UAMS has taken the extraordinary step of asking leadership across our health system to refrain from traveling over the coming holidays and report to work or be available if needed. Other hospitals in our state are considering similar measures.

(1)

Although the health care system in the state of Arkansas is stressed right now, it is holding up, and additional surge capacity exists. But that capacity is not infinite.  Every day, we become more and more concerned about our ability to manage what lies ahead.

(2)

As health professionals, we are doing all we can. However, one thing is certain. We can’t meet this challenge unless you are with us. As Secretary Jose Romero of the AR Dept. of Health has said, we are in the midst of a “surge within a surge” in this COVID-19 pandemic.

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Right now, the @UAMS_COPH COVID-19 forecasts, which have been strikingly accurate so far, indicate that the density of COVID-19 infections exceeds each of our abilities—yours & mine -- to avoid contact with actively infected individuals in our state...

(4)

...whenever we venture outside our homes. They predict an exponential increase in coronavirus deaths in the next two weeks, more than we saw in the first four months of the pandemic. We may soon exceed the number of beds, ventilators, & most importantly...

(5)

APL Apollo conducted their earnings con-call today at 2:00 pm

"Vision of capacity of 4 Million Tone till 2025"

@hiddengemsindia @gvkreddi

Here are the key highlights 😀👇

Business Updates:

• Net Working Capital Remains under 10 days which is best in the building material
• Continue expanding rural region.
• Added 15 new distributors.
• Value added products contributed 50-60% of the topline.

Revenue breakup

• EBIDTA Margin Improvement: This was mainly because of cost structarize and better operational

• Working Capital Cycle as per mgmt should remain sustainable

• Blue Ocean: Company owns 100% subsidiary which contributes nothing but own property where corporate office is there

Improvement in Net Selling Realization:
• With expanding capacities at 2.6Million Tones and utlization of 75%, scalability has been affected.
• While the prices of steel has gone by by around 35%, due to shortage of steel.

• Apl Apollo being the dominant player past connection with steel companies worked well.
• Steel tubes supply from China is shrinking.
• Hence the discounting factor while selling the products has went away.

This one is for the real stats folks.

Let's deal with some objections to the deaths after flu vax/deaths after Covid vax comparison.

1) I agree Covid vaccine deaths are probably more likely to be reported than flu vaccine deaths. Are they 900 times more likely? Very doubtful...

2) Here's one good reason to think the gap may be small. The ratio of non-serious to serious Vaers reports is far HIGHER for the flu vax than for Covid. In other words, people have basically STOPPED filing non-serious event reports after Covid shots, because they are so common...

3) If people were clogging VAERS with Covid vaccine side effects reports because they are so sensitized to them, we'd see the opposite - tons of reports in every category. We aren't, though.

4) Children aside (and children do receive a lot of flu shots), the idea that the Covid vaccine is going to a meaningfully different population than the flu vaccine is nonsense. Flu campaigns are targeted at the elderly and healthcare workers, just like the Covid vaccine...

5) The correct area under the curve at risk post-Covid vaccinations is not 41 million doses x 8 weeks of followup. It's more like 41 million doses x 3 days. READ THE VAERS REPORTS YOURSELF. I have. The "he was hit by a bus a week after being vaccinated" isn't what's in there...

Let’s talk about ORGANIC.

Robert Paarlberg’s new book on the food system is out today, and here’s an excerpt.

He’s not a fan of organic, and he makes some good points but misses others.

Here we go.

Organic's biggest shortcoming is that you need more land to grow the same amount of food.

The yield penalty happens in almost every crop, in almost every study.

The gap could narrow with more research/varieties, but it won’t go away.

This has big, bad climate implications.

The second issue I have with organic, which Paarlberg shares, is that its basic criterion is naturalness.

Natural doesn’t mean safe, or even safer. A farming standard based on it forces farmers to sometimes use more dangerous, less effective tools.

On human health, there’s scant evidence that pesticide residues on conventional produce are harmful to consumers (though it’s possible farmworkers could be at risk).

