上次同大家分享COVID現有的不同治療方案
今日跟大家分享下當一個國家COVID爆發時需要大量接種COVID疫苗時面對的困難和難題
***以下內容只作分享用途,所有臨床診斷的考慮請跟隨個別醫院指引***
首先講講全球最常見較為有效而又打了很多劑的疫苗
Adenovirus vector: AZ and J&J
mRNA: Pfizer-BNT and Moderna
至於另一款疫苗如Novavax或台灣高端由於打的人數不多,就沒有太多數據分享
第一件事要認清的是,由於Delta的出現,疫苗並非神藥,以往大家期望的群體免疫在original或alpha上可能可以達到,但在delta蔓延的今日,似乎有難度。
根據大名鼎鼎的NEJM的研究,兩劑AZ對symptomatic infection的保護率大約為67%、而Pfizer-BNT的保護率大約為88%。不過可惜的是同時間有一些研究,例如牛津大學研究發現當接種疫苗過一段時間後,保護力會漸減,BNT尤其受到時間的影響。
另外,初步數據顯示針對delta,疫苗並不能像alpha或original一樣大幅減少打完疫苗的人的病毒含量。打了疫苗的人的病毒含量跟沒打的相當接近,不過疫苗對防止出現病徵和重症或死亡非常有效,只耐何疫苗來得太遲,delta搶先在世上出現。同時初步數據顯示Delta似乎較alpha/original更大機會出現重症和住院的機會,尤其於年輕人身上,不過這需要更多數據支持。
這代表面對惡名昭彰的Delta,我們不能再依靠打疫苗去保護他人,因為疫苗並不能夠阻止delta asymptomatic transmission。當打完疫苗後的病毒量一樣高時,唯一可以做的便是靠打疫苗保護自己,減低自己感染、住院、重症和死亡風險。
不過當大量接種疫苗時,便會出現一些罕有的副作用,這些副作用醫護人員必須Alert的,而處理這些懷疑的副作用亦對醫療系統造成沉重的負擔。但目前所有大型研究都顯示,疫苗副作用造成對醫療系統的負擔跟任由COVID爆發的社會和醫療成本相比是兩個不同級數的事。
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VITTS - Vaccine-induced immune thrombosis thrombocytopenic syndrome
在adenovirus vector的疫苗身上被發現罕有地會出現這種病症。初步數據是懷疑因為出現platelet factor 4 (PF-4) antibodies,原理跟HITTS (Heparin Induced thrombotic thrombocytopenic syndrome)類似。
VITTS多數會出現Cerebral Venous Sinus或Splanchnic thrombosis,但亦可在一般常見的血栓位置,例如DVT or PE but much less likely
一般臨床上可能會出現劇烈頭痛/腹痛/成因不明的瘀血(Petechiae)等等,較常於第一劑的4-42日內出現,亦較常見於年輕女性身上 機率視乎人種和年齡和研究的地方,歐洲數據為約0.00034%的機會出現。同時驗血報告中亦會發現血小板偏低和D-dimer偏高以及positive anti-PF4。
不過值得注意的是即使病發初期血小板和d-dimer正常都不一定沒有VITTS,個別個案可以於24-48小時後才出現這些features,視乎clinical suspicion, serial review and FBC might be indicated
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心肌炎及心包炎Myocarditis and pericarditis
在mRNA疫苗身上發現的已知罕有副作用,常見炎第二針後的年輕男性(30歲以下)身上,大多於接種第二針後第1-5日後出現,多以心口痛、心悸、暈厥(Syncope)、呼呼短促(SOB)等呈現,病發機率視乎人種、年齡和性別,美國數據為Myocarditis/Pericarditis - 12.6/million = 0.000126% (American Heart Association)
成因未完全了解,但似乎跟免疫系統激活的過程有關(詳情refer AHA report)。大部分患者病情相對輕微,個別患者可能有ECG dynamic changes, ST elevation, troponin rise, mild reduced LvEF on echo,但大部分患者都在短期內出院with full recovery (96% as per AHA)
值得注意的是,myocarditis在歷史上的其他疫苗例如流感、乙肝、天花(small pox)等等都有罕有的機會出現,約10-20 individual/100000 per year
同時感染COVID或其他病毒性感染的話亦可能會出現myocarditis,臨床懷疑的話或需要ECG, troponin, CXR, +/- echo +/- cardiac MRI
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任何醫療選擇都有風險,當一個國家進行社區大型接種時,便需要處理這些問題,英美兩大國的經驗其實為世人提供了好多寶貴實用的資訊,好讓大家不用走冤枉路。
隨著時間的過去,愈來愈多數據和研究讓大家自行分析,多讀書多看研究才不會被任何人誤導,緊記保持批判性思考,無論任何人的高見都別不經消化和思考去接受。
Reference for further reading
1. ATAGI statement ATAGI statement regarding COVID-19 vaccines in the setting of transmission of the Delta variant of concern
https://www.health.gov.au/news/atagi-statement-regarding-covid-19-vaccines-in-the-setting-of-transmission-of-the-delta-variant-of-concern
