V dnešní době navštíví nejproslulejší náměstí New Yorku přes 130 milionů turistů ročně. Stojí tu obří obchod s cukrovinkami M&M's i konkurenční Hershey's. Před třiceti lety se ale na Times Square odvážili jen ti nejotrlejší. Každoročně zde docházelo ke zhruba 2500 zločinů a místo turistů tu vládly prostitutky.

Fr Joseph, at home with the peeps of St Joseph/Houston (masks and all), says: Christ is Risen!

CLOSE to one million youths have successfully claimed their eBelia credit via ShopeePay. As of June 7, the programme has succeeded in generating sales amounting to 120% of the total amount disbursed by the Ministry of Finance (MOF) through ShopeePay. Additionally, some 140,000 sellers and traders that accept ShopeePay have already benefited from the eBelia programme.

Head of ShopeePay Malaysia Alain Yee said: ”As one of the newest mobile wallets to enter a crowded space, it is indeed humbling to receive the resounding support from eligible eBelia participants. When compared against MOF’s announcement, the bulk of the 1.7 million successful applicants have chosen ShopeePay. This is possibly because our e-wallet can be used both online and offline nationwide, with a reach as far and wide as Semporna, Sabah; Miri, Sarawak; Kemaman and Gong Badak in Terengganu and Bachok, Kelantan.”

Yee added that based on the preliminary data from June 1 till 7, user behaviour amongst eBelia recipients suggest that the programme has driven adoption of e-wallets and is likely going to lead to long term usage.

“Of the total successful eBelia applicants via our mobile wallet, about 40% are new ShopeePay users that activated their e-wallet just for eBelia. Additionally, we are positive that customer retention rate amongst these new users will be high as over 20% have already topped up their e-wallet at least once within the first week of using ShopeePay,” he explained.

On what the recipients have been spending on, Yee shared that many were seen to be using the eBelia credit on very practical purchases: daily necessities, food and beverages, books, as well as home and living items, among others. A closer look into the spending pattern of these eBelia youths for the past week reveals the following (Observations are made based on top 100 merchants by transactions recorded offline, online (merchants’ webstores and Apps), and on Shopee.

These dynamics manifest in various ways, influencing interactions, decision-making and overall outcomes.

It’s an unmistakable sound. One that elicits memories, sights and scents of events long ago. It recalls the joy of youth, the possibility of a spring evening. But it can also incite insomnia and the blind rage that accompanies it.

This week's Fun Friday includes a bagel with no holes, the most popular pizza chains by state, and more.

LITTLE BO PEEP LIMITED EDITION PRINT by Scott Gustafson is a(n) Limited Edition. The Edition is Limited to Limited to 950 pcs

Kerry Washington co-stars in Peeples, Saturday at 7P/6C.

Ain't no feed grain too good for mah peeps.

Read more at http://blogs.smithsonianmag.com/science/2010/04/01/a-peep-experiment/ Our Surprising Science blogger tests whether stale peeps or fresh peeps are better for the spring tradition of peep jousting.

The viewfinders are outfitted with special lenses that help people with red-green colorblindness distinguish between hues

BACKGROUND:PEEP is a cornerstone treatment for children with pediatric ARDS. Unfortunately, its titration is often performed solely by evaluating oxygen saturation, which can lead to inadequate PEEP level settings and consequent adverse effects. This study aimed to assess the impact of increasing PEEP on hemodynamics, respiratory system mechanics, and oxygenation in children with ARDS.METHODS:Children receiving mechanical ventilation and on pressure-controlled volume-guaranteed mode were prospectively assessed for inclusion. PEEP was sequentially changed to 5, 12, 10, 8 cm H2O, and again to 5 cm H2O. After 10 min at each PEEP level, hemodynamic, ventilatory, and oxygenation variables were collected.RESULTS:A total of 31 subjects were included, with median age and weight of 6 months and 6.3 kg, respectively. The main reasons for pediatric ICU admission were respiratory failure caused by acute viral bronchiolitis (45%) and community-acquired pneumonia (32%). Most subjects had mild or moderate ARDS (45% and 42%, respectively), with a median (interquartile range) oxygenation index of 8.4 (5.8–12.7). Oxygen saturation improved significantly when PEEP was increased. However, although no significant changes in blood pressure were observed, the median cardiac index at PEEP of 12 cm H2O was significantly lower than that observed at any other PEEP level (P = .001). Fourteen participants (45%) experienced a reduction in cardiac index of > 10% when PEEP was increased to 12 cm H2O. Also, the estimated oxygen delivery was significantly lower, at 12 cm H2O PEEP. Finally, respiratory system compliance significantly reduced when PEEP was increased. At a PEEP of 12 cm H2O, static compliance had a median reduction of 25% in relation to the initial assessment (PEEP of 5 cm H2O).CONCLUSIONS:Although it may improve arterial oxygen saturation, inappropriately high PEEP levels may reduce cardiac output, oxygen delivery, and respiratory system compliance in pediatric subjects with ARDS with low potential for lung recruitability.

Used as a supply route during the Second World War, the Vizag coast became home to army camps and eventually, to safeguard India’s maritime interests following Chinese aggression, became the site for the Naval Coast Battery

If fortune favours the brave, it also tends to desert the timid, which is what India were in the Hyderabad Test

Don't act like you didn't laugh at these.

Don't act like you didn't laugh at these.

Kerry Washington co-stars in Peeples, Saturday at 7P/6C.

(in-package #:cl-pestilence)

;;   This is _not_ a simulation. It's just a game. And any resemblance
;; to any world, real or imaginary, is entirely coincidental.

;;   You can copy/paste this post in its entirety into a Common Lisp
;; REPL and play around with it if you like. I'm documenting it where
;; possible, but it's just a small toy to poke at for the moment.

;;   I've been thinking a lot about asymmetric multiplayer games and
;; <gestures wildly to world at large> all this.
;; I'm not actively _trying_ to model it accurately, but it's probably
;; obvious what's been consuming my thoughts lately.

;;   Let's get right into this. I'll explain as I go, and tie a few things
;; together neatly at the end. I hope. Regardless, there will absolutely
;; be a repo sometime fairly soon.

;; A place can be tagged arbitrarily, and can contain occupants.
;; They also collect points.

(defclass place ()
  ((tags :initarg :tags :initform nil :accessor tags)
   (occupants :initarg :occupants :initform nil :accessor occupants)
   (points :initform 0 :accessor points)))

(defun place? (thing)
  (eq (find-class 'place) (class-of thing)))

(defun place (&key tags occupants)
  (make-instance 'place :tags tags :occupants occupants))

(defun gen-place ()
  (let ((tag (pick '(:apartment-building :house :cottage
		     :office-building :factory :store
		     :cafe :lounge :theater))))
    (place :tags (list tag))))

(defmethod details ((place place))
  (format nil "====================~%~a {~{~a~}}~%~{  ~a~^~%~}~%"
	  (first (tags place))
	  (rest (tags place))
	  (mapcar #'details (occupants place))))

(defmethod show ((place place))
  (format nil "~20@a ~5a [~{~a~}]~%"
	  (first (tags place)) (points place)
	  (mapcar #'show (occupants place))))

;; A peep goes places.
;; They have
;;  - their daily routine (a list of places to visit)
;;  - their todo (the part of their routine they still need to do;
;;                they are currently at the first place in this list)
;;  - their health (a number from 0 to 100)
;;  - a list of plagues
;; Finally, they _also_ collect points.

(defclass peep ()
  ((routine :initarg :routine :initform (list) :accessor routine)
   (todo :initarg :todo :initform nil :accessor todo)
   (health :initarg :health :initform 100 :accessor health)
   (plagues :initform nil :accessor plagues)
   (points :initform 0 :accessor points)))

(defun peep? (thing)
  (eq (find-class 'peep) (class-of thing)))

(defun peep (&key places)
  (make-instance 'peep :routine places :todo places))

(defun health->string (health)
  (cond ((>= health 90) "@")
	((>= health 80) "0")
	((>= health 70) "O")
	((>= health 50) "o")
	((>= health 30) ":")
	((>= health 1)  ".")
	(t "☠")))

(defmethod details ((peep peep))
  (format nil "[~a ~3d [~{ ~a~^ ->~}]]"
	  (health->string (health peep)) (health peep)
	  (mapcar
	   (lambda (place) (first (tags place)))
	   (routine peep))))

(defmethod show ((peep peep)) (health->string (health peep)))

;; A world is a list of places, occupied by peeps. The world we start
;; peeps in also determines their routine.

