Active and passionate rest on the water. A little romance on a warm sunny day on the Volga. The city of Konakovo. Russia.

Cyclic, rhythmic rowing on a boat is ideal for strengthening the myocardium. Paddle manipulation trains, in particular, the left ventricle, which is in charge of transporting arterial blood.

The systolic volume of the heart in rowers reaches significant values. Active contraction of the myocardium during the stroke helps to work the "second heart" - all muscle groups that are involved in the return blood circulation and accelerate the outflow of "used" venous blood. At the same time, our "fiery motor" operates in particularly comfortable conditions. He, too, is "swimming" - bathing in oxygen-enriched arterial blood.

Rowing develops the respiratory system, and working lungs strengthen the diaphragm. The pull of the paddle helps the intercostal muscles to expand and increase the volume of the chest, increasing the lung capacity to seven liters!

Those who are engaged in rowing have good muscle tone, a toned figure - an attractive appearance, and fat reserves ... and the appearance is not served. Apparently, they burn out much faster than they allow themselves to be discovered.

The need to keep an effort on the oar, sometimes up to thirty kilograms, including up to 95% of all muscles in the work. But this figure depends on what kind of rowing sport you are doing: family tourism with children and fishing or rowing at the limit of possibilities.

With age, the human musculoskeletal system acquires a lot of irreversible changes. They touch all bones and joints, but are especially noticeable at the level of the spine - our "axis of symmetry". No amount of gymnastics will ever help the skeleton to escape from them. Accumulating, these changes limit the range of motion, radiculitis, osteochondrosis, discosis and other, as one friend of mine says, bodily monsters appear.

Nevertheless, no one forbids an attempt to "swim away" from them. During rowing, the connective tissue elements are stretched and tense. This prevents the deposition of salts in the ligaments and tendons, in the joints of the arms and legs, in all parts of the spine. Rotational movements of the body, right and left, back and forth, "grind" the deposits of "minerals" accumulated in the intervertebral discs.

Anabolic and metabolic processes in the body, activated during rowing, promote the absorption of nutrients and the utilization of toxins. By flicking the paddle, the work of the nervous, endocrine, digestive and excretory systems of the body improves.

 

It is shown to be engaged in rowing at any age - from pioneers to pensioners - and, I must say, at the same time, grandfather with an oar evokes respect and sympathy no less than a young man with a barbell.

To maintain musculoskeletal balance, juvy Brown Pelican self-adjusts to the opposite side (see previous post) from its perch atop Old Friend on Armand Bayou.

Many of you have wondered why I have been away from Flickr for almost 4 years. This is a photo of me in 2017 doing one of my favorite things..walking. However a year later I came down with an autoimmune musculoskeletal disease and it left me unable to walk for a long time. My first sign was being unable to raise my arm to take a photo !! After years of various medications and plasma exchange, I’m doing a lot better, (although things can change from day to day). It’s great being back on Flickr and seeing all the amazing photos of others I have followed in the past. Thanks to all of you who have built up my spirits with your favs and nice comments 💕. By the way, I AM able to walk now (except for long distances) and can now take photos again. I’m getting stronger every day !!

Like all professions being a chef has its risks:

 

Chefs face a multitude of health risks due to the demanding nature of their profession. These risks include physical injuries from slips, trips, and falls, burns, and cuts, as well as musculoskeletal issues like back pain and repetitive strain injuries.

 

Furthermore, the high-pressure environment can lead to mental health problems such as stress, anxiety, and even depression. Long hours, constant tasting of rich foods, and exposure to various hazards also contribute to other health issues.

  

Daniel was kind enough to stop work for a moment to let me take this shot - Thanks.

 

Address:

The Blue Hut

Strand, Teignmouth, Devon, UK.

TQ14 8XZ

Phone: 07453 464037

loreph.it/portfolio-item/228/

 

Bathhouse No.5 was one of the nine thermal baths located within the large central park of Tskaltubo (წყალტუბო), the town located in west-central Georgia designated as an important balneotherapy centre by the government of the former Soviet Union.

Tskaltubo has always been famous for its healing mineral waters and radon bath treatments. The centre focuses on balneotherapy for circulatory, nervous, musculoskeletal, gynaecological and skin diseases.

The first balneological baths were opened around 1870 and in 1925, the first sanatoriums and curative structures were built. Development continued apace and in 1931 the town was designated a balneotherapy and spa centre by the Soviet government. Tskaltubo was one of Stalin's favourite holiday resorts: he had a private swimming pool in Bathhouse No. 9, which is still in use today and not far from the abandoned Bathhouse No. 5.

 

loreph.it/portfolio-item/228/

 

Bathhouse No.5 was one of the nine thermal baths located within the large central park of Tskaltubo (წყალტუბო), the town located in west-central Georgia designated as an important balneotherapy centre by the government of the former Soviet Union.

Tskaltubo has always been famous for its healing mineral waters and radon bath treatments. The centre focuses on balneotherapy for circulatory, nervous, musculoskeletal, gynaecological and skin diseases.

The first balneological baths were opened around 1870 and in 1925, the first sanatoriums and curative structures were built. Development continued apace and in 1931 the town was designated a balneotherapy and spa centre by the Soviet government. Tskaltubo was one of Stalin's favourite holiday resorts: he had a private swimming pool in Bathhouse No. 9, which is still in use today and not far from the abandoned Bathhouse No. 5.

 

Muscles of the Lower Extremity Anatomy Visual Guide

 

This is part of a photographic atlas I created as a laboratory study resource for my BIOL 121 Anatomy and Physiology I students on the muscles of the lower extremity and their actions.

 

Credits: All photography, text, and labels by Rob Swatski, Professor of Biology, Harrisburg Area Community College - York Campus, York, PA. Email: rjswatsk@hacc.edu

 

Studying Anatomy and Physiology? Check out my Survive and Thrive in Anatomy & Physiology series of A&P textbooks! I wrote and illustrated these books to help biology and healthcare students succeed in A&P! Available in paperback, e-book, and Kindle.

 

Available for purchase on my website and Amazon: robswatski.com/

 

Biology Core Concepts - Chemistry and Cells (Book 1): a.co/d/0ijoG8Jv

 

The Histology Comic Book (Book 2): a.co/d/09BADvyS

 

The next book in the series, focusing on the skin, skeleton, and muscles, will be available in Late Spring/Early Summer 2026!

This is part of a photographic atlas I created as a laboratory study resource for my BIOL 121 Anatomy and Physiology I students on the muscles of the upper extremity and their actions.

 

Credits: All photography, text, and labels by Rob Swatski, Professor of Biology, Harrisburg Area Community College - York Campus, York, PA. Email: rjswatsk@hacc.edu

 

Studying Anatomy and Physiology? Check out my Survive and Thrive in Anatomy & Physiology series of A&P textbooks! I wrote and illustrated these books to help biology and healthcare students succeed in A&P! Available in paperback, e-book, and Kindle.

 

Available for purchase on my website and Amazon: robswatski.com/

 

Biology Core Concepts - Chemistry and Cells (Book 1): a.co/d/0ijoG8Jv

 

The Histology Comic Book (Book 2): a.co/d/09BADvyS

 

The next book in the series, focusing on the skin, skeleton, and muscles, will be available in Late Spring/Early Summer 2026!

This is part of a photographic atlas I created as a laboratory study resource for my BIOL 121 Anatomy and Physiology I students on the muscles of the upper extremity and their actions.

 

Credits: All photography, text, and labels by Rob Swatski, Professor of Biology, Harrisburg Area Community College - York Campus, York, PA. Email: rjswatsk@hacc.edu

 

Studying Anatomy and Physiology? Check out my Survive and Thrive in Anatomy & Physiology series of A&P textbooks! I wrote and illustrated these books to help biology and healthcare students succeed in A&P! Available in paperback, e-book, and Kindle.

 

Available for purchase on my website and Amazon: robswatski.com/

 

Biology Core Concepts - Chemistry and Cells (Book 1): a.co/d/0ijoG8Jv

 

The Histology Comic Book (Book 2): a.co/d/09BADvyS

 

The next book in the series, focusing on the skin, skeleton, and muscles, will be available in Late Spring/Early Summer 2026!

This is part of a photographic atlas I created as a laboratory study resource for my BIOL 121 Anatomy and Physiology I students on the muscles of the upper extremity and their actions.

 

Credits: All photography, text, and labels by Rob Swatski, Professor of Biology, Harrisburg Area Community College - York Campus, York, PA. Email: rjswatsk@hacc.edu

 

Studying Anatomy and Physiology? Check out my Survive and Thrive in Anatomy & Physiology series of A&P textbooks! I wrote and illustrated these books to help biology and healthcare students succeed in A&P! Available in paperback, e-book, and Kindle.

 

Available for purchase on my website and Amazon: robswatski.com/

 

Biology Core Concepts - Chemistry and Cells (Book 1): a.co/d/0ijoG8Jv

 

The Histology Comic Book (Book 2): a.co/d/09BADvyS

 

The next book in the series, focusing on the skin, skeleton, and muscles, will be available in Late Spring/Early Summer 2026!

This is part of a photographic atlas I created as a laboratory study resource for my BIOL 121 Anatomy and Physiology I students on the muscles of the upper extremity and their actions.

 

Credits: All photography, text, and labels by Rob Swatski, Professor of Biology, Harrisburg Area Community College - York Campus, York, PA. Email: rjswatsk@hacc.edu

 

Studying Anatomy and Physiology? Check out my Survive and Thrive in Anatomy & Physiology series of A&P textbooks! I wrote and illustrated these books to help biology and healthcare students succeed in A&P! Available in paperback, e-book, and Kindle.

 

Available for purchase on my website and Amazon: robswatski.com/

 

Biology Core Concepts - Chemistry and Cells (Book 1): a.co/d/0ijoG8Jv

 

The Histology Comic Book (Book 2): a.co/d/09BADvyS

 

The next book in the series, focusing on the skin, skeleton, and muscles, will be available in Late Spring/Early Summer 2026!

Muscles of the Lower Extremity Anatomy Visual Guide

 

This is part of a photographic atlas I created as a laboratory study resource for my BIOL 121 Anatomy and Physiology I students on the muscles of the lower extremity and their actions.

 

Credits: All photography, text, and labels by Rob Swatski, Professor of Biology, Harrisburg Area Community College - York Campus, York, PA. Email: rjswatsk@hacc.edu

 

Studying Anatomy and Physiology? Check out my Survive and Thrive in Anatomy & Physiology series of A&P textbooks! I wrote and illustrated these books to help biology and healthcare students succeed in A&P! Available in paperback, e-book, and Kindle.

 

Available for purchase on my website and Amazon: robswatski.com/

 

Biology Core Concepts - Chemistry and Cells (Book 1): a.co/d/0ijoG8Jv

 

The Histology Comic Book (Book 2): a.co/d/09BADvyS

 

The next book in the series, focusing on the skin, skeleton, and muscles, will be available in Late Spring/Early Summer 2026!

Kulthi ( Macrotyloma uniflorum) dal is used in the treatment of inflamed joints, fever, musculoskeletal disorder, breast milk purifier, sinus wounds, tumors, ascites and kidney stone.

A native of Western Australia, most prolific in remote Rottnest Island near Perth.

 

A quokka weighs 2.5 to 5.0 kg (5.5 to 11 lb) and is 40 to 54 cm (16 to 21 in) long with a 25-to-30 cm-long (9.8-to-12 in) tail, which is quite short for a macropod. It has a stocky build, well developed hind legs, rounded ears, and a short, broad head. Its musculoskeletal system was originally adapted for terrestrial bipedal saltation, but over its evolution, its system has been built for arboreal locomotion. Although looking rather like a very small kangaroo, it can climb small trees and shrubs up to 1.5 metres. Its coarse fur is a grizzled brown colour, fading to buff underneath. The quokka is known to live for an average of 10 years. Quokkas are nocturnal animals; they sleep during the day.

 

Quokkas are such show-stealers, their entire home is named after them! Dutch captain Willem de Vlanmigh named the island ‘t Eylandt Rottenest (Rat’s Nest Island) in 1696, mistaking the quokkas for giant rats!

   

I need to say this somewhere, and Facebook would be too public, so here I am.

 

I just found out there is a name for the painful musculoskeletal issue I have been dealing with for years now. It’s called accessory nerve disorder. It is caused by injury/paralysis of the eleventh cranial nerve, and results in damage to the muscles of the neck and shoulder. One of the common symptoms of it is something called a winged scapula, which I have a very pronounced case of, and suffer great pain from. (It's somewhat visible here -- notice my left shoulder droops lower than my right, even though I was using all my might to keep it aligned for the photo.)

 

This is in addition to another musculoskeletal disorder called craniocervical instability – basically, my head is unstable on my neck and it causes tearing/pulling of the nerves in the base of my skull, resulting in chronic pain, dizziness, and nausea. ….And the hip on my left side is completely destabilized, though I’m not sure if there’s a specific name for that yet -- maybe Piriformis Syndrome. (That's also somewhat visible here, in how the muscles around my left hip look atrophied as compared to the righthand side.)

 

These things are likely as a result of a hypermobility disorder (Ehler’s Danlos) and chronic Lyme’s Disease – basically, I had bacteria eating away at my already hyperextensible joints and tendons. (I’d like to think the bacteria has calmed down by now, but the damage is definitely there.)

 

Over the past few years these disorders have gotten to the point I can’t ignore them. It’s become obvious to me that if I don’t correct these issues, I will have an excruciatingly painful life of progressive physical degeneration. So I’m over here eating my body weight in grams of protein and doing intensive physical therapy. That’s it. That’s the blog. Besides the need to vent, I’m not sure why I’m posting this – except maybe as an incentive to hold myself accountable. If my self portraits don’t reveal someone getting progressively more muscular, I deserve to be questioned.

Todos los derechos reservados - All rights reserved - copyright © Pilar Azaña Talán

 

♫♥♥♫

 

El Balneario de Panticosa se encuentra a 1.636 m. de altitud, en pleno Pirineo de Huesca, dentro de un entorno natural privilegiado, rodeado de imponentes montañas y éste maravilloso lago (la cubeta de un circo glaciar), pura belleza y majestuosidad, gran patrimonio para la humanidad.

Cinco manantiales diferentes de aguas nitrogenadas, oligometálicas y sulfurosas (conocidas ya desde tiempos del Emperador romano Tiberio), convierten al Balneario en una auténtica cura de salud. Son aguas especialmente indicadas para el tratamiento de afecciones hepáticas, renales, digestivas, respiratorias, reúmaticas, nerviosas, obesidad y piel.

Contemplar las estrellas desde la Piscina Exterior sumergidos en tan mágicas Aguas Termales, eleva los sentidos hasta creer tocar el cielo...

-------------------------

The Panticosa Spa is 1636 m. altitude in the Pyrenees of Huesca, in a natural setting, surrounded by imposing mountains and this wonderful lake (the basin of a glacial cirque), sheer beauty and majesty, great heritage for humanity.

Five different water springs nitrogen, and sulfur oligometalic (known since the time of the Roman Emperor Tiberius), make a real spa health treatment. The waters are particularly suitable for the treatment of liver, kidney, digestive, respiratory, musculoskeletal, nervous, obesity and skin.

Contemplating the stars from the outdoor pool so magical submerged in exterior swimming pool, elevates the senses to believe touch the sky...

2021

 

More artwork at: www.permiandesigns.com/

 

Instagram: www.instagram.com/permiandesigns/

Bluesky: bsky.app/profile/permiandesigns.bsky.social

 

**INTERESTED IN A CUSTOM COMMISSION? If so, please feel free to contact me at permiandesigns@gmail.com

 

NOTE: All works featured here are completely original creations. None are made with the assistance of any form of AI technology in any fashion whatsoever.

