Il Presidente del Consiglio dei ministri Giuseppe Conte nella conferenza stampa del, 10 aprile, ha confermato di aver predisposto un nuovo Dpcm per prorogare le misure restrittive al 3 maggio.
“Una decisione difficile – ha detto il Presidente Giuseppe Conte – ma una decisione necessaria, di cui mi assumo tutta la responsabilità politica. È una decisione che ho assunto dopo diversi incontri tenuti con la squadra dei Ministri, con gli esperti del nostro Comitato tecnico-scientifico, con le Regioni, le Province e i Comuni, con i sindacati, il mondo delle imprese, dell’industria, con le associazioni di categoria.
Il Comitato tecnico-scientifico ci ha dato una conferma: i segnali della curva epidemiologica sono incoraggianti. Ci sono evidenti indicazioni che le misure di contenimento sin qui adottate dal Governo stanno dando dei frutti, ma proprio per questo non possiamo vanificare gli sforzi fin qui compiuti.”
Il Presidente del Consiglio dei ministri ha raccomandato di tenere alta la soglia dell’attenzione anche in questi giorni di festa, per Pasqua come per i ponti del 25 aprile e del 1° maggio.
Riaprono librerie, cartolibrerie e negozi per neonati e bambini
La proroga delle Misure restrittive fino al 3 maggio prevista dal Dpcm, appena firmato, vale anche per le attività produttive. L’intenzione è di allentare il primo possibile le misure per far ripartire le attività economiche, ma non ci sono ancora le condizioni perché ciò sia possibile.
Rispetto alle precedenti misure restrittive relative alle attività commerciali, nel Decreto ci sono alcune piccole variazioni, che riguardano parziali riaperture. Con il nuovo Dpcm, a partire dal 14 aprile, sarà consentita l’apertura delle cartolerie, delle librerie e dei negozi di vestiti per bambini e neonati e vengono inserite tra le attività produttive consentite la silvicoltura e l’industria del legno.
La fase 2
Giuseppe Conte ha poi ricordato che “il Governo è già al lavoro per programmare la fase 2, non possiamo aspettare che il virus sparisca dal nostro Paese. Il programma – ha dichiarato Conte – poggia su due pilastri: l’istituzione di un Comitato di esperti in materia economica e sociale e il Protocollo per la sicurezza nei luoghi di lavoro”.
Il Comitato di esperti sarà presieduto da Vittorio Colao e costituito da professionalità diverse, selezionate fra le eccellenze italiane. Il gruppo di esperti dialogherà con il Comitato Tecnico Scientifico, per disegnare un nuovo modello organizzativo. Il Comitato avrà il compito di elaborare e proporre misure necessarie a fronteggiare l’emergenza e per una ripresa graduale nei diversi settori delle attività sociali, economiche e produttive.
Il secondo pilastro è il rafforzamento del Protocollo per la sicurezza nei luoghi di lavoro, già siglato il 14 marzo.
Leggi la dichiarazione integrale sulle misure restrittive fino al 3 maggio e guarda il video nel sito del governo
#IORESTOACASA
Gruppo Ge.Ma. Srl e Iso-Studio Srl credono nelle istituzioni. Credono nelle regole e nel rispetto delle indicazioni che provengono dalle istituzioni.
Le leggi non si interpretano, si rispettano. Per questo da oggi, a causa delle nuove misure restrittive fino al 03 Maggio saremo aperti, ma con alcune importanti novità, legate al momento difficile che stiamo vivendo.
Abbiamo provveduto ad attivare per chi poteva le forme di telelavoro ed a mettere in pratica tutti gli interventi possibili per tutelare la salute dei nostri dipendenti. Se il Governo decide chiusura attività produttive non essenziali o strategiche noi restiamo aperti per i nostri clienti strategici. #DISTANTIMAUNITI #INSIEMECELAFAREMO #IORESTOACASA
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I had to look at each mistake and ugly part of my past up close; examine every crack and mineral and texture; and then held it in my palms, washed it clean, kissed it, and set it back down. I did this because I realized there was no amount of self-denigration or punishment that would keep those rocks from coming back to shore, anyway. So rather than try to banish half of me or more, I decided to invite it all in.
