health

I Know You See It, Too


April 30, 2020

Reading time – 3:23  .  .  .

The population of the United States makes up approximately 4% of the of the total world population. Yet we have managed to have 32.3% of all coronavirus cases and 26.7% of all coronavirus deaths on the planet. Even if all the illness and deaths in the  New York tri-state region are removed from the totals, the U.S. is still disproportionately sicker and possesses disproportionately more occupied body bags than any other nation. The math is right. The outcomes are not. (Ref: this post)

How has the richest country in the world, with first rate medical capabilities in healthcare delivery, research, development and the rest managed to perform like a failed nation with pitiful resources? That is the question that will be explored extensively over the next few years. If we are very lucky, the answers will give guidance for how to deal with the next pandemics, which are coming. If we can avoid our current self-defeating behavior, perhaps we’ll even follow that guidance.

Actually, we’ve done that. It happened following the Ebola epidemic ten years ago. President Obama established a standing group of 3 teams for the sole purpose of ensuring that we would be ready for the next pandemic. Wise move. Likely a life-saving move. But in his continuing quest to remove any trace of President Obama, President Trump disbanded those teams and fired all the team members he could.

So, the answer to the question about how we could be performing like a failed nation with pitiful resources is that we have a self-focused executive, devoid of the orientation and skills needed for leadership in a crisis. Everyone who is observing what’s going on knows it. We are left with little national leadership that is anything more than political posturing. Many of our state governments are similarly focused on political gain and they’re putting millions of Americans at greater risk in the process. It’s worse than no leadership at all, because it’s counter-productive.

I want to be wrong in my belief that this early “reopening” of our economy will produce a huge spike of illness with terrible consequences for us. I want to be wrong that the partisan cowardice driving these early “reopening” decisions is going to lead to a shortage of body bags very soon. I don’t think I’ll get my wish and be wrong.

Before the Civil War, escaped slaves would hide in safe houses along the Underground Railroad. They might spend a long time in a dirt hole beneath a cabin to avoid capture and there might be little or no food. Anne Frank spent 2 years in an unheated attic to avoid the Nazis. There are innumerable examples of people having to “hole up” for long periods of time, often in dreadful conditions, yet they did what they needed to do.

In contrast, we are being asked to stay at home with Netlix, home pizza delivery, video games, online school instruction and more. Honestly, it’s just a few inconveniences for most of us. We can wear our big boy and big girl pants a while longer.

On the other hand, for those who have lost their income and have no buffer, it’s a problem. A really big problem. Answer for yourself what you’d do to make sure your children don’t go hungry. You might be willing to risk your life working in a pork processing plant or a nursing home. Our federal and state governments have done a little to help these people, but no long term solution has been offered. That makes the future look particularly bleak for those hit hardest by our need to hunker down and many of the most pandemically dangerous places to work aren’t doing enough to provide protection for these workers.

Our government hasn’t figured out how to lead and deliver the healthcare protections we need, like extensive, universal testing, so:

  1. What are the chances the geniuses in DC can figure out how to keep our children fed?
  2. What are the chances they can figure out how we can stop being the world’s biggest pandemic loser?

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Ed. note: We need to spread the word so that we make a critical difference, so

  1. Pass this along to three people, encouraging them to subscribe (IT’S A FREEBIE!).
  2. Engage in the Comments section below to help us all to be better informed.

Thanks!

The Fine Print:

  1. Writings quoted or linked from my posts reflect a point I want to make, at least in part. That does not mean that I endorse or agree with everything in such writings, so don’t bug me about it.
  2. Sometimes I change my opinions because I’ve learned more about an issue. So, educate me. That’s what the Comments section is for.
  3. Errors in fact, grammar, spelling and punctuation are all embarrassingly mine. Glad to have your corrections. Refreshing when someone wants to get the facts right, eh?
  4. Responsibility for the content of these posts is unequivocally, totally, unavoidably mine.

JA


Copyright 2024 by Jack Altschuler
Reproduction and sharing are encouraged, providing proper attribution is given.

American Death Rates For Your Consideration


Reading time – 2:14  .  .  .

There continue to be comparisons made between the seasonal flu and COVID-19, with the apparent goal of decreasing our perception of the danger of this pandemic. After all, we suffer thousands of deaths every year from the seasonal flu and we don’t shut down the country. To put this into perspective, I did some research to compare various high body count episodes of our history, which resulted in the chart below. Decide for yourself what you should do in this pandemic.