Rovingian Sacred Natural Landscapes – Volcanic Zones And Animist Symbolism Part II by Daniel Arrhakis (2026)

  

Sacred Natural Landscapes of Rovinge - Volcanic Zones and Animistic Symbolism - Part II

 

The Canary Islands

 

The Canary Islands possess one of the richest and most mysterious heritages of sacred volcanic landscapes, shaped by their original inhabitants of Berber origin (often called Guanches in Tenerife, although each island had its own indigenous name).

 

Isolated in the Atlantic for centuries, these peoples developed a profound animistic and polytheistic system centered on the worship of the stars, Mother Earth, and above all, the impressive volcanic peaks that dominated their horizon.

  

Mount Teide (Tenerife) – Echeyde, the Gateway to the Underworld

 

Mount Teide (known as Echeyde or Hell by the ancient Guanches) is the highest peak in Spain and one of the largest volcanoes in the world.

In the local animistic cosmology, it was seen as the axis of the world that held up the sky, but also as a portal to the underworld.

It was believed that the interior of the volcano was the abode of Guayota, the supreme god of evil, darkness, and destruction; it was known to the ancient Guanches as Echeyde (Hell).

 

According to local legend, the interior of the crater was the abode of Guayota, the supreme god of evil and darkness. One day, Guayota kidnapped Magec, the sun god, plunging the Earth into darkness. Faced with the despair of the Guanches, the creator god Achamán intervened: he defeated the demon, freed the sun, and sealed the evil one forever in the bowels of Teide.

Whenever the volcano erupted, the natives lit sacred bonfires to invoke the celestial forces and offered milk and butter to appease the fury of the imprisoned demon.

  

Tindaya Mountain (Fuerteventura) – The Sacred Mountain of the Majes

 

Tindaya Mountain, the epicenter of the religious cult of the indigenous Majos, is considered the most important natural and spiritual monument in Fuerteventura. This sacred site houses more than 300 podomorphic petroglyphs (stone engravings in the shape of human feet) carved into the volcanic rock, aligned with Teide and the solstices, functioning as an ancestral temple dedicated to fertility.

 

Unlike Teide, which generated fear, Tindaya was a place of high sacredness and astronomical protection. For animistic thought, these stone contours symbolized the union between the spiritual agency of the Earth, the movement of the stars, and the invocation of rain, acting as an open-air temple dedicated to fertility.

 

Risco Caído and the Sacred Mountains (Gran Canaria) – Temples in the Rock

 

The geological heart of Gran Canaria hides fissures, ravines, and volcanic cones that served as shelter and sacred space for the ancient Canarians. The Risco Caído complex, classified as a UNESCO World Heritage Site, perfectly exemplifies the animistic fusion between volcanism and cosmos.

 

The natives carved circular temples (called almogarenes) atop cliffs and vertical volcanic formations, such as the majestic Roque Bentayga or the emblematic Roque Nublo.

 

Cave 6, in Risco Caído, exemplifies this fusion between volcanism and cosmos, where sunlight and moonlight illuminate fertility symbols engraved on the walls during solstices and equinoxes, transforming the volcano into a sacred and conscious receiver of the universe's energies.

 

Synthesis of Animism in the Canary Islands

 

The Guardian Spirits (Tibicenas): Canarian mythology populated the volcanic landscapes with the Tibicenas, ancestral spirits in the form of large black dogs with fiery eyes, created by Guayota. They personified the invisible dangers of the nights in the arid lava zones.

 

Mother Earth Worship: Caves formed by lava tubes were used both for communal habitation and for complex mummification funeral rituals. Entering the depths of the volcanic rock was a symbolic return to the womb of Mother Earth.

  

Porto Santo (Madeira Archipelago) - The Healing Sands

 

The animistic symbolism of the volcano in Porto Santo (Madeira Archipelago) manifests itself in the way ancient geological activity is perceived as a "vital force" of the island itself.

 

Formed approximately 18 million years ago and now geologically inactive, the island expresses this animism through three main vectors:

 

The Mountain as a Living Entity: The ancient volcanic cones and chimneys, such as Pico do Facho and Pico do Castelo, are seen as guardians of the island. Their rocky grandeur conveys the idea of an ancestral "breath" of the Earth.

 

Duality of Fire and Water: The transition from the fury of the magma to the serenity of the crystalline waters symbolizes the balance between the elements. The destructive fire has transformed into life (sandy beaches), reflecting a worldview of constant renewal and rebirth.

 

Sand and Healing Energy: In local tradition and mysticism, the biogenic and volcanic sands of Porto Santo (rich in calcium carbonate and minerals) carry the energy of the earth. They are used for therapeutic purposes, directly linking human well-being to the island's telluric past.

 

The sands contain high concentrations of calcium, magnesium, phosphorus, sulfur, and strontium (a powerful natural anti-inflammatory).

 

This natural treatment, known as sand therapy, is especially recommended for:

 

- Musculoskeletal diseases: Relief of pain associated with osteoarthritis, osteoporosis, certain autoimmune diseases, and rheumatism.

- Physical recovery: Highly sought after by athletes and people recovering from fractures or orthopedic surgeries.

- Chronic pain: Effective in the treatment of fibromyalgia.

- Skin problems: Relief of eczema and other dermatological diseases.

  

The Pillars of Animistic Symbolism in Volcanoes

 

Duality of Destruction and Creation: The volcano embodies the supreme cycle of life. The same force that destroys forests and villages with ash and magma creates the most fertile lands on the planet and new islands.

 

Human Agency and Humor: In animistic cultures, volcanic activity reflects the emotional state of the deity. Smoke and tremors indicate displeasure or a warning, requiring communal rituals of reconciliation.

 

Axes of the World (Axis Mundi): Due to their vertical imposingness, volcanoes serve as cosmic bridges. They connect the depths of the earth (the underworld of the ancestors), the surface of mortals, and the sky (the spiritual realm).

  

________________________________________________________________________________________________________

  

Paisagens Naturais Sagradas Rovingianas - Zonas Vulcânicas e Simbolismo Animista - part II

 

As Canárias

 

As Ilhas Canárias possuem uma das heranças mais ricas e misteriosas de paisagens sagradas vulcânicas, moldada pelos seus habitantes originais de origem berbere (frequentemente chamados de Guanches em Tenerife, embora cada ilha tivesse a sua própria denominação indígena).

Isolados no Atlântico durante séculos, estes povos desenvolveram um profundo sistema animista e politeísta centrado na adoração dos astros, da Terra-Mãe e, acima de tudo, dos impressionantes picos vulcânicos que dominavam o seu horizonte.

 

O Vulcão Teide (Tenerife) – Echeyde, a Porta do Submundo

 

O Monte Teide (conhecido como Echeyde ou Hell pelos antigos Guanches) é o pico mais alto de Espanha e um dos maiores vulcões do mundo.

Na cosmologia animista local, era visto como o eixo do mundo que segurava o céu, mas também como um portal para o mundo inferior.

Acreditava-se que o interior do vulcão era a morada de Guayota, o deus supremo do mal, da escuridão e da destruição; era conhecido pelos antigos Guanches como Echeyde (Inferno).

 

Segundo a lenda local, o interior da cratera era a morada de Guayota, o deus supremo do mal e da escuridão. Certo dia, Guayota raptou Magec, o deus do sol, mergulhando a Terra nas trevas. Perante o desespero dos Guanches, o deus criador Achamán interveio: derrotou o demónio, libertou o sol e selou o maligno para sempre nas entranhas do Teide.

Sempre que o vulcão entrava em erupção, os nativos acendiam fogueiras sagradas para invocar as forças celestes e ofereciam leite e manteiga para aplacar a fúria do demónio aprisionado.

  

Montanha de Tindaya (Fuerteventura) – A Montanha Sagrada dos Majos

 

A Montanha de Tindaya, epicentro do culto religioso dos majos indígenas, é considerada o monumento natural e espiritual mais importante de Fuerteventura. Este local sagrado alberga mais de 300 petróglifos podomorfos (gravações em pedra com formato de pés humanos) esculpidos na rocha vulcânica, alinhados com o Teide e os solstícios, funcionando como um templo ancestral dedicado à fertilidade.

Ao contrário do Teide, que gerava temor, Tindaya era um local de elevada sacralidade e proteção astronómica. Para o pensamento animista, estes contornos em pedra simbolizavam a união entre a agência espiritual da Terra, o movimento dos astros e a invocação das chuvas, atuando como um templo ao ar livre dedicado à fertilidade.

  

Risco Caído e as Montanhas Sagradas (Gran Canária) – Templos na Rocha

 

O coração geológico da Gran Canária esconde fendas, barrancos e cones vulcânicos que serviram como abrigo e espaço sagrado para os antigos Canários. O complexo de Risco Caído, classificado como Património Mundial da UNESCO, exemplifica na perfeição a fusão animista entre o vulcanismo e o cosmos.

Os nativos escavaram templos circulares (chamados almogarenes) no topo de penhascos e formações vulcânicas verticais, como o majestoso Roque Bentayga ou o emblemável Roque Nublo.

A Gruta 6, em Risco Caído, exemplifica essa fusão entre vulcanismo e cosmos, onde a luz solar e lunar ilumina símbolos de fertilidade gravados nas paredes durante solstícios e equinócios, transformando o vulcão num recetor sagrado e consciente das energias do universo.

  

Síntese do Animismo nas Canárias

 

Os Espíritos Guardiões (Tibicenas): A mitologia canária povoava as paisagens vulcânicas com os Tibicenas, espíritos ancestrais em forma de grandes cães negros com olhos de fogo, criados por Guayota. Eles personificavam os perigos invisíveis das noites nas áridas zonas de lava.

 

Culto à Terra-Mãe: As cavernas formadas por tubos lávicos eram utilizadas tanto para habitação comunitária como para rituais fúnebres complexos de mumificação. Entrar nas profundezas da rocha vulcânica era um regresso simbólico ao útero da Terra-Mãe.

  

Porto Santo (Arquipélago da Madeira) - As Areias Que Curam

 

O simbolismo animista do vulcão no Porto Santo (Arquipélago da Madeira) manifesta-se na forma como a antiga atividade geológica é percebida como uma "força vital" da própria ilha.

 

Formada há cerca de 18 milhões de anos e hoje geologicamente inativa, a ilha expressa este animismo através de três vetores principais:

 

A Montanha como Entidade Viva: Os antigos cones e chaminés vulcânicas, como o Pico do Facho e o Pico do Castelo, são vistos como guardiões da ilha. A sua imponência rochosa transmite a ideia de uma "respiração" ancestral da Terra.

 

Dualidade Fogo e Água: A transição da fúria do magma para a serenidade das águas cristalinas simboliza o equilíbrio entre elementos. O fogo destruidor transformou-se em vida (praias arenosas), refletindo uma cosmovisão de renovação e renascimento constante.

 

A Areia e a Energia Curativa: Na tradição e mística local, as areias de origem biogénica e vulcânica do Porto Santo (ricas em carbonato de cálcio e minerais) carregam a energia da terra. São utilizadas para fins terapêuticos, ligando o bem-estar humano diretamente ao passado telúrico da ilha.

As areias contêm elevadas concentrações de cálcio, magnésio, fósforo, enxofre e estrôncio (um poderoso anti-inflamatório natural)

 

Este tratamento natural, conhecido como arenoterapia, é especialmente recomendado para:

 

- Doenças músculo-esqueléticas: Alívio de dores associadas a artroses, osteoporose, certas doenças autoimunes e reumatismo.

- Recuperação física: Muito procurado por atletas e pessoas em recuperação pós-fraturas ou cirurgias ortopédicas.

- Dores crónicas: Eficaz no tratamento da fibromialgia.

Problemas de pele: Alívio de eczemas e outras doenças dermatológicas.

  

Os Pilares do Simbolismo Animista nos Vulcões

 

Dualidade de Destruição e Criação: O vulcão encarna o ciclo supremo da vida. A mesma força que destrói florestas e aldeias com cinza e magma cria as terras mais férteis do planeta e novas ilhas.

Agência e Humor Humano: Nas culturas animistas, a atividade vulcânica reflete o estado emocional da divindade. Fumo e tremores indicam desagrado ou aviso, exigindo rituais comunitários de reconciliação.

 

Eixos do Mundo (Axis Mundi): Devido à sua imponência vertical, os vulcões servem como pontes cósmicas. Eles ligam as profundezas da terra (o submundo dos ancestrais), a superfície dos mortais e o céu (o reino espiritual).

   

Vitamin D is needed to keep muscles and bones healthy (musculoskeletal health). However, we know that dietary sources of vitamin D are limited and that we obtain the majority of our vitamin D from exposure of our skin to the sun during the spring and summer.

 

Existing advice is for everyone to consider taking a daily dietary supplement of vitamin D between October and March, and for some at risk groups, including people who are not often outdoors such as the frail or housebound, and those with dark skin, to consider taking a dietary supplement throughout the year. However, we know that uptake of dietary supplements is poor and intakes of vitamin D fail to meet recommendations in all age groups.

ISS047e038968 (04/05/2016) --- ESA (European Space Agency) astronaut Tim Peake operates the Muscle Atrophy Research and Exercise System (MARES) equipment inside the Columbus module. MARES is an ESA system that will be used for research on musculoskeletal, biomechanical, and neuromuscular human physiology to better understand the effects of microgravity on the muscular system.

🇬🇧 English

General information

Dobrna Health Resort is one of the oldest still-operating health resorts in Europe. It is located in the town of Dobrna in eastern Slovenia and has been in continuous operation for over 600 years.

History

The first written record of the Dobrna thermal spring dates back to 1403. During the 19th century, the resort became a fashionable destination for the Austro-Hungarian elite. Historic buildings have since been restored and integrated into a modern spa complex.

Thermal water

The thermal water in Dobrna is acratothermal, with low mineral content and a temperature of approximately 36 °C. Its mild composition makes it suitable for long-term therapeutic use.

Medical use

The resort is particularly known for the treatment of gynecological conditions, as well as for therapies related to:

•musculoskeletal disorders

•rheumatic and neurological diseases

•post-operative and post-injury rehabilitation

•stress-related conditions and chronic fatigue

Present-day role

Today, Dobrna functions as a center for medical rehabilitation, preventive health care, and wellness tourism, emphasizing tradition, natural surroundings, and holistic well-being.

12007 R Toplice Dobrna - 4 Fotolik - Celje ~ 1954

 

colnect.com/en/postcards/postcard/495026-Dobrna_Thermal_s...

Target focused, locked and tracked with million calculations running in the brain to coordinate with musculoskeletal system to execute the midair bee kill. Can’t be more intense in the life of Bee-eater.

Green Bee-eater for the final jump and flight.

23 March, 2023

Jhal Thikriwal, Kapurthala, Punjab

OM1, 300f4-MC14

1/4000, f5.6, ISO 1600

Down here in Devon, like all rural communities farming goes on despite the weather and Coronavirus. Farming can be a solitary, lonely occupation at the best of times.

 

Several issues contribute to depression and anxiety among farmers and their employees. Serious weather events such as snowfall and floods can drastically impact a season’s yield, which can increase worry over finances exponentially. The day-to-day management of these conditions can also weigh heavily on those responsible for handling them.

 

Agricultural workers are rated as 46 percent more likely than those in other industries to endure illness overall. That means their risk of physical illness, especially lung disease and musculoskeletal disorders, is higher than it is for other workers, which can also contribute to stress and anxiety.

 

In addition, many farm jobs are incredibly solitary – and those doing them can go for days or even weeks without interacting with other people. This type of isolation is often correlated with depression, and the United Kingdom’s Farm Safety Foundation research suggests that many agricultural workers report struggling with this issue.