2. NEJM - Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant
https://www.nejm.org/doi/full/10.1056/NEJMoa2108891
3. Oxford University Studies Preprint - Vaccines still effective against Delta variant of concern, says Oxford-led study of the COVID-19 Infections Survey
https://www.ox.ac.uk/news/2021-08-19-vaccines-still-effective-against-delta-variant-concern-says-oxford-led-study-covid
4. AHA - Myocarditis With COVID-19 mRNA Vaccines
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056135
Photo: internet
同時也有69部Youtube影片,追蹤數超過142的網紅Shawniez,也在其Youtube影片中提到,Timestamps 00:00 - 00:55 A Quick Hello & Catch Up! ?? 00:57 - 01:23 My 2nd semester was crazyyyyy ? 01:24 - 01:59 What my Homepage looks like 02:00 ...
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university of reading 在 Scholarship for Vietnamese students Facebook 的最讚貼文
HỌC SINH VIỆT NAM ĐOẠT GIẢI TIỂU LUẬN QUỐC TẾ Writing Prize
~ Update với mọi người bản dịch & nhận xét theo Vietnamnet”Hi các bạn bản dịch cũ chúng mình lấy trên 1 website sau khi kiểm tra lại thì website chưa chính thống lắm & nội dung dịch chưa chuẩn nên update lại nội dung trên website chính thống hơn. Cảm ơn mọi người đã đưa ra ý kiến tranh luận & feedback kịp thời, page sẽ lưu ý hơn về nội dung & caption của các post nhé❤️”
Nguyễn Tiến Thành, một bạn học sinh ở Hà Nội, thắng giải Writing Prize hàng năm lần thứ hai do tạp chí The Atlantic và College Board tổ chức (2016). Trong cuộc thi viết tiểu luận dành cho học sinh trung học, người tham gia bình phẩm về một tác phẩm nghệ thuật gây cảm hứng cho mình.
Năm nay có hơn 2.000 học sinh từ 44 nước tham gia. Hai chục giáo sư môn viết luận và lịch sử nghệ thuật chọn lọc còn 20 người vào bán kết, và một ban giám khảo của College Board và tạp chí The Atlantic bầu chọn người thắng. Bạn Thành cũng đã theo học Duke University vào mùa thu 2016.
Bài luận của Thanh T. Nguyen có nhan đề “Reading Raphael in Hanoi“, về tác phẩm The School of Athens của danh họa Raphael thời Phục hưng.
Theo tác giả Nguyen Tien Thanh, Trường học Athens là sự ẩn giấu quan điểm và tầm nhìn của Raphael về học tập: không ngừng nghỉ, phản biện công khai, vượt qua những ranh giới về địa lý, văn hoá, thời đại.
“Bài học sâu sắc nhất là tôi rút ra được từ The School of Athens là, những nhà tư tưởng vĩ đại ở đó không phải là để cho chúng ta tôn trọng một cách không hoài nghi, mà là để cho chúng ta hoài nghi một cách tôn trọng. Với tôi, tác phẩm này đầy sức mạnh vì nó đã nhắc nhở tôi rằng ngay cả trong điều kiện của đất nước tôi thì những người say mê học tập luôn có thể làm việc hướng tới lý tưởng mà bức hoạ đã vẽ ra.