(defun gen-world (&key (num-places 20) (num-peeps 100))
  (let ((places (loop repeat num-places collect (gen-place))))
    (loop repeat num-peeps
       do (let* ((routine (loop repeat 5 collect (pick places)))
		 (peep (peep :places routine)))
	    (push peep (occupants (first routine)))))
    places))

(defmethod details ((world list))
  (format nil "~%~{~a~}~%" (mapcar #'details world)))

(defmethod show ((world list))
  (format nil "~%~{~a~}~%" (mapcar #'show world)))

(defmethod all-peeps ((world list))
  (loop for place in world append (all-peeps place)))

(defmethod all-peeps ((place place))
  (loop for o in (occupants place) if (peep? o) collect o))

;; `tick!`ing a world means moving every peep through their routine once.
;;   We `tick!` each peep, then `tick!` each place until all the peeps are
;; done. Then we reset their routines.
;; You can think of this as a turn in the game.

(defmethod tick! ((world list))
  (let ((peeps (all-peeps world)))
    (loop while peeps
       do (setf peeps
		(loop for p = (pop peeps) while p
		   for res = (tick! p)
		   if res collect res))
       do (mapc #'tick! world)
       do (format t "~a" (show world)))
    (loop for p in (all-peeps world)
       do (setf (todo p) (routine p))))
  world)

;; Don't worry about the details of how to `tick!` peeps or places yet.

;;   Ok, here's where it gets a bit darker. Although we _did_
;; foreshadow this in the definition of `peep`. And also in the title
;; of the accompanying blog post.

;; A plague is another living thing.
;; It has
;;  - a host (a peep that it's infecting)
;;  - a signature (a token representing its lineage and strain)
;;  - health (how well it's doing inside its host)
;;  - virulence (how likely it is to spread to another host)
;;  - efficiency (how efficient they are at feeding)
;;  - reproduce (a function that returns a new instance to push into a new host)
;;  - and a strategy (a function, possibly closed, that takes
;;    itself and its host peep and mutates)

;; Plagues do not collect points; they score differently.

(defclass plague ()
  ((host :initarg :host :initform nil :accessor host)
   (signature :initarg :host :initform "SIG" :accessor signature)
   (health :initarg :health :initform 10 :accessor health)
   (virulence :initarg :virulence :initform 10 :accessor virulence)
   (efficiency :initarg :efficiency :initform 0.2 :accessor efficiency)
   (reproduce
    :initarg :reproduce
    :initform
    #'plague
    :reader reproduce)
   (strategy
    :initarg :strategy
    :initform
    (lambda (plague peep)
      (feed! plague peep 30))
    :reader strategy)))

(defun plague ()
  (make-instance 'plague))

;; Plagues can `feed!` on peeps or plagues. To feed means to
;; take away some of the targets' health and add some to your own.

(defmethod feed! ((self plague) (peep peep) (amount integer))
  (decf (health peep) amount)
  (incf (health self) (* (efficiency self) amount)))

(defmethod feed! ((self plague) (plague plague) (amount integer))
  (decf (health plague) amount)
  (incf (health self) (* (efficiency self) amount)))

;; Plagues can also `infect!` peeps by `reproduce`ing into them.

(defmethod infect! ((self plague) (peep peep))
  (unless (infected-by? self peep)
    (let ((child (funcall (reproduce self))))
      (setf (host child) peep)
      (push child (plagues peep)))))

(defmethod infected-by? ((self plague) (peep peep))
  (member (signature self) (mapcar #'signature (plagues peep))
	  :test #'string=))

;;  `tick!`ing a plague causes it to weaken and also carry out its strategy.
;; This models the background effect of the immune system of its host.

