關於 but oxford ，我們在網路上蒐集到這些相關的討論、資訊與評價

อ้อลืมไป เรื่อง herd immunity หรือภูมิคุ้มกันหมู่ ตปท เลิกคุยกันแล้วนะครับ
ตั้งแต่ตอนที่ cdc ออกมาเผยข้อมูลว่า โควิดสายพันธ์เดลต้า ค่าr0 = 8 เท่าอีสุกอีใส
เพราะถ้าอัตราการแพร่ระบาดแม่งเว่อรวังขนาดนี้ ไอ้ที่เราเคยประเมินว่า
ถ้าฉีดวัคซีนถึง 70-80% ของประชากร จะมีภูมิคุ้มกันหมู่ และหยุดการแพร่ระบาดได้นั้น
พอค่า r0 แม่งพุ่งขึ้นไปขนาดนี้ %ของประชากรที่ต้องฉีดวัคซีนในระดับที่ต้องการ
คือ 95% ซึ่งเป็นไปไม่ได้ในทางปฎิบัติ พูดง่ายๆคือ ไม่มีทางหยุดมันได้แล้ว แต่ฉีดวัคซีนเพื่อป้องกันคนให้รอดตายยังเป็นไปได้

อันนีเให้ข้อมูลโดยนักวิจัยของออกฟอร์ดครับ

https://www.theguardian.com/world/2021/aug/10/delta-variant-renders-herd-immunity-from-covid-mythical

I wish I had studied at Oxford! But Hello Sunny Li this picture of me you are using without my permission are taken in Sardinia ya!

My all Dear friends , please help me to report her!🙏🙏🙏

Below is the Sunny Li link:
https://www.facebook.com/profile.php?id=100068226471507

上次同大家分享COVID現有的不同治療方案

今日跟大家分享下當一個國家COVID爆發時需要大量接種COVID疫苗時面對的困難和難題

***以下內容只作分享用途，所有臨床診斷的考慮請跟隨個別醫院指引***

首先講講全球最常見較為有效而又打了很多劑的疫苗

Adenovirus vector: AZ and J&J

mRNA: Pfizer-BNT and Moderna

至於另一款疫苗如Novavax或台灣高端由於打的人數不多，就沒有太多數據分享

第一件事要認清的是，由於Delta的出現，疫苗並非神藥，以往大家期望的群體免疫在original或alpha上可能可以達到，但在delta蔓延的今日，似乎有難度。

根據大名鼎鼎的NEJM的研究，兩劑AZ對symptomatic infection的保護率大約為67%、而Pfizer-BNT的保護率大約為88%。不過可惜的是同時間有一些研究，例如牛津大學研究發現當接種疫苗過一段時間後，保護力會漸減，BNT尤其受到時間的影響。

另外，初步數據顯示針對delta，疫苗並不能像alpha或original一樣大幅減少打完疫苗的人的病毒含量。打了疫苗的人的病毒含量跟沒打的相當接近，不過疫苗對防止出現病徵和重症或死亡非常有效，只耐何疫苗來得太遲，delta搶先在世上出現。同時初步數據顯示Delta似乎較alpha/original更大機會出現重症和住院的機會，尤其於年輕人身上，不過這需要更多數據支持。

這代表面對惡名昭彰的Delta，我們不能再依靠打疫苗去保護他人，因為疫苗並不能夠阻止delta asymptomatic transmission。當打完疫苗後的病毒量一樣高時，唯一可以做的便是靠打疫苗保護自己，減低自己感染、住院、重症和死亡風險。

不過當大量接種疫苗時，便會出現一些罕有的副作用，這些副作用醫護人員必須Alert的，而處理這些懷疑的副作用亦對醫療系統造成沉重的負擔。但目前所有大型研究都顯示，疫苗副作用造成對醫療系統的負擔跟任由COVID爆發的社會和醫療成本相比是兩個不同級數的事。

================================
VITTS - Vaccine-induced immune thrombosis thrombocytopenic syndrome