What I don’t want is for folks who can’t afford organic to worry about feeding their kids conventional produce.

On the plus side, Paarlberg acknowledges that the organic standard has some real advantages for animal welfare.

This is why I buy organic animal products.

Many in the organic world would like more regs ensuring animals have decent lives.

I never wanted to write a Prof thread here since I wanted this to be break.
But some comments regarding Dentistry is pushing me to be writing this, making me do what I have been trying to explain to people for a long time.
#Thread
#Dentistry
1)

Oral health has been the least concern of people in India. A Dentist is only sought after in case of emergency or when a certificate is needed. Making it a 2nd tier speciality.
However it can't be further from the truth.
This is about Dentistry & it's relation to Gen health
2

Heart:
Since someone commented teeth can't stop heart!
Well! It can
Sub acute endocarditis
Species of Streptococci that live on the teeth, gums& related structures, get mobilized into blood stream when the load of infection increases
If a patient has a valve defect or
3

Previous surgery, these bacteria colonize & cause blockage that is slow & fatal.
Also untreated dental infection can cause the failure of any Cardiac procedure performed.
Hence it's advised to get teeth treated before a cardiac surgery.

Brain:
Teeth have lymph drainage
4

Into a Sinus called Cavernous sinus. That's also connected to brain.
Untreated dental infection can lead to abscess in brain, causing epilepsy like seizures & de@th if not treated.
Seen a 6 yr old boy losing life bcoz of it since Doctor could not trace the source of infection
5

The new Variant Under Investigation (VUI) was re-designated Variant of Concern (VOC) 202012/01 on 18 December

This is an excellent report by @PHE_UK, but it’s a bit technical so I’ll try to unpick it for you

https://t.co/M9f3zaimF5

1/14

The team at @PHE_uk begin by explaining that on 8 Dec they investigated the surge in cases in the South of England. Only 4% (255/6130) of Kent cases had genetic sequence data, but of these 117 genetically similar cases had been collected between 10-18 Nov

2/14

When looking at national data, these 117 cases were part of a larger cluster of 962 (to 8 Dec) in Kent, NE London, plus a few in rest London, Anglia, Essex

3/14

915 or the 962 cases had additional data: 828 were from November, 79 in Oct, 4 from Sept

90% were from <60 years old (further detail not yet available here)

6 patients had already died

4/14

As of 20 Dec, most cases were in London, the SE and East of England.

Of note, 3 of the main testing labs use a PCR test for 3 different viral genes: N, ORF1ab, S.

The new VOC has a mutation that makes this test negative for S (spike), but positive for the others.

5/14

I entered this conversation thinking that I already knew the story, in a way. Dr Wodarg had succeeded in preventing the WHO from creating a fake pandemic in 2009. He thought the world wasn't silly enough to be fooled twice, but he'd been wrong. 1/9

He'd previously had ready access to mainstream media and found this suddenly cut off when he opened his mouth to voice his concern about the hysterical mania of Covid. The comically corrupt whom he'd vanquished all those years ago had been waiting for him. 2/9

All sorts of web entries about his courageous and humane career in public health and politics had morphed into caricatures that painted him as a freak; a "denier", as the post-modern parlance goes, with no means of redress. 3/9

This much I knew before I even started asking questions. What I hadn't expected was to find political correspondence with him, & we found that all of a sudden towards the end of the interview. He calls himself a socialist, I call myself scale dependent, & stop there. But ... 4/9

... it turned out we'd kindled the same central concept—subsidiarity. Subsidiarity is a principle in social organisation holding that functions which are performed effectively by local organisations belong more properly to them than to a dominant central one. 5/9

Many of us who have been health activists have been crying hoarse for years about the need to strengthen our health system, focus on public health
Last summer brought policy and public focus to this dire need. One thought lessons were learnt.
Clearly not.

There is INCREDIBLE stress on the health system right now in many parts of the country. Health professionals over worked, burning out, turning positive with families in droves. And sometimes cannot find beds for themselves or their family in the hospitals they are working in.

I have never seen this kind of a situation before. Lots of people reaching out for help. To provide care, advice, help patients and those in medical need is what health providers are trained for. It is what this is unique about health as a profession.

Imagine not being able to help because there is no capacity, no bed, because there are multiple claimants for that one bed all with medical need. Where the only way a bed might be available is a patient discharge or sadly, a patient death

Ambulances lined up outside hospitals waiting to be able to transfer the patient to the facility, and at times to ferry out those who could not make it.

They called it elephantiasis
A disease said to be caused by a strange mosquito
I was at the Bible College at the time
I had been sent for my Teaching Practice at a church located at Ogudu Ori-Oke
The pastor of this church was a gentleman
He and his wife were chartered accountants

and they were blessed
I was a personal assistant to another pastor and the coordinator of the Bible College had to practically beg my boss to allow me to observe the Teaching Practice at another church (He had insisted I do it with him and I would have spent the time carrying his

Bible and practicing nothing)
When I reported for duty, I was assigned the duty of follow up and evangelism
My primary assignment was to liaise with the follow-up lady and visit all the members who have not been to that church in weeks
I was also given the altar to minister one

Sunday a month (sermon) and other Sundays in various capacities like leading the church in prayer, taking testimonies, and closing prayer
We met this brother on the way to a member's house early one Sunday morning
He was sitting outside a building, wearing yellow slippers and

looking hopeless
We had walked past him but my spirit reached out to me, so I asked the sister to turn around with me so that we can minister to this brother
He was happy we came around
He said he had spent everything he had on the leg and he was desperate enough to accept any

Anxiety resides in 4 spaces:

1. The space inside you
2. The space between you and another
3. The space between others
4. The space inside another.

A powerful de escalation tools is to first locate the anxiety. Where is it?

Often the answer is 'all 4.' Yikes!

1/

Anxiety is contagious, we spread it and escalate it unless we know how to manage it.

This was perhaps my biggest lesson as a trauma chaplain - the very hard work of not catching someone's anxiety.

2/

When I caught it, I was no good to them. I no longer saw what was going on, I was now 'infected' by my own triggers, assumptions, the story I tell myself. I was all wrapped up in myself.

But when I managed my anxiety, I was able to be calm, aware and fully present to them.

3/

Even in the very worst moment of their lives, even if they had me by the shoulders screaming, 'how could God allow this to happen?'

4/

Incidentally, early in chaplaincy, I thought this was an actual question. Because I was anxious, I was more infected by my need to answer than I was to simply be calm and present with them in their pain.

5/

Here is a tweetorial from our latest publication in @Annals_Oncology about longitudinal tracking of esophageal adenocarcinoma. #OesophagealCancer #EsophagealCancer https://t.co/QWvrzBXmK7 1/8

We sequenced 245 plasma samples from 97 patients with oesophageal adenocarcinoma using a 77 gene pan-cancer ctDNA panel. 2/8

Variants derived from previously characterised driver oesophageal adenocarcinoma genes had a significantly higher VAF than variants from other genes, indicating selection. 3/8

Peripheral blood cell samples were also sequenced for 78/97 patients. CHIP mutations were identified in 23% of cases, longitudinal tracking of CHIP variants suggested these variants were dynamic over time. 4/8

We found patients that were ctDNA positive post-surgery had a significantly poorer survival than ctDNA negative patients, and the elimination of CHIP variants improved the positive predictive value. 5/8

UK variant update:

50% more contagious and the main difference is in the rate of infection in children up to the age of 9.

No significant difference found yet in clinical course, mortality within 28 days or chance of re-infection.

1/

https://t.co/D8DXVvBeew

50% higher infection rate

(Secondary attack rate 15.1% versus 9.8%)

2/

Main effect in children under 9 years old

(see age distributions, second image has overlay of reference onto UK variant)

3/

Essential to stop the UK variant: 50% higher transmission will lead to more cases, more hospitalizations, more ICU cases, more deaths, and greater economic costs.

