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

A thread on the latest Sturgeon-Salmond revelations. 👇
1/13

Evidence has emerged of a deliberate cover-up.

A crucial detail was apparently hidden from the public.

According to Sky, the official knew it would potentially end their career if it came to light.

This is important because it may undermine Nicola Sturgeon’s story. 2/13

Throughout the Alex Salmond affair, the First Minister has dodged questions at every turn.

She has tried to hide behind legalities, false narratives, straw men.

Every tactic in the book has been rolled out to stop the truth reaching the public. 3/13

To her utmost shame, the First Minister uses the women who were so badly let down by her government as a shield.

She argues they are being attacked, when nothing could be further from the truth.

We all want to get to the bottom of what happened here - for those women. 4/13

Instead of justice, those women have been caught in this uncivil war - that they never wanted to be part of.

They’ve been failed by basic, unforgivable errors from Nicola Sturgeon’s government.

And failed ever since by the SNP’s obstruction over what went on. 5/13

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

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!

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.

(3)

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)

Want to include the menstrual cycle in your scientific work, but aren't sure how to do it? My lab (@katjaschmalen) have just published an article on best practices for observational studies of the cycle! Thread below! 🧵

Despite decades of research on the menstrual cycle, empirical studies have not adopted consistent methods for operationalizing the menstrual cycle, resulting in confusion in the literature and limited possibilities to conduct systematic reviews and meta-analyses.

Below, I summarize this "how to" article, and relay some of the key points!

PARTICIPANTS: All participants should be naturally-cycling people with ovaries (remember that they are not necessarily "women"! 🏳️‍⚧️ ⚧).

We provide a Reproductive Status Questionnaire with rules for identifying naturally-cycling people (current function of the sexual organs and hormonal/other medications that stop the cycle).

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

I’m going to tag this as a little tutorial for @MichaelYeadon3 who keeps saying that there’s no problem from the suppliers of medical ‘gasses’

Most hospitals in the U.K. run their O2 supply from a Vacuum Insulated Evaporator (VIE)

https://t.co/Lu9ktGFSSm

1/n

This VIE is essentially a large thermos flask/ vacuum insulated cylinder at -180C
O2 is supplied from (typically) BOC in liquid form; when required, allowed to evaporate into gas, & supplied to hospital outlets.

Most hospitals have a VIE big enough to meet their needs

2/n

The problem is the pipes

Most ~12 bed ICUs have pipes that allow ~400L/min flow

This is Ok because most ventilators don’t use >20l/min; giving useful buffer capacity

Modern non invasive ventilation systems- CPAP, NIV, and High flow nasal Oxygen (HFNO), however, need more
3/n

A typical patient on HFNO will have 60-80Lmin flow. If they’re on 90% O2, that’s 60L O2 for 1 patient

6 of these patients will come very close to triggering the O2 flow alarm for this 12 bed unit.

4/n

Aside from breaking walls and re engineering the O2 supply for the whole hospital there’s no easy way of solving this problem
5/n

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...

Things look dire in SoCal hospitals. Check out these quotes!

“We’ve never had so many patients,” said Adrian Cotton, chief of medical operations at Loma Linda University Health in San Bernardino County.”
1/

(read to the last quote please)

“...at least one hospital has set up an outdoor triage tent to handle the overflow of people”

“In Long Beach, hospitals have started visitor restrictions. In the South Bay, a conference center has been transformed into an ambulatory clinic.”
2/

We have signage set up all over the hospital to inform patients that, if they have any family members with even signs of symptoms, not to visit”

“Loma Linda emergency physicians are seeing about 60 more patients a day than usual, Cotton said.”
3/

“About 150 patients have so far been treated in the tent, which is staffed according to the number of people inside. It’s expected to be up through March.”
3/

“As the main emergency room gets full, patients are moved to the tent. For example, a patient who comes in with a broken arm is likely to be treated inside the tent, he said. Visitor restrictions have also been implemented.”

“The county saw a 300-percent increase”
4/

There are some of us that don't have the pleasure of being able to consume milk products like we wish because when we do, it is accompanied by diarrhea, abdominal pains and bloating.

Sorry my dear friend, you're lactose intolerant. Let's talk about lactose intolerance today.

Lactose intolerance is a common disorder and is due to the inability to digest lactose into its constituents, glucose and galactose, secondary to low levels of lactase enzyme in the digestive tract.

So when you consume milk, it contains lactose. This lactose must be broken down.