在adenovirus vector的疫苗身上被發現罕有地會出現這種病症。初步數據是懷疑因為出現platelet factor 4 (PF-4) antibodies，原理跟HITTS (Heparin Induced thrombotic thrombocytopenic syndrome)類似。

VITTS多數會出現Cerebral Venous Sinus或Splanchnic thrombosis，但亦可在一般常見的血栓位置，例如DVT or PE but much less likely

一般臨床上可能會出現劇烈頭痛/腹痛/成因不明的瘀血（Petechiae）等等，較常於第一劑的4-42日內出現，亦較常見於年輕女性身上 機率視乎人種和年齡和研究的地方，歐洲數據為約0.00034%的機會出現。同時驗血報告中亦會發現血小板偏低和D-dimer偏高以及positive anti-PF4。

不過值得注意的是即使病發初期血小板和d-dimer正常都不一定沒有VITTS，個別個案可以於24-48小時後才出現這些features，視乎clinical suspicion, serial review and FBC might be indicated

================================
心肌炎及心包炎Myocarditis and pericarditis

在mRNA疫苗身上發現的已知罕有副作用，常見炎第二針後的年輕男性（30歲以下）身上，大多於接種第二針後第1-5日後出現，多以心口痛、心悸、暈厥（Syncope）、呼呼短促（SOB）等呈現，病發機率視乎人種、年齡和性別，美國數據為Myocarditis/Pericarditis - 12.6/million = 0.000126% (American Heart Association)

成因未完全了解，但似乎跟免疫系統激活的過程有關（詳情refer AHA report）。大部分患者病情相對輕微，個別患者可能有ECG dynamic changes, ST elevation, troponin rise, mild reduced LvEF on echo，但大部分患者都在短期內出院with full recovery （96% as per AHA）

值得注意的是，myocarditis在歷史上的其他疫苗例如流感、乙肝、天花（small pox）等等都有罕有的機會出現，約10-20 individual/100000 per year

同時感染COVID或其他病毒性感染的話亦可能會出現myocarditis，臨床懷疑的話或需要ECG, troponin, CXR, +/- echo +/- cardiac MRI
=================================
任何醫療選擇都有風險，當一個國家進行社區大型接種時，便需要處理這些問題，英美兩大國的經驗其實為世人提供了好多寶貴實用的資訊，好讓大家不用走冤枉路。

隨著時間的過去，愈來愈多數據和研究讓大家自行分析，多讀書多看研究才不會被任何人誤導，緊記保持批判性思考，無論任何人的高見都別不經消化和思考去接受。

Reference for further reading
1. ATAGI statement ATAGI statement regarding COVID-19 vaccines in the setting of transmission of the Delta variant of concern
https://www.health.gov.au/news/atagi-statement-regarding-covid-19-vaccines-in-the-setting-of-transmission-of-the-delta-variant-of-concern

2. NEJM - Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant
https://www.nejm.org/doi/full/10.1056/NEJMoa2108891

3. Oxford University Studies Preprint - Vaccines still effective against Delta variant of concern, says Oxford-led study of the COVID-19 Infections Survey
https://www.ox.ac.uk/news/2021-08-19-vaccines-still-effective-against-delta-variant-concern-says-oxford-led-study-covid

4. AHA - Myocarditis With COVID-19 mRNA Vaccines
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056135

Photo: internet

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Instagram: http://instagram.danlok.link
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This video is about Dan Peña's Hardcore Seminar
https://youtu.be/HBeS9NaZS8o
https://youtu.be/HBeS9NaZS8o

Hey guys.,

Hope you guys enjoy this video. Been collecting a couple high street items here and there and thought id share them all as well as sharing how i'd style the items. Sorry there is a really annoying drilling noise in the background, i didn't address is in the video in case some people may have not noticed it until i say something. To be honest, i would have waited for the construction to stop but 1. living in London means theres ALWAYS noise, but 2. i got so used to it, i didn't hear it when i was filming! I only noticed when i was editing. Anyway, i hope the music helped it a bit :)

Thanks again for watching, below are links to the outfits i've shared.

