Essential reading for intensivists: things you didn't even dream were going on in your ventilated patients' lungs. With credit to @robertpdickson who does some very clever translational work on lungs

Firstly, we are aware of the inherent badness of oxygen. Here is protein content in alevoli after 48 hours of FiO2 95% (i.e. oedema), delightful.
Secondly, all those VAP's we get cross with (can someone silver impregnante the ET tube or something) that we think is just orally communicating flora/immunosuppression? Mais non. High FiO2 all but destroys weakling bacteria, leaving the redox-armoured king, staph aureus, to rule
Unmitigated staph surges and produces a truckload of PAMPs (pathogen associated molecular patterns). Being redoxically armoured, it is fairly happy to thwart oxidative burst from neutrophils attempting to kill them too.
Indeed the lung flora changes prior to the alveolar protein content - like both a canary in the coalmine moment, and then contributing to pathology.
As you'd expect, the usual criminals are involved in whipping up lung injury by the 48 hour mark
So, we have been breeding oxidation resistant pneumonia, brilliant. Does that mean people above a certain FiO2 should get prophylactic antibiotics? I mean, germ free mice don't get the same severity lung injury...
Graphs below: show less alveolar protein/immunoglobulin after 48-72 hours of FiO2 95%, and more nicely retained alveolar histology in germ free mice
On the other hand, as if that wasn't confusing enough, there is also a problem with gut microbiome and lung injury. How upsetting.
The gut microbiome changes later than the lung.
If you do give systemic antibiotics (this study used ceftriaxone and vancomycin all of which we use in ITU in UK) you make things much worse :O
BUT WHY YOU JUST TOLD ME STAPH WAS TAKING OVER AND NEEDED KILLING. Well, when you give these antibiotics you especially get rid of clostridia species in lung and gut. In gut, clostridia provides butyrate for colonocytes. When they don't get butyrate
they start to respire anaerobically, leaving gut lumen oxygen higher, meaning enterobacteriae go whoosh, and take over gut. In lung, staph goes whoosh. And no doubt it's the ceftriaxone resistant version of staph that does.
As a side note, the mechanisms that staph use to resist oxidative damage are the ones we use - superoxide dismutase, thioredoxins, flavins, DNA protection. But we only have this sufficiently available during the DAY and we don't have good anti-ox at NIGHT
which is why bad idea to have big brain bleed full of oxygenated Hb at NIGHT because the heme and the oxygen mess you up, especially badly.
Original paper here https://t.co/za56C6ET0I
As usual, understand less than when I started, about good lung care in ICU.
starting point for circadian difference sub arach https://t.co/VkoLf4teK5
starting point for circadian difference in bleomycin toxicity https://t.co/F16IoZ4jpi

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This is the $1mln question still without an answer: why were these workers cleaning bat guano from that abandoned mine?

Surprisingly we simply don't know.

China would have all interest in clarifying that point if for instance they were prospecting or selling guano. It did not.


What we know is that EcoHealth + WIV were sampling bat sites in the vicinity at the exact time of the workers being in that mine.

#DRASTIC wrote about this and about other oddities in the official story:

Maybe it's just one of these coincidences.

Then it gets interesting: about a year after the miners death, Olival & Epstein from EcoHealth Alliance co-authored a paper about the coronavirus risk infection from bat guano collection.

No mention of the

That paper oddly used some old bat samples collected by DARPA in 2006/7 at the famous Thai bat cave.

It never mentioned that the Thai monks have been doing this every Sunday for many many years without infection.

But most interestingly it never mentioned the Mojiang mine accident, even if the perfect timing and recycling of old DARPA bat samples seem to point to a likely knowledge of it.

Anyway, the idea was to ask for more money, as you correctly

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A THREAD ON @SarangSood

Decoded his way of analysis/logics for everyone to easily understand.

Have covered:
1. Analysis of volatility, how to foresee/signs.
2. Workbook
3. When to sell options
4. Diff category of days
5. How movement of option prices tell us what will happen

1. Keeps following volatility super closely.

Makes 7-8 different strategies to give him a sense of what's going on.

Whichever gives highest profit he trades in.


2. Theta falls when market moves.
Falls where market is headed towards not on our original position.


3. If you're an options seller then sell only when volatility is dropping, there is a high probability of you making the right trade and getting profit as a result

He believes in a market operator, if market mover sells volatility Sarang Sir joins him.


4. Theta decay vs Fall in vega

Sell when Vega is falling rather than for theta decay. You won't be trapped and higher probability of making profit.
I’m torn on how to approach the idea of luck. I’m the first to admit that I am one of the luckiest people on the planet. To be born into a prosperous American family in 1960 with smart parents is to start life on third base. The odds against my very existence are astronomical.


I’ve always felt that the luckiest people I know had a talent for recognizing circumstances, not of their own making, that were conducive to a favorable outcome and their ability to quickly take advantage of them.

In other words, dumb luck was just that, it required no awareness on the person’s part, whereas “smart” luck involved awareness followed by action before the circumstances changed.

So, was I “lucky” to be born when I was—nothing I had any control over—and that I came of age just as huge databases and computers were advancing to the point where I could use those tools to write “What Works on Wall Street?” Absolutely.

Was I lucky to start my stock market investments near the peak of interest rates which allowed me to spend the majority of my adult life in a falling rate environment? Yup.