WARNING: THIS POST CONTAINS INFO LIKELY TO MAKE STEAM COME OUT YOUR EARS
Personally, I don't use but I gotta ask b/as long time SA Counselor & Clinical Neuropsychologist,
What ARE these people so on re weed about? Theres NOTHING abt weed comes anywhere close to t/individual, 1/

@GoadGatsby WARNING: THIS POST CONTAINS INFO LIKELY TO MAKE STEAM COME OUT YOUR EARS
Personally, I don't use but I gotta ask b/as long time SA Counselor & Clinical Neuropsychologist,
What ARE these people so on re weed about? Theres NOTHING abt weed comes anywhere close to t/individual, 1/

relational, marital familial, societal and physical and mental health damage done by alcohol (ism) daily. PERIOD FULL STOP

& Research that was so long denied has found a plethora of bennies.

That's not to say no abuse occurs or is possible, (however, [stick with me here] 2/

I see a variety of WS groups currently abusing [t/great American symbol of home family & motherhood] MILK these days...
Hey, if it's a substance/any substance or something transduced or processes by your chemical brain [neurochemistry baby] use misuse, abuse addiction & 3/

deadly addiction is a thing, A BIG THING including "thought addiction," [we MH profs call this obsession] which seems a likely group DX for folks on the right who are virtually obsessed with weed as if it were Hitler, meanwhile they're tryna convince themselves he had a 4/

rational national plan on repeat. But I digress).
Bottom line: Cannabis Use/Abuse Disorder is far less (note t/word LESS) common, far less damaging both in t/short- & long-term & pop #s for Cannibis Use/Abuse are no where near those of alcoholics & the resulting death maiming 5/

@KEBrightbill Since 1980-90s WS successful ongoing intentional strategy to blend w/fundamentalist W Christian & infiltrate/integrate/take over these spaces; emerging in homeschooling tied to natural CB, attachment style parenting, Le Leche League, Natural child rearing & ecological mov'nts

Theres not a lot 1 can do abt this either. There are SOME divisions but not as many as one might like to think & there are an infinite number of fuzzy boundaries ie., as in vaccinations. This is a highly fluid & often volatile life stage to navigate married or single & 2/

things are muddy as hell (this is an area I've researched tracked, and personally experienced as part of that natural child birth community). Women are isolated by society and thats a problem on both the right and the left. Women are vilified & looked down on when they do 3/

have kids, and are pilloried if they stay home, go to work, if they breastfeed, for how long or not and are essentially cut off from an elder community that might help them navigate the enormous shift in their lives not to mention having to put up with petulant manbaby 4/

husbands who drag them via their own negative ideals, expections, insecurities fears angers hurts at the sudden usurping of their position as number 1 in a womans life when she has a baby, & especially the first baby. BOTH WHITE SUPREMACY AND FUNDAMENTALIST WHITE CHRISTIANITY 5/

@KathyGrants @slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE All the clinical Neuropsychological and forensic testing manuals that match the clinical measures we use...
Then made cheat sheets. (ok geek comment alert) the reason to do this is because if you don't understand the base rates and how they were derived, the populations 1/

@slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE sampled to gain those "norms" and the year in which this was done, your interpretation of testing data will be significantly "off". If you can't assess the accurate diagnosis (meaning you misdiagnose) you end up causing pain and suffering not to mention treatment especially 2/

@slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE if it involves psychopharm (meds)doesn't treat what actually ails the patient. When this happens, at best no one's treated for the actual illness they have which causes undue pain & suffering, at worst symptoms are exacerbated and or meds cause adverse reactions that can 3/

@slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE have lasting effects (more pain and suffering) not to mention totally messing with the outcomes of legal cases
In short an inaccurate Diagnosis totally messed with people's lives.
. ..... So, if I use a measure you can bet Ive read the manual and understand the cautions, and 4/

@slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE when to augment via clinical judgement. That often puts me at odds with folks in terms of opinions but I can back it all up via research and what's written in the manuals which often have caveats re use and application that people miss. More, as I went along it became obvious 5/

“Should I give them more fluid?”

Extremely common question during AKI referrals from junior docs.

