Worked on the pond this afternoon. The lily pads had taken over, it was full of algae, some of the stones had fallen in, etc. 'Before' picture attached. Thinned out the lily pads, fished out the stone and re-edged, added a few floating water hyacinth, cleaned out a ton of algae, refilled the water (it was low due to evaporation), added a Canna Longwood 'Endeavor. ' It looks a lot better!

A rather grey day. Very windy today. Visited HUG for the first time, visiting my (admitted) brother

The Nirody household is getting in the holiday spirit...

1/x Ack, ridiculous opinion piece: How to restore and reshore vital medicationswashingtonexaminer.com/restoring-amer… 2/x No differentiation between pharma and supplies/equipment supply chains! washingtonexaminer.com/restoring-amer…

Arrival GVA Just in time for quite a 'warm' stretch!

1/x Drug shortages - Part 1. linkedin.com/pulse/drug-sho…
2/x First entry of a series of mind maps listing actions that can be taken in various areas. I - We need to improve pharmaceutical manufacturing capacity and capability!

1/2 In the U.S. the zip code a patient resides in is an indicator/factor in their health & even life expectancy, with huge discrepancies found even a few miles or blocks apart! This should be 'front & center' in the devpt. of acute care '𝐇𝐨𝐬𝐩𝐢𝐭𝐚𝐥 𝐚𝐭 𝐇𝐨𝐦𝐞' programs! 2/2 "𝐇𝐨𝐬𝐩𝐢𝐭𝐚𝐥 𝒂𝒕 𝒉𝒐𝒎𝒆" essentially "𝐡𝐞𝐚𝐥𝐭𝐡 𝐜𝐚𝐫𝐞 𝒊𝒏 𝒚𝒐𝒖𝒓 𝒛𝒊𝒑 𝒄𝒐𝒅𝒆!" If health services provided are not "wrapped" in additional services that recognize/address all appropriate factors, then H@H could perpetuate or even exacerbate disparities!

14/x From the angle/view from the front yard you can't really tell that half the tree is gone: 15/x But from in front and on the Sunnyslope side it is painfully obvious!

2/x They say they've been sent by the city to cut down the tree because a limb is interfering with the power pole.

1/3 𝐕𝐞𝐫𝐲 𝐨𝐥𝐝"news." Often a threshold ($10, $15, etc.) for items to be individually chargeable (if less their costs are rolled into the procedure charge or room rate). Then a markup structure that decreases markup as item more expensive. A 𝐠𝐞𝐧𝐞𝐫𝐢𝐜 example attached.

https://twitter.com/Davidlaz/status/1469411645617160195

2/3 The markup percentage table is 'tweaked' annually (i.e. gradually increased). Alternatively, no items individually charged, patients are billed rolled up bundled charge for procedure.

1/5 I haven't seen these two potential issues discussed in any of the "acute hospital care at home" articles I've read; let alone be included as programmatic considerations... 2/5 For example, this article - Hospital Care at Home: The CMS Waiver Experience - makes no mention of these considerations. Seems like "home selection criteria" should be added to "patient selection criteria."bit.ly/3Gon6sUAcute

42/x More on #COVID19 opportunity costs:

https://twitter.com/BainAlerts/status/1326953719292960771

43/x More on #COVID19 opportunity costs:

Thread of effects on children:

https://twitter.com/sgdambrauskas/status/1353351086170632192

1/x Beyond the more direct costs associated with #covidー19 there will also be massive associated opportunity costs! Here's an ongoing thread with examples.

One example: the suspension of polio eradication campaigns! bit.ly/2VaMvkL 2/x Another example of #covidー19 opportunity cost:

https://twitter.com/emilylmullin/status/1248318258446548992

1/7 Time to look at the bigger picture and work on global solutions and systematic fixes.

What do I mean?

Well the current "crise du jour" everyone focused on is high drug prices... 2/7 But even if that issue were to get "fixed," next up would be all the people who can't afford their long-term care... bit.ly/30NfBq0