Tinh thần tự do trí tuệ và tinh thần phản biện trên khắp toàn cầu không thể bị khuất phục. Một mặt tôi luôn mong rằng một ngày nào đó sẽ được tận mắt chiêm ngưỡng bức bích hoạ này, mặt khác tôi cũng luôn cố gắng xây dựng một Trường học Athens cho riêng mình ở bất cứ nơi nào mà cuộc tìm kiếm tri thức đưa tôi đến”.
Chị đọc được bài viết trên website Dollars and Sense nên xin phép chia sẻ với mọi người, mọi người cũng có thể đọc thêm bài luận xuất sắc này tại đây nhé: https://www.theatlantic.com/magazine/archive/2016/09/reading-raphael-in-hanoi/492725/
Ngoài ra, bạn Thành cũng người đã nhận được học bổng của 7 đại học Mỹ.
#HannahEd
university of reading 在 國立臺灣大學 National Taiwan University Facebook 的最佳解答
【本校防疫訊息 配合防疫警戒降為二級調整各項防疫措施】
NTU COVID-19 Prevention Message—Preventive Measures in the Upcoming Alert Level 2
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全校教職員工生大家好:
配合指揮中心宣布防疫警戒降為二級,本校調整各項防疫措施如下:
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1.7月27日起上午7時至下午7時校園進出口增至七處,夜間則維持三處進出口。校內各館舍管制維持目前三級管制方式。
總務處公告:( https://ga.ntu.edu.tw/main_ch/docDetail/55/55/28445/1100513 )
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2.暑期校方辦理課程維持遠距離,如果院系有些課程,需要實體實施,請跟教務處申請;教室內只允許50人以下上課;校屬教學大樓空間暫時維持不外借。
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3.強烈建議社團仍以辦理線上活動為主;在防疫相關規範下,於7/27~8/9期間,有條件開放室內50人、室外100人以下之實體活動(體育性活動限制室內20人、室外40人以下);音樂性社團如無法全程配戴口罩,則不開放辦理活動;其餘體育性及旅遊性活動,因易有肢體碰觸或無法全程配戴口罩(住宿),將輔導社團嚴格遵守防疫政策,如降低活動人數、住宿一人一室等。
課外組公告:( https://osa_activity.ntu.edu.tw/board/detail/sn/2132)
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4.學生活動中心開放社團辦公室及場地借用,惟食品、飲料技藝社辦在臺北市政府宣布開放餐廳內用前,仍暫停開放。
學生活動中心公告:(http://www.active.ntu.edu.tw/board/detail/sn/758)
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5.學生心理輔導中心(含資源教室)即日起進行三級警戒前以及警戒期間之學生的初、晤談安排,以及開放初談預約。
心輔中心公告:( https://scc_osa.ntu.edu.tw/board/detail/sn/142 )
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6.保健中心門診維持現行僅上午家醫科看診的模式,且開放接受校外人士初診。
保健中心公告:( https://shmc.ntu.edu.tw/board/detail/sn/878 )
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7.圖書館配合措施如下:
(1) 8月2日上午8時起恢復開放讀者入館,7月27~30日期間,仍維持現行閉館窗口服務及開放時間。
(2)全館各樓層開放(含自習室),開放時間調整為週一至週五8-17時,週六、週日不開放。
(3)閱覽區及自習室一律採梅花座,總圖書館一至五樓閱覽區容留人數上限為400人,自習室容留人數上限為394人。
圖書館公告:( https://www.lib.ntu.edu.tw/node/4052 )
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8.體育室轄管之運動場館,戶外場地將開放田徑場、棒壘球場、網球場、籃球場及排球場;綜合體育館與舊體將開放室內球類場地及健身中心,供本校教職員工生、校友及本校退休人員使用。運動時須全程配戴口罩,不得違規群聚,詳細規範請洽詢體育室或參考各場地現場張貼的使用規範。
新體公告:( https://ntusportscenter.ntu.edu.tw/#/ )
體育室公告:( https://pe.ntu.edu.tw/?tid=96#/news/2366/news )
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9.校內餐廳一律外帶使用,校外委外場地防疫措施是否鬆綁依台北巿政府規定辦理,目前暫停營業商家將再協調開業時間。
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10.公文傳送仍暫維持現有運作方式。
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11.自7月27日起各單位居家辦公人數調整為不超過單位總人數之二分之一為原則,居家辦公者須完成網路電話設定,維持辦公室聯絡無中斷。此外,居家辦公人員採1小時彈性上下班時間(上班08:00至09:00、下班17:00至18:00)規定。
人事室公告:( https://ann.cc.ntu.edu.tw/asp/Show.asp?num=82539 )
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其他相關防疫措施細節,請以各權責單位網頁公告為準。
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國立臺灣大學防疫小組 敬上
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Dear NTU students and colleagues,
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According to the Central Epidemic Command Center (CECC), the current alert level will be lowered to Level 2 starting July 27. In response to this, the University is asking all of you to fully comply with the newly adjusted measures as follows.
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1.Starting July 27, the Main Campus will be accessed via the current three to seven gates, from 7 a.m. to 7 p.m. The campus can only be accessed in the evenings through the three gates. Level 3 access control will continue to be implemented to all university premises.
Click the link for more information
( https://ga.ntu.edu.tw/main_ch/docDetail/55/55/28445/1100513 )
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2.Summer courses will continue to be taught remotely. If necessary, applications for in-person classes may be filed with the Office of Academic Affairs. To this end, each in-person class should accommodate no more than 50 people. Rental of the University’s lecture buildings remains unavailable.
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3. Club events are strongly advised to be held online. In compliance with the regulations during the lowered alert level period (July 27-August 9), in-person events with no more than 50 people indoors or 100 people outdoors may be held (the number is reduced to 20 people indoors and 40 people outdoors for sports events). In-person music club events should not be held if the mask-wearing mandate cannot be enforced. For other types of sports and leisurely events where physical contact cannot be avoided or masks cannot be worn at all times (e.g. accommodation), the organizing clubs will be instructed to strictly abide by preventive measures such as reducing the number of participants and following the one person per room policy.
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4. The Student Activity Center will reopen student club offices and open rental of its spaces. However, the food and beverage club will remain closed before resumption of dining-in is announced by the Taipei City Government.
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5. The Student Counseling Center (including the Disability Support Services) will resume counseling services and reservation as of the day of the lowered alert level. Click the following for more information
(https://scc_osa.ntu.edu.tw/en/board/detail/sn/144 )
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6. The morning Family Medicine clinics at the Health Center will continue. First-time registration is allowed for non-NTU members. Click the following for more information
( https://shmc.ntu.edu.tw/board/detail/sn/878 )
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7. Preventive measures at the NTU Library are as follows:
1) The library will reopen to the general public beginning 8 a.m. August 2. From July 27 to 30, it will remain closed and only the circulation service is available.
2) All floors will reopen (including the B1 study rooms). The opening hours are 8 a.m.-5 p.m., Mon. through Fri. The library is closed on weekends.
3) Criss-cross seating will be implemented in the reading areas and study rooms. The library may accommodate up to 400 people in its reading areas (1st to 5th floors). The reading rooms may accommodate up to 394 people. Click the following for more information
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8. The Athletic Department will reopen the outdoor Sports Field, baseball and softball fields, tennis courts, basketball courts and volleyball courts. Indoor ball courts and the fitness center at the NTU Sports Center and the old Sports Center will be reopened to all members of the NTU community. Please wear a mask at all times when you play sports. Clustering in these locations is strictly forbidden. For more information, please contact the Athletic Department or refer to terms of use at every venue.
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9.On-campus food locations provide take-outs only; off-campus restaurants will follow the announcements by the Taipei City Government. Talks with the food providers on resuming operation is still ongoing.
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10. The current method for delivering official documents will continue.
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11. Starting July 27, not more than ½ of all the staff in a given academic/administrative office should work from home. Those that do should have their internet phone set up and abide by the one-hour flextime (clock in 8-9 a.m.; clock out 5-6 p.m.).
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For details of other preventive measures, please refer to online announcements of respective competent offices.
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Sincerely yours,
NTU Epidemic Prevention Team
university of reading 在 Shawniez Youtube 的最佳貼文
Timestamps
00:00 - 00:55 A Quick Hello & Catch Up! ??
00:57 - 01:23 My 2nd semester was crazyyyyy ?