Sources:

    • War stats: https://en.wikipedia.org/wiki/United_States_military_casualties_of_war
    • *CDC, as reported at https://www.health.com/condition/cold-flu-sinus/how-many-people-die-of-the-flu-every-year and
      https://www.statnews.com/2020/04/09/its-difficult-to-grasp-the-projected-deaths-from-covid-19-heres-how-they-compare-to-other-causes-of-death/
    • **With no social distancing, masks or other protective gear, testing or extensive use of disinfectants and hand washing.
    • #CDC at https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html

Some comments are in order.

  1. The war deaths per year are skewed because there were vastly different rates of deaths depending on the year. For example, for the first 7 or 8 years of the Vietnam War there were relatively few deaths, while there were many thousands per year following that. The same issue of variation applies to the Iraq and Afghanistan wars.
  2. Deaths from seasonal flu depend on the strain of influenza and other factors, so the number of annual deaths varies greatly.
  3. The total deaths from the 1918 Spanish Flu is a CDC estimate.
  4. The actual annual deaths per year from COVID-19 is yet to be determined because we’re only 3 months into the pandemic in the U.S. and only 4 months into the calendar year. Experts believe the rate of illness and death will decrease in the warmer months and may increase substantially in the coming fall and winter months. In other words, we may bend the curve in summer, but that won’t eliminate the threat. Consequently, the actual deaths per year may turn out to be substantially different from that shown. Or this calculated number of deaths per year might prove to be frightfully accurate.
  5. Not shown is the death rate, which is approximately 0.6% for seasonal flu and 6% for COVID-19. That is to say, 6 people of every 100 who contract COVID-19 will die. As more cases are identified due to expanded testing, that calculated rate will decrease due to the method used to determine the rate – simple division.
  6. Disease transmission rates were not found, so they are not included. However, the medical professionals have consistently said that COVID-19 transfers from human to human with remarkable and perilous efficiency.
  7. Many experts have said that the strongest predictors of both contracting and succumbing to COVID-19 are, 1. underlying or existing conditions, like heart disease, diabetes, cancer and other infirmities, and, 2. a weakened immune system. A primary cause of a weakened immune system is lifestyle choices, including food choices, exercise, smoking, stress, etc. Translation: Make better lifestyle choices and you’ll have a much better chance of surviving this pandemic.
  8. For more on our COVID-19 testing efforts, have a look at this from STAT. Looks like we’ll be ramping up our testing capabilities soon to the point that we may have 1/3 to 1/2 of the capacity we need. Maybe.
  9. We Americans love to set records, so this should be a time of celebration, because we passed not one but two landmark numbers: 1. We now have over 1 million cases of COVID-19, and 2. We now have more Americans dead from COVID-19 than the number of names on the somber black granite Vietnam War Memorial on the Mall in DC. We’re number one.
  10. Leonard Pitts’ article, I Will Not Die of Stupid is a must-read. And if you like parodies, click here.

Like I said: Decide for yourself what you should do.

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Ed. note: We need to spread the word so that we make a critical difference, so

    1. Pass this along to three people, encouraging them to subscribe (IT’S A FREEBIE!).
    2. Engage in the Comments section below to help us all to be better informed.

Thanks!

The Fine Print:

    1. Writings quoted or linked from my posts reflect a point I want to make, at least in part. That does not mean that I endorse or agree with everything in such writings, so don’t bug me about it.
    2. Sometimes I change my opinions because I’ve learned more about an issue. So, educate me. That’s what the Comments section is for.
    3. Errors in fact, grammar, spelling and punctuation are all embarrassingly mine. Glad to have your corrections. Refreshing when someone wants to get the facts right, eh?
    4. Responsibility for the content of these posts is unequivocally, totally, unavoidably mine.

JA

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Copyright 2024 by Jack Altschuler
Reproduction and sharing are encouraged, providing proper attribution is given.

The Damned Idiot In November


Reading time – 3:34  .  .  .

Trump isn’t an idiot for all the stupid, vacuous drivel he spouts. He’s a damned idiot because he refuses to know truth and act properly to save lives, reduce suffering, protect our nation, honor our values and all the rest.