 

A recent survey conducted by the organisation found that over 80 percent of farmers under the age of 40 believe poor mental health is the biggest hidden problem that they and their peers are facing today. In Ireland, a 2019 survey by Empathy Research and AgriLand reported that 57 percent and 46 percent were impacted by anxiety and depression to some degree respectively.

  

So next time you see a farmer smile or wave, even if he seems like a grumpy old guy.

en.wikipedia.org/wiki/Sea_urchin

taken at the bottom of the tall cliffs

Digital images from rawpixel's own physical collection of antique chromolithographic plates

 

Free download under CC Attribution (CC BY 4.0). Please credit the artist and rawpixel.com.

 

Higher resolutions with no attribution required can be downloaded: www.rawpixel.com/board/427285/rawpixel-original-lithographs

Down here in Devon, like all rural communities farming goes on despite the weather and Coronavirus. Farming can be a solitary, lonely occupation at the best of times.

 

Several issues contribute to depression and anxiety among farmers and their employees. Serious weather events such as snowfall and floods can drastically impact a season’s yield, which can increase worry over finances exponentially. The day-to-day management of these conditions can also weigh heavily on those responsible for handling them.

 

Agricultural workers are rated as 46 percent more likely than those in other industries to endure illness overall. That means their risk of physical illness, especially lung disease and musculoskeletal disorders, is higher than it is for other workers, which can also contribute to stress and anxiety.

 

In addition, many farm jobs are incredibly solitary – and those doing them can go for days or even weeks without interacting with other people. This type of isolation is often correlated with depression, and the United Kingdom’s Farm Safety Foundation research suggests that many agricultural workers report struggling with this issue.

 

A recent survey conducted by the organisation found that over 80 percent of farmers under the age of 40 believe poor mental health is the biggest hidden problem that they and their peers are facing today. In Ireland, a 2019 survey by Empathy Research and AgriLand reported that 57 percent and 46 percent were impacted by anxiety and depression to some degree respectively.

  

So next time you see a farmer smile or wave, even if he seems like a grumpy old guy.

This is Jenna. Here's the story about her new leg brace.

 

PRESS RELEASE: FOR IMMEDIATE RELEASE

 

Date: June 3, 2022

Contact: Gabrielle Jansen | (334) 314-6690

Email: gjansen@montgomeryal.gov

   

Montgomery Zoo giraffe Jenna debuts new brace, collaboration made with Alabama State University

 

MONTGOMERY ZOO (Montgomery, AL): The Montgomery Zoo is excited to announce that Jenna the giraffe has a new shoe!

   

Many of our visitors are familiar with Jenna’s story. Jenna is a 17-year-old reticulated giraffe born here at the Montgomery Zoo. She experienced a traumatic injury 12 years ago that left her with a permanent musculoskeletal abnormality in her left rear leg. Her care team at the time of the injury managed her very well throughout the ordeal. They even developed a brace for her to wear, adding support to her leg. Over the years, the brace did require upkeep- not surprising for a piece of equipment worn daily by a 1,200-pound animal! No design changes were made to the brace during this ten year timespan, however. So when the brace was next in need of repair, we began to wonder if it was time to make adjustments to the design. After all, a lot of scientific advancements are made in a decade! Perhaps there were new ideas or materials out there that would improve upon Jenna’s original brace?

   

The question was posed, “What adjustments could be made to improve upon the original design ten years later?” After all, a lot of scientific knowledge can be gained in ten years! It is imperative that as time goes on, we update our current medical and husbandry practices to meet the present day’s science.

   

And so began the partnership between the Montgomery Zoo and Alabama State University’s College of Health Sciences Department of Prosthetics and Orthotics in the summer of 2020. That’s right, it has taken two years to design, build, and apply this new brace to Jenna’s leg. The process took longer than expected because Zoo care staff wished to train Jenna to voluntarily participate in her medical care. With time and a lot of patience, Jenna now voluntarily goes into a chute and allows her care staff to take off and put on the brace as needed. Jenna trusts her care staff, and her training will ensure ongoing participation in the process.

   

ASU Department of Prosthetics and Orthotics students were at the forefront of the new design and development, with Zoo veterinary and care staff providing insight and suggestions for the new brace. The first step of the process required acquiring a model of Jenna’s leg. The ASU team had a brilliant idea- to use a 3D scanner to generate a digital model of her leg that could then be made into a physical replica for brace fitting/sizing. The 3D scanner was the way to go because we did not have to create a traditional mold by wrapping Jenna’s leg. The following steps of the process included brace design, brace fabrication, and many fittings and adjustments on Jenna’s leg.

   

A sincere thank you to all Zoo staff involved in this journey, and a special thank you to Alabama State University’s College of Health Sciences Department of Prosthetics and Orthotics team for all they’ve done to help our beloved Jenna. This process has been long and has required a lot of patience from both teams, and even the patient. The result was worth it. Jenna is loving her new brace.

   

She is noticeably quicker and more stable when wearing her brace. She allows her care staff to remove it and put it back on whenever necessary while she’s in our giraffe chute. She sleeps with it on, too.

  

The main source of vitamin D is from direct sunlight exposure on the skin. Between late March and early April to the end of September, most people can make (synthesise) all the vitamin D they need through sunlight exposure on their skin and from a balanced diet. However, during the autumn and winter months, the sun is not strong enough to enable this synthesis to take place. Therefore, current government advice is that everyone should consider taking a daily vitamin D supplement during the autumn and winter months. Current vitamin D recommendations are based on musculoskeletal (muscle and bone) health.

 

During the summer months, some people have very little or no sunshine exposure and will not make enough vitamin D from sunlight. This may include the elderly, people who are housebound, confined to the indoors for longer periods, or those in care homes or confined indoors in other institutions, and those who usually wear clothes that cover up most of their skin when outdoors.

iss064e010944 (Dec. 8, 2020) --- NASA astronaut and Expedition 64 Flight Engineer Victor Glover is pictured inside Japan's Kibo laboratory module installing research gear that will develop a biological model to study the effects of spaceflight on musculoskeletal disease. The investigation could lead to drugs that will prevent the progression of the disease.

Digital images from rawpixel's own physical collection of antique chromolithographic plates

 

Free download under CC Attribution (CC BY 4.0). Please credit the artist and rawpixel.com.

 

Higher resolutions with no attribution required can be downloaded: www.rawpixel.com/board/427285/rawpixel-original-lithographs

Camera Model Name: Canon EOS 5D Mark II

Lens: EF100-400mm f/4.5-5.6L IS USM

Tv (Shutter Speed): 1/250

Av (Aperture Value): 5.0

Metering: Evaluative Metering

ISO Speed: 200

Focal Length: 220.0 mm

 

|| My Website and Blog: A Gallery of Dreams.||

 

Tibetan nomads known as ndrogba are synonymous with the remote high elevation grasslands. Herding cattle presents them with the very basic opportunity to survive in the harsh environment.

 

For centuries they have developed and devised a method to live in harmony in the inhospitable terrain by using their herds. During the summer months the herds are moved long distances for grazing, while during winters some of the animals are taken in the market for selling or bartering for other essential goods.

 

Traditionally nomads were entirely dependent on their herds but in modern times they have become dependent on cash.

 

By practicing seasonal migration the nomads not only have survived to their best ability for generations but also allowed the fragile soil of the plateau to recover from one year to the other and prevent over grazing.

 

The yaks and mountain sheep not only provide meat and milk, but their skins are dried and used to insulate tents in which the nomads live. Dung is also dried and used to heat the tents and provide fuel for cooking, wool and fur from the animals are used for clothing.

 

This unique culture of over four thousand years of the nomads are being seriously challenged and stand at the risk of being wiped away by Chinese policies adopted for economic and political reasons. An estimated two million nomads and semi nomads are being forced into settlement as government is implementing 'Comfortable Housing Project' or 'CHP'. It involves so called improvements on existing plots of land or dwellings.

 

Many of the nomads have been forced to adapt alternate methods of living after being forced to move from their ancestral and pastoral land. Among other things many have taken up foraging for yarsta gunbu also known as yarsagumba (meaning summer grass, winter worm in Tibetan) or Caterpillar fungus (Cordyceps sinensis) used in Chinese medicines and internationally known as the 'Himalayan Viagra'. The precious fungus (costing over USD 31 per gram) forces to tread dangerous paths - along precipitous slopes, on the brink of abysses, through mountain passes over 5, 000 meters / 16, 404 ft. high, through streams that many times turn into mighty rivers during snow melts causing lose of life every single season.

 

Incidentally, these half caterpillar and half fungus tells a gruesome story of formation. The Cordyceps Fungal spores enters the the larva of the Ghost Moth or Ghost Swift (Hepialus humuli) and starts to eat the host alive. The vital organs are initially spared so that the caterpillar is active. In the final phase the parasite takes control of the musculoskeletal system and steers it into the desired position before death, that is a few centimeters below ground surface with the head pointing upwards. Then, the rapidly growing fungus sprout breaches the larva's head like a horn and emerges into the daylight.

         

iss069e000087 (March 29, 2023) --- UAE (United Arab Emirates) astronaut and Expedition 69 Flight Engineer Sultan Alneyadi services tissue sample cassettes inside the Columbus laboratory Module's BioFabrication Facility (BFF). The BFF-Meniscus study investigates bioprinting tissues to heal musculoskeletal injuries both in space and on Earth,

This image is excerpted from a U.S. GAO report:

www.gao.gov/products/GAO-16-337

 

WORKPLACE SAFETY AND HEALTH: Additional Data Needed to Address Continued Hazards in the Meat and Poultry Industry

Time to get back into the swing of things! Something tells me Musculoskeletal Anatomy will be the death of me this semester... heaven help me - don't even get me started on Neuroanatomy, ouch. Thankfully, I'm studying none of that dreaded subject, Pharmacology this semester!

 

Founded in 1850, the University of Sydney is Australia's first university and is regarded as one of its most prestigious, ranked as the 24th most reputable university in the world. In 2014, it was ranked 37th and in the top 0.3% in the QS World University Rankings. Seven Nobel or Crafoord laureates have been affiliated with the university as graduates and faculty. The University is colloquially known as one of Australia's prestigious "Sandstones", a status similar to that of the "Ivy League" in the United States and the "Russell Group" in the United Kingdom.

 

The university's Coat of Arms, granted by the College of Arms by order of Queen Victoria, are an amalgamation of the arms of the universities of Oxford and Cambridge, and important figures, heraldry and other references to the two ancient universities are sprawled throughout the university in its architecture and character. Its motto, "Sidere mens eadem mutato" translated literally gives "Though the stars change, the mind is the same", but has been more liberally translated to give, "Sydney University is really just Oxford or Cambridge laterally displaced approximately 12,000 miles".

 

The 2013 QS World University Rankings placed Sydney in the top 20 in the world in 11 subjects; more than a third of the 30 measured. The University of Sydney was ranked 8th in the world for Education, 9th in Accounting and Finance and 10th in Law. Additionally, Sydney was placed 12th in English Language and Literature, History and Archaeology, Linguistics and Civil Engineering and Structural Engineering, the highest in Australia of those subjects. Psychology at Sydney was ranked 14th, Pharmacy and Pharmacology, and Communication and Media were ranked 16th, and the Sydney Medical School was ranked 17th.

 

Its main campus has been ranked in the top 10 of the world's most beautiful universities by the British Daily Telegraph, The Huffington Post and Disney Pixar, among others such as Oxford and Cambridge and is spread across the inner-city suburbs of Camperdown and Darlington.

 

The Main Quadrangle's Great Tower houses the largest and oldest of Australia's two carillons, a performance may be viewed here: youtu.be/6xLslgpOVho

The German Shepherd, also known in Britain as an Alsatian, is a German breed of working dog of medium to large size. The breed was developed by Max von Stephanitz using various traditional German herding dogs from 1899.

 

It was originally bred as a herding dog, for herding sheep. It has since been used in many other types of work, including disability assistance, search-and-rescue, police work, and warfare. It is commonly kept as a companion dog, and according to the Fédération Cynologique Internationale had the second-highest number of annual registrations in 2013.

 

History

During the 1890s, attempts were being made to standardise dog breeds. Dogs were being bred to preserve traits that assisted in their job of herding sheep and protecting their flocks from predators. In Germany this was practised within local communities, where shepherds selected and bred dogs. It was recognised that the breed had the necessary skills for herding sheep, such as intelligence, speed, strength and keen senses of smell. The results were dogs that were able to do such things, but that differed significantly, both in appearance and ability, from one locality to another.

 

To combat these differences, the Phylax Society was formed in 1891 with the intention of creating standardised development plans for native dog breeds in Germany. The society disbanded after only three years due to ongoing internal conflicts regarding the traits in dogs that the society should promote; some members believed dogs should be bred solely for working purposes, while others believed dogs should be bred also for appearance. While unsuccessful in their goal, the Phylax Society had inspired people to pursue standardising dog breeds independently.

 

With the rise of large, industrialised cities in Germany, the predator population began to decline, rendering sheepdogs unnecessary. At the same time, the awareness of sheepdogs as a versatile, intelligent class of canine began to rise. Max von Stephanitz, an ex-cavalry captain and former student of the Berlin Veterinary College, was an ex-member of the Phylax Society who firmly believed dogs should be bred for working. He admired the intelligence, strength and ability of Germany's native sheepdogs, but could not find any one single breed that satisfied him as the perfect working dog.

 

In 1899, von Stephanitz was attending a dog show when he was shown a dog named Hektor Linksrhein. Hektor was the product of few generations of selective breeding and completely fulfilled what von Stephanitz believed a working dog should be. He was pleased with the strength of the dog and was so taken by the animal's intelligence, loyalty, and beauty, that he purchased him immediately. After purchasing the dog he changed his name to Horand von Grafrath and von Stephanitz founded the Verein für Deutsche Schäferhunde (Society for German Shepherd Dogs). Horand was declared to be the first German Shepherd Dog, and was the first dog added to the society's breed register. In just a few decades of the Verein für Deutsche Schäferhunde's establishment, the breed became one of the world's most popular and numerous, a position it has maintained to this day. By 1923, the Verein für Deutsche Schäferhunde claimed 50,000 dues-paying members in more than 500 branches in Germany alone.

 

Horand became the center-point of the breeding programs and was bred with dogs belonging to other society members that displayed desirable traits and with dogs from Thuringia, Franconia, and Württemberg. Fathering many pups, Horand's most prolific was Hektor von Schwaben. Hektor was inbred with another of Horand's offspring and produced Heinz von Starkenburg, Beowulf, and Pilot, who later sired a total of 84 pups, mostly through being inbred with Hektor's other offspring. This inbreeding was deemed necessary in order to fix the traits being sought in the breed. Beowulf's progeny also were inbred and it is from these pups that all German Shepherds draw a genetic link. It is believed the society accomplished its goal mostly due to von Stephanitz's strong, uncompromising leadership and he is therefore credited with being the creator of the German Shepherd Dog.

 

During the first half of the twentieth century, the breed came to be strongly identified with Imperial and Nazi Germany, because of its association with purity and militarism. German Shepherds were coveted as "germanische Urhunde", being close to the wolf, and became very fashionable during the Nazi era. Adolf Hitler acquired a German Shepherd named "Prinz" in 1921, during his years of poverty, but he had been forced to lodge the dog elsewhere. However, she managed to escape and return to him. Hitler, who adored the loyalty and obedience of the dog, thereafter developed a great liking for the breed. Hitler kept several more of the breed, including Blondi, who was among several dogs in the 'Führerbunker' during the Battle of Berlin at the end of the Second World War. Dogs played a role in Nazi propaganda by portraying Hitler as an animal lover. Preparing for his suicide, Hitler ordered Dr. Werner Haase to test a cyanide capsule on Blondi, and the dog died as a result. Erna Flegel, a nurse who worked at the emergency casualty station in the Reich Chancellery stated in 2005 that Blondi's death had affected the people in the bunker more than Eva Braun's suicide. German Shepherds were also used widely as guard dogs at Nazi concentration camps during the Holocaust.

 

When the German Shepherd was introduced to the United States it was initially a popular dog. But as the dogs' popularity grew, it became associated as a dangerous breed owned by gangsters and bootleggers. The reputation of the German Shepherds as a dangerous breed had grown to such an extent that it was briefly banned to import them in Australia in 1929. Potential legislation was even considered to require that all German shepherds in South Australia be sterilised.

 

Naming

The breed was named Deutscher Schäferhund, by von Stephanitz, literally translating to "German Shepherd Dog". At the time, all other herding dogs in Germany were referred to by this name; they thus became known as Altdeutsche Schäferhunde, or old German herding dogs.

 

The direct translation of the name was adopted for use in the stud-book; however, at the end of the First World War, it was believed that the inclusion of the word "German" would harm the breed's popularity, due to the anti-German sentiment of the era. The breed was officially renamed by the UK Kennel Club to "Alsatian Wolf Dog", after the French region of Alsace bordering Germany.

 

Eventually, the appendage "wolf dog" was dropped, after numerous campaigns by breeders who were worried that becoming known as a wolf-dog hybrid would affect the breed's popularity and legality. The name Alsatian remained for five decades, until 1977, when successful campaigns by dog enthusiasts pressured the British kennel clubs to allow the breed to be registered again as German Shepherds. The word "Alsatian" once appeared in parentheses as part of the formal breed name of the American Kennel Club and was removed in 2010.

 

Description

German Shepherds are medium to large-sized dogs. The breed standard height at the withers is 60–65 cm (24–26 in) for males, and 55–60 cm (22–24 in) for females. German Shepherds can reach sprinting speeds of up to 30 miles per hour. Shepherds are longer than they are tall, with an ideal proportion of 10 to 8+1⁄2. The AKC official breed standard does not set a standard weight range. They have a domed forehead, a long square-cut muzzle with strong jaws and a black nose. The eyes are medium-sized and brown. The ears are large and stand erect, open at the front and parallel, but they often are pulled back during movement. A German Shepherd has a long neck, which is raised when excited and lowered when moving at a fast pace as well as stalking. The tail is bushy and reaches to the hock.

 

German Shepherds have a double coat which is close and dense with a thick undercoat. The coat is accepted in two variants: medium and long. The gene for long hair is recessive, and therefore the long-haired variety is rarer. Treatment of the long-haired variation differs across standards; it is accepted but does not compete against standard-coated dogs under the German and UK Kennel Clubs while it can compete with standard-coated dogs, but is considered a fault, in the American Kennel Club. The FCI accepted the long-haired type in 2010, listing it as the variety b, while the short-haired type is listed as the variety a.

 

Most commonly, German Shepherds are either tan/black or red/black. Most colour varieties have black masks and black body markings which can range from a classic "saddle" to an overall "blanket". Rarer colour variations include sable, pure-black, pure-white, liver, silver, blue, and panda varieties. The all-black and sable varieties are acceptable according to most standards; however, the blue and liver are considered to be serious faults and the all-white is grounds for instant disqualification from showing in conformation at All Breed and Specialty Shows.

 

Intelligence

German Shepherds were bred specifically for their intelligence. In a list of breeds most likely to bark as watchdogs, Stanley Coren ranked the breed in second place. Coupled with their strength, this trait makes the breed desirable as police, guard and search and rescue dogs, as they are able to quickly learn various tasks and interpret instructions better than other breeds.

 

Temperament

German Shepherds are moderately active dogs and are described in breed standards as self assured. The breed is marked by a willingness to learn and an eagerness to have a purpose. They are curious, which makes them excellent guard dogs and suitable for search missions. They can become overprotective of their family and territory, especially if not socialised correctly. They are not inclined to become immediate friends with strangers. German Shepherds are highly intelligent and obedient, as well as protective of their owners.

 

Aggression and biting

Further information: Dog bite prevention

A 2020 literature review in Plastic and Reconstructive Surgery found that from 1971 to 2018, of all pure breed dogs in the United States, the German Shepherd was responsible for the most bites severe enough to require hospital treatment.

 

While an Australian report from 1999 provides statistics showing that German Shepherds are the breed third most likely to attack a person in some Australian locales, once their popularity is taken into account, the percentages of attacks by German Shepherds drops to 38th.

 

According to the National Geographic Channel television show Dangerous Encounters, the bite of a German Shepherd has a force of over 1,060 newtons (238 lbf) (compared with that of a Rottweiler, over 1,180–1,460 newtons (265–328 lbf), a Pit bull, 1,050 newtons (235 lbf), a Labrador Retriever, of approximately 1,000 newtons (230 lbf), or a human, of approximately 380 newtons (86 lbf)).

 

Modern breed

The modern German Shepherd breed is criticised by experts for straying away from Max von Stephanitz's original ideology that German Shepherds should be bred primarily as working dogs and that breeding should be strictly controlled to eliminate defects quickly.  He believed that, above all else, German Shepherds should be bred for intelligence and working ability.

 

Controversy

The Kennel Club, in the United Kingdom, is involved in a dispute with German Shepherd breed clubs about the issue of soundness in the show strain of the breed. Some show strains have been bred with an extremely roached topline (back) that causes poor gait in the hind legs.

 

The issue was raised in the BBC documentary, Pedigree Dogs Exposed, which said that critics of the breed describe it as "half dog, half frog". An orthopaedic vet remarked on footage of dogs in a show ring that they were "not normal".

 

The Kennel Club's position is that "this issue of soundness is not a simple difference of opinion, it is the fundamental issue of the breed's essential conformation and movement."[46] The Kennel Club has decided to retrain judges to penalise dogs with these problems.

 

The Kennel Club also recommends testing for haemophilia and hip dysplasia, other common problems with the breed.

 

Main article: East-European Shepherd

The East-European Shepherd is a variety of the German Shepherd bred in the former Soviet Union with the purpose of creating a larger, more cold-resistant version of the German Shepherd. It lacks the physical deformities bred into western show lines of German Shepherds and has become one of Russia's most popular dog types.

 

King Shepherd

The King Shepherd is a variety of the German Shepherd bred in the United States, its breeders hoping to rectify the physical deformities that have been bred into the original breed.

 

Shiloh Shepherd

The Shiloh Shepherd is a variety of the German Shepherd bred in the United States. It was developed in the 1970s and 1980s to correct behavioural and conformational issues that have been bred into modern German Shepherds, and was bred for its large size, length of back, temperament and soundness of hips. It has been recognised since 1990 by the American Rare Breed Association.

 

Main article: White Shepherd

The White Shepherd is a variety of the German Shepherd bred in the United States. White-coated German Shepherds were once banned from registration in their native Germany, but in the United States and Canada the coloration gained a following and a breed club was formed specifically for white German Shepherds, calling their variety the White Shepherd. The variety is recognised as a separate breed by the United Kennel Club.

 

Main article: White Swiss Shepherd Dog

The White Swiss Shepherd Dog (French: Berger Blanc Suisse, German: Weisser Schweizer Schäferhund, Italian: Pastore Svizzero Bianco) is a variety of the German Shepherd bred in Switzerland. It descends from the American White Shepherds; the first stud dog of what was to become the breed was an American dog born in 1966 and imported to Switzerland. The variety was recognised by the Fédération Cynologique Internationale as a separate breed in 2003, and it is now recognised by a number of national kennel clubs.

 

Use as a working dog

German Shepherds are a popular selection for use as working dogs. They are known for being easy to train and good for performing tasks and following instructions. They are especially well known for their police work, being used for tracking criminals, patrolling troubled areas and detection and holding of suspects. Additionally, thousands of German Shepherds have been used by the military. These military working dogs (MWD) are usually trained for scout duty, and they are used to warn soldiers to the presence of enemies or of booby traps or other hazards. German Shepherds have also been trained by military groups to parachute from aircraft or as anti-tank weapons. They were used in World War II as messenger dogs, rescue dogs and personal guard dogs. A number of these dogs were taken home by foreign servicemen, who were impressed by their intelligence.

 

The German Shepherd is one of the most widely used breeds in a wide variety of scent-work roles. These include search and rescue, cadaver searching, narcotics detection, explosives detection, accelerant detection and mine detection dog, among others. They are suited for these lines of work because of their keen sense of smell and their ability to work regardless of distractions. At one time the German Shepherd was the breed chosen almost exclusively to be used as a guide dog for the visually impaired. When formal guide dog training began in Switzerland in the 1920s under the leadership of Dorothy Eustis, all of the dogs trained were German Shepherd females. An experiment in temperament testing of a group of Labrador Retrievers and German Shepherds showed that the Retrievers scored higher on average in emotional stability, ability to recover promptly from frightening situations, cooperative behaviour and friendliness; while the German Shepherds were superior in aggression and defensive behaviour. These results suggested that Labrador Retrievers were more suited to guide dog work while German Shepherds were more suited to police work.

 

Currently, Labradors and Golden Retrievers are more widely used for this work, although there are still German Shepherds being trained. In 2013, about 15% of the dogs trained by Guide Dogs of America were German Shepherds, while the remainder are Labrador Retrievers and Golden Retrievers. The Guide Dogs for the Blind Association in the United Kingdom trains some German Shepherds, while the comparable organisation in the US only trains Labrador Retrievers, Golden Retrievers and crosses between these breeds.

 

German Shepherds are still used for herding and tending sheep grazing in meadows next to gardens and crop fields. They are expected to patrol the boundaries to keep sheep from trespassing and damaging the crops. In Germany and other places these skills are tested in utility dog trials also known as Herdengebrauchshund (HGH) herding utility dog trials.

 

One Mexican German Shepherd, Zuyaqui, was dissected and his body put on display at the Sedena's "Narco Museum" in Mexico. He is regarded to be the dog who has captured the most drugs in Mexican police and military history.

 

A nine-week-old puppy

When the UK Kennel accepted registrations in 1919, 54 German Shepherds were registered. By 1926 this number had grown to over 8000. The breed gained international recognition after the end of World War I. Returning soldiers spoke highly of the breed and animal actors Rin Tin Tin and Strongheart popularised the breed further. The first German Shepherd Dog registered in the United States was Queen of Switzerland. Her offspring had defects as the result of poor breeding, which caused the breed to decline in popularity during the late 1920s.

 

Popularity increased again after Sieger Pfeffer von Bern became the 1937 and 1938 Grand Victor in American Kennel club dog shows, only to have another decline at the conclusion of World War II, due to anti-German sentiment. Popularity increased gradually until 1993, when they became the third most popular breed in the United States. As of 2016, the German Shepherd is the second most popular breed in the US. It is typically among the most frequently registered breeds in other countries. It was the third-most registered breed by the American Kennel Club in 2020, and seventh-most registered breed by The Kennel Club in the United Kingdom in 2016.

 

Health

Many common ailments of the German Shepherd are a result of the inbreeding practised early in the breed's life. One such common ailment is hip and elbow dysplasia which may cause the dog to experience pain later on in life and may cause arthritis. A study conducted by the University of Zurich found that 45% of the police working dogs were affected by degenerative spinal stenosis, although a small sample size was used. The Orthopedic Foundation for Animals found that 19.1% of German Shepherd are affected by hip dysplasia. There are, however, ways to help prevent hip dysplasia, including getting a pup from a good breeder, keeping it on a healthy diet, and limiting the amount of jumping or rough play. German Shepherds have low frequency of ear infections, since this breed is well known for hyperactivity of its cerumen-producing glands. According to a recent survey in the UK, the median life span of German Shepherds is 10.95 years, which is normal for a dog of their size.

 

Degenerative myelopathy, a neurological disease, occurs with enough regularity specifically in the breed to suggest that the breed is predisposed to it. A very inexpensive DNA saliva test is now available to screen for degenerative myelopathy. The test screens for the mutated gene that has been seen in dogs with degenerative myelopathy. A small study in the UK showed 16% of young asymptomatic German Shepherds to be homozygous for the mutation, with a further 38% being carriers. Now that a test is available the disease can be bred out of breeds with a high preponderance. The test is only recommended for predisposed breeds, but can be performed on DNA samples from any dog, collected through swabbing the inside of the animal's cheek with a sterile cotton swab. Prospective German Shepherd buyers can now request the test from the breeder or buy from a breeder who is known to test their dogs.

 

German Shepherds have a higher-than-normal incidence of Von Willebrand disease, a common inherited bleeding disorder, and exocrine pancreatic insufficiency (EPI), a degenerative disease of the pancreas. It is estimated that 1% of the UK population of German Shepherds has this disease. Treatment is usually provided in the form of pancreatic supplements taken with food.

 

Skeletal health and supplementation

Musculoskeletal disorders are debilitating conditions that are often associated with genetic makeup, malnutrition, and stress-related events. Some breeds like the German Shepherd, are predisposed to a variety of different skeletal disorders, including but not limited to: canine hip dysplasia, Cauda equina syndrome, and osteoarthritis. These conditions can be a result of poor breeding or induced by intense exercise and poor diet.

 

Canine hip dysplasia (CHD) is an orthopaedic condition resulting from abnormal development of the hip joint and surrounding tissue causing the instability and partial dislocation of the hip joint, resulting in pain, inflammation, lameness, and potentially osteoarthritis of the joint. German Shepherds are genetically predisposed to CHD and the University of Veterinary Medicine in Germany found its prevalence estimated to be approximately 35% of veterinary cases associated with the disorder.

 

Osteoarthritis is one of the main contributors of musculoskeletal pain and disabilities that commonly affect German Shepherds. Mechanical stress, oxidative damage and inflammatory mediators combine to induce the gradual degeneration of the articular cartilage in the joint, resulting in reduced muscle mass, pain, and locomotion.

 

Feeding a well-balanced diet designed for large breeds like the German Shepherd to ensure adequate growth rates and proper maintenance of musculoskeletal health is essential. Dietary energy levels should be monitored and controlled throughout all life stages and activity levels of the German Shepherd to assist in the prevention and treatment of musculoskeletal disorder symptoms. Several dietary factors play a crucial role in maintaining skeletal health and are described as follows:

 

Appropriate calcium levels are vital in developing a strong skeletal system and aid in preventing orthopaedic diseases like Canine Hip Dysplasia. Furthermore, the ratio of calcium and phosphorus must be balanced and at a recommended ratio of 1.2:1 to ensure proper bone development and structure. Imbalances in calcium and phosphorus levels can result in various skeletal complications. Excess phosphorus can produce lesions in bones whereas excessive calcium can lead to hypocalcaemia and result in excess bone deposition, interfering with normal bone development. In extreme circumstances of insufficient calcium intake, bone resorption can occur due to the body withdrawing calcium deposits from the skeletal frame as a last resort to fulfill dietary needs.

 

Omega-3 fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been shown to be highly effective in the prevention of cartilage catabolism in in vitro models, suggesting that its supplementation in food could aid in decreasing the symptoms of osteoarthritis in German Shepherds. Furthermore, EPA and DHA inhibit key regulators of the inflammatory process and suppress their activation which can help alleviate pain and reduce inflamed joints associated with many skeletal disorders. Ensuring an appropriate ratio of omega-3 to omega-6 fatty acids of approximately 5:1 is very important for inflammation processes. Animals source, specifically marine life such as fish, krill, and mussels, and plant sources such as flaxseed, soybean and canola oil, are particularly rich in omega-3 fatty acids.