⛔️ Fluid management is tricky, often misunderstood, & can cause huge iatrogenic harm ⛔️

We try to convey important principles in THREAD 👇

#tipsfornewdocs #medtwitter #tweetorial

Currently too often patients with high creatinine are given too much IV fluid, driven by an AKI ➡️ fluid reflex

We’ve seen 7 litres be given in one shift.

Medics & surgeons, juniors & seniors, it seems everyone loves to reach for extra IV fluid (especially if urine output poor)

Why does huge volume IV fluid ‘resuscitation’ consistently occur?

Lots of reasons, including FALSE beliefs:
🛑 IV fluid always “treats AKI”
🛑 Hypotension = hypovolaemia
🛑 Lactate >2 means fluid deficiency
🛑 Septic patients are very hypovolaemic

The rule with IV fluids and AKI is to remember this 5 word phrase:

💥 💥 Aim for euvolaemia, then stop💥 💥

Fluid status is like Goldilocks - hypovolaemia is bad for the kidneys BUT excess volume is also harmful for renal function and will cause other complications too.

It is easy to say “target euvolaemia” - but we agree it is more difficult to do!

Fluid status assessment is certainly made harder by a belief that we must only rely on a snapshot assessment of examination features which are NOT specific / sensitive / reliable to elicit like.…

🧵 on Importance of correct indication of colonoscopic surveillance studies (English 🇺🇸🇬🇧)
@KM_Pawlak @KMonkemuller @drkeithsiau @JacquelineChuMD @PerelmansPearls @stevenbollipo @SWexner @DrBloodandGuts @ebtapper @DCharabaty @RashidLui @AdvaniRashmiMD @AtoosaRabiee @DrMohdZein

@GI_Guy @RodriguezParra_ @DrHarryThomas @TennysonMD @AustinChiangMD @KralJan @thomaskroner @alinkmd #GITwitter

1/ The implementation of screening and surveillance programs can reduce the incidence and mortality of

2 / But for these to be effective and to guarantee protection against CCR, they must meet a series of conditions. One of them is the correct indication for endoscopic studies for both screening and surveillance.

3 / According to a recent meta-analysis, the minority of patients who undergo colonoscopies have a correct indication, with less than 50% adherence to the surveillance intervals proposed by scientific

The importance of T-cell immunity!
A recent study has found that after one dose of Pfizer’s vaccine, patients had a strong T-cell response, and a boosted antibody response after their second dose. This is good news for many reasons so let’s read up.

This study found that people’s antibodies were moderately effective against the original strain after their first dose of Pfizer’s vaccine, less effective against the B.1.1.7 variant, and were unable to neutralize the B.1.351 variant. Read what I said, that’s only after ONE dose.

However, they had strong T-cell responses against ALL known variants after the first dose. So why is this important? To recap, T-cells stimulate B-cells to make antibodies. Antibodies are just your first line of defense which is what is initiated when you get a vaccine.

It’s our T-cells that are responsible for long-term immunity. When antibodies diminish after your initial inoculation, your T-cells-will tell your B-cells it’s time to produce more antibodies. As long as your T-cells still recognize this virus and inform your B-cells they need

to produce antibodies, the vaccine is still doing its job. Your antibodies will get built up over and over again. Just FYI your TCRs and your BCRs target different parts of the Coronavirus’ spike protein. Antibodies can prevent infection, your T cell-responses ensure that those

I do want to talk a bit about connections, conflicts and information during a pandemic. Since @fordnation insinuated I have COI which I don't, let's take a look at a single instance where @fordnation and Hospital for Sick Children are both making interesting decisions.

Both share a powerful supporter in Peter Gilgan, who has been a great supporter of Sickkids

But his company, Mattamy Homes, has also substantially bankrolled Ontario Proud, which I have reason to believe pushed the Postmedia hit on my reputation.

Sickkids and Mattamy have very close ties. Here is Mary Federau, a longtime Sickkids exec who has moved to Mattamy but remains involved with the Sickkids foundation:

Mary's bio is too modest. It looks as though it has been scrubbed a bit over the last 72 hours. Here's the google cache from Jan 25: