My last #tweetorial focused on the GCS. Now let's look at another hugely important clinical window into the brain: the pupil. What does a 'blown pupil' really imply? What about small fixed pupils? To understand this, we need to see how pupil size is governed. #FOAMed 1/20

The pupil has two functions, constriction and dilation, both under autonomic control. Sympathetics dilate the pupil and open the eyelid - easy to remember, because in 'fight or flight' mode, maximum information needs to get in to keep you alive. 2/20

By contrast, constriction is parasympathetic. Its main function is to regulate the amount of light on the retina, so in response to high light intensity (like a pen torch), both pupils constrict. 3/20

These parasympathetics have a straightforward course (literally). They hitchhike on the third nerve, which runs forward from the midbrain to the orbit to supply most of the extraocular muscles and eyelid. As they're superficial, they're vulnerable to extrinsic compression. 4/20

Plenty of things can compress the third nerve and produce mydriasis (a dilated pupil) - most classically a posterior communicating artery aneurysm. But in the context of an acutely comatose patient, it suggests something worrying: 'uncal herniation'. Why is this? 5/20

AS A MAN THINKETH:
Chapter 1
THOUGHT AND CHARACTER

https://t.co/SoqHVbwOw4

1/21 Parliament votes on the new tiered restctions on Tuesday. A lot of comment in today’s papers on what’s happening in the hospital sector. Important questions on NHS capacity, demand, preparedness, Nightingales etc. Thread below sets out NHS hospital trust perspective.

2/21 Have deliberately concentrated in thread on hospitals as this is where current public debate ahead of Tuesday’s vote is. But many of same issues apply to community, mental health and ambulance trusts, all of whom are under the same current level of pressure as hospitals.

3/21 Running a hospital at the moment is much more complex & difficult than normal due to COVID-19. That often doesn’t show up in usual national data that some are currently quoting (e.g. NHS capacity levels below last year / not under real pressure so where's the problem?)

4/21 Remember pre-covid starting context. NHS already had large demand supply mismatch. Insufficient hospital beds. 100,000 staff vacancies. Despite frontline efforts, worst A&E/elective surgery performance in a decade. Huge overstretch in winter (late Dec-Feb) for last 5 yrs.

5/21 COVID-19 then made task massively more difficult in number of ways. Need to treat three sets of patients - COVID-19; planned care with urgent/important backlog cases from first phase of covid that simply can’t wait any longer; and usual emergency patients needing treatment.

I want a New Honest America for the children who will inherit it.

A series of things that we must absolutely accomplish

1. Schedule an honest revote for every elected office as soon a possible

2. The CIA and the FBI have become pockets of criminal activity, they must be completely reevaluated to determine if they are beneficial to the United States.

3. Ever since the Rockefeller's infiltrated and corrupted the medical industry, disease has not gone down, it's skyrocketed. This has to be changed, starting with this - Vaccines.

4. The Media in America is Corrupt and it's in he hands of a few, whose goals are aligned -- and are not in the best interests of America.
Break up the Media~!

5. Stop the intrusion of Big Tech into the private lives of Americans. Break up the Google Monopoly. Destroy "all" internet monopolies. Remove Social Media's protection under Section 230.

Postal Rant 2...In December there’s a clause in the union contract that they eliminate any double time pay. DT is usually paid after 10 hrs in a day or after 40 hrs in a week. In Dec there is no limit to how many hrs they work us WITHOUT FAIR WAGES. Tell me that’s not sick!?

How did the Right come to hate this country so much?

Remember when (justifiably) criticizing the United States, even over minor flaws/errors, would cause the Right to seethe with contempt over your lack of Patriotism?

Yet now,….1/

...the Right claims the country is a cesspool run by corrupt, deep-state conmen who have exploited the system to get rich.....