Cases in point:

  • – The damned idiot dissolved the team of people who were a standing resource to our nation expressly because a pandemic might visit us again, like the Spanish flu and Ebola. President Obama set that up because he wanted to be sure we would be ready. Not so the damned idiot.

– The damned idiot closed his eyes and closed his ears to the warnings of a coming pandemic that were put before him at least as far back as early January.^ But he didn’t close his mouth. That’s when he called the looming pandemic a hoax perpetrated by the Democrats (check here for how hoax-y it isn’t) and he blamed the Chinese and had public tantrums about “fake news.” The epidemiologists and scientists were urging action and were themselves ready for the fight. Not so the damned idiot.

– When state governors were taking actions that he should be taking and they were asking him to do things only a President could set in motion to help our hospital workers and all the American people, he had a swift response. He declared himself to be a “wartime president,” then did next to nothing for over a week and taunted the governors, calling them stupid playground bully names. Plus, he childishly refused to communicate with governors he thought had been critical of him, this as people were dying. Others were taking action. Not so the damned idiot.*

– Trump was told about the pitiful ready condition of our hospitals to deal with a true pandemic and the health needs of the American people. We all knew most hospitals were scrambling to supplement their woefully thin supply of critical needs materials. They and we were acting on that. Not so the damned idiot.

  • – On March 24 Trump declared that quarantines should be lifted and everyone should go back to normal activities by Easter (April 12). He urged that the churches be packed on Easter Sunday, implying that social distancing should end. He made no consideration for COVID-19 infection spread, were we to follow his direction. His interest, as always, was about money and the economy, which he needs to be strong in order to be re-elected. After all, everything is all about promoting Trump. Others were focused on the terrible plight of so many sick and at-risk Americans. Not so the damned idiot.**

Trump listens to nobody. After all, he knows better than everyone about everything – just ask him. So, I have nothing for him, but I do have something for those who on Easter would follow this Pied Piper of Destruction, this damned idiot.

Ode to a MAGA Hat Wearer

I’m sure you’re nice and kind and good, as these things often go.

I bet you do those kindness acts for random lifts of woe.

You touch the folks in need and give to causes that are dear,

A bedrock solid citizen, we’re lucky that you’re here.

 

The President says Easter is the time that we go back

To resurrect our markets like the virus has gone slack.

But if you follow Trump’s advice to how we used to be,

Do anything you want, but keep the f##k away from me.

Click the pic for the story

When people are afraid, especially in a crisis, the natural thing to do is to look for and follow a leader because it gives us at least a little sense of safety, however illusory that might be. A lot of analytical thinking goes out the window in such circumstances and that’s what millions of Americans are doing right now. They’re giving Trump unusually high marks, and that’s not just the Republicans, but also some independents and even some Democrats.

If this virus is subdued by election day, even if only temporarily, Trump will take credit, proclaim himself a hero – only he could have done such wondrous things! – and we will be in terrible danger of him being reelected by a public refusing to know the truth, like what’s laid out in this post about this damned idiot. If the economy has rebounded a bit by then, the same dynamic will be at work.

We better start thinking right now about how we’ll deal with that, because if we wait until this fall, it will be way too late to stop this damned idiot.***

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Offered by reader MG, a quote from author Louis L’Amour:

“No man has the right to be ignorant. In a country like this, ignorance is a crime.”

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For readers in the Chicago North Shore area: Here’s a link to how you can help the NorthShore University HealthSystem professionals in their work to care for COVID-19 patients and others in this time of peril and avoid their becoming ill themselves. If you live elsewhere, find your local hospital online and extend a hand. This is urgent. Do it now.

^ Years of NSA simulations had warned not only that pandemics would arrive on our shores, but that we were woefully unprepared to deal with them. Trump made that worse by under-funding everything that would be mandatory to fight such disease. Read The Trump Administration’s Botched Coronavirus Response, Explained,  We Were Warned and Before Virus Outbreak, a Cascade of Warnings Went Unheeded and you’ll understand.

*For more, read Sheila Markin’s report on our “wartime president.” She rightly points out that Trump is not responsible for this pandemic. I will add that this damned idiot most certainly is responsible for allowing it to become far worse than it would have been had he acted early and decisively, as the epidemiologists and pandemic experts had counseled. He didn’t, which makes him culpable for many deaths that should not have happened. That’s just a vague claim in this post, of course, but when it’s your granny who dies needlessly, there’s nothing vague about it. And it will be your granny. Indeed, you may be that granny.