 

Glucosamine is an amino-monosaccharide that naturally occurs in all tissues, particularly in articular cartilage of joints and from the biosynthesis of glucose. Natural synthesis of glucosamine occurs in the extracellular matrix of articular cartilage in joints. However, as a result of damage to the joint or cartilage, there is decreased ability to synthesize glucosamine resulting in the deterioration of the joint, and supplementation is required. Clinical trials of long term administration of glucosamine in German Shepherds have reduced symptoms of degenerative joint disease and accelerated cartilage healing. Anti-inflammatory effects of glucosamine are believed to contribute to the reduction of pain, promote joint recovery and mobility, and prevent further cartilage degradation. Similarly, chondroitin supplementation is proposed to have comparable results in inhibiting degradative enzymes within the cartilage matrix to reduce the effects of osteoarthritis, but further research is required to assess long term benefits.

 

Vitamins such as A and D also have crucial roles in bone development and maintenance by regulating bone and calcium metabolism. Adequate levels should be incorporated into a German Shepherd diet to promote a healthy musculoskeletal system.

 

In popular culture

German Shepherds have been featured in a wide range of media. In 1921 Strongheart became one of the earliest canine film stars, and was followed in 1922 by Rin Tin Tin, who is considered the most famous German Shepherd. Both have stars on the Hollywood Walk of Fame.

 

Batman's dog Ace the Bat-Hound appeared in the Batman comic books, initially in 1955, through 1964. From 1964 onwards, his appearances have been sporadic.

 

A German Shepherd named Inspector Rex is the star of an Austrian Police procedural drama program of the same name, which won many awards, where German Shepherd Rex assists the Vienna Kriminalpolizei homicide unit. The show was aired in many languages.

 

Kántor [hu] was a famous and very successful police dog in Hungary in the 1950s and early 1960s. After his death his story was fictionalised by two crime novels by Rudolf Szamos [hu], titled Kántor Investigates [hu] and Kántor in the Big City. A five-part thriller series for television titled Kántor was produced in 1975, which was loosely based on the actual dog's story, setting the events more than a decade after the real Kántor died. It became one of the staple productions of Hungarian television history, making German Shepherds the most popular dog breed in the country ever since. The taxidermy mount of Kántor's body is on display at the Police Museum in Budapest.

 

Notable individual German Shepherds

The dog on which the breed was founded

Horand von Grafrath (January 1, 1895 – after 1899), considered the first German Shepherd and the genetic basis for modern German Shepherds

In film, television and fiction

Strongheart (1 October 1917 – 24 June 1929), featured in Hollywood films of 1921–1927

Rin Tin Tin (September 1918 – 10 August 1932), Rin Tin Tin Jr., and Rin Tin Tin III, featured in Hollywood films of 1922–1947

Thunder the Dog (7 September 1921 – after October 1928), featured in Hollywood films of 1923–1927

Silver Streak (born 1924), featured in Hollywood films of 1924–1928

Lightning, grandson of Strongheart, featured in Hollywood films of 1934–1938

Ace the Wonder Dog, featured in Hollywood films and serials of 1938–1946

Rex the Wonder Dog, fictional superhero in the DC Comics universe 1952–present

Ace the Bat-Hound, fictional partner of Batman in DC Comics 1955–present

Joe, protagonist in the NBC television series Run, Joe, Run in 1974–1975

Won Ton Ton, protagonist of the 1976 comedy film Won Ton Ton, the Dog Who Saved Hollywood, a spoof of Rin Tin Tin

Koton, sometimes identified as Rando, police dog later featured in the 1989 film K-9 with James Belushi

Rex, protagonist of the Austrian-Italian comedy-drama television series Inspector Rex of 1994–2015, and remakes in other countries

Pets of political figures

Blondi (1941 – 29 April 1945), Hitler's pet on which he tested the cyanide capsules he later consumed to commit suicide, killing her

Champ (11 November 2008 – 19 June 2021), Commander (born 1 September 2021), and Major (born 17 January 2018), pets of US President Joe Biden

Major, police dog later kept as a pet of United States president Franklin D. Roosevelt while he was in office, which bit a United States senator and the Prime Minister of the United Kingdom in 1933 while living at the White House

PDSA Dickin Medal recipients (for military and civil defence service dogs)

Awards in the original 1943–1949 series for service in the Second World War

Antis (1939–1953), 28 January 1949 for war service in North Africa and England and post-war assistance in an escape from communist Czechoslovakia

Bing, a.k.a. Brian (c. 1943 – October 1955), 29 March 1947 for service with the 13th (Lancashire) Parachute Battalion paratroopers

Irma, 12 January 1945 for rescuing people trapped under destroyed buildings in civil defence service in the London Blitz

Jet (21 July 1942 – 18 October 1949), 12 January 1945 for rescuing people trapped under destroyed buildings in civil defence service in the London Blitz

Rex, April 1945 for locating casualties in thick smoke in burning buildings in civil service in England

Rifleman Khan, 27 March 1945 for rescuing a drowning soldier in November 1944 in the Netherlands in the Battle of Walcheren Causeway, an engagement of the Battle of the Scheldt

Thorn, 2 March 1945 for locating air-raid casualties in thick smoke in a burning building in civil service

After revival of the medal in 2000

Apollo (c. 1992 – 2006), 5 March 2002 on behalf of all search and rescue dogs that served at the World Trade Center site and the Pentagon in the aftermath of the 11 September 2001 attacks in New York City, United States

Lucca (c. 2003 – 20 January 2018), 5 April 2016 for service with the United States Marine Corps of 2006–2012 in two tours in Iraq and one in Afghanistan for explosives and insurgent detection until injured by an IED

Lucky (service c. 1950), 6 February 2007 for anti-insurgency service with the Royal Air Force against the Malayan National Liberation Army in the Malayan Emergency in 1949–1952 (the only surviving dog of a four-dog team)

Sam (died 2000), 14 January 2003 for service in April 1998 in apprehending a gunman and in crowd control during protection of refugees in the Royal Army Veterinary Corps of the British Army in the Bosnia and Herzegovina conflict

PDSA Gold Medal recipients (for non-military dogs)

Ajax, 11 June 2013 for service in the civil guard that saved lives by detection of an ETA bomb near a guard barracks site on the Spanish island of Majorca in 2009 under dangerous circumstances

Anya, 6 July 2010 for service as a British police dog in defending an officer from a knife attack in January 2008

Ellie and Jones (Shepherd mixes), 22 August 2013 for saving their owner who collapsed and lost consciousness due to diabetic shock in November 2010

Finn (born March 2009), 6 May 2018 for service as a police dog in a knife attack on a police officer in Stevenage, Hertfordshire, England, on 5 October 2016

Gage (died 13 July 2010), 22 August 2013 (posthumously) for service as a police dog in a suburb of Christchurch, New Zealand, defending an officer in an attack by a man with a rifle (in which the dog was killed)

Other military, police, search-and-rescue, and institutional guard dogs

Gabi, 1980s guard dog at the Belgrade Zoo that protected a security guard and the public by fighting with an escaped jaguar

Kántor [hu], police dog in Hungary in the 1950s and early 1960s, later portrayed in fictionalized versions for novels and television

Lex (1999 – March 25, 2012), used by the United States Marine Corps in Iraq and later adopted by the family of a soldier who died in a rocket attack while serving as his handler

Mancs (1994–2006), earthquake search and rescue dog of Miskolc, Hungary, that helped rescue a 3-year-old girl who had spent 82 hours under ruins of a 1999 earthquake in Turkey

Nemo A534 (died December 1972), served in battle in the United States Air Force during the Vietnam War

Rajah, performing and unofficial police dog in New Zealand, suggested as a candidate replacement for Rin Tin Tin in films

Trakr (c. 1994 – April 2009), Canadian police dog that discovered the last survivor of the 11 September 2001 attacks in New York City, United States

Zuyaqui (died 2000s), used by Mexican military and police forces for detection of illegal drugs

I was in midtown Toronto getting my bicycle serviced and was told I could go somewhere for a cup of coffee and return in an hour or so. I crossed the street, got a coffee, and began walking. I passed her as she was using her smart phone and I was struck by her hair but couldn’t see her face. I walked past and by the time I realized I would like to meet her for my project, she had begun walking and crossed the street. Another opportunity lost to that dreaded foe: hesitation. Wait a minute, she paused and sat down on a doorstep. Hope is renewed. Oh no, a friend of hers appeared and they engaged in conversation. Throwing caution to the wind I approached and apologized for interrupting. I introduced myself and told her why I would like to photograph her. She laughed and said “We were just talking about my hair!” Her friend excused herself and said she should be on her way. A handshake later and Julia was no longer a stranger.

 

Julia told me she was just on break from her work and was waiting for her boyfriend to come by so she could hand him his lunch. “I only have a couple of minutes and we might get interrupted” she said. Beggars can’t be choosers and I was happy to have the few minutes. We were near a wood fence and I explained how I wanted to position her to use the unpainted wood as a background. Julia said “I’m afraid I’m not at all photogenic and never take a good photo.” I said “If I had a dollar for every time I’ve heard that, I’d be rich by now.” We made a few portraits and checked them on my camera display and were both pleased. Julia gave me the credit. Can you believe that? I asked to take one more with Julia turned partly away from the camera and looking over her shoulder. I’m glad I did. Both poses worked great.

 

Just then her boyfriend pulled up in a delivery truck and I joked that he was in the middle of a “big time photo shoot.” He laughed. I explained Julia was graciously helping me with my photography project. She handed him his lunch, they exchanged a kiss and he said he had to be on his way.

 

Julia and I chatted for a few more minutes. She told me she was born in St. Catherines not far from Niagara Falls but has lived all her life in Toronto. She is 36 which she said with a groan. I told her I will be 70 in a week and when she reaches my age she will be entitled to a groan. Her greatest challenge so far in life? “I’ve actually been pretty lucky. My biggest challenge has probably been health. I worked for several years as an editor and using a computer for hours on end really messed me up with musculoskeletal issues. I wound up leaving that world and got my current job which is in a health food shop just down the street. Now I couldn’t be healthier.” She sure looked healthy.

 

Her message to the world? “It’s all about thriving, not just surviving.”

 

Julia told me how much she liked the concept of The Human Family photo project. That’s this second time I heard that comment today.

 

Thank you Julia for sharing part of your break with me and for participating in The Human Family photography project. Keep on thriving.

 

This is my 129th submission to The Human Family Group on Flickr.

 

You can view more street portraits and stories by visiting The Human Family.

 

This image is excerpted from a U.S. GAO report:

www.gao.gov/products/GAO-16-337

 

WORKPLACE SAFETY AND HEALTH: Additional Data Needed to Address Continued Hazards in the Meat and Poultry Industry

Hi everyone! I thought I'd update you on my ankle issues today! As a lot of you know, I've had problems for over 18 months now, when I stamped hard in the kitchen, thinking I was going to drop a hot saucepan. I stamped very hard and knew I was going to suffer for a while. So after a couple of months I saw a physio. She was very kind and tried to help but I still had problems so she referred me to MSK (Musculoskeletal ) Dept.

 

I've been seeing Greer (MSK consultant) since last September, but she didn't refer me for an X-ray till earlier this year. The results showed nothing was wrong, but I was still hobbling despite the insoles she'd given me. So then she referred me for an MRI.

 

I visited Greer yesterday before going to visit Tim in hospital to find out the results of the MRI. I was pleased to hear her confirm my pain wasn't in my imagination, but I had to get a photo of her screen to remind me of the things she'd said!

 

*Normal Achilles tendon and plantar fascia

*Full-thickness tear of the tibialis posterior tendon

*Pes planovalgus deformity *Osteoarthritis of the Subtalar joint

*Possible features of subfibular impingement in association with the hindfoot valgus deformity.

 

Well, I only understood a few of those words, but basically I've completely torn the tendon and it's left me with a flat foot (more than it was before!). So she suggested I order PTTD Aircast ankle brace, which I have done - should come tomorrow (if I'm not at the hospital!) An operation could be possibility (not sure which problem that was for!), but we agreed I would try the brace first. (Apparently you can pump it up under your foot for support - let me know if you've used one). So sadly no more sandals during this long-lasting heatwave! My foot is a bit swollen at the moment - I assume mainly because of the heat.

 

So that's it - I can at least honestly say there was a reason for my hobbling around! Frustratingly, with Tim in hospital having had an operation, it means I have to do most of the dog walking. On the bright side, as we have a heatwave I can't take him far!

 

I should also say that this photo was taken while we were in London last Friday, on our way to the My Chemical Romance concert. You may not have heard of them, but they really blew Wembley away with a dynamic show, so I'm so glad we didn't miss that!

The overarching mission of the Physical Activity Energetics/Mechanics Laboratory at Colorado State University is to get more people to move more often; typically the more active you are, the healthier you are.

The lab itself seems to take this same mental attitude to heart in the enormous and diverse amount of research conducted by the lab, which is composed of faculty, undergraduate students, graduate students, and research assistants. Involved in everything from musculoskeletal biomechanics to physical activity monitoring, the lab is constantly producing interesting and widely applicable data and knowledge.

The Physical Activity Energetics/Mechanics Laboratory is associated with the Department of Health and Exercise Science, in the College of Health and Human Sciences at Colorado State University.

 

This is a microscopic view of lab-grown human muscle bundles stained to show patterns made by basic muscle units and their associated proteins (red), which are a hallmark of human muscle. These lab-grown human muscle tissues will allow researchers to test new drugs and study diseases in muscle tissues outside of the human body.

 

Credit: Nenad Bursac, Ph.D., Duke University

 

This image is not owned by the NIH. It is shared with the public under license. If you have a question about using or reproducing this image, please contact the creator listed in the credits. All rights to the work remain with the original creator.

 

NIH funding from: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

 

Male musculoskeletal system front and back isolated on a white background

Pappas Physical Medicine & Rehabilitation, PLLC is a new practice in Astoria specializing in the non-surgical treatment of neck, back and extremity pain due to auto/work related trauma and sports injuries, as well as post-operative therapeutic management.

 

Pappas Physical Medicine & Rehabilitation, PLLC

31-35 31st Street

Astoria, NY 11106

 

painandinjury.com/mike-pappas.html

 

Call: 800-949-6100 to set-up an appointment

This image is excerpted from a U.S. GAO report:

www.gao.gov/products/GAO-16-337

 

WORKPLACE SAFETY AND HEALTH: Additional Data Needed to Address Continued Hazards in the Meat and Poultry Industry

 

Note: USDA defines large plants as establishments that have 500 or more employees.

 

Also known as Blue Krait.

Location: Kedah, Malaysia

Local name: Ular Katam Tebu

Thai: Ngoo tap saming kla, or ngoo kan plong

Length: 1.2m, max 1.6m

Toxicity: Very venomous (fatal)

 

Malayan krait or blue krait, is a species of krait, a venomous elapid snake.

Distribution: Entire southeast Asia from south Indochina south to Java and Bali in Indonesia.

 

Venom: In mice, the IV LD50 for this species is 0.1 mg/kg (Tan, N. H., 2013). It has caused an untreated mortality rate of 60-70% on humans. Blue Krait’s venom consists of extremely powerful neurotoxins (presynaptic and postsynaptic toxins). This "venom cocktail" directly impair the victim's capacity for thought or speech and have the power to immobilize the musculoskeletal system. Secondly, it also attacks victim’s respiratory system, causing suffocation within hours. However, if left untreated, death can come within four hours. The most horrifying fact is that the bite causes no pain, hence giving the victim false reassurance.