Outfit 1:
& Other Stories "Paris" top: https://goo.gl/QFy2dt
& other stories hair accessory: https://goo.gl/cUVzQ7

Outfit 2:
Asos Simpsons top: Unfortunately out of stock but search for "The Simpsons X Asos Design" on Asos for other options
Good American Jeans
Fendi boots: https://goo.gl/kfm1Tj
Chanel purse

Outfit 3:
Asos (Pretty Little Thing) bike/legging shorts: https://goo.gl/by3pPb
Brandy Melville top

Outfit 4:
Zara multicolor pleated dress: https://goo.gl/ChHP2m
Chanel purse and mules

Outfit 5:
Zara leopard print playsuit: https://goo.gl/VL1RLF
Louis Vuitton Gilet: Unfortunately, i can't find it online, here is another option though- i have this one as well which would work, however, i prefer the suede gilet for this time of year: https://goo.gl/rEkktc
Saint Laurent boots

Outfit 6:
Zara white skirt: https://goo.gl/7cjKWj
Top shop white top: Unfortunately a lot of the Top Shop things i've bought recently aren't online (yet?)... there were plenty in stock when i last went to the one of Oxford Circus within the last 2 weeks.
Chanel purse from Vestiaire

Zara leopard coat: https://goo.gl/rW39H6

Outfit 7:
Zara white skirt: https://goo.gl/7cjKWj
Top shop white top: Unfortunately a lot of the Top Shop things i've bought recently aren't online (yet?)... there were plenty in stock when i last went to the one of Oxford Circus within the last 2 weeks.
Chanel purse from Vestiaire
Dior boots

Outfit 8:
Top shop Gold suit: Unfortunately a lot of the Top Shop things i've bought recently aren't online (yet?)... there were plenty in stock when i last went to the one of Oxford Circus within the last 2 weeks.
Fendi purse
Chanel flats

Outfit 9:
Top shop blue faux fur jacket: https://goo.gl/vpcLQq
Asos (Pretty Little Thing) bike/legging shorts: https://goo.gl/by3pPb
Brandy Melville top
Chanel purse

Outfit 10:
Top shop red coat: Top shop Gold suit: Unfortunately a lot of the Top Shop things i've bought recently aren't online (yet?)... there were plenty in stock when i last went to the one of Oxford Circus within the last 2 weeks.
Louis Vuitton purse
Dior boots

✩ DISCOUNT VOUCHER → https://bit.ly/2Ahg7oc
Please download this file to redeem your discount voucher from the Tourist Information once you have arrived in Bicester Village.

✩ SHOPPING EXPRESS DISCOUNTS:
Promo Code → BVTHAILAND
Booking → https://bit.ly/2Olf0XH

✩ THAI VERSION: coming soon

✩ ABOUT BICESTER VILLAGE:
#BicesterVillage offers goods from some of the most internationally recognised brands with attractive discounted prices. They are located near Oxford, and a train ride away from London, UK.

From 1st Oct 2018, there will be updates regarding the London hotels pickup locations as follow:
09.15 Golden Tours Office, Fountain Square, Victoria
09.35 Cumberland Hotel, Great Cumberland Place, Marble Arch
10.00 Hilton Kensington Hotel, Holland Park Avenue

This video is the first video of #TheLondonSeries.

✩ Similar Videos:
WERTHEIM VILLAGE (Germany) → https://youtu.be/p440DvHTPjg
PARIS HAUL (France) → https://youtu.be/MmjrbwA5wFI

✩ About Me:
My name is Pamme Lim. I'm still deciding my area of expertise to be worth sharing on YouTube, but for now, I often create videos about travel and beauty. More lifestyle videos are definitely on my to-do list. Stay subscribe if this sounds like your cup of tea: http://youtube.com/pammelim

✩ Follow me on my social media:
My Blog → https://pammelim.com
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Food Instagram → https://instagram.com/foodloverbk

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E-mail → pammelim7@gmail.com

✩ Music → In My Dreams by Lakey Inspired
https://soundcloud.com/lakeyinspired