You are reading Love Story, a weekly newsletter about relationships, recovery, and writing from Laura McKowen. Laura is the founder of The Luckiest Club, an international sobriety support community, and the bestselling author of two books, We Are The Luckiest: The Surprising Magic of a Sober Life and Push Off from Here: 9 Essential Truths to Get You Through Sobriety (and Everything Else).
Writing this third book, about emotional sobriety in romantic relationships (more or less), has been at turns emotionally devastating and cathartic. I\u2019m right in the belly of the beast\u2014my ground zero, the root of my deepest pain. Unbelievably, writing about this stuff has made writing about the darkness of my addiction seem like walking through a field of fucking tulips on a seventy degree day.
Since reading Fawning and talking more with about her work (you can watch/listen to our conversation here), I\u2019ve gained a different understanding of the role shame has played in my life, and I want to share it because I sense it\u2019s not only useful for me.
Until a few years ago, I would have had no defense against those words from the rumor mill. But when I heard them that day, I did. On that day, I had already looked every one of my worst nightmares straight in the face. I had already turned over every shameful part of me, like rocks on a muddy beach. And I had decided \u2014 instead of casting them back into the sea, or smashing them, or trying to bury them out of existence \u2014 I would treat them as if they were holy. I would treat every part of me that way.
Writing that out here now\u2014seeing the words I wrote, and felt, and knew to be true in the deepest part of me when I put them down six years ago\u2014well, I can\u2019t access that place. I wonder where she went.
The lump in my throat. The way my body has been shaking for days now. The way I feel as young as I ever have. The way I\u2019ve needed my friends to remind me of what\u2019s true, over and over and over again. The way I\u2019ve called out for God and can\u2019t feel her. The terror of that.
Some part of me knows she\u2019s still there: my wise, grounded, functional adult self; the writer who wrote those words; the creative, whole spirit who knows they are never, ever disconnected from God. She\u2019s still there. She\u2019s just not running the show at the moment.
What I named: I was ashamed long before I had any reason to be. That\u2019s what I\u2019m working through in this book, and in this chapter of my life. I\u2019m facing down the reasons that was true, and what it\u2019s meant for me throughout my life: how it warped my sense of self, caused me to abandon myself in thousands of big and small ways, and how, when triggered, that shame can still\u2014even still\u2014show up and take me down. I\u2019m pulling the thread on what\u2019s true and not true, and on the conflicting things that are true at the same time, and understanding in a new, deeper way that this too is both not my fault and also my responsibility.
When I am in this place, and I\u2019ve been here many times over the years\u2014many times since I wrote those words for my book, and in the early years of sobriety, and certainly less than in my childhood and early adult years when I had to fight against it all the time\u2014when I am in this place now, at a time when I\u2019ve (fortunately, unfortunately?) outgrown all my prior coping mechanisms (alcohol, drugs, starving myself, overworking, over-functioning, sex, fantasy, endless dating, etc.), I am seeing that this is going to burn all the way through me. Of course it is.
It feels like a battle for my life because that\u2019s what it was. As a child, because I could not see my caregivers as bad (because I needed them to be good), I had to see myself as bad instead, because at least that\u2019s something I could control.
In this way, and over time, shame has unconsciously become my master tool of protection. (I think, to varying degrees, it is every woman\u2019s master tool of protection.) And the protection, as much as it makes us want to die, is the idea that I am/we are simply, inherently, and irrevocably bad. Black and white. Binary. No room for anything else. And if I just take that on, as Ingrid shared with me the other day, I can eat up all the pain and all the discomfort and all the blame so I can be done with it. Again. For the seventeenth thousandth millionth time.
I didn\u2019t know I could see the message of shame, and the fact that it\u2019s still there after all this time, not as proof of some bottom line truth (that I am ultimately bad) but as a very sneaky, very powerful mechanism of control and protection. Because I don\u2019t know about you, but shame pretty much feels like the opposite of protection and control, no? It feels like a spiraling hellhole swamp where my limbs are slowly being torn off my body and like I deserve it.