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019. The disease has since spread worldwide, leading to an ongoing pandemic.

 

Symptoms of COVID-19 are variable, but often include fever, cough, fatigue, breathing difficulties, and loss of smell and taste. Symptoms begin one to fourteen days after exposure to the virus. Of those people who develop noticeable symptoms, most (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging), and 5% suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). Older people are more likely to have severe symptoms. At least a third of the people who are infected with the virus remain asymptomatic and do not develop noticeable symptoms at any point in time, but they still can spread the disease.[ Around 20% of those people will remain asymptomatic throughout infection, and the rest will develop symptoms later on, becoming pre-symptomatic rather than asymptomatic and therefore having a higher risk of transmitting the virus to others. Some people continue to experience a range of effects—known as long COVID—for months after recovery, and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

The virus that causes COVID-19 spreads mainly when an infected person is in close contact[a] with another person. Small droplets and aerosols containing the virus can spread from an infected person's nose and mouth as they breathe, cough, sneeze, sing, or speak. Other people are infected if the virus gets into their mouth, nose or eyes. The virus may also spread via contaminated surfaces, although this is not thought to be the main route of transmission. The exact route of transmission is rarely proven conclusively, but infection mainly happens when people are near each other for long enough. People who are infected can transmit the virus to another person up to two days before they themselves show symptoms, as can people who do not experience symptoms. People remain infectious for up to ten days after the onset of symptoms in moderate cases and up to 20 days in severe cases. Several testing methods have been developed to diagnose the disease. The standard diagnostic method is by detection of the virus' nucleic acid by real-time reverse transcription polymerase chain reaction (rRT-PCR), transcription-mediated amplification (TMA), or by reverse transcription loop-mediated isothermal amplification (RT-LAMP) from a nasopharyngeal swab.

 

Preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. The use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions. Several vaccines have been developed and several countries have initiated mass vaccination campaigns.

 

Although work is underway to develop drugs that inhibit the virus, the primary treatment is currently symptomatic. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.

 

SIGNS AND SYSTOMS

Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste, nasal congestion and rhinorrhea, cough, muscle pain, sore throat, fever, diarrhea, and breathing difficulties. People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum, shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19.

 

Most people (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging) and 5% of patients suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). At least a third of the people who are infected with the virus do not develop noticeable symptoms at any point in time. These asymptomatic carriers tend not to get tested and can spread the disease. Other infected people will develop symptoms later, called "pre-symptomatic", or have very mild symptoms and can also spread the virus.

 

As is common with infections, there is a delay between the moment a person first becomes infected and the appearance of the first symptoms. The median delay for COVID-19 is four to five days. Most symptomatic people experience symptoms within two to seven days after exposure, and almost all will experience at least one symptom within 12 days.

Most people recover from the acute phase of the disease. However, some people continue to experience a range of effects for months after recovery—named long COVID—and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

CAUSE

TRANSMISSION

Coronavirus disease 2019 (COVID-19) spreads from person to person mainly through the respiratory route after an infected person coughs, sneezes, sings, talks or breathes. A new infection occurs when virus-containing particles exhaled by an infected person, either respiratory droplets or aerosols, get into the mouth, nose, or eyes of other people who are in close contact with the infected person. During human-to-human transmission, an average 1000 infectious SARS-CoV-2 virions are thought to initiate a new infection.

 

The closer people interact, and the longer they interact, the more likely they are to transmit COVID-19. Closer distances can involve larger droplets (which fall to the ground) and aerosols, whereas longer distances only involve aerosols. Larger droplets can also turn into aerosols (known as droplet nuclei) through evaporation. The relative importance of the larger droplets and the aerosols is not clear as of November 2020; however, the virus is not known to spread between rooms over long distances such as through air ducts. Airborne transmission is able to particularly occur indoors, in high risk locations such as restaurants, choirs, gyms, nightclubs, offices, and religious venues, often when they are crowded or less ventilated. It also occurs in healthcare settings, often when aerosol-generating medical procedures are performed on COVID-19 patients.

 

Although it is considered possible there is no direct evidence of the virus being transmitted by skin to skin contact. A person could get COVID-19 indirectly by touching a contaminated surface or object before touching their own mouth, nose, or eyes, though this is not thought to be the main way the virus spreads. The virus is not known to spread through feces, urine, breast milk, food, wastewater, drinking water, or via animal disease vectors (although some animals can contract the virus from humans). It very rarely transmits from mother to baby during pregnancy.

 

Social distancing and the wearing of cloth face masks, surgical masks, respirators, or other face coverings are controls for droplet transmission. Transmission may be decreased indoors with well maintained heating and ventilation systems to maintain good air circulation and increase the use of outdoor air.

 

The number of people generally infected by one infected person varies. Coronavirus disease 2019 is more infectious than influenza, but less so than measles. It often spreads in clusters, where infections can be traced back to an index case or geographical location. There is a major role of "super-spreading events", where many people are infected by one person.

 

A person who is infected can transmit the virus to others up to two days before they themselves show symptoms, and even if symptoms never appear. People remain infectious in moderate cases for 7–12 days, and up to two weeks in severe cases. In October 2020, medical scientists reported evidence of reinfection in one person.

 

VIROLOGY

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. It was first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. All structural features of the novel SARS-CoV-2 virus particle occur in related coronaviruses in nature.

 

Outside the human body, the virus is destroyed by household soap, which bursts its protective bubble.

 

SARS-CoV-2 is closely related to the original SARS-CoV. It is thought to have an animal (zoonotic) origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13). The structural proteins of SARS-CoV-2 include membrane glycoprotein (M), envelope protein (E), nucleocapsid protein (N), and the spike protein (S). The M protein of SARS-CoV-2 is about 98% similar to the M protein of bat SARS-CoV, maintains around 98% homology with pangolin SARS-CoV, and has 90% homology with the M protein of SARS-CoV; whereas, the similarity is only around 38% with the M protein of MERS-CoV. The structure of the M protein resembles the sugar transporter SemiSWEET.

 

The many thousands of SARS-CoV-2 variants are grouped into clades. Several different clade nomenclatures have been proposed. Nextstrain divides the variants into five clades (19A, 19B, 20A, 20B, and 20C), while GISAID divides them into seven (L, O, V, S, G, GH, and GR).

 

Several notable variants of SARS-CoV-2 emerged in late 2020. Cluster 5 emerged among minks and mink farmers in Denmark. After strict quarantines and a mink euthanasia campaign, it is believed to have been eradicated. The Variant of Concern 202012/01 (VOC 202012/01) is believed to have emerged in the United Kingdom in September. The 501Y.V2 Variant, which has the same N501Y mutation, arose independently in South Africa.

 

SARS-CoV-2 VARIANTS

Three known variants of SARS-CoV-2 are currently spreading among global populations as of January 2021 including the UK Variant (referred to as B.1.1.7) first found in London and Kent, a variant discovered in South Africa (referred to as 1.351), and a variant discovered in Brazil (referred to as P.1).

 

Using Whole Genome Sequencing, epidemiology and modelling suggest the new UK variant ‘VUI – 202012/01’ (the first Variant Under Investigation in December 2020) transmits more easily than other strains.

 

PATHOPHYSIOLOGY

COVID-19 can affect the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs). The lungs are the organs most affected by COVID-19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell. The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and decreasing ACE2 activity might be protective, though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective. As the alveolar disease progresses, respiratory failure might develop and death may follow.

 

Whether SARS-CoV-2 is able to invade the nervous system remains unknown. The virus is not detected in the CNS of the majority of COVID-19 people with neurological issues. However, SARS-CoV-2 has been detected at low levels in the brains of those who have died from COVID-19, but these results need to be confirmed. SARS-CoV-2 could cause respiratory failure through affecting the brain stem as other coronaviruses have been found to invade the CNS. While virus has been detected in cerebrospinal fluid of autopsies, the exact mechanism by which it invades the CNS remains unclear and may first involve invasion of peripheral nerves given the low levels of ACE2 in the brain. The virus may also enter the bloodstream from the lungs and cross the blood-brain barrier to gain access to the CNS, possibly within an infected white blood cell.

 

The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium as well as endothelial cells and enterocytes of the small intestine.

 

The virus can cause acute myocardial injury and chronic damage to the cardiovascular system. An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China, and is more frequent in severe disease. Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart. ACE2 receptors are highly expressed in the heart and are involved in heart function. A high incidence of thrombosis and venous thromboembolism have been found people transferred to Intensive care unit (ICU) with COVID-19 infections, and may be related to poor prognosis. Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels caused by blood clots) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in people infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside the presentation of viral pneumonia. Furthermore, microvascular blood vessel damage has been reported in a small number of tissue samples of the brains – without detected SARS-CoV-2 – and the olfactory bulbs from those who have died from COVID-19.

 

Another common cause of death is complications related to the kidneys. Early reports show that up to 30% of hospitalized patients both in China and in New York have experienced some injury to their kidneys, including some persons with no previous kidney problems.

 

Autopsies of people who died of COVID-19 have found diffuse alveolar damage, and lymphocyte-containing inflammatory infiltrates within the lung.

 

IMMUNOPATHOLOGY

Although SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, people with severe COVID-19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.

 

Additionally, people with COVID-19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.

 

Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in people with COVID-19 . Lymphocytic infiltrates have also been reported at autopsy.

 

VIRAL AND HOST FACTORS

VIRUS PROTEINS

Multiple viral and host factors affect the pathogenesis of the virus. The S-protein, otherwise known as the spike protein, is the viral component that attaches to the host receptor via the ACE2 receptors. It includes two subunits: S1 and S2. S1 determines the virus host range and cellular tropism via the receptor binding domain. S2 mediates the membrane fusion of the virus to its potential cell host via the H1 and HR2, which are heptad repeat regions. Studies have shown that S1 domain induced IgG and IgA antibody levels at a much higher capacity. It is the focus spike proteins expression that are involved in many effective COVID-19 vaccines.

 

The M protein is the viral protein responsible for the transmembrane transport of nutrients. It is the cause of the bud release and the formation of the viral envelope. The N and E protein are accessory proteins that interfere with the host's immune response.

 

HOST FACTORS

Human angiotensin converting enzyme 2 (hACE2) is the host factor that SARS-COV2 virus targets causing COVID-19. Theoretically the usage of angiotensin receptor blockers (ARB) and ACE inhibitors upregulating ACE2 expression might increase morbidity with COVID-19, though animal data suggest some potential protective effect of ARB. However no clinical studies have proven susceptibility or outcomes. Until further data is available, guidelines and recommendations for hypertensive patients remain.

 

The virus' effect on ACE2 cell surfaces leads to leukocytic infiltration, increased blood vessel permeability, alveolar wall permeability, as well as decreased secretion of lung surfactants. These effects cause the majority of the respiratory symptoms. However, the aggravation of local inflammation causes a cytokine storm eventually leading to a systemic inflammatory response syndrome.

 

HOST CYTOKINE RESPONSE

The severity of the inflammation can be attributed to the severity of what is known as the cytokine storm. Levels of interleukin 1B, interferon-gamma, interferon-inducible protein 10, and monocyte chemoattractant protein 1 were all associated with COVID-19 disease severity. Treatment has been proposed to combat the cytokine storm as it remains to be one of the leading causes of morbidity and mortality in COVID-19 disease.

 

A cytokine storm is due to an acute hyperinflammatory response that is responsible for clinical illness in an array of diseases but in COVID-19, it is related to worse prognosis and increased fatality. The storm causes the acute respiratory distress syndrome, blood clotting events such as strokes, myocardial infarction, encephalitis, acute kidney injury, and vasculitis. The production of IL-1, IL-2, IL-6, TNF-alpha, and interferon-gamma, all crucial components of normal immune responses, inadvertently become the causes of a cytokine storm. The cells of the central nervous system, the microglia, neurons, and astrocytes, are also be involved in the release of pro-inflammatory cytokines affecting the nervous system, and effects of cytokine storms toward the CNS are not uncommon.

 

DIAGNOSIS

COVID-19 can provisionally be diagnosed on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) or other nucleic acid testing of infected secretions. Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection. Detection of a past infection is possible with serological tests, which detect antibodies produced by the body in response to the infection.

 

VIRAL TESTING

The standard methods of testing for presence of SARS-CoV-2 are nucleic acid tests, which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used. Results are generally available within hours. The WHO has published several testing protocols for the disease.

 

A number of laboratories and companies have developed serological tests, which detect antibodies produced by the body in response to infection. Several have been evaluated by Public Health England and approved for use in the UK.

 

The University of Oxford's CEBM has pointed to mounting evidence that "a good proportion of 'new' mild cases and people re-testing positives after quarantine or discharge from hospital are not infectious, but are simply clearing harmless virus particles which their immune system has efficiently dealt with" and have called for "an international effort to standardize and periodically calibrate testing" On 7 September, the UK government issued "guidance for procedures to be implemented in laboratories to provide assurance of positive SARS-CoV-2 RNA results during periods of low prevalence, when there is a reduction in the predictive value of positive test results."

 

IMAGING

Chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening. Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection. Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses. Characteristic imaging features on chest radiographs and computed tomography (CT) of people who are symptomatic include asymmetric peripheral ground-glass opacities without pleural effusions.

 

Many groups have created COVID-19 datasets that include imagery such as the Italian Radiological Society which has compiled an international online database of imaging findings for confirmed cases. Due to overlap with other infections such as adenovirus, imaging without confirmation by rRT-PCR is of limited specificity in identifying COVID-19. A large study in China compared chest CT results to PCR and demonstrated that though imaging is less specific for the infection, it is faster and more sensitive.

Coding

In late 2019, the WHO assigned emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID-19 without lab-confirmed SARS-CoV-2 infection.

 

PATHOLOGY

The main pathological findings at autopsy are:

 

Macroscopy: pericarditis, lung consolidation and pulmonary oedema

Lung findings:

minor serous exudation, minor fibrin exudation

pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation

diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia.

organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis

plasmocytosis in BAL

Blood: disseminated intravascular coagulation (DIC); leukoerythroblastic reaction

Liver: microvesicular steatosis

 

PREVENTION

Preventive measures to reduce the chances of infection include staying at home, wearing a mask in public, avoiding crowded places, keeping distance from others, ventilating indoor spaces, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.

 

Those diagnosed with COVID-19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.

 

The first COVID-19 vaccine was granted regulatory approval on 2 December by the UK medicines regulator MHRA. It was evaluated for emergency use authorization (EUA) status by the US FDA, and in several other countries. Initially, the US National Institutes of Health guidelines do not recommend any medication for prevention of COVID-19, before or after exposure to the SARS-CoV-2 virus, outside the setting of a clinical trial. Without a vaccine, other prophylactic measures, or effective treatments, a key part of managing COVID-19 is trying to decrease and delay the epidemic peak, known as "flattening the curve". This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available.

 

VACCINE

A COVID‑19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus causing coronavirus disease 2019 (COVID‑19). Prior to the COVID‑19 pandemic, there was an established body of knowledge about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which enabled accelerated development of various vaccine technologies during early 2020. On 10 January 2020, the SARS-CoV-2 genetic sequence data was shared through GISAID, and by 19 March, the global pharmaceutical industry announced a major commitment to address COVID-19.

 

In Phase III trials, several COVID‑19 vaccines have demonstrated efficacy as high as 95% in preventing symptomatic COVID‑19 infections. As of March 2021, 12 vaccines were authorized by at least one national regulatory authority for public use: two RNA vaccines (the Pfizer–BioNTech vaccine and the Moderna vaccine), four conventional inactivated vaccines (BBIBP-CorV, CoronaVac, Covaxin, and CoviVac), four viral vector vaccines (Sputnik V, the Oxford–AstraZeneca vaccine, Convidicea, and the Johnson & Johnson vaccine), and two protein subunit vaccines (EpiVacCorona and RBD-Dimer). In total, as of March 2021, 308 vaccine candidates were in various stages of development, with 73 in clinical research, including 24 in Phase I trials, 33 in Phase I–II trials, and 16 in Phase III development.