**The Black Plague wiped out a quarter of the population of Europe, but the area on either side of the Pyrenees, the greater Milan area and Poland were largely spared. The reasons for their relative success: quarantines – “social distancing” – and closed borders. Think about that if you decide to mingle with others on Easter.

***Watch this satire of Trump’s call for the resurrection of the economy on Easter. Many thanks to RS for pointing it out.

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Ed. note: We need to spread the word so that we make a critical difference, so

  1. Pass this along to three people, encouraging them to subscribe (IT’S A FREEBIE!).
  2. Engage in the Comments section below to help us all to be better informed.

Thanks!

The Fine Print:

  1. Writings quoted or linked from my posts reflect a point I want to make, at least in part. That does not mean that I endorse or agree with everything in such writings, so don’t bug me about it.
  2. Sometimes I change my opinions because I’ve learned more about an issue. So, educate me. That’s what the Comments section is for.
  3. Errors in fact, grammar, spelling and punctuation are all embarrassingly mine. Glad to have your corrections.
  4. Responsibility for the content of these posts is unequivocally, totally, unavoidably mine.

JA


Copyright 2024 by Jack Altschuler
Reproduction and sharing are encouraged, providing proper attribution is given.

Destiny


Reading time – 2:46  .  .  .

President Trump has not just bungled facts, spewed false happy talk and continued to lie his way through his presidency and this pandemic. He has also made clear that he is not responsible for anything that’s happening if he thinks it might make him look bad.

He told us that he’s not responsible for our total lack of preparedness for COVID-19 or for its reach or for the severity of its impact, this in the face of his having completely disbanded our Pandemic Response Team and cut funding for the CDC in 2018. The people he canned are the very people who made up the very team that could have minimized our suffering due to COVID-19, had they been in place and had they proper funding and authority. Of course, the President would also have had to listen to them, follow their advice and not say stupid stuff. There was never much of a chance of any of that happening.

So, here’s a little snark from last Sunday’s post, in case you missed it. It is not offered because of the snark; it is offered because this is our reality.

[youtube=http://www.youtube.com/watch?v=BIjZae-hSiU&w=300]

As Granny struggles in her hospital bed, gasping for just a little more air from her respirator for her pneumonia-soaked lungs, her MAGA hat wearing family is gathered around her. They know this is the end and they weep for their love of her and for their looming loss. Suddenly, the lights go blue-black, the walls begin to shake, and the ceiling speakers boom in Darth Vader’s voice: “It is your des-ti-ny.” And they tremble in their horror and their fear, because all at once they realize that this is what they chose.*

It didn’t have to be this way for Granny, but we made it this way. We made this our destiny.

Last Friday the President bragged about non-existent tests for COVID-19 and about drive-thru testing sites that are nothing but fantasy. He has no plans to enlist the Army Corps of Engineers to transform buildings to meet the enormous hospital capacity we’ll need in just a couple of weeks. There’s no action to re-purpose unused manufacturing capacity to build the ventilators, hospital protective gear or anything else that is already in desperately short supply. The result of this ineptitude is that more people will die for lack of testing and care.

The differentiator that is invisible to Trump is that this isn’t a reality TV show, a make believe land where he can make up stuff and it becomes so, where everyone goes out for drinks after the taping. This isn’t a Hollywood movie where murdered characters get up after doing a scene and go home at the end of the day. This is real life and death and the people who will die from this virus will never go out for drinks or ever go home again because they will stay dead. Worse, more will die because of Trump’s ineptitude and dishonesty, including Granny.

This pandemic is completely over the head of this President and this time it isn’t a little thing like a trillion dollar gift to his rich pals. This time it is life or death for countless Americans. He is incompetent to discharge the duties of his office, including protecting the citizens of this country.

Back to the Star Wars metaphor:

Both Darth Vader and the evil Emperor told Luke Skywalker that joining with them was his destiny. With just the force of his will he refused both of them and that destiny and eventually set things right throughout the galaxy. We can do that. We can refuse the destiny of so many Americans gasping their last breaths due to COVID-19. We can lead our country and the world to set things right.

It’s about our choices as a nation and the consequences our choices bring. We can make our own des-ti-ny. That’s always been the American way.