A way to gobble up all the nuance and discomfort and take the blame so I can try to get back to safety. A part I can actually talk to, as Ingrid suggested, and say, \u201CHi shame \u2026 I see you – wanting to take this all on so we can be done with it – eat it all up and move on. But that doesn\u2019t work for me anymore. I don\u2019t want to take what isn\u2019t mine. I can tolerate feeling uncomfortable as I wrestle with this.\u201D
I\u2019m still pulling the thread on this, and I\u2019m still in that very shaky place (I haven\u2019t slept well for a few days; I spent all of yesterday bed rotting under a weighted blanket; my heart is in my throat), but there\u2019s a crack of insight that wasn\u2019t there before. The tiniest opening of something new.
P.S. \u2019s new podcast, co-regulation, is fantastic if you have had a chance to listen yet. Her latest episode with , titled \u201CAre you betraying the world by being okay?\u201D is incredible. Listen and subscribe. (The episode with our conversation is coming soooon.)
I find joy in seing the signs from my loved ones who are on the other side, i find joy in micro moments of connection with random people, i find joy when i manage to be in the present moment in nature and feel it’s beauty and energy in my body.
I love your perspective on joy, that there is an active component in it. I think there’s truth in that. I think you can definitely find joy in the routines we build for ourselves, but in my experience it tends to come more from the surprises than anything else.There’s a quote from James Clear that I love “Happiness will always be fleeting because your needs change over time. The questions is: what do you need right now?”I think there are certain activities that more often than not bring me joy. Things like cooking a meal for my family, training martial arts with friends that push each other to be better or a bike ride early in the morning to catch the sunrise. More often than not, these experiences provide purpose + reason for being. But sometimes they don’t, sometimes they’re tiresome or deplete me rather than energise me. I think this push + pull is part of life. There is no silver bullet, cure-all for finding joy. I just try + listen to my body to figure out what I need in that moment. I don’t always get it right, but by surrounding myself with good people and doing activities that challenge me mentally + physically, that’s usually a good way to find joy.
I find joy in watching my dog run, in feeling the wind on my face, in hearing about people rescuing and protecting animals. I often feel it in many of the natural things, trees, plants, flowers, birds, music, books, art and so on. What I wonder about is how brief the joy is, it bursts in and then goes again, usually under a cloud of thoughts.
Joy is a very rare sensation in most people’s lives, I think in terms of the life goals being content with sporadic moments of happiness is what most people would refer to as being happy, a balanced life with the sun largely outweighing the shit. Very few of these happy moments graduate to joy as I understand it as often they can only be fully recognized in hindsight. Joy on the other hand is very much a here and now sensation which I feel exists solely as an individual experience, several people can enjoy it in the same room at the same time with their collective fires lit by the same match but burning in their own different ways. I tend to find my moments of joy are largely created by a great mixture of nostalgia, comfort, and great expectations being exceeded and I most often experience this when at a gig. When a song which is irrevocably intwined with warm memories and emotion starts to build, and the crowd builds with it in a sense of collective anticipation and then that break just drops and it’s so much more powerful than you expected and all you can do is grin like a tit, THAT is my joy. https://drive.google.com/file/d/1PNhWkP3IZtdaJ90_Vm9_rQeqt0jzXkym/view
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With very different and highly innovative business models, Dr. Peter Boulden and Dr. Craig Spodak are redefining the dental industry standard of care and the patient + dentist experience. On their podcast, Bulletproof Dental Practice, they provide insight on what it takes to be competitive in the age of Uber, Amazon, and corporate dentistry. Peter and Craig will help you build and realize your vision for a kick-ass practice that s not only successful, but also fulfilling.
Many medical professionals feel like they’ve been studying their whole life, through medical school, working as a registrar, and then specialist training, but despite all that study they feel like they have never learned how to run a successful business. They build a business around their medical skills, but despite their high level of medical achievement they feel like their finances, overall stress levels and personal life are suffering, and they don’t know where to start to fix it.
How can America’s healthcare system be transformed to provide consistently higher-quality and lower-cost care? Nothing else in healthcare matters more. Prescription for the Future identifies some standout medical organizations that have achieved higher-quality, more patient-focused, and lower-cost care, and from their examples distills 12 transformational practices that could transform the entire healthcare sector.
Great medical practices create an experience so positive that patients can’t stop talking about it. Patients talk to friends, relatives, and acquaintances about the care they received. They can’t help posting nice things about this great practice on social media. And they can’t imagine recommending anyone else. Patient Care The Sandler Way shows how to create this experience. It offers timeless, proven principles for effective patient care, based on the communication skills and success principles of the Sandler Selling System.
