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MunoRN

MunoRN

Critical Care
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Content by MunoRN

  1. MunoRN

    The President Donald Trump Thread

    I knew I recognized the author's name from somewhere, It wasn't until Herring's post that I remembered recently reading an article about Q-anon, and that one of their core beliefs has become that JFK jr faked his death and is actually Q, the person who came up with that theory is Liz Crokin, the author of Lucy's article. Just because someone is a "prominent voice" in Q-anon doesn't mean everything they say is false, so lets' review the author's claims. 1. Trump is actually an altruistically generous person, as evidenced by donating money to a woman to keep her farm after husband committed suicide. Trump donated approximately $20,000 to a woman to help her keep her farm, a small portion of the money required, and organized an extravagant press conference to publicize the donation. The positive PR press he got as a result was well in excess of $200,000 in PR costs, even in 1987 dollars, hardly 'altruistic'. 2. Trump paid off the mortgage of someone who changed the tire on his limo. This is one of the most repeated urban legends of all time. Best guess is that it started with an Oscar Wilde story, it was then repeated in reference to Henry Ford, Nat King Cole, Perry Como, Leon Spinks, Bill Gates, and now Trump. There is no more evidence to support that this actually happened with Trump than with any of the other cases. That leaves us with charitable use of his private jets, which is far below the typical charitable use of private jets. There are numerous charitable organizations that exist for the sole purpose of making use of the jets of rich people for charitable purposes when they aren't using them, and given the amount of time Trump has owned private jets his limited examples of offering it for charitable purposes is concerningly low. Not only is Trump's chartable giving record surprisingly sparse, he has had a charitable organization, which he apparently used as a way of diverting charitable funds to himself, which is a purely sociopathic way of behaving. This isn't hypothetical, Courts have forced him to shutter his 'charitable' organizations because he was embezzling those funds for personal use, including a such necessities as a Tim Tebow signed football and a personal portrait. Long story short, he took money people gave to help really unfortunate individuals and illegally used it to feed his ego and personal vanities, he's a ***ing scumbag, it really is just as simple as it appears.
  2. MunoRN

    The President Donald Trump Thread

    I'm not sure that going to Home Depot is generally considered "safe", but it's also not a constitutional right to go to Home Depot, and the accessibility of shopping at Home Depot isn't a basic measure of the strength of a democracy, accessibility to voting is however. Florida's troubles with mail-in voting, which have required the intervention of courts, haven't been helped by the fact that it's secondary to in-person voting, which they don't exactly have a grip just by itself. Limiting what they need to focus on to one type of voting would seem to be an obvious way of giving Florida the best chance of managing a voting process in a reasonably competent manner. Since there seems to be general agreement that absentee voting (voting by mail) should always be an option, vote-by-mail-only would seem to be the obvious choice for narrowing it down to one method of voting.
  3. As complicated as things have been they're only going to get more complicated as we try to figure out to move out of hiding and somehow live with Covid-19. So what's next? Do we keep our current plan until it goes away? That could be years and potentially longer depending how long an infection imparts immunity for. Obviously an effective vaccine would negate the need for any plan, although at the earliest that would be about a year away, and while there are claims of potential vaccines, it should be noted that despite trying for decades we have never successfully created a vaccine for any coronavirus strain, although there is certainly more incentive now than in the past. At this point there are certainly parts of the US where they can't cope with a rate of infection higher than what they already have, but much if not most of the US is ready for more cases than they are seeing. Particularly since I think we've been over-hospitalizing these patients, early on we didn't know what patients would and wouldn't benefit from acute care in a hospital, now we have a better idea of who can benefit and it's a much smaller group than we were initially hospitalizing. Most patients that will survive Covid will do so without any medical help, and most who die will die with or without aggressive treatment, it's that relatively small group in the middle that will take up hospital beds. So I would argue we go ahead and get life going again, this will result in more infections, and more deaths, but I think it's unlikely these folks won't get it or wont' die from it eventually even if we stay on our current track.
  4. MunoRN

    ISideWith 2020 Political Quiz

    I'm 67% "transhumanist". Not sure what that means. Although in answering many of the questions I'm sure my answer was lumped in with folks that I hold opposite view from. For instance, not everyone who opposes the measures put forward by Obamacare oppose those measures for the same reasons, many of those in that "opposed to Obamacare" group oppose it for completely opposite reasons.
  5. MunoRN