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Finally, the people of Italy are just ahead of us in dealing with this killer disease. Here is a video message from them that you’re sure to want to watch .

Second finally, Mike Pence proudly claimed on Monday that we have a million COVID-19 test kits out right now. Great – perhaps that’s true. Only 319 million to go.

Really finally, it’s St. Patrick’s Day. Large gatherings are prohibited, so drink a Guinness in your kitchen and be your own parade.

* The legal thing: The Empire Strikes Back (from which this clip is taken) and all other movies are copyrighted material. I pay royalties to be allowed to use movie clips legally both here and in my leadership keynotes and workshops. Just thought you might like to know.

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Ed. note: We need to spread the word so that we make a critical difference, so

  1. Pass this along to three people, encouraging them to subscribe (IT’S A FREEBIE!).
  2. Engage in the Comments section below to help us all to be better informed.

Thanks!

The Fine Print:

  1. Writings quoted or linked from my posts reflect a point I want to make, at least in part. That does not mean that I endorse or agree with everything in such writings, so don’t bug me about it.
  2. Sometimes I change my opinions because I’ve learned more about an issue. So, educate me. That’s what the Comments section is for.
  3. Errors in fact, grammar, spelling and punctuation are all embarrassingly mine. Glad to have your corrections.
  4. Responsibility for the content of these posts is unequivocally, totally, unavoidably mine.

JA


Copyright 2024 by Jack Altschuler
Reproduction and sharing are encouraged, providing proper attribution is given.

Consequences


Reading time – 3:55  .  .  .

Caution: There’s just a little bit of snark at the very end. Please practice safe snark.

We’re still in the early stages of the COVID-19 pandemic, although if they were able to speak for themselves the over 5,800 people who have died of the illness might describe this stage a bit differently. Nevertheless, all healthcare professionals have made it clear that this is going to get far worse before it gets better. What you need to know is where we are and how we got here. That will be instructive for knowing where we must go.

To become clear about where we are with this disease you can view a regularly updated global tracker at the Johns Hopkins CSSE site. The acceleration of the numbers is most alarming, as we’re seeing a doubling of cases every six days. Click here for a most useful analogy that explains that.

As for how we got here, start with this: we knew about this virus as far back as December 2019 – a quarter of a year ago. The epidemiologists were clear at that time that this was going to be a very big problem and advised immediate preparation; however, their cautionary recommendations were ignored. Perhaps as bad, had we taken their advice, there would have been a huge obstacle to overcome in order for anything helpful to happen. Here’s why.

President Donald Trump fired the U.S. Pandemic Response Team in 2018, calling it a cost cutting measure. I don’t buy it.

The Pandemic Response Team had been instituted by President Obama following the successful battle against the Ebola virus in 2014. It included sub-teams at the CDC, the Defense Department and at the National Security Agency so that we would be ready in all those areas when – not if – the next pandemic arrived. Based on so many other episodes of Trump, in his boundless insecurity, deleting Obama’s programs regardless of their value to the nation, my belief about his motivation to disband this critical unit is that it was yet another effort to erase everything bearing Obama’s name.*

Regardless, the professionals were removed. Those firings left us with no immediate expertise or mechanisms to deal with a new pandemic. None. And Trump accepts no responsibility for that. Further, “Trump also cut [overall] funding for the CDC, forcing the CDC to cancel its efforts to help countries prevent infectious-disease threats from becoming epidemics .  .  .  Among the countries abandoned? China.”

COVID-19 was first identified in Wuhan City, China. Had we helped to mitigate its spread then, world conditions might be far better right now.

This story gets worse, as you know, because we still don’t have one tenth of one percent of the testing capability we need. The CDC’s kit was fouled by a bad reagent, making it essentially useless. Our commercial labs are still ramping up and we haven’t sourced test kits from abroad. The resources we do have are not just insufficient in quantity, but are also slow and cumbersome. There are other proven options ready to go now, including a machine made in Germany that can produce accurate results in 1 hour instead of 4 hours or even a day or two. However, the FDA is bumbling through authorization to use these machines. Here’s a link to a full report on how this COVID-19 testing ineptitude happened.