Independent SAGE's plan for the UK variant

With the new Covid variant everywhere, it's not enough to just wait for the vaccine | Stephen Reicher

breaking my social media fast, which may or may not exist anymore, to share something i found really really helpful from today's therapy sesh. i figured out why i (we?) have so much trouble celebrating our wins

so ive been in therapy for 100 years. still anxious, but im pretty sure i was born that way so i'll stay that way. still depressed too, which i thought id be cured of by now. aa few sessions ago we talked about what i think a return to health 'should' look like

initially i figured itd look like being the person i was before i got depressed. energetic, not needing pep talks to do shit like go outside, cooking everyday, working out at least 30 mins at least 3 days a week, calling my mom everyday, etc.

that session i realized that im a completely different person than i was before i got depressed. also the world has changed a lot & things are just done differently now. not allowing for those things had me reaching for shit that was impossible.

so i make some concessions but say that i *still* want to be able to do some things that i dont want to do. like i cant just sit on the couch and never move in the name of accepting who i am, which is A Bitch Who Don't Like To Move. i still want to be able to eve if i dont want

My name is Maryjane and the woman in the picture is Okolo Beatrice, my mother.

In August, my mom started having constant headaches. She went to the hospital, and was attended to by a doctor, but the headache persisted.

At a point, she started having loss of memory and disorientation.

We were asked to go to the Neuropsychiatric hospital to ask for a Neurologist.

She went, but did not see a Neurologist on seat, but met with another doctor there.

She was given some medications and asked to come back in a month. She returned to the hospital on the 29th of September with the same complaints. She was given medications again and was sent back home.

At a point I was no longer comfortable with the complaints.

I assumed it was a result of stress. So on the 1st of October, I went to my parents house, picked her up and went straight to the lab, where blood work as suggested by a doctor was carried out. From the lab, I took her to my house. My plan was for her to rest well.

The results of the test came back on the 4th of October, and the outcome prompted me to start looking for a Neurologist. I started making calls. Fortunately, we got a number and the following day which was the 5th of October, I took her to the doctor in Onitsha.

Mistakes natural lifters make

THREAD ⬇️

1) Bro Splits

Let's start off with the big one.

A natural lifter needs the actual training session to trigger the increase in anabolism that a steroid user will get 24/7.

After a workout, anabolism/protein synthesis is elevated for roughly 30-36 hours.

So training a muscle once a week is sub optimal as you're getting 30-36 hours of enhanced growth out of a 168 hour week.

Whereas if you train a muscle 2-3x per week this goes up to 60-72 hours or even 90-108 hours of enhanced anabolism, leading to faster growth.

Obviously there will be some individual differences here, but as a natural, if you only train a muscle once per week, you're leaving a good chunk of gains on the table.

It's optimal to spread your total weekly volume out across the week by increasing your frequency.

2) Not getting strong

If you get strong on the basic lifts and their variations such as the squat, deadlift, presses, rows and chins, I guarantee your physique will show it.

Take your squat from 225lbs x 10 up to 315 x 10 your legs will be bigger.

Stop fucking around!

Controversial 3D. Probably none of you knows about Leber congenital amaurosis type 10, congenital blindness that affects 3 out of 100,000 children, condemning them to blindness for life. The only possible treatment is through gene therapy. 1/n

Thanks to Crispr-CAS9 technology we MODIFY the defective gene inside the patient eye ( they directly inject the treatment into the eye). Before CRISPR the treatment was based on Adenovirus carrying the correct form of the gene

In both cases, we MODIFY the patient DNA and that's the only way (today) to treat this disease. LCA10 is not the only genetic disease affecting kids unfortunately the list is long and the variety of diseases is terrifying.

Now think about a parent with a kid with a genetic disease, he/she would try and do anything to save him/her. ANYTHING and they would take some RISKS, gene therapy was a risk at the beginning, and any new experimental treatment shares a percentage of risk. 4/n

Now we come to #COVID19 and #vaccines. The new RNA vaccines are a HUGE scientific breakthrough, that may open new amazing therapeutic paths. And like ANY other human activity share a risk.