(defmethod tick! ((plague plague))
  (decf (health plague) 1)
  (funcall (strategy plague) plague (host plague))
  plague)

;;  `tick!`ing a peep means moving them to their next place, and also
;; `tick!`ing any plagues they may have contracted. Also, peeps are
;; resilient; they heal a small amount each time they tick (to a
;; maximum of 100).
;;  If a peep dies, they no longer move. And their plagues probably
;; won't do well. Peeps like to go places. They score points for each
;; place they go to.

(defun dead? (thing) (>= 0 (health thing)))

(defmethod tick! ((peep peep))
  (unless (dead? peep)
    (let ((location (pop (todo peep))))
      (incf (points peep))
      (setf (occupants location) (remove peep (occupants location)))
      (push peep (occupants (or (first (todo peep)) (first (routine peep)))))
      (setf (health peep) (min 100 (+ 5 (health peep))))
      (mapc #'tick! (plagues peep))
      (unless (empty? (todo peep))
	peep))))

;; `tick!`ing a place causes it to score for each `peep` present. And it causes
;; any `plague`s on present `peep`s to try to `infect!` other nearby peeps.
;; Places also lose points for each dead peep they contain.

(defmethod tick! ((place place))
  (incf (points place) (length (occupants place)))
  (loop for peep in (all-peeps place)
     if (dead? peep)
     do (decf (points place) 2)
     else do (loop for plague in (plagues peep)
		do (loop for victim in (remove peep (all-peeps place))
		      if (>= (virulence plague) (random 100))
		      do (infect! plague victim))))
  place)

;;  So, now we've got the basic framework of the game in place. There are three
;; players in this game: places, peeps and plagues.
;;   A plague player automatically loses if they are completely cured, and
;; automatically wins if they manage to kill everyone. That's fairly simple.
;;   A place player wins if they manage to cure the plague. They automatically
;; lose if all the peeps die. Also, fairly simple.
;;   A peep player is trying to survive. If they manage to make it some numer
;; of turns before dying, then we have to score the game instead of declaring
;; an outright winner regardless of game state.

;;   A peep player's score is the total number of points plus remaining health
;; on all of their peeps, minus the number of active plagues on said peeps.
;;   A plague player's score is the total number of health of their plagues,
;; with a multiplier equal to the number of places fully infected by
;; their plague.
;;   A place player's score is the total number of points in their places.

(defun score (world)
  (list :peep (let ((score 0))
		(loop for p in (all-peeps world)
		   unless (dead? p)
		     do (incf score (+ (health p) (points p)))
		   do (decf score (length (plagues p))))
		score)
	:place (let ((score 0))
		 (loop for p in world
		    do (incf score (points p)))
		 score)
	:plague (let ((score 0))
		  (loop for victim in (all-peeps world)
		     do (loop for p in (plaguesvictim)
			   do (incf score (max 0 (health p)))))
		  (loop for target in world
		     if (every
			 (lambda (victim)
			   (not (empty? (plagues victim))))
			 (all-peeps target))
		     do (setf score (* 2  score)))
		  score)))

;;   I think that's all I've got for now. This is definitely an idea I want
;; to run with. At the moment, it's just a tiny, in-repl proof-of-concept,
;; and not particularly fun, but I'm going to try developing it further with an
;; eye towards turning it into an actual web game playable from this site.

;; As always, I'll let you know how it goes.

(defun pick (lst)
  (nth (random (length lst)) lst))

(defun empty? (lst)
  (null lst))

Cy rubs one out for us! See more at Peepshow.tv.

The post PeepShow.tv: Cy appeared first on QueerClick.

Blending marshmallows with scientific rigor, the contest offers levity during a difficult time

Ventilatory settings are critical in mechanically ventilated extremely preterm newborn infants due to the risk of ventilation-induced lung injury (VILI) and the subsequent development of bronchopulmonary dysplasia (BPD) [1]. Positive end-expiratory pressure (PEEP) settings usually rely on blood gases, oxygen requirement, lung auscultation, evaluation of chest radiograph and assessment of the pressure/volume curves provided by ventilators. Studies of optimal PEEP settings in the surfactant-treated preterm infant in need of mechanical ventilation are limited and evidence-based clinical guidelines are sparse [2, 3]. A bedside method identifying the PEEP value that comprises maximal lung volume recruitment and minimising tissue overdistension could improve real-time optimisation of PEEP and potentially minimise the risk of VILI and BPD [4, 5].

BACKGROUND:Pneumoperitoneum and Trendelenburg position affect respiratory system mechanics and oxygenation during elective pelvic robotic surgery. The primary aim of this randomized pilot study was to compare the effects of a conventional low tidal volume ventilation with PEEP guided by gas exchange (VGas-guided) versus low tidal volume ventilation tailoring PEEP according to esophageal pressure (VPes-guided) on oxygenation and respiratory mechanics during elective pelvic robotic surgery.METHODS:This study was conducted in a single-center tertiary hospital between September 2017 and January 2019. Forty-nine adult patients scheduled for elective pelvic robotic surgery were screened; 28 subjects completed the full analysis. Exclusion criteria were American Society of Anesthesiologists physical status ≥ 3, contraindications to nasogastric catheter placement, and pregnancy. After dedicated naso/orogastric catheter insertion, subjects were randomly assigned to VGas-guided (FIO2 and PEEP set to achieve SpO2 > 94%) or VPes-guided (PEEP tailored to equalize end-expiratory transpulmonary pressure). Oxygenation (PaO2/FIO2) was evaluated (1) at randomization, after pneumoperitoneum and Trendelenburg application; (2) at 60 min; (3) at 120 min following randomization; and (4) at end of surgery. Respiratory mechanics were assessed during the duration of the study.RESULTS:Compared to VGas-guided, oxygenation was higher with VPes-guided at 60 min (388 ± 90 vs 308 ± 95 mm Hg, P = .02), at 120 min after randomization (400 ± 90 vs 308 ± 81 mm Hg, P = .008), and at the end of surgery (402 ± 95 vs 312 ± 95 mm Hg, P = .009). Respiratory system elastance was lower with VPes-guided compared to VGas-guided at 20 min (24.2 ± 7.3 vs 33.4 ± 10.7 cm H2O/L, P = .001) and 60 min (24.1 ± 5.4 vs 31.9 ± 8.5 cm H2O/L, P = .006) from randomization.CONCLUSIONS:Oxygenation and respiratory system mechanics were improved when applying a ventilatory strategy tailoring PEEP to equalize expiratory transpulmonary pressure in subjects undergoing pelvic robotic surgery compared to a VGas-guided approach. (ClinicalTrials.gov registration NCT03153592).

BACKGROUND:Observational studies report that lower driving pressure (ie, the difference between plateau pressure and PEEP) is associated with improved survival in patients with ARDS and may be a key mediator of lung-protective ventilation strategies. The primary objective of this study was to characterize reductions in driving pressure that could be achieved through changes in PEEP.METHODS:In this prospective physiological pilot study, 10 subjects with ARDS were placed on PEEP according to the ARDS Network Lower PEEP/FIO2 Table. PEEP was adjusted in small increments and decrements above and below this initial PEEP, and driving pressure was measured at each PEEP level. Subsequently, PEEP was set at the level resulting in the lowest driving pressure, and driving pressure was measured after 1, 5, 15, and 30 min to assess stability over time at constant PEEP.RESULTS:All subjects had ARDS with a median (interquartile range [IQR]) PaO2/FIO2 of 116 (98–132) at enrollment. Median (IQR) driving pressure at baseline was 14 (13–17) cm H2O. After PEEP titration, median driving pressure decreased to 13 (12–14) cm H2O. The largest reduction in driving pressure was 4 cm H2O. Two subjects had no change in driving pressure at multiple PEEP levels. To achieve the lowest driving pressure, final PEEP was increased in 6 subjects and decreased in 4 subjects from the baseline PEEP prescribed by the ARDS Network Lower PEEP/FIO2 Table. Driving pressure reached equilibrium within 1–5 min and remained stable for 30 min following PEEP titration.CONCLUSIONS:PEEP titration had a variable effect in changing driving pressure across this small sample of ARDS subjects. In some subjects, PEEP was decreased from values given in the ARDS Network Lower PEEP/FIO2 Table to minimize driving pressure. Changes in driving pressure stabilized within a few minutes of PEEP titration.

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