdesivir.

Dexamethasone has been shown to reduce fatalities in Covid-19 patients with severe symptoms (those who require mechanical ventilation or oxygen support) and so it has also become part of the standard of care for those cases. However, it does not appear to make much of a difference for patients who do not need respiratory support, and doctors are still trying to figure out the best time to administer it.

Because dexamethasone is a steroid, it can have other deleterious effects on a patient’s body, making it more difficult to regulate blood sugar and sometimes leading to high blood pressure. Patients are also more vulnerable to opportunistic infections, Kuritzkes told me.

“You don’t want to give it where the benefits don’t outweigh the potential risks,” he said.

So there is still much to learn. And these are all imperfect measures. A vaccine or a cure would go even further toward reducing the coronavirus’s toll. Improvements in treatment are not a reason to be complacent about social distancing or wearing masks, either.

But heading into the fall, when many experts expect another uptick in Covid-19 cases, doctors are in a much better position to treat their patients than they were in the spring.


Will you become our 20,000th supporter? When the economy took a downturn in the spring and we started asking readers for financial contributions, we weren’t sure how it would go. Today, we’re humbled to say that nearly 20,000 people have chipped in. The reason is both lovely and surprising: Readers told us that they contribute both because they value explanation and because they value that other people can access it, too. We have always believed that explanatory journalism is vital for a functioning democracy. That’s never been more important than today, during a public health crisis, racial justice protests, a recession, and a presidential election. But our distinctive explanatory journalism is expensive, and advertising alone won’t let us keep creating it at the quality and volume this moment requires. Your financial contribution will not constitute a donation, but it will help keep Vox free for all. Contribute today from as little as $3.

Wisdom Quotes


Wisdom is the sum of all you learned in school and haven’t forgotten to this day.

Education is what remains after one has forgotten what one has learned in school. (Albert Einstein)

All roads lead you to your destination if you don’t know where you’re going.
If you don’t know where you are going, any road will get you there. (Lewis Carroll)


