BC HEALTH
Saved by @jacobhtml

Folks, we need to talk about this Vitamin D trial. I have no stake in this game - take Vitamin D if you want but this pre-print is super sus.

The paper is presented as a randomized trial of vitamin D supplementation in hospitalized patients with COVID. Interesting and important question! And the results appear dramatic:
If true, this would be one of (if not THE most) effective treatments for COVID. But there are problems...
The first clue something is up is that the randomized groups aren't the same size:
It took me a while to figure out why this was, then I saw in the text that INDIVIDUALS were not randomized, WARDS in the hospital were.
OK - 8 wards, 5 randomized to Vitamin D, 3 to usual care. (Why not 4 and 4?? - but whatever). So this is actually a CLUSTER-randomized trial. That means you need to use CLUSTERED statistics to analyze it. They do not.
This is a big problem. But there is more. It seems that, even if the wards were randomized, the PATIENTS weren't randomized to the wards.
In other words, some hospital wards take different patients than others (different risk factors, etc). This is why we see this really weird finding in Table 1:
Baseline vitamin D levels dramatically lower in the "non-treated" group. Why? Preseumaby because different types of people got admitted to the wards than were randomized to usual care.
You'd expect