....and that none of this country's institutions (FBI/Intelligence/democracy/etc.) can be trusted, and therefore must be torn down. 2/

We are currently seeing this in real time as Trump challenges the election in the courts. The danger being exposed during all of this is that the Right’s contempt isn’t limited to just the “liberal judges” whose professional integrity can’t be trusted because they’re liberal….3/

...the contempt also extends to Republican state office holders and a Trump-appointed appellate court judge/panel who wrote an opinion, that not only eviscerated Trump’s legal claims, but emphasized the danger that Trump and the conspiratorial Right poses to our democracy. 4/

Article III of the Constitution empowers the judicial branch to finds facts/settle disputes. When half the country believes that every “liberal” judge, and any Republican judge that rules against Trump is corrupt and can’t be trusted, then this country is headed for disaster. 5/

Am I the only one who can only relate to frens on here?
I've changed...
I noticed it this week!
Unable to take Holidays off because I forgot to ask...
since I was so deep into the battle, time slipped!
The only time I served was for eight years...

Patriots and mental attitudes.

This is going to be a rough one. I’m calling a lot of you out in this one. You’ll know who you are. If you protest too loudly and get offended, yes, you are the topic here.

What’s it like in a #drug and #alcohol #rehab? What is recovery? #advicefromdrugandalcoholcaseworker #aod #recovery

The people who do best in rehabs are those who don’t get involved with drama, and talk openly with staff if they feel there is a problem.

You can see recovery behaviour very easily. It’s often pro social in nature, and authentic, pro-self care and pro seeking help. Even strong, opinionated personalities who act authentically but put people offside, tend to do well. I’ve seen behaviour & coping changes in 2-3 weeks.

Rehab is hard, but it’s also the best way to stay sober. It’s a controlled environment. And yeah, it’s not like home. There are strict rules, it can feel unfair, and staff can make mistakes. The hard rules are for the one or two members who occasionally do the wrong thing.

Rehab is a controlled environment intended to minimise your exposure to triggers and drugs. But you’re in there with people who are impulsive and struggling with lifelong trauma. Once the drugs are gone, that trauma comes out. Don’t be afraid. Do rehab, but lean on the staff.

And don’t go to rehab thinking it’s like normal society, it’s a place where your coping will be tested just by being in such close proximity with other people who may have hit rock bottom, or think they have. Who are often distressed. You’re there for you, not them.

1. Well this seems like the perfect day for a thread about old baseball stadiums in Toronto.

It's a history that stretches all the way back to the 1800s and a place called the Toronto Baseball Grounds…

2. It might not look like it, but this is the very oldest image we have of a baseball stadium in Toronto — the only surviving visual representation of the city's first ballpark.

You have to zoom way, way in to see it…

3. …but here it is, standing on Queen Street on a spot overlooking the Don Valley.

It was originally known as the Toronto Baseball Grounds, but would soon be nicknamed Sunlight Park — in honour of the nearby Sunlight Soap Works factory.

4. Spectators could walk in off Queen St or ride up & park their carriage on the grounds. Admission was a quarter — plus an extra dime for the best seats in the house.

The sheltered grandstand could seat 2,000 people & there was standing room for another 10,000 beyond that.

5. A sellout at Sunlight Park meant that 10% of the city's entire population was at the ballgame that day.

When the stadium opened in 1886, even the Lieutenant Governor came out for the event. Someone in his entourage had their hat knocked off by a foul ball.

“What do you despise? By this are you truly known. Let me tell you about how much I fukken hate worms." - Frank 'I Hate Worms' Herbert

It's Friday. Normally I'd be swilling some cheap rotgut in a fancy glass, but the holiday has waged war on my insides.

#HouseCiderino

As you might recall, we're playing the Dune boardgame. Originally published in 1979 by Avalon Hill, recently republished by Gale Force 9.

Originally designed as part of the Project MKUltra to teach nightcrawlers how to have anxiety, it has since become a classic of the genre.