Dubrovnik, Croatia
DISCOVERER NEWSLETTER I LIKE
Dubrovnik, Croatia 4:39 read time
Dubrovnik, Croatia | @worduuupWe see you, Dubrovnik. The Pearl of the Adriatic has undergone an extreme revival over the last decade. From a war-scarred city to one of the hottest European destinations, Dubrovnik has truly blossomed. And for good reason. With the azure sea licking its ancient stone walls, and picturesque stairwells rising to meet quaint neighborhoods, even the biggest cynic will be charmed by this ancient port. 
 Fun Fact:Dubrovnik has long been an advocate for freedom and justice. The city was one of the first to recognize the United States as its own country during the Revolutionary War. It also abolished slavery 600 years ago in 1416, making it one of the first in Europe to do so. 
Dubrovnik, CroatiaN 42.65° / E 18.09° 
@calmlykaoticNovember — MarchThanks to those sneaky Lannisters over on Game of Thrones, Dubrovnik has seen a massive surge in tourism in the past few years, which has caused quite a few problems for the city. Crowds are threatening the city’s UNESCO status, so the mayor has limited the number of cruise ships and tourists allowed in. With that in mind, consider planning your trip in the off season. It might require some creative planning and a sturdy umbrella but trust us, Dubrovnik is just as gorgeous. 
Walls of Dubrovnik | paulprescott72Beyond the WallEncircling the old city of Dubrovnik are its iconic stone walls. These bad boys have never been breached, and today draw visitors from around the world. Climb up onto the stone walkways and just explore, peering down into the many corners of historic Dubrovnik. Pass through the impressive forts, like Lovrijenac and Bokar, to feel like you’re in Game of Thrones. Side Note: This is one of the most touristy parts of the city, so get there early in the morning before the cruise ship crowds arrive and leave before lunch, as the restaurants around here tend to be more expensive.Island of Lokrum | @siljemjoIsle Be BackSituated on the turquoise Adriatic Sea, Dubrovnik is in close proximity to several incredible islands. Most people will swear by Lokrum island, with its lush botanic gardens and roaming peacocks. But if you aren’t satisfied with just one island adventure, there’s plenty where that came from. From the idyllic Elafiti islands to sunny Hvar to the remote Lastovo municipality, go island hopping for a day (or a week) and soak up the sun.Mount Srd, Dubrovnik | @mahvibesThe Hills Are AliveDubrovnik’s charming alleys and historic wonders can occupy you for hours, but if you find yourself feeling a little claustrophobic, strike out into nature. The most popular retreat is nearby Srđ hill. With a breathtaking cable car ride to the top, panoramic views of the city, and a tasty restaurant, it’s easy to see why most people flock here. You can also skip the cable car and take a hiking trail to the top to catch an unbelievable sunset. If you want to get even more off the beaten path, head to local favorite Park Orsula or Velika Petka hill south of Lapad Bay. There are plenty of quieter hikes throughout these areas with incredible cliffside views.#dubrovnikonmymind | @emkanchJust Around the CornerDubrovnik puts on a good face for the thousands of tourists that visit each year. It’s a wonder to see, but when you want to get local, head outside old town and into the outskirts of the city. Ascend the narrow streets and steep stairwells to discover hidden corners, like Pile district. Or, take the coastal route and look for hidden beaches such as Pasjaca Beach. If you take the time to travel a little further than other tourists, you’ll discover the true soul of Croatia.@just.dream.lili LILIYA’S DISCOVERY@just.dream.lili“Start exploring Dubrovnik from the main gates which lead to houses with orange roofs and narrow streets. You will see the beautiful harbor through holes in the bridge which resemble ornaments of Van Cleef jewelry. Don’t use the main tourist streets in the city; the real soul of Dubrovnik is on its narrow streets and high paths of stairs. For those who get tired of walking around, stop by the harbor. Feel like a local – grab a cube of ice cream and find a comfortable bench with a nice view. Now you are ready to watch the sunset. When the sun goes down street musicians start to play and that is how a day in Dubrovnik should end.” 
Buza Bar Dubrovnik | @crownsandpeacocksSea to PlateSituated this close to the sea, Dubrovnik delivers on the seafood and stunning views. Keep in mind that restaurants in the old town tend to be more expensive, so when your stomach starts growling head out of the main district up into the narrow back alleys to find some hidden gems. If there’s one touristy location you should check out, it’s Buza Bar. Carved into the side of a cliff, you enter this bar through a literal hole in the wall for tasty cocktails and an seaside view. Get there a little early before it gets packed. 
@metinogurluuCzeching InComfortable, cozy, and offering all the amenities, St. Joseph’s is a boutique hotel that is the perfect city hideaway. Villa Sheherezade, a glamorous 1920’s villa that is romantic and luxurious, features lush gardens and balconies with a spectacular view. Set in the middle of the action, City Walls Hostel is perfect for travelers who would rather explore than sleep. 
#ilovedubrovnik | @playfullensStock Up”I would recommend buying basics like sun cream, bottled drinks, etc. outside of the old city as prices do go up a lot. Also, the water from the big fountain that you pass when coming through the main entrance is drinking water, so refill your bottles for free.” – @christie.rawcliffePlan Ahead”Try to plan your trip around the big cruise ships that come into port. If you can, book dates when there won’t be any, or only a few small ones. The first day we arrived there was a very large cruise ship and the old town was standing room only. So if you actually want to enjoy your trip, plan it around the cruise schedule. (This can be found by searching ‘Dubrovnik cruise ship schedule’.)” – @natalienrcSUBMIT TO UPCOMING DESTINATIONS! 
        

(850) The last living members of an extinct species – Jan Stejskal – YouTube


via (850) The last living members of an extinct species – Jan Stejskal – YouTubehttps://www.youtube.com/watch?v=hNNqht30TDo&feature=youtu.be&utm_source=newsletter&utm_medium=social&utm_campaign=weekly-newsletter&utm_source=TED-Ed+Subscribers&utm_campaign=ccc6f3350d-2013_09_219_19_2013_COPY_01&utm_medium=email&utm_term=0_1aaccced48-ccc6f3350d-53640709&mc_cid=ccc6f3350d&mc_eid=80f46c9d8f

Did you know…


Did you know…

… that today is Gold in the Yukon Day? While salmon fishing near the Klondike River in Canada’s Yukon Territory on this day in 1896, George Carmack spotted nuggets of gold in a creek bed. His lucky discovery sparked the last great gold rush in the American West.

WORLD NEWS AND COVID 19


World News

COVID-19

$760 Mn Worth Venture Capital Lost In Shutdown Of Indian Startups


Reliance Eyes Urban Ladder, Milkbasket To Expand Ecommerce Footprint


Haunting dispatches from the edge of the Roman Empire, just before its collapse | Aeon Videos


What pro wrestling can teach us about the quest for truth | Psyche Ideas


The rest cure challenges cherished myths about a working body | Aeon Essays


THRIVE GLOBAL NEWSLETTER


Monday, August 17, 2020
 
Image

Here’s How to Get the Most Out of Your At-home Workouts

Three science-backed ways to keep moving and see results — without leaving your living room.

Image

Jopwell’s CEO Porter Braswell on the Money Advice He’d Give His Younger Self

The co-founder of the leading career advancement platform for people of color on generosity, budgeting, and spending money as a parent.

Image

5 Ways to Make Time for Things That Bring You Joy

Finding your happy place may feel like a luxury in these tough times, but research shows it’s essential for your well-being. 

Image

Practicing Daily Gratitude Keeps Me Grounded During the Pandemic

Here’s how it can help you, too.

Image

Bumping Into a Friend Helped Me See Old Wounds In a New Light

A brief moment reminded me to lead with compassion.

M O R E   G R E A T  R E A D S 

How to Connect With Your Kids as They Grow Into Teenagers

Jopwell’s CEO Porter Braswell on the Money Advice He’d Give His Younger Self

How Some Stress Can Be Good For You

3 Strategies to Help You Find Your Balance

How to Deepen Our Bonds With Loved Ones During a Crisis

WORD OF THE DAY


Zen

zen

Part of speech: nounOrigin: Japanese, 12th century1

A Japanese school of Mahayana Buddhism emphasizing the value of meditation and intuition.Examples of Zen in a sentence”‘

I have lived with several Zen masters — all of them cats.’ ― Eckhart Tolle,

The Power of Now: A Guide to Spiritual Enlightenment”

“I admire the Zen philosophies and have tried to adapt those principles into my meditation practice.”

United States: Justice Department Issues Rare FCPA Opinion Letter


via United States: Justice Department Issues Rare FCPA Opinion Letter

Ethical Alliance Daily News

United States: Justice Department Issues Rare FCPA Opinion Letter
Aug 18, 2020 06:00 pm
The U.S. Justice Department issued a rare Foreign Corrupt Practices Act opinion letter, saying it doesn’t intend to bring an enforcement action against a U.S.-based investment adviser for a fee the company planned to pay to a foreign government entity for services. The letter, issued by the department in response
Read More  

Mexico: Piles of cash in viral video stoke bribery scandal in Mexico
Aug 18, 2020 05:30 pm
An unverified video showing piles of cash being handed to Mexican congressional staffers went viral on Monday, fuelling a corruption scandal that is already convulsing the country even as the clip’s source and context remain unclear. President Andres Manuel Lopez Obrador, who has made combating graft his top issue, earlier
Read More  

United Kingdom: Purplebricks fined after money-laundering breach
Aug 18, 2020 05:00 pm
The online estate agency Purplebricks has been fined more than £260,000 for breaching laws on money laundering. HM Revenue & Customs said that it had been guilty of “failures in having the correct policies, controls, and procedures, conducting due diligence and timing of verification”. It cannot appeal. Under 2017 money-laundering
Read More  

Malaysia: MACC detains 11 for alleged bribery over ship repair project
Aug 18, 2020 04:30 pm
Eleven individuals, including a former operations unit chief of a ship engineering company, were remanded for alleged involvement in a bribery case amounting to RM750,000. They are alleged to have committed the graft in relation to a ship repair project from 2015 to 2019. Magistrate Mohd Zulhilmi Ibrahim granted the
Read More  

United States: FBI arrests Puerto Rico lawmaker, family in corruption probe
Aug 18, 2020 04:00 pm
FBI agents on Monday arrested Puerto Rico Rep. María Milagros Charbonier after the legislator who once presided over the island’s House Ethics Committee was charged in a public corruption case that officials say also involved her son, husband, and an assistant. U.S. Attorney Stephen Muldrow said it was a simple
Read More  

Israel: Police recommend Kiryat Motzkin mayor stand trial for bribery
Aug 18, 2020 03:30 pm
Police on Monday recommended that Haim Tzuri, the mayor of Kiryat Motzkin in northern Israel, be put on trial on a series of corruption charges. Officers say they have gathered evidence indicating that Tzuri and some of his associates took bribes, committed fraud and breach of trust, and obstructed justice, as well
Read More  

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