BC EDUCATION
Saved by @SteveeRogerr

I held back from commenting overnight to chew it over, but I am still saddened by comments during a presentation I attended yesterday by Prof @trishgreenhalgh & @CIHR_IMHA.

The topic was “LongCovid, Myalgic Encephalomyelitis & More”.
I quote from memory.
1/n
#MECFS #LongCovid

 The bulk of Prof @Trishgreenhalgh’s presentation was on the importance of recognising LongCovid patient’s symptoms, and pathways for patients which recognised their condition as real. So far so good.

She was asked about “Post Exertional Malaise”... 2/n
PEM has been reported by many patients, and is the hallmark symptom of ME/CFS, leading many to query whether LongCovid and ME/CFS are similar or have overlapping mechanisms.

@Trishgreenhalgh acknowledged the new @NiceComms advice for LongCovid was planned to complement... 3/n
the ME/CFS guidelines, acknowledging some similarities.

Then it all went wrong.
@TrishGreenhalgh noted the changes to the @NiceComms guidance for ME/CFS, removing support for Graded Exercise Therapy / Cognitive Behavioural Therapy. She noted there is a big debate about this. 4/n
That is correct: The BMJ published Prof Lynne Turner Stokes’ column criticising the change (Prof Turner-Stokes is a key proponent of GET/CBT, and I suspect is known to Prof @TrishGreenhalgh).

https://t.co/0enH8TFPoe

However Prof Greenhalgh then went off-piste.

5/n
Prof Greenhalgh avoided acknowledging significant objective issues with the science underpinning GET/CBT: unblinded trials, subjective outcomes, and candidates not meeting current ME/CFS criteria (few/any trials required Post Exertional Malaise (PEM) to include in the trial).
6/n
Instead, @TrishGreenhalgh blamed the change in @Nicecomms guidelines on “aggressive” (I quote from memory) patient groups. She then identified a well-known friend of hers who did GET, and found it helpful.

Aside from ethical issues of naming patients, this is an n=1 case.

7/n
If I told my GP “my mate got better by doing X” I would be laughed out of the surgery. Why is that being presented as “evidence” to a @CIHR_IMHA audience?

Furthermore, @TrishGreenhalgh failed to mention Prof Jonathan Edwards’ (not on twitter) Expert Testimony.

8/n
Prof Edwards went in to detail on the issues with the GET/CBT trials as part of @NiceComms’ review.

His testimony can be found here:
https://t.co/qLhsBJ4Bcu

9/n
In blaming “aggressive patients” for the change, Prof Greenhalgh took fire not on the science, nor an academic equal, but on patients who, like LongCovid sufferers, probably just want to be acknowledged and recover.

I find this ill-befitting of an academic of her standing.
10/n
She is respected. She has a big platform, to use it to support non-science (n=1 cases) and blame patients is awful, and deserves criticism.

It puts her view in the field of politics not medicine.

That opens her to political-style criticism, which would be a shame.
11/n
There are other medics who have done that, and have become infamous for their poor pronouncements. I hope that @TrishGreenHalgh will not go the same way.

We must play the ball, not the player.

12/n
As for ME/CFS patients? Well, who needs research when they get better with graded exercise, right?

Perhaps that is why, between 2015-2016 only £5m / year was spent on researching the condition.

Or aproximatly £0.35p per person, per year. Ouch.

https://t.co/TUPEiSCLZq

13/n
As to “aggressive patients”, I do not know their story, but perhaps LongCovid and Endometriosis sufferers will sympathise with the pain of being dismissed?
It really hurts.

And how ‘aggressive’ were these patients? Is this tweet aggressive? Will I be blocked and blamed?

14/n
Why do I care?
I have a fatiguing gut condition and was mis-diagnosed with ME/CFS 4 years ago. I walked 6Km / day.

A specialist ‘undiagnosed’ me as I did not have PEM.

But in 2005, could I have been eligible for a GET study, and might have felt better after exercise.

15/n
I am not alone. A friend was diagnosed with #MECFS for a decade. It turned out she had Cushings.

She likes to go for walks, and exercises when she can. Had she taken up the offer to participate in a trial, she may have improved too.

16/n
Both would have erroneously supported GET & CBT, in spite of not having PEM or ME/CFS.

I also experienced gas-lighting from the 20+ docs who told me it was all in my head. Thankfully I now have much better medical support, but many struggle.

17/n
As fellow humans, we should support the sick.

The condition needs research, and that starts with belief, and develops with high-quality, objective science.

END/
@bendymarsh, @benh_mecfs grateful for your thoughts.
Addendum: Well, I have been blocked, and comments have been made.

I am actually a big supporter of Prof Greenhalgh’s work. Masks are good. So is good patient care.

I have no malicious intent, but it is right to challenge bad pronouncements on this issue.
In my comment I have tried hard to avoid Ad Hominem or malice. Challenge is not malice.

If you think I have got it wrong, please let me know.

Please challenge misinformation about on ME/CFS, but accept that even great people make mistakes. Forgive.
People have a right to reply. She didn't reply to me, but this is her recollection of the discussion. I hope including it makes this thread more balanced.

More from Education

Newlane University
Newlane University
@NewlaneU
Newlane University Manifesto--12 tenets: 1. Education should be available and accessible to every person on earth; making quality education inaccessible or exclusive is immoral. Education belongs in the same category as shelter, clean water, and basic food.

2. Education should be disconnected from geography. Students should be able to learn anything from anywhere on earth. With few exceptions, tying education to geography is a form of exclusion.

3. Education should be disconnected from a schedule. The most effective time to learn something is when the student is ready, not when the teacher or institution is available.

4. Education should not be admission- or permission-based, but freely available upon the asking. The current admission-based system is a vestige of a scarcity model that could only fit a limited number of seats in a classroom.

(4 continued) No one should have to be admitted or ask permission to learn a subject.
EDUCATION
Dominik Mertz
Dominik Mertz
@DocDominik
Time for some thoughts on schools given the revised SickKids document and the fact that ON decided to leave most schools closed. ON is not the only jurisdiction to do so, but important to note that many jurisdictions would not have done so -even with higher incidence rates.


As outlined in the tweet by @NishaOttawa yesterday, the situation is complex, and not a simple right or wrong https://t.co/DO0v3j9wzr. And no one needs to list all the potential risks and downsides of prolonged school closures.


On the other hand: while school closures do not directly protect our most vulnerable in long-term care at all, one cannot deny that any factor potentially increasing community transmission may have an indirect effect on the risk to these institutions, and on healthcare.

The question is: to what extend do schools contribute to transmission, and how to balance this against the risk of prolonged school closures. The leaked data from yesterday shows a mixed picture -schools are neither unicorns (ie COVID free) nor infernos.

Assuming this data is largely correct -while waiting for an official publication of the data, it shows first and foremost the known high case numbers at Thorncliff, while other schools had been doing very well -are safe- reiterating the impact of socioeconomics on the COVID risk.
EDUCATION
Advertisement
Product School
Product School
@productschool
Our top 15 tweets

A #prodmgmt thread 👇

https://t.co/Yv854Sd3P3


https://t.co/sXaMH1bZ9m


https://t.co/5X7bOTsS7m


https://t.co/w1y6LTtPS2
EDUCATION
Rob Sansom
Rob Sansom
@Sansom_Rob
Many of us are about to begin a new semester of online teaching. The learning curve for moving my lecture units last semester was STEEP, so I compiled some sort of hand over notes to people approaching this for the first time. I hope it's useful for someone somewhere.

Reduction in the amount of content was important. What used to be 2 x 1 hr in-person lectures/week had to be condensed down into 6 x 10 minute prerecorded videos (aka aynchronounous content) with 1 x hr live zoom session (synchronous). Even that was too much.

For the sake of yourself and your students, SLASH. Slash your content down. This doesn't mean having to lose important stuff, but keeping it short and sweet.

10 minute video chunks was just about short enough to hold attention. Have you tried watching an online lecture? It is HARD to maintain focus. The shorter the better.

Importantly, each 10 minute video had an explicit Intended Learning Objective given at the end and in the associated text, so that everyone knew what the point was (and how this might relate to assessment later).
EDUCATION
Andrew Lee
Andrew Lee
@andrewleedr
Normally I enjoy the high standards of journalism in @guardian . Not today as disappointed with misleading headline that suggest infections are spreading fastest in children. It'll worry parents/teachers & I doubt most readers will unpick the

The latest REACT1 report shows prevalence of infection in ALL age groups has fallen, including children aged 5-12 from 1.59% in Round 8 to 0.86% in Round 9a. The authors of REACT1 report also (wisely) didn't try to interpret the prevalence figures.

If this were a research trial you wouldn't place much weight on the age differences in % prevalence because of the wide confidence intervals, i.e. differences weren't statistically significant.
3/

I've previously tweeted on the challenges (& dangers) of interpreting surveillance data. One would need lots more contextual info to make sense of it & arrive at sound


Undoubtedly some will extrapolate from the prevalence of infection figures in children to other settings i.e. schools based on the headline. I'd advise caution as there is a real risk of over-interpretation through extrapolation of limited data. Association is not causation.
5/
EDUCATION

You May Also Like

KrishnaLeela
KrishnaLeela
@Talesofkrishna
🌿𝑻𝒉𝒆 𝒔𝒕𝒐𝒓𝒚 𝒐𝒇 𝒂 𝑺𝒕𝒂𝒓 : 𝑫𝒉𝒓𝒖𝒗𝒂 & 𝑽𝒊𝒔𝒉𝒏𝒖

Once upon a time there was a Raja named Uttānapāda born of Svayambhuva Manu,1st man on earth.He had 2 beautiful wives - Suniti & Suruchi & two sons were born of them Dhruva & Uttama respectively.
#talesofkrishna https://t.co/E85MTPkF9W


Now Suniti was the daughter of a tribal chief while Suruchi was the daughter of a rich king. Hence Suruchi was always favored the most by Raja while Suniti was ignored. But while Suniti was gentle & kind hearted by nature Suruchi was venomous inside.
#KrishnaLeela


The story is of a time when ideally the eldest son of the king becomes the heir to the throne. Hence the sinhasan of the Raja belonged to Dhruva.This is why Suruchi who was the 2nd wife nourished poison in her heart for Dhruva as she knew her son will never get the throne.


One day when Dhruva was just 5 years old he went on to sit on his father's lap. Suruchi, the jealous queen, got enraged and shoved him away from Raja as she never wanted Raja to shower Dhruva with his fatherly affection.


Dhruva protested questioning his step mother "why can't i sit on my own father's lap?" A furious Suruchi berated him saying "only God can allow him that privilege. Go ask him"
RELIGION
Patrick McKenzie
Patrick McKenzie
@patio11
A thing which I unironically and enthusiastically believe which is unpopular among smart people of my acquaintance: financial engineering has in the recent past and present contributed substantially to human welfare. We should hope to see more of it.

Maybe more geeks need to meet someone who says “My job is teleporting value across time and space.”

Financial engineering is sort of a squishy term. I don’t primarily mean payments infrastructure or financial rails, although both of those involve substantial engineering.

I mean more “We took a thing and performed some alchemy, and now have a new thing.”

Except instead of alchemy it is generally quite a bit of math, a huge amount of contract law and due diligence, often an impressive amount of ops work, and a dusting of technology that web devs would recognize as such.
ALL
Advertisement
Kieran Snyder
Kieran Snyder
@KieranSnyder
1 There's a chasm between an NLP technology that works well in the research lab and something that works for applications that real people use. This was eye-opening when I started my career, and every time I talk to an NLP engineer at @textio, it continues to strike me even now.

2 Research conditions are theoretical and/or idealized. A huge problem for so-called NLP or AI startups with highly credentialed academic founders is that they bring limited knowledge of what it takes to build real products outside the lab.

3 A product is ultimately a thing that people pay for - not just cool technology or user experience. But I’m not even talking about knowledge gaps in go-to-market work. I'm talking purely technical gaps: how you go from science project to performant + delightful user experience.

4 Most commoditized NLP packages solve well-understood problems in standard ways that sacrifice either precision or performance. In a research lab, this is not usually a hard trade-off; in general, no one is using what you make, so performance is less important than precision.

5 In software, when you’re making something for real people to use, these tradeoffs are a big deal. Especially if you’re asking those people to pay for what you’ve made (can’t get away from that pesky GTM thinking). They expect quality, which includes precision AND performance.
MACHINE LEARNING
Ethan \U0001f468\u200d\U0001f3a4
Ethan 👨‍🎤...
@Booligoosh
First update to https://t.co/lDdqjtKTZL since the challenge ended – Medium links!! Go add your Medium profile now 👀📝 (thanks @diannamallen for the suggestion 😁)


Just added Telegram links to https://t.co/lDdqjtKTZL too! Now you can provide a nice easy way for people to message you :)


Less than 1 hour since I started adding stuff to https://t.co/lDdqjtKTZL again, and profile pages are now responsive!!! 🥳 Check it out -> https://t.co/fVkEL4fu0L


Accounts page is now also responsive!! 📱✨


💪 I managed to make the whole site responsive in about an hour. On my roadmap I had it down as 4-5 hours!!! 🤘🤠🤘
MAKERS
Cookie Cyboid
Cookie Cyboid
@CookieCyboid
“Why are Tumblr and Facebook cracking down on sex so much? And why is Facebook in so over zealous about it? It’s all Apples fault!” Etc etc

I can explain all. It is largely the fault of a set of US laws called SESTA and FOSTA.
TECH