Lactose in it's original form is a disaccharide, but for it to be absorbed by your small intestine, an enzyme called Lactase is required to break it down (hydrolysis) into a monosaccharide. In those with Lactose Intolerance, Lactase is absent. So Lactose remains a disaccharide.

The osmotic load or weight of this undigested lactose disaccharide causes secretion of lots of fluid and electrolytes into your digestive system, and that's where wahala starts. This leads to enlargement (dilation) of the small intestine that induces quick movement of the...

undigested lactose into the large intestine. Now when this lactose gets to the large intestine, it becomes fermented by bactaeria and this yields short chain fatty acids and gas. The combined effects of increased water in the feces, movement of the poorly digested lactose, gas...

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

"Public health" isn't just about vaccinations, clinics and urgent care: it's a holistic discipline that encompasses all the contributors to health outcomes, which include things like housing, employment, transportation, pollution and more.

1/

A new working paper from @nberpubs estimates the number of US covid deaths that could have been prevented with a coherent, effective eviction moratorium and a ban on utility cutoffs:

The paper, written by a multidisciplinary group of Duke researchers from medicine and economics, found that housing precarity (a risk of losing your home) drove risky behavior that increased the spread of the disease and the resulting deaths.

3/

For example, it forced people to double-up on lodgings, making social distancing impossible, to say nothing of self-isolating after an exposure. It also drove people to tolerate high-risk workplace conditions, including illegal conditions.

4/

The authors used regression techniques to control for confounding variables, and used like-for-like counties with different utility and eviction policies to estimate the effect that these had on infection rates.

5/

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/

Transduction is the process by which foreign DNA is introduced into a cell by a virus or viral vector.

Viral vectors are tools commonly used by molecular biologists to deliver genetic material into cells.

Viruses have evolved?

specialized molecular mechanisms

to efficiently

transport their genomes

inside the cells they infect.

Delivery of genes, or other genetic material, by a vector is termed transduction and the infected cells are described as transduced.

A transducer is a device that converts energy from one form to another. Usually a transducer converts a signal in one form of energy to a signal in another.

I am no psychiatrist or therapist, but I have been on the receiving end of verbal abuse, multiple times over decades, and managed to escape and recover from (most of) the trauma. I'm not sure that really "qualifies" me to say the following, in the academic sense, but...1/

I am seeing the press engaging in what I would call verbal abuse. When you invite a "guest" onto a program to present his or her POV, or to discuss their "expert" opinion on a subject, and then laugh at them, roll your eyes and talk over them, ask only rhetorical questions 2/

...and then accuse the guest of harming/doing disservice to the audience, you are behaving like an abuser. You are "informing" no one of anything other than your willingness to bully and abuse other human beings. Hosts with honest disagreements can and should ASK questions 3/

The hallmark of sincere disagreement is the listener who first checks for understanding of the speaker's POV, then asks why they say that. The host could challenge their arguments on the merits, with their evidence, then allow the guest to respond. This is how adults act. 4/

Immature, irrational, indoctrinated, and/or abusive, people talk OVER, mock, belittle, and accuse guests with different points of view of being "dangerous" or "harming" viewers/listeners. This is the behavior of deeply insecure people who know their ideas lack merit. 5/

It's Monday AM post-@ASCO #GU21 & clinic starts in a couple of hours! Lots to process - I'll try to tackle optimal 1L tx for #kidneycancer. I'll make a case for cabo/nivo, leaning on the beautiful (& timely) tables below from @lalaniMD, @SoaresAndrey & @brian_rini (1/15)

What about IO/IO? We have long f/u w #CM214 data w nivo/ipi, no doubt (@AlbigesL et al in @myESMO Open). And treatment-free interval discussed by McDermott @BIDMChealth is no doubt impt. But we've known data not as impressive for favorable risk (2/15)

And furthermore, as @ERPlimackMD points out in another tweet, impt to look at primary PD rates (seen in @lalaniMD's table) - nivo/ipi at 19%!!! CR rate used to be something we highlighted w nivo/ipi, but now comparable across studies (3/15)

Okay now to the really tough stuff - comparing TKI/IO regimens. Something interesting I will add to @brian_rini @uromigos table above is the HR for PFS by INVESTIGATOR review. If the diff in HR for PFS by IND review caught your eye, this is even more striking (4/15)

I think INV-assessed PFS is impt, but if you're a skeptic, forget that argument. Turn instead to #QOL with axi/pembro. Kudos to @brian_rini @tompowles1 @ERPlimackMD et al for advocating for QOL in KN-426. @crisbergerot et al have taughts us the importance of these metrics. (5/15)