The truth is that we don’t know how many people in America have the virus because we are unable to test any but extreme cases due to our lack of test kits. That’s an impediment to our knowing who needs to be quarantined so they don’t infect others, where the virus is spreading, the extent of its impact, where to deploy resources like ventilators, protective gear for hospital staff, oxygen generation equipment, surgical masks and so much more.

During Trump’s Oval Office talk on March 11 he told us, “Testing and testing capabilities are expanding rapidly, day by day. We are moving very quickly.” None of that was true. That is a key problem, not just because of our inability to know what’s going on, but because as Trump continues to spew happy talk and magical thinking, he isn’t firmly addressing our very real challenges or providing the leadership we need. Almost as bad, he contradicts the experts who, unlike Trump, are knowledgeable. That leaves all the rest of us not knowing what to believe. That’s a potent way to spread fear.

In my day job I deliver keynotes and workshops on great leadership and I know when I don’t see it.

The point of all of this is not to pen yet another diatribe about our incompetent President. Rather, it is to illustrate how we got to where we are. We must be clear about what can happen when we aren’t careful in our political choices, because this pandemic, which could have been minimized, is in the process of killing hundreds, thousands or even millions of Americans who could have been protected had we been prepared.

Elections do have consequences and what’s happening right now is one of them.

It didn’t have to be this way.**

Links to Resources

There is a cost to getting people tested and to help those who need treatment. Watch the entire clip – ALL THE WAY TO THE END – of Rep. Katie Porter (D-CA) making sure we’ll get what we’ll need.

Advice For the Public – World Health Organization – WHO

Nine Charts that Explain the Corona Virus Pandemic – Vox

CoronaVIrus (COVID-2019) – What You Should Know – Centers for Disease Control and Prevention (CDC)

Download and read this. It is a PDF format of an email received yesterday from a local shop and contains the comments of four doctors, two of them in Italy. It is long – please read all of it.

Beware of those who poo-poo the threat of COVID-19, claiming far more people die annually from the flu and other terrible things. Every year the flu starts with small numbers; that’s how it was with the terrible Spanish influenza epidemic of 1918; it was the same for Bubonic Plague, which eventually killed 25% of the people in Europe. The disease number comparisons are meaningless until it’s all over. Right now we can’t even see to when this corona virus will be over. Worse, these comparisons can lull people into carelessness. Ignore them.

Fun Facts

We’re already running out of respirators and, as mentioned, the patient load doubles every six days.

It is expected that between 75 – 150 million Americans will contract COVID-19 and 15-20% of those affected will require hospitalization. That’s between 11,250,000 and 30,000,000 hospital patients, nearly all of whom will need to stay a while. Those numbers don’t include patients suffering from other maladies requiring hospitalization.

There are 924,107 staffed hospital beds in the U.S.

Do the math.

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Finally, stay well and don’t do medically foolish stuff. Help your family, friends and neighbors, the old lady across the street – and do it carefully. We’re all in this together. Because Hillary Clinton was right: It takes a village. And we are that village.

  • *President Trump has repeatedly insisted that he’s not to blame for our medically threatening conditions. His having disbanded the Pandemic Response Team puts the lie to his words.
  • ** “This way” – As Granny struggles in her hospital bed, gasping for just a little more air from her respirator for her pneumonia-soaked lungs, her MAGA hat wearing family is gathered around her. They know this is the end and they weep for their love of her and for their looming loss. Then the walls shake, as the ceiling speakers boom in Darth Vader’s voice: “It is your des-ti-ny.” And they tremble in their horror and their fear, because all at once they realize that this is what they chose.

————————————


Ed. note: We need to spread the word so that we make a critical difference, so

  1. Pass this along to three people, encouraging them to subscribe (IT’S A FREEBIE!).
  2. Engage in the Comments section below to help us all to be better informed.

Thanks!

The Fine Print:

  1. Writings quoted or linked from my posts reflect a point I want to make, at least in part. That does not mean that I endorse or agree with everything in such writings, so don’t bug me about it.
  2. Sometimes I change my opinions because I’ve learned more about an issue. So, educate me. That’s what the Comments section is for.
  3. Errors in fact, grammar, spelling and punctuation are all embarrassingly mine. Glad to have your corrections.
  4. Responsibility for the content of these posts is unequivocally, totally, unavoidably mine.

JA


Copyright 2024 by Jack Altschuler
Reproduction and sharing are encouraged, providing proper attribution is given.

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