    Justice Dept. Drops Case Against Michael Flynn

    The "phony scandal" argument seems dependent on the person believing it having no idea what triggered the investigation, which was that multiple members of Trump's campaign and incoming administration were acting as unregistered agents of the Russian government and/or Putin-tied interests. These facts don't seem to be disputed, but instead ignored by those pushing the 'phony scandal narrative. Your article makes no attempt to dispute the material basis of the investigation, if you disagree with it yourself then feel free to elaborate. To start, Trump hired a campaign manager who was already known to be a paid promoter of Russian interests, although as the investigation discovered, what we knew at the time he was made campaign manager was the just the beginning. Then there was Carter Page, who while also a member of the Trump campaign was acting as an unregistered agent for the Russian government, and had met with Russian government and Putin-linked individuals. The allegations made against him were the main basis for claims that the Steele Dossier was not accurate, although it then turned out that the allegations against him were shown to be true. Then there's Flynn, also simultaneously part of the campaign and incoming administration while acting on behalf of the Russian government. Then there's Rick Gates, Trump's odd pro-Russian stance, etc. Taken together, I don't see how any rational person can argue there was no basis for any investigation, but feel free to try.
  6. MunoRN

    The President Donald Trump Thread

    Taken out of context you're correct that it seems like he simply lied, although the remainder of the "more than circumstantial evidence" quote was this: ""I don’t want to go into specifics, but I will say that there is evidence that is not circumstantial and is very much worthy of investigation, so that is what we ought to do,” Schiff said." Whether there was enough evidence to be "worthy of investigation" isn't really debatable. We had already known that Russia was actively meddling in our politics, and the incoming Presidential administration included at least four people who were acting as unregistered agents of foreign countries, including Russia. Not to mention a President who openly welcomed Russian political assistance. If there's been a murder and somebody is at the scene of the murder covered in blood and talking about how much they like to kill people, it doesn't seem unreasonable to investigate them.
  7. MunoRN

    The President Donald Trump Thread

    The law is pretty clear that it's the federal governments job to maintain our strategic PPE stockpile. Trump has claimed, correctly, that Obama failed to fill the 'cupboard' during his term, which means Trump also failed to do so for three years. So based on his argument; that it should have been filled whether there was an imminent pandemic or not, then it shouldn't have mattered whether he believed coronavirus was an imminent threat at the time.
  8. MunoRN

    The President Donald Trump Thread

    He told the same lies to Pence, did Pence set him up? Was Pence actually part of 'a corrupt Obama administration'. Flynn was under investigation because he had repeatedly failed to disclose foreign contacts, including contacts with the Russian government, ie for lying. Asking him questions about his foreign contacts to see if he would lie about them wasn't a "set up", it was what they were investigating. They didn't trick him into lying, nor did they arrange for this contacts to occur to then put him in the situation of having to lie about them. ,
  9. MunoRN

    President Trump National Scandal

    As the father of 3 young kids I can tell you that no parent out there got excited about the idea of a 5 month summer break. And between being a critical care nurse in an area hard-hit by Covid and being a parent of kids right now, it's being a parent during social distancing that is by far the hardest. There's not actually any reason why people shouldn't be leaving there homes, it's the potential exposure to viral transmission that's the issue and that doesn't rise to a level of unacceptable risk just by stepping out your front door. Letting kids socialize, which is arguably vital to their health, is challenging to be sure. But as both my County Health Department and State Department of Health recommend, kids should still be having 'play dates', although with some considerations. Kids should have a defined smaller circle of friends and that circle shouldn't overlap into other play date circles, but they should still be having play dates with other kids.
  10. MunoRN

    President Trump National Scandal

    I have no problem with him being "salty as a sailor", and while that's a separate issue of annoyance for many, it's the substance of his policy and leadership (or lack thereof) that people have a problem with. LBJ was by far the most crude and "salty" President in recent history, aside from frequent salty language, he was known to enjoy showing others his male member, when having a conversation with someone in the oval office he would insist that the staffer, journalist, congressperson, etc accompany him into the bathroom so they could carry on their conversation uninterrupted while he pooped, he also once stripped naked during a press gaggle on Air Force One because he said it was hot. Despite all of that, his political resume is commonly viewed separate from his personality 'quirks'. I don't think Trump is held to a different standard, although to deflect from his political resume Team Trump is quick to suggest any criticism of him politically is just because people find him uncouth, rather than try to debate the substance of his presidency. I notice that when Trump supporters try to list his successes, those examples become extremely vague, as though they're taking Trump's word for his claims of successful leadership without feeling the need to evaluate that for themselves. It's like if my all-too-trusting grandma told me excitedly about how a used car dealer got her trade her brand new Mercedes for a used Yugo and how much she benefitted from this trade because the used car salesman told her how much better it was to have a used Yugo and she took his word for it. Trump defined what a successful Presidency would look like for him prior to taking office, just objectively he hasn't gotten anywhere near that definition, so I'm not sure what there is to be excited about, except that Team Trump told you that you should be excited, enjoy your Yugo I guess.
  11. MunoRN