Great medical practices create an experience so positive that patients can’t stop talking about it. Patient Care The Sandler Way shows how to create this experience. It offers timeless, proven principles for effective patient care….
Heart failure (HF), also known as congestive heart failure (CHF), is a complex clinical syndrome characterized by the heart’s inability to pump blood effectively due to structural or functional impairments. The most common cause of HF is ischemic heart disease, but other factors, such as hypertension, valvular disease, and myocarditis, also contribute to its development.
HF is classified based on left ventricular ejection fraction (LVEF) and clinical staging. Common symptoms of HF include shortness of breath, fatigue, fluid retention, and edema. This course explores the complexities surrounding HF’s extensive etiologies, assessment, classification, and staging. This activity for healthcare professionals is designed to enhance the learner’s competence in identifying HF, performing the recommended multifaceted evaluation, and implementing an appropriate interprofessional approach when managing this condition, which is essential to improve patient outcomes and quality of life.
Objectives:Evaluate clinical presentation and apply the staging and classification systems of heart failure.Assess the etiology of heart failure using clinical assessment and appropriate diagnostic tests. Develop a management plan for patients with heart failure based on their clinical stage and investigations.Collaborate with interprofessional healthcare teams, including cardiologists, nurses, physiotherapists, and pharmacists, to ensure coordinated and comprehensive care for heart failure patients.Access free multiple choice questions on this topic.
Heart failure (HF), as defined by the American College of Cardiology (ACC) and the American Heart Association (AHA), is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. HF is a common disorder worldwide with a high morbidity and mortality rate. With an estimated prevalence of 26 million people worldwide, CHF contributes to increased healthcare costs, reduces functional capacity, and significantly affects quality of life. Accurately diagnosing and effectively treating the disease is essential to prevent recurrent hospitalizations, decrease morbidity and mortality, and enhance patient outcomes.[1]
The etiology of HF is variable and extensive. Ischemic heart disease is the leading cause of HF. The general management of HF aims to relieve systemic and pulmonary congestion and stabilize hemodynamic status, regardless of the cause. The treatment of HF requires a multifaceted approach involving patient education, optimal medication administration, and decreasing acute exacerbations. Per the recent ACC/AHA guidelines for HF 2022, patients with HF are classified based on left ventricle ejection fraction (LVEF), whereas clinical and laboratory parameters are integrated to stage patients. The New York Heart Association (NYHA) classification stratifies and defines the functional capacity and severity of HF symptoms. This system is subjectively determined by clinicians and is widely used in clinical practice to direct therapy. Management of patients depends on the classification and staging of the disease.[1]
The etiologies of HF are extensive, though coronary artery disease (CAD) causing ischemic heart disease is the most common cause. Every attempt should be made to identify causative factors to help guide treatment strategies. The etiologies can be broadly classified as intrinsic heart disease and pathologies that are infiltrative, congenital, valvular, myocarditis-related, high-output failure, and secondary to systemic disease.[3][4] These classifications have significant overlap.
The 4 most common etiologies responsible for about two-thirds of HF cases are ischemic heart disease, chronic obstructive pulmonary disease (COPD), hypertensive heart disease, and rheumatic heart disease. Higher-income countries have higher rates of ischemic heart disease and COPD; lower-income countries have higher rates of hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and myocarditis.
Ischemic heart disease is by far the most common cause of HF worldwide. Ischemia leads to a lack of blood flow to heart muscles, reducing the EF. Incidence is increasing in developing countries as they adopt a more Western diet and lifestyle, and improved medical care decreases the infectious burden in these countries (myocarditis is often infection-related.)
Valvular heart disease is another common intrinsic heart condition that can cause HF. Rheumatic heart disease is the most common cause of valvular heart disease in children and young adults worldwide. It is caused by an immune response to group A Streptococcus and primarily causes mitral and aortic stenosis.[5] Age-related degeneration is the most common overall cause of valvular disease, and the aortic valve is the most commonly affected. Women are more likely to experience mitral valve rheumatic heart disease or mitral valve prolapse, while men are more likely to suffer from aortic valve diseases such as regurgitation or stenosis. Endocarditis is also more common in men. https://drive.google.com/file/d/1IMoxMSY9E3lbdxNXx_xPu9hkO9j-pdqb/view
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