I am playing Padishah-Emperor Shaddam IV of House Corrino as I attempt to fistfight my enemies for control of a very large spice rack. Those enemies are:

- House Harkonen, baddies
- House Atreides, baddies with good PR
- Spacing Guild, Uber w/ LSD and gun
- Fremen, ??? sand

I didn't put the Bene Gesserit on there as an enemy because a) I ran out of characters and b) they're like a combination of Catholic nuns and Народный комиссариат внутренних дел. Keeping their name out of your mouth is safer.

Last session we saw some interesting developments. With the arrival of Shai Hulud (Bless the Maker and His Water. Bless the Coming and going of Him. May His passage cleanse the world. May He keep the world for His people), we were allowed to ally!

You know all those mysterious disappearances youtubers?

If I were a serial killer, it would be an irresistible temptation to get in on that action.

It'd be simple.

Capture a hiker. Immediately freeze their body.

Wait 5 years, 10 years.

Place their body 15km away in an inaccessible location.

Wait 5 years to make a video about it.

"search and rescue parties scoured the area for weeks, with no result. 5 years later, a troop of boy scouts discovered his body over 30 miles away, in a tree. Forensics indicate he'd only been dead less than a week."

Imagine publicly describing, with millions of views, the circumstances of one of your victims and *no one* having a clue.

5.6 million views where you describe exactly where and when that hiker disappeared, and how mysteriously they were found.

"Park rangers say the only way to get there is to climb down a 2,000 foot cliff using climbing equipment. It's not a straight fall. How did he get there?"

Hyperice, the leading sports recovery company, is set to become the next multi-billion-dollar sports business.

The part you didn't know?

Without Kobe Bryant, it would have never happened.

Time for a thread 👇👇👇

1) Let's start in 2007 — Anthony Katz is a 30-year-old high school teacher and basketball coach in Southern California.

For exercise, he regularly organizes pickup basketball games.

The only problem?

As he got older, the games started to leave him increasingly sore & fatigued.

2) Looking for a way to recover faster & prevent injury, Anthony Katz researched how professional athletes dealt with soreness & fatigue.

"I wanted to get the level of treatment the pros were getting."

A combo of elevation, ice & compression made sense — but ice bags didn't…

3) Despite ice bags being used by athletes all over the world, Anthony Katz saw one glaring issue.

As the ice melts, the bag fills with air — causing it to lose its coldness & compression.

Not to mention, they looked ugly.

Instead, Katz set out to engineer a better solution.

4) In an effort to make his own ice compression wrap, Anthony Katz bought Neoprene from a Huntington Beach wetsuit maker, cut it with a knife, and sewed Velcro to hold the ice bag in place.

But would it work?

Next up — testing & feedback.

@SidneyPowell1 @RudyGiuliani @GenFlynn @tracybeanz
Incase you haven't seen this..extra to add to your notes from

Do I look like I know what an MPEG is?

di i look like i know what an mpeg is

do i liook like i pw what am ,[eg os

A pie thread. Send the children out of the room.

Know how you're eating something so good that you hunch over it, damn the utensils, go full Altered States proto-human, baring your teeth and flailing at anybody who gets too close?

Let👏Me👏Tell👏You👏About👏The👏Sweet👏Potato👏Pie👏I👏Made Yesterday praise gawd.🙏
That pie achieved consciousness long enough to know true love.

First off, I didn't have any brown sugar. I realized that Wednesday evening. Was I about to go to the CDC testing center to get some? Hell no, Kroger was hella crowded. So Thursday morning, I take inventory. No cane sugar, no white sugar, no Alaga syrup. Started to lose hope.

Then I remembered.

I had mother-loving lemon honey. It's not super sweet, it's got a ting-tang of lemon, and--I swear to this--when I put it in my tea my 3rd eye opens in appreciation. So I do the math: brown sugar is just about the sweetness; 1/2 a jar of lemon honey should do.

And it did. You wouldn't think the combination of cinnamon, sweet potatoes, butter, eggs, and lemon honey would make you stomp a Smurf if it got too close to your pie pan, but yeah, it does.