01:24 - 01:59 What my Homepage looks like
02:00 - 02:29 [Tutorial] How to make 2-3 columns
02:31 - 02:40 [Tutorial] Changing font colours
02:41 - 02:47 [Tutorial] Shortcut to Making Quotes
02:48 - 03:12 [Tutorial] Shortcut to Making Callouts
03:13 - 03:30 My Quick Link Box is a Callout
03:34 - 03:38 [Tutorial] Shortcut for Emojis
03:38 - 03:47 [Tutorial] Shortcut to link words
03:48 - 03:53 [Tutorial] Shortcut for Highlighting
03:54 - 04:17 Showing other pages on the Homepage
04:18 - 04:40 The Real Deal - The Main Notebook for all my Documents
04:41 - 05:07 Comparing Notion to a Physical Notebook
05:08 - 07:03 Notebook #1: The Ojibala Notebook
07:04 - 08:47 Notebook #2: Academics Only Notebook
08:48 - 10:00 Notebook #3: Weekly Views' Notebook
10:01 - 11:46 Notebook #4: Media Law Notebooks
11:47 - 12:22 Notebook #5: Child Language Notebooks
12:23 - 12:57 Notebook #6: CELTA Notebooks
12:58 - 13:53 [Tutorial] Settings/ Categories for the Notebooks
13:54 - 15:59 [Tutorial] Lets make templates together!
16:00 - 16:15 [Tutorial] How to move your notes around
16:16 - 16:52 Comparing Notion to a Physical Notebook (again)
16:53 - 17:42 [Tutorial] How to link other Notion pages to a word
17:43 - 18:03 Just casually boasting about Notion
18:03 - 18:17 Comparing Notion to other Note-taking Apps
18:18 - 18:38 Conclusion
and hello again!! ??
?? I really missed putting videos out here - this has got to be the longest one, I apologise!!! I love talking about Notion because of the 101 ways you can organise your messy life in there ?️
** If you have a student email ending with ac.uk, Notion is free for you! **
? I am currently wrapping up my 2nd semester of my 2nd year. I'm studying remotely from Malaysia due to the circumstances that we are in ????
??
If you're new here, my name is Shawn & I'm a 2nd Year English and Media (Joint Honours) Student, studying in Swansea University, Wales. I really enjoy Ali Abdaal's videos hence why I am trying to make such a productive video & wished I wasnt this busy but second year has left me with no choice... ?
I wished I made more videos!! My First Year videos were so memorable & looking back at them really made me cherish my time in Swansea & my friends ?
If you read all the way until this point, I just want to say thank you for reading!! If you specifically want to hear more about my university course in my videos, drop me a message down below!
university of reading 在 TheMingThing Youtube 的最佳貼文
We're back once again to read even MORE nasty uni confessions!
Thank you guys for tuning in to Season 1 of See You See Me! This show is definitely much different than what we usually do and we're so glad so many of you enjoyed it! We'll be taking a break to create more new shows for you guys so until then, binge watch the whole series or check out our other stuff!
Follow Melissa!
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We hope you’ve enjoyed the video fam! :D
Remember to HIT that THUMBS UP & SHARE the video!
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university of reading 在 Bubzvlogz Youtube 的最佳貼文
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It’s funny how life works out. Drawing was so integral throughout my entire childhood and early teen years. I used to write and draw my own comics with my cousins. We made our own little club and we would spend our weekends reading each other’s work. Then became life’s distractions like school work, boys, teen things, university, partying, work, marriage, parenthood, divorce and co parenting life. Now I have come back to my roots by drawing again. It’s been a great outlet for me. When I hold my stylus, I only focus on my strokes. It calms me. I’m so thankful for art.
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Hi, I'm Lindy! Welcome to the Bubz family. I am a beauty, lifestyle and mom vlogger. I make daily vlogs I call daily doses of happiness! Join me as I navigate this journey we call life and keep up with my little adventures. Be sure to SUBSCRIBE so I can continue to put a smile on your face. Do make new friends with fellow Bubscribers. I promise you they are the sweetest bunch ever! If you enjoyed today’s vlog, don’t forget to give it a LIKE.
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university of reading 在 UniofReading - YouTube 的推薦與評價
Discover the University of Reading's main campus with BA Theatre graduate, Yvonne, as she takes you on a tour around Whiteknights campus. ... <看更多>
university of reading 在 University of Reading - 主頁| Facebook 的推薦與評價
The University of Reading is a global university that enjoys a world-class reputation for teaching, research and enterprise. The University was established ... ... <看更多>