Many countries have implemented phased distribution plans that prioritize those at highest risk of complications, such as the elderly, and those at high risk of exposure and transmission, such as healthcare workers. As of 17 March 2021, 400.22 million doses of COVID‑19 vaccine have been administered worldwide based on official reports from national health agencies. AstraZeneca-Oxford anticipates producing 3 billion doses in 2021, Pfizer-BioNTech 1.3 billion doses, and Sputnik V, Sinopharm, Sinovac, and Johnson & Johnson 1 billion doses each. Moderna targets producing 600 million doses and Convidicea 500 million doses in 2021. By December 2020, more than 10 billion vaccine doses had been preordered by countries, with about half of the doses purchased by high-income countries comprising 14% of the world's population.

 

SOCIAL DISTANCING

Social distancing (also known as physical distancing) includes infection control actions intended to slow the spread of the disease by minimising close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others. Many governments are now mandating or recommending social distancing in regions affected by the outbreak.

 

Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing. In the United States, the prisoner population is aging and many of them are at high risk for poor outcomes from COVID-19 due to high rates of coexisting heart and lung disease, and poor access to high-quality healthcare.

 

SELF-ISOLATION

Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected. Health agencies have issued detailed instructions for proper self-isolation. Many governments have mandated or recommended self-quarantine for entire populations. The strongest self-quarantine instructions have been issued to those in high-risk groups. Those who may have been exposed to someone with COVID-19 and those who have recently travelled to a country or region with the widespread transmission have been advised to self-quarantine for 14 days from the time of last possible exposure.

Face masks and respiratory hygiene

 

The WHO and the US CDC recommend individuals wear non-medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain. This recommendation is meant to reduce the spread of the disease by asymptomatic and pre-symptomatic individuals and is complementary to established preventive measures such as social distancing. Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking, breathing, and coughing. A face covering without vents or holes will also filter out particles containing the virus from inhaled and exhaled air, reducing the chances of infection. But, if the mask include an exhalation valve, a wearer that is infected (maybe without having noticed that, and asymptomatic) would transmit the virus outwards through it, despite any certification they can have. So the masks with exhalation valve are not for the infected wearers, and are not reliable to stop the pandemic in a large scale. Many countries and local jurisdictions encourage or mandate the use of face masks or cloth face coverings by members of the public to limit the spread of the virus.

 

Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease. When not wearing a mask, the CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available. Proper hand hygiene after any cough or sneeze is encouraged. Healthcare professionals interacting directly with people who have COVID-19 are advised to use respirators at least as protective as NIOSH-certified N95 or equivalent, in addition to other personal protective equipment.

 

HAND-WASHING AND HYGIENE

Thorough hand hygiene after any cough or sneeze is required. The WHO also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose. The CDC recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available. For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant.

 

SURFACE CLEANING

After being expelled from the body, coronaviruses can survive on surfaces for hours to days. If a person touches the dirty surface, they may deposit the virus at the eyes, nose, or mouth where it can enter the body cause infection. Current evidence indicates that contact with infected surfaces is not the main driver of Covid-19, leading to recommendations for optimised disinfection procedures to avoid issues such as the increase of antimicrobial resistance through the use of inappropriate cleaning products and processes. Deep cleaning and other surface sanitation has been criticized as hygiene theater, giving a false sense of security against something primarily spread through the air.

 

The amount of time that the virus can survive depends significantly on the type of surface, the temperature, and the humidity. Coronaviruses die very quickly when exposed to the UV light in sunlight. Like other enveloped viruses, SARS-CoV-2 survives longest when the temperature is at room temperature or lower, and when the relative humidity is low (<50%).

 

On many surfaces, including as glass, some types of plastic, stainless steel, and skin, the virus can remain infective for several days indoors at room temperature, or even about a week under ideal conditions. On some surfaces, including cotton fabric and copper, the virus usually dies after a few hours. As a general rule of thumb, the virus dies faster on porous surfaces than on non-porous surfaces.

However, this rule is not absolute, and of the many surfaces tested, two with the longest survival times are N95 respirator masks and surgical masks, both of which are considered porous surfaces.

 

Surfaces may be decontaminated with 62–71 percent ethanol, 50–100 percent isopropanol, 0.1 percent sodium hypochlorite, 0.5 percent hydrogen peroxide, and 0.2–7.5 percent povidone-iodine. Other solutions, such as benzalkonium chloride and chlorhexidine gluconate, are less effective. Ultraviolet germicidal irradiation may also be used. The CDC recommends that if a COVID-19 case is suspected or confirmed at a facility such as an office or day care, all areas such as offices, bathrooms, common areas, shared electronic equipment like tablets, touch screens, keyboards, remote controls, and ATM machines used by the ill persons should be disinfected. A datasheet comprising the authorised substances to disinfection in the food industry (including suspension or surface tested, kind of surface, use dilution, disinfectant and inocuylum volumes) can be seen in the supplementary material of.

 

VENTILATION AND AIR FILTRATION

The WHO recommends ventilation and air filtration in public spaces to help clear out infectious aerosols.

 

HEALTHY DIET AND LIFESTYLE

The Harvard T.H. Chan School of Public Health recommends a healthy diet, being physically active, managing psychological stress, and getting enough sleep.

 

While there is no evidence that vitamin D is an effective treatment for COVID-19, there is limited evidence that vitamin D deficiency increases the risk of severe COVID-19 symptoms. This has led to recommendations for individuals with vitamin D deficiency to take vitamin D supplements as a way of mitigating the risk of COVID-19 and other health issues associated with a possible increase in deficiency due to social distancing.

 

TREATMENT

There is no specific, effective treatment or cure for coronavirus disease 2019 (COVID-19), the disease caused by the SARS-CoV-2 virus. Thus, the cornerstone of management of COVID-19 is supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support and prone positioning as needed, and medications or devices to support other affected vital organs.

 

Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), proper intake of fluids, rest, and nasal breathing. Good personal hygiene and a healthy diet are also recommended. The U.S. Centers for Disease Control and Prevention (CDC) recommend that those who suspect they are carrying the virus isolate themselves at home and wear a face mask.

 

People with more severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is strongly recommended, as it can reduce the risk of death. Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing. Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.

Several experimental treatments are being actively studied in clinical trials. Others were thought to be promising early in the pandemic, such as hydroxychloroquine and lopinavir/ritonavir, but later research found them to be ineffective or even harmful. Despite ongoing research, there is still not enough high-quality evidence to recommend so-called early treatment. Nevertheless, in the United States, two monoclonal antibody-based therapies are available for early use in cases thought to be at high risk of progression to severe disease. The antiviral remdesivir is available in the U.S., Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for people needing mechanical ventilation, and is discouraged altogether by the World Health Organization (WHO), due to limited evidence of its efficacy.

 

PROGNOSIS

The severity of COVID-19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks. The Italian Istituto Superiore di Sanità reported that the median time between the onset of symptoms and death was twelve days, with seven being hospitalised. However, people transferred to an ICU had a median time of ten days between hospitalisation and death. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to ICU.

 

Some early studies suggest 10% to 20% of people with COVID-19 will experience symptoms lasting longer than a month.[191][192] A majority of those who were admitted to hospital with severe disease report long-term problems including fatigue and shortness of breath. On 30 October 2020 WHO chief Tedros Adhanom warned that "to a significant number of people, the COVID virus poses a range of serious long-term effects". He has described the vast spectrum of COVID-19 symptoms that fluctuate over time as "really concerning." They range from fatigue, a cough and shortness of breath, to inflammation and injury of major organs – including the lungs and heart, and also neurological and psychologic effects. Symptoms often overlap and can affect any system in the body. Infected people have reported cyclical bouts of fatigue, headaches, months of complete exhaustion, mood swings, and other symptoms. Tedros has concluded that therefore herd immunity is "morally unconscionable and unfeasible".

 

In terms of hospital readmissions about 9% of 106,000 individuals had to return for hospital treatment within 2 months of discharge. The average to readmit was 8 days since first hospital visit. There are several risk factors that have been identified as being a cause of multiple admissions to a hospital facility. Among these are advanced age (above 65 years of age) and presence of a chronic condition such as diabetes, COPD, heart failure or chronic kidney disease.

 

According to scientific reviews smokers are more likely to require intensive care or die compared to non-smokers, air pollution is similarly associated with risk factors, and pre-existing heart and lung diseases and also obesity contributes to an increased health risk of COVID-19.

 

It is also assumed that those that are immunocompromised are at higher risk of getting severely sick from SARS-CoV-2. One research that looked into the COVID-19 infections in hospitalized kidney transplant recipients found a mortality rate of 11%.

See also: Impact of the COVID-19 pandemic on children

 

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years and 4% aged 10–19 years. They are likely to have milder symptoms and a lower chance of severe disease than adults. A European multinational study of hospitalized children published in The Lancet on 25 June 2020 found that about 8% of children admitted to a hospital needed intensive care. Four of those 582 children (0.7%) died, but the actual mortality rate could be "substantially lower" since milder cases that did not seek medical help were not included in the study.

 

Genetics also plays an important role in the ability to fight off the disease. For instance, those that do not produce detectable type I interferons or produce auto-antibodies against these may get much sicker from COVID-19. Genetic screening is able to detect interferon effector genes.

 

Pregnant women may be at higher risk of severe COVID-19 infection based on data from other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.

 

COMPLICATIONS

Complications may include pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, and death. Cardiovascular complications may include heart failure, arrhythmias, heart inflammation, and blood clots. Approximately 20–30% of people who present with COVID-19 have elevated liver enzymes, reflecting liver injury.

 

Neurologic manifestations include seizure, stroke, encephalitis, and Guillain–Barré syndrome (which includes loss of motor functions). Following the infection, children may develop paediatric multisystem inflammatory syndrome, which has symptoms similar to Kawasaki disease, which can be fatal. In very rare cases, acute encephalopathy can occur, and it can be considered in those who have been diagnosed with COVID-19 and have an altered mental status.

 

LONGER-TERM EFFECTS

Some early studies suggest that that 10 to 20% of people with COVID-19 will experience symptoms lasting longer than a month. A majority of those who were admitted to hospital with severe disease report long-term problems, including fatigue and shortness of breath. About 5-10% of patients admitted to hospital progress to severe or critical disease, including pneumonia and acute respiratory failure.

 

By a variety of mechanisms, the lungs are the organs most affected in COVID-19.[228] The majority of CT scans performed show lung abnormalities in people tested after 28 days of illness.

 

People with advanced age, severe disease, prolonged ICU stays, or who smoke are more likely to have long lasting effects, including pulmonary fibrosis. Overall, approximately one third of those investigated after 4 weeks will have findings of pulmonary fibrosis or reduced lung function as measured by DLCO, even in people who are asymptomatic, but with the suggestion of continuing improvement with the passing of more time.

 

IMMUNITY

The immune response by humans to CoV-2 virus occurs as a combination of the cell-mediated immunity and antibody production, just as with most other infections. Since SARS-CoV-2 has been in the human population only since December 2019, it remains unknown if the immunity is long-lasting in people who recover from the disease. The presence of neutralizing antibodies in blood strongly correlates with protection from infection, but the level of neutralizing antibody declines with time. Those with asymptomatic or mild disease had undetectable levels of neutralizing antibody two months after infection. In another study, the level of neutralizing antibody fell 4-fold 1 to 4 months after the onset of symptoms. However, the lack of antibody in the blood does not mean antibody will not be rapidly produced upon reexposure to SARS-CoV-2. Memory B cells specific for the spike and nucleocapsid proteins of SARS-CoV-2 last for at least 6 months after appearance of symptoms. Nevertheless, 15 cases of reinfection with SARS-CoV-2 have been reported using stringent CDC criteria requiring identification of a different variant from the second infection. There are likely to be many more people who have been reinfected with the virus. Herd immunity will not eliminate the virus if reinfection is common. Some other coronaviruses circulating in people are capable of reinfection after roughly a year. Nonetheless, on 3 March 2021, scientists reported that a much more contagious Covid-19 variant, Lineage P.1, first detected in Japan, and subsequently found in Brazil, as well as in several places in the United States, may be associated with Covid-19 disease reinfection after recovery from an earlier Covid-19 infection.

 

MORTALITY

Several measures are commonly used to quantify mortality. These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health. The mortality rate reflects the number of deaths within a specific demographic group divided by the population of that demographic group. Consequently, the mortality rate reflects the prevalence as well as the severity of the disease within a given population. Mortality rates are highly correlated to age, with relatively low rates for young people and relatively high rates among the elderly.

 

The case fatality rate (CFR) reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 2.2% (2,685,770/121,585,388) as of 18 March 2021. The number varies by region. The CFR may not reflect the true severity of the disease, because some infected individuals remain asymptomatic or experience only mild symptoms, and hence such infections may not be included in official case reports. Moreover, the CFR may vary markedly over time and across locations due to the availability of live virus tests.

 

INFECTION FATALITY RATE

A key metric in gauging the severity of COVID-19 is the infection fatality rate (IFR), also referred to as the infection fatality ratio or infection fatality risk. This metric is calculated by dividing the total number of deaths from the disease by the total number of infected individuals; hence, in contrast to the CFR, the IFR incorporates asymptomatic and undiagnosed infections as well as reported cases.

 

CURRENT ESTIMATES

A December 2020 systematic review and meta-analysis estimated that population IFR during the first wave of the pandemic was about 0.5% to 1% in many locations (including France, Netherlands, New Zealand, and Portugal), 1% to 2% in other locations (Australia, England, Lithuania, and Spain), and exceeded 2% in Italy. That study also found that most of these differences in IFR reflected corresponding differences in the age composition of the population and age-specific infection rates; in particular, the metaregression estimate of IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. These results were also highlighted in a December 2020 report issued by the WHO.

 

EARLIER ESTIMATES OF IFR

At an early stage of the pandemic, the World Health Organization reported estimates of IFR between 0.3% and 1%.[ On 2 July, The WHO's chief scientist reported that the average IFR estimate presented at a two-day WHO expert forum was about 0.6%. In August, the WHO found that studies incorporating data from broad serology testing in Europe showed IFR estimates converging at approximately 0.5–1%. Firm lower limits of IFRs have been established in a number of locations such as New York City and Bergamo in Italy since the IFR cannot be less than the population fatality rate. As of 10 July, in New York City, with a population of 8.4 million, 23,377 individuals (18,758 confirmed and 4,619 probable) have died with COVID-19 (0.3% of the population).Antibody testing in New York City suggested an IFR of ~0.9%,[258] and ~1.4%. In Bergamo province, 0.6% of the population has died. In September 2020 the U.S. Center for Disease Control & Prevention reported preliminary estimates of age-specific IFRs for public health planning purposes.

 

SEX DIFFERENCES

Early reviews of epidemiologic data showed gendered impact of the pandemic and a higher mortality rate in men in China and Italy. The Chinese Center for Disease Control and Prevention reported the death rate was 2.8% for men and 1.7% for women. Later reviews in June 2020 indicated that there is no significant difference in susceptibility or in CFR between genders. One review acknowledges the different mortality rates in Chinese men, suggesting that it may be attributable to lifestyle choices such as smoking and drinking alcohol rather than genetic factors. Sex-based immunological differences, lesser prevalence of smoking in women and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men. In Europe, 57% of the infected people were men and 72% of those died with COVID-19 were men. As of April 2020, the US government is not tracking sex-related data of COVID-19 infections. Research has shown that viral illnesses like Ebola, HIV, influenza and SARS affect men and women differently.

 

ETHNIC DIFFERENCES

In the US, a greater proportion of deaths due to COVID-19 have occurred among African Americans and other minority groups. Structural factors that prevent them from practicing social distancing include their concentration in crowded substandard housing and in "essential" occupations such as retail grocery workers, public transit employees, health-care workers and custodial staff. Greater prevalence of lacking health insurance and care and of underlying conditions such as diabetes, hypertension and heart disease also increase their risk of death. Similar issues affect Native American and Latino communities. According to a US health policy non-profit, 34% of American Indian and Alaska Native People (AIAN) non-elderly adults are at risk of serious illness compared to 21% of white non-elderly adults. The source attributes it to disproportionately high rates of many health conditions that may put them at higher risk as well as living conditions like lack of access to clean water. Leaders have called for efforts to research and address the disparities. In the U.K., a greater proportion of deaths due to COVID-19 have occurred in those of a Black, Asian, and other ethnic minority background. More severe impacts upon victims including the relative incidence of the necessity of hospitalization requirements, and vulnerability to the disease has been associated via DNA analysis to be expressed in genetic variants at chromosomal region 3, features that are associated with European Neanderthal heritage. That structure imposes greater risks that those affected will develop a more severe form of the disease. The findings are from Professor Svante Pääbo and researchers he leads at the Max Planck Institute for Evolutionary Anthropology and the Karolinska Institutet. This admixture of modern human and Neanderthal genes is estimated to have occurred roughly between 50,000 and 60,000 years ago in Southern Europe.

 

COMORBIDITIES

Most of those who die of COVID-19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease. According to March data from the United States, 89% of those hospitalised had preexisting conditions. The Italian Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available, 96.1% of people had at least one comorbidity with the average person having 3.4 diseases. According to this report the most common comorbidities are hypertension (66% of deaths), type 2 diabetes (29.8% of deaths), Ischemic Heart Disease (27.6% of deaths), atrial fibrillation (23.1% of deaths) and chronic renal failure (20.2% of deaths).

 

Most critical respiratory comorbidities according to the CDC, are: moderate or severe asthma, pre-existing COPD, pulmonary fibrosis, cystic fibrosis. Evidence stemming from meta-analysis of several smaller research papers also suggests that smoking can be associated with worse outcomes. When someone with existing respiratory problems is infected with COVID-19, they might be at greater risk for severe symptoms. COVID-19 also poses a greater risk to people who misuse opioids and methamphetamines, insofar as their drug use may have caused lung damage.

 

In August 2020 the CDC issued a caution that tuberculosis infections could increase the risk of severe illness or death. The WHO recommended that people with respiratory symptoms be screened for both diseases, as testing positive for COVID-19 couldn't rule out co-infections. Some projections have estimated that reduced TB detection due to the pandemic could result in 6.3 million additional TB cases and 1.4 million TB related deaths by 2025.

 

NAME

During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus", with the disease sometimes called "Wuhan pneumonia". In the past, many diseases have been named after geographical locations, such as the Spanish flu, Middle East Respiratory Syndrome, and Zika virus. In January 2020, the WHO recommended 2019-nCov and 2019-nCoV acute respiratory disease as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species, or groups of people in disease and virus names in part to prevent social stigma. The official names COVID-19 and SARS-CoV-2 were issued by the WHO on 11 February 2020. Tedros Adhanom explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019). The WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications.

 

HISTORY

The virus is thought to be natural and of an animal origin, through spillover infection. There are several theories about where the first case (the so-called patient zero) originated. Phylogenetics estimates that SARS-CoV-2 arose in October or November 2019. Evidence suggests that it descends from a coronavirus that infects wild bats, and spread to humans through an intermediary wildlife host.

 

The first known human infections were in Wuhan, Hubei, China. A study of the first 41 cases of confirmed COVID-19, published in January 2020 in The Lancet, reported the earliest date of onset of symptoms as 1 December 2019.Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019. Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020. According to official Chinese sources, these were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. In May 2020 George Gao, the director of the CDC, said animal samples collected from the seafood market had tested negative for the virus, indicating that the market was the site of an early superspreading event, but that it was not the site of the initial outbreak.[ Traces of the virus have been found in wastewater samples that were collected in Milan and Turin, Italy, on 18 December 2019.

 

By December 2019, the spread of infection was almost entirely driven by human-to-human transmission. The number of coronavirus cases in Hubei gradually increased, reaching 60 by 20 December, and at least 266 by 31 December. On 24 December, Wuhan Central Hospital sent a bronchoalveolar lavage fluid (BAL) sample from an unresolved clinical case to sequencing company Vision Medicals. On 27 and 28 December, Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test, showing a new coronavirus. A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December. On 30 December, a test report addressed to Wuhan Central Hospital, from company CapitalBio Medlab, stated an erroneous positive result for SARS, causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result. The Wuhan Municipal Health Commission issued a notice to various medical institutions on "the treatment of pneumonia of unknown cause" that same evening. Eight of these doctors, including Li Wenliang (punished on 3 January), were later admonished by the police for spreading false rumours and another, Ai Fen, was reprimanded by her superiors for raising the alarm.

 

The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 cases—enough to trigger an investigation.

 

During the early stages of the outbreak, the number of cases doubled approximately every seven and a half days. In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the Chinese New Year migration and Wuhan being a transport hub and major rail interchange. On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen. Later official data shows 6,174 people had already developed symptoms by then, and more may have been infected. A report in The Lancet on 24 January indicated human transmission, strongly recommended personal protective equipment for health workers, and said testing for the virus was essential due to its "pandemic potential". On 30 January, the WHO declared the coronavirus a Public Health Emergency of International Concern. By this time, the outbreak spread by a factor of 100 to 200 times.

 

Italy had its first confirmed cases on 31 January 2020, two tourists from China. As of 13 March 2020 the WHO considered Europe the active centre of the pandemic. Italy overtook China as the country with the most deaths on 19 March 2020. By 26 March the United States had overtaken China and Italy with the highest number of confirmed cases in the world. Research on coronavirus genomes indicates the majority of COVID-19 cases in New York came from European travellers, rather than directly from China or any other Asian country. Retesting of prior samples found a person in France who had the virus on 27 December 2019, and a person in the United States who died from the disease on 6 February 2020.

 

After 55 days without a locally transmitted case, Beijing reported a new COVID-19 case on 11 June 2020 which was followed by two more cases on 12 June. By 15 June there were 79 cases officially confirmed, most of them were people that went to Xinfadi Wholesale Market.

 

RT-PCR testing of untreated wastewater samples from Brazil and Italy have suggested detection of SARS-CoV-2 as early as November and December 2019, respectively, but the methods of such sewage studies have not been optimised, many have not been peer reviewed, details are often missing, and there is a risk of false positives due to contamination or if only one gene target is detected. A September 2020 review journal article said, "The possibility that the COVID-19 infection had already spread to Europe at the end of last year is now indicated by abundant, even if partially circumstantial, evidence", including pneumonia case numbers and radiology in France and Italy in November and December.

 

MISINFORMATION

After the initial outbreak of COVID-19, misinformation and disinformation regarding the origin, scale, prevention, treatment, and other aspects of the disease rapidly spread online.

 

In September 2020, the U.S. CDC published preliminary estimates of the risk of death by age groups in the United States, but those estimates were widely misreported and misunderstood.

 

OTHER ANIMALS

Humans appear to be capable of spreading the virus to some other animals, a type of disease transmission referred to as zooanthroponosis.

 

Some pets, especially cats and ferrets, can catch this virus from infected humans. Symptoms in cats include respiratory (such as a cough) and digestive symptoms. Cats can spread the virus to other cats, and may be able to spread the virus to humans, but cat-to-human transmission of SARS-CoV-2 has not been proven. Compared to cats, dogs are less susceptible to this infection. Behaviors which increase the risk of transmission include kissing, licking, and petting the animal.

 

The virus does not appear to be able to infect pigs, ducks, or chickens at all.[ Mice, rats, and rabbits, if they can be infected at all, are unlikely to be involved in spreading the virus.

 

Tigers and lions in zoos have become infected as a result of contact with infected humans. As expected, monkeys and great ape species such as orangutans can also be infected with the COVID-19 virus.

 

Minks, which are in the same family as ferrets, have been infected. Minks may be asymptomatic, and can also spread the virus to humans. Multiple countries have identified infected animals in mink farms. Denmark, a major producer of mink pelts, ordered the slaughter of all minks over fears of viral mutations. A vaccine for mink and other animals is being researched.

 

RESEARCH

International research on vaccines and medicines in COVID-19 is underway by government organisations, academic groups, and industry researchers. The CDC has classified it to require a BSL3 grade laboratory. There has been a great deal of COVID-19 research, involving accelerated research processes and publishing shortcuts to meet the global demand.

 

As of December 2020, hundreds of clinical trials have been undertaken, with research happening on every continent except Antarctica. As of November 2020, more than 200 possible treatments had been studied in humans so far.

Transmission and prevention research

Modelling research has been conducted with several objectives, including predictions of the dynamics of transmission, diagnosis and prognosis of infection, estimation of the impact of interventions, or allocation of resources. Modelling studies are mostly based on epidemiological models, estimating the number of infected people over time under given conditions. Several other types of models have been developed and used during the COVID-19 including computational fluid dynamics models to study the flow physics of COVID-19, retrofits of crowd movement models to study occupant exposure, mobility-data based models to investigate transmission, or the use of macroeconomic models to assess the economic impact of the pandemic. Further, conceptual frameworks from crisis management research have been applied to better understand the effects of COVID-19 on organizations worldwide.

 

TREATMENT-RELATED RESEARCH

Repurposed antiviral drugs make up most of the research into COVID-19 treatments. Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.

 

In March 2020, the World Health Organization (WHO) initiated the Solidarity trial to assess the treatment effects of some promising drugs: an experimental drug called remdesivir; anti-malarial drugs chloroquine and hydroxychloroquine; two anti-HIV drugs, lopinavir/ritonavir; and interferon-beta. More than 300 active clinical trials were underway as of April 2020.

 

Research on the antimalarial drugs hydroxychloroquine and chloroquine showed that they were ineffective at best, and that they may reduce the antiviral activity of remdesivir. By May 2020, France, Italy, and Belgium had banned the use of hydroxychloroquine as a COVID-19 treatment.

 

In June, initial results from the randomised RECOVERY Trial in the United Kingdom showed that dexamethasone reduced mortality by one third for people who are critically ill on ventilators and one fifth for those receiving supplemental oxygen. Because this is a well-tested and widely available treatment, it was welcomed by the WHO, which is in the process of updating treatment guidelines to include dexamethasone and other steroids. Based on those preliminary results, dexamethasone treatment has been recommended by the NIH for patients with COVID-19 who are mechanically ventilated or who require supplemental oxygen but not in patients with COVID-19 who do not require supplemental oxygen.

 

In September 2020, the WHO released updated guidance on using corticosteroids for COVID-19. The WHO recommends systemic corticosteroids rather than no systemic corticosteroids for the treatment of people with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence). The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID-19 (conditional recommendation, based on low certainty evidence). The updated guidance was based on a meta-analysis of clinical trials of critically ill COVID-19 patients.

 

WIKIPEDIA

This image shows mouse muscle cells viewed under a microscope. The cells have fused together to form myotubes that have many nuclei (stained blue). The cells are from mouse skeletal muscle stem cells treated with a harmless virus that caused them to glow green. The green color remained when the stem cells fused into myotubes. Some myotubes are stained red for a protein involved in muscle contraction (myosin heavy chain), a characteristic of mature muscle fibers. The researchers plan to use the same viral delivery system to genetically modify the cells and assess how impairing cell fusion alters myotube growth. This image was a 2017 winner in the BioArt competition of the Federation of American Societies for Experimental Biology (FASEB).

 

Credit: Kevin A. Murach, Ph.D., University of Kentucky

 

NIH support from: National Institute of Arthritis and Musculoskeletal and Skin Diseases; National Institute on Aging

'I have learned a lot from the masterclass. It was great to interact with peers and learn what shooting technics they use. Engaging with the tutors was super helpful in terms of getting ideas and inspirations for creating new photo stories. It was also great to receive a feedback on how to create a portfolio and what it means to build a real story (spend enough time with the subject, be patient, wait for the right moment, etc.).' Nazik Muradova, Turkmenistan.

 

See her blog: morepeacenowar.wordpress.com/the-peace-lines/

 

Nazik Muradova is from Turkmenistan and started doing photography in 2014. She works as communications associate and aspires to become a documentary photographer depicting the issues of human rights in conflict-affected areas. Nazik holds a degree in security studies and regularly contributes articles on Central Asia’s developments. In 2013, Nazik started an online magazine the PULS of Central Asia. Her main interests lay in the sphere of security issues in Eurasia.

 

THE POWER OF ACCEPTING CHALLENGE

 

15% of the world population has a disability. By the age of 65, 40% of us will have a disability. By age of 80 almost everyone has a disability.

 

Due to the lack of employment and educational opportunities, social stigma and a failure to integrate PWDs into the society, a country’s annual GDP loss can account to 7%. PWDs face social and economic discrimination 50% more often than healthy, i.e. explicit refusal of employment due to medical condition, lack of adequate medical help and lack of education.

 

However, there are families who do not treat disability as a social condition. Disability is only a medical condition that challenges people, but should not make them suffer.

 

This is a story of Ahmed (who has cerebral palsy) and Bahar (with infraction of musculoskeletal system) and their family. Ahmed works for a printing and packaging company, Bahar is a housewife. They have two healthy kids.

This image shows the restoration of dystrophin (stained green) in Duchenne muscular dystrophy (DMD) muscle cells derived from human induced pluripotent stem cells. DMD is caused by mutations in the DMD gene that affect the production of dystrophin, a protein involved in muscle cell membrane structure. Researchers used CRISPR/Cas9 gene editing technology to correct a mutation, resulting in dystrophin restoration. This technology could be therapeutic in up to 60% of DMD patient mutations. Nuclei in the muscle cells are stained blue and the contractile protein myosin is stained red.

 

Credit: Courtney Young, M.S., Melissa Spencer lab, University of California, Los Angeles.

 

NIH support from: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Here you see the bladder (blue) of a laboratory mouse that was re-infected 24 hours earlier with the bacterium Escherichia coli (pink), a common cause of UTIs. White blood cells (yellow) reach out with what appear to be stringy extracellular traps to immobilize and kill the bacteria.

 

Valerie O’Brien, a graduate student in Scott Hultgren’s lab at Washington University, St. Louis, snapped this battle of microbes and white blood cells using a scanning electron microscope and then colorized it to draw out the striking details. It was one of the winners in the Federation of American Societies for Experimental Biology’s 2016 BioArt competition.

 

More information: directorsblog.nih.gov/2017/05/25/snapshots-of-life-fighti...

 

Credit: Valerie O’Brien, Matthew Joens, Scott J. Hultgren, James A.J. Fitzpatrick, Washington University, St. Louis

 

This image is not owned by the NIH. It is shared with the public under license. If you have a question about using or reproducing this image, please contact the creator listed in the credits. All rights to the work remain with the original creator.

  

NIH support from: National Institute of Diabetes and Digestive and Kidney Diseases; National Institute of Neurological Disorders and Stroke; and Office of Research on Women’s Health; National Institute of Allergy and Infectious Diseases; National Institute of Arthritis and Musculoskeletal and Skin Diseases; National Institute on Deafness and Other Communication Disorders