    President Trump National Scandal

    Considering the president was promoting cleaning patients lungs with disinfectant I'm not sure that the problem is nurses not staying in their lane, so to speak. I agree that nurses need to be careful when making purely political statements as part of their nursing role, but I dont think its correct that promoting basic public health concepts, like the need to flatten the curve, are outside the role of any nurse. I would agree there is a nuanced debate to be had about how to balance the need to manage the extra burden we're placing on nurses while not disrupting people's lives more than is really necessary, but there hasn't been much of any nuance in the positions these protesters have been taking. As long as these protesters are effectively volunteering nurses to get even more slammed, nurses clearly have the right to reply.
  12. MunoRN

    Covid Pandemic Plan 2.0, What's next

    Obviously, not a popular conclusion. And I'm still not clear how having exponentially more people die from this virus by letting it cycle through the population for years is better than far fewer deaths from a coordinated inoculation event. https://www.mediaite.com/politics/harvard-law-prof-laurence-tribe-under-fire-for-apparently-suggesting-mass-coronavirus-infection-and-death-to-solve-pandemic/ So outside of a vaccine, how else does this end?
  13. MunoRN

    The President Donald Trump Thread

    To clarify (read: I'm bored and feeling argumentative), most of the actions on that list are actions of the states, not federal government. Managing, ie "streamlining" the UI application process is done by the states, not the federal government, there are states that have prohibited evictions of renters, the federal government has not, UI coverage for the self-employed is up to individual states, etc... anyway, carry on.
  14. MunoRN

    Covid Pandemic Plan 2.0, What's next

    I tell you what though, I don't know how much my word means but I promise to only criticize Trump's actions and statements based on the actions and statements themselves, not by the person doing or saying them. And I'll argue for any credit he should have coming his way.
  15. MunoRN

    Covid Pandemic Plan 2.0, What's next

    If his claim was that he wanted to start a return to normal by Easter that might have been less sharply criticized than his proposal to fully 're-open by Easter' without offering any sort of coherent plan, but regardless you're correct that there are those who will criticize him no matter what, which is true of every President. There are also those who will defend his actions and views no matter, which is no less problematic. There's a saying in sports that what defines a great referee or umpire is that each team hates them equally, which I think is also true of politics. Good leaders are willing to make well reasoned, well conceived decisions even though there will inevitably be those who criticize that decision. Even though decisions a President makes that will be revered in years to come will inevitably receive at least some amount of criticism at the time, Trump has a hard time coping with any negative feedback at all, which is why his goal has been more to rid himself leadership responsibilities than it is to lead. Take today's "plan". Any plan to start to open things back up hinges on testing and PPE availability. Trump's plan makes PPE supplies the responsibility of states, a direct violation of Federal law which requires that the Federal government is responsible for dealing with our PPE stockpile, and even if it wasn't specifically stated in the law it's really only workable for the federal government be responsible for this given the differences in how States and the Federal government are allowed to tax and spend. Good leaders seek out the best advice, then make the best possible decisions they can and let the criticism roll off your back, Bad leaders avoid and dodge their responsibilities so that they have no decisions to make and no plan can fail if there is no plan.
  16. MunoRN

    Covid Pandemic Plan 2.0, What's next

    The most effective way I can think of for moving past Covid-19 assuming it isn't subject to seasonality and the antibodies created by an infection last as long as other coronaviruses (4 months to a year) is for mass purposeful inoculation. I don't think that's something we'll be able to stomach anytime soon, but the only way knock out a virus with those characteristics is for everyone to have it or be in the immunity window at the same time, which would require everyone to intentionally get it. Otherwise we're potentially looking at an endless cyclical community spread, the problem with that is there's no guarantee people will have the same response every time they become infected, the vast majority will survive a single infection, having it 10 times though is going to significantly increase everyone's chances of having a fatal bout of Covid-19.
  17. MunoRN

    Covid Pandemic Plan 2.0, What's next

    The type of contact tracing used in East Asia and that is being proposed here probably won't work here. Places that have had apparent success with contract tracing, like Hong Kong, have been using mandatory smartphone apps in combination an electronic bracelet. Removal of the bracelet automatically reports you to authorities, as does getting to far from your phone (in case you try to go out without your phone). Since it's possible to avoid the system by just turning your phone off, authorities call your phone at random times twice a day to make sure it's turned on. Aside from the cost, these are collective societies under authoritarian or 'democratic'/authoritarian rule that lend themselves to this sort of system, the US not so much. Also, these systems were used to contain more than mitigate, they really work best when only a very small portion of the population are vectors. It would be difficult to effectively act on this information since there are widely varying circumstances of transmission. The 'close contact within 6 feet for more than 10 minutes' is often quoted but as even the CDC points out, there's no reason to believe this can reliably differentiate contacts at risk for transmission from those that aren't. If an infected person sneezes or coughs in your face (even if they're wearing a mask) then that 5 seconds of contact is more than enough to transmit the virus. And then there's surface vectors which are likely also a mode of transmission. Just because you weren't at the grocery store at the same time or even the same day as an infected person doesn't mean you can't contract their virus by touching something they touched and then touching your face.
  18. MunoRN

    Covid Pandemic Plan 2.0, What's next

    Social distancing and other mitigation strategies still need to be used and restarted when necessary when there is excessive demand on healthcare resources, but there are large swaths of the US where healthcare resources are far from being overwhelmed. If our current efforts were likely to actually reduce the number of people who become ill with CV then that would be a different argument, but that's unlikely, all we're doing is manipulating the timeline of infections, so if large parts of the country are ready deal with unavoidable infections there doesn't seem to be much reason to prolong that process. There are certainly patients for whom ICU care can potentially make a difference, but a large portion of the burden on ICUs has been patients that we now know are medically futile for aggressive treatment, so more appropriate plans of care can significantly reduce the need for ICU beds, even in places hard hit.
  19. MunoRN

    Covid Pandemic Plan 2.0, What's next

    I'm not sure how wanting to open things back up become such a politically divided issue either. Those hardest hit are those who've been working paycheck to paycheck, which would seem to make restarting at least some portions of the economy a liberal-backed issue. I think there's probably an understandable reflexive opposition to the idea since it's also something Trump is pushing for, although possibly for different reasons. Trump seems to views the economy as a reflection of his manhood, and just like a guy getting out of ice-cold water in a revealing speedo searching for a hot-air dryer, Trump is looking to get the economy back to it's normal size.
  20. MunoRN

    Covid Pandemic Plan 2.0, What's next

    The doctor calls it agoraphobia, but I think more commonly it's just called -people-who-don't-like-crowds. Although I suppose not everyone who doesn't like crowds has times where they black-out, finding themselves blocks from where they were, sometimes having crossed major roadways without having any memory of doing so. It's been less of an issue after biofeedback sessions. My routines haven't changed much with social distancing, I generally hang out with family at home anyways, when I go out I bike, ski, hike; things that are social distancing compliant. I like music but hate concerts. I'm a baseball fan but find TV to be a superior way to watch a game. I much prefer shopping at Costco now, the long line to get in is a pain, but being able to be in their while it's almost empty means I've actually been able to finish a shopping trip there rather than at some point just realizing I have to go. It's definitely been harder on my wife and kids who normally interact with others in close proximity as much as they can.
  21. MunoRN

    Covid Pandemic Plan 2.0, What's next

    I've been training my whole life to avoid crowds, so I'm fine with keeping social distancing something that's encouraged rather than being viewed as a personality flaw. I'm an ICU nurse who's been caring for COVID-19 patients since February, and one thing we've found is that most of these patients don't benefit from ICU care. We got slammed at first, mainly with 80+ year olds with multiple comorbidities, which we've learned don't belong in the ICU, they are more appropriately treated in a palliative care setting. So I don't think that with what we know now that we need to be as concerned with overwhelming ICUs. PPE and testing are still certainly issues that need to be resolved no matter how we move forward. No plans works well without both of those resources. I'm not real keen on contact tracing for Covid-19, that sort of things works great for Ebola and even the 2009 SARS, but based on it's transmission characteristics I don't think it serves much purpose for Covid. Probably the best case study on the usefulness of contact tracing came out of the first Seattle area case for which there was fairly extensive genetic analysis done, maybe the most interesting thing was that in the time the patient likely spread the virus prior to becoming symptomatic was that there was little rhyme or reason to who contracted it from him (more likely through multiple intermediary vectors). And even if we know who was in a grocery store at the same time as someone who turned out to be positive, it wouldn't make sense to apply a different set of rules than what we're already moving to for exposed healthcare workers which is to continue to work but to monitor for symptoms. So basically, we can skip the contact tracing and just tell everyone to monitor for symptoms all the time.
  22. MunoRN

    The President Donald Trump Thread

    I think the issue with people fleeing 'hot spots' to less effected areas is that people travelling freely is how this spread so quickly in the first place. So while somebody fleeing NYC might then be less likely to contract CV, they might also be the source of a new 'hot spot', overall we certainly can't say that letting people travel / relocate / flee saves more lives than it risks. The bigger issue is when people leave areas with better hospital capacity to places with little-to-no acute and critical care capabilities. When those people get sick and have to be moved back to where they fled from in the first place to get medical treatment, that eats up a lot of resources unnecessarily. As for a right to keep a CV diagnosis private, I'm all for protecting people's privacy where there isn't sufficient public benefit to outweigh a person's right to privacy, but there are already various circumstances related to communicable diseases that require public or least potentially affected members of the public to be notified, I don't know that this is all that much different. All that being said, I don't think it makes sense at this point to overshoot limiting the spread of CV. We're no longer in a containment effort, this is now mitigation which isn't about keeping people from ever getting CV, regardless of what we do everyone who is going to get it will most likely get it, no matter what pace we go at, so there's no reason to go excessively slow and that probably does more harm than good. It's reasonable to be concerned about 'hot spots', where the rate of infection exceeds the system's ability to cope, but we also need to deal with 'cold spots', places where the inevitable community transmission is occurring at a rate far slower than the system's ability to cope with it.
  23. MunoRN

    The President Donald Trump Thread

    Stories of enforcing restrictions on out-of-state visitors don't appear uncommon: https://www.capegazette.com/article/out-state-travelers-turned-away-delaware-border/200424 https://kdvr.com/news/coronavirus/texas-attorney-general-calls-gunnison-countys-temporary-nonresident-ban-unconstitutional/ If your point is that people impairing mitigation because they're going to church are more likely get in the radar of law enforcement then I don't disagree with you, although I don't think it's because they are targeting religion. If everyone travelling from out-of-state agreed to park their cars in a designated park lot at a designated time, making them that easily identifiable to authorities then I don't doubt they would get the same attention. But of course it's not as easy to identify out-of-towners as it is cars in a church parking lot. I do think though everyone should be allowed to do whatever they want, with the exception of hospital visitors, patients and staff can't chose to limit their exposure. Other than that people should be able to chose to take risks.
  24. MunoRN

    Questioning Elizabeth Warren

    Your connotation in claiming she "lied" seems to be that she was aware her family's understanding of their heritage was incorrect, there's no reason to believe that's the case since up until recently, this was all your understanding of heritage could be based on. The narrative passed down in my family was also that there was native American heritage in our ancestry, and I get that since I'm often asked which of the two local tribes I belong to (according to ancenstryDNA I am about as white as it gets). Since Warren didn't make any sort of claim to Harvard of Native American ancestry until long after she was hired, your claim would have required Harvard to have had a time machine, gone forward in time and looked at her employee questionnaire, and then based on that travelled back in time and given her a job because of their time travelling adventure, I'm sorry but that seems unlikely. There has been no reason to believe that "she allowed the mistreatment of minorities that work on her campaign", there have been complaints that people hired to do the necessary yet menial jobs of the campaign were not then surprised with much more impactful roles, which is not mistreatment in any way.
  25. MunoRN

    Winning...the economy under Trump

    I think there's a significant portion of "anti-Trumpers" who came to oppose Trump largely because of his fiscal irresponsibility, rather than this being a new concern for them. Other than massive a massive budget deficit, he's also failed to deal with healthcare despite promising to do so, which has a significant effect on the economy, and he's shifted support to dead-end industries from those with promise for growth. What concerns me as that much of Trump's support seems to be for the purpose of cutting off one's nose to spite their face. Conservatives see Trump as a way to 'pwn the libs' since they hate impending fiscal collapse, authoritarianism, and corruption, but then the question is, since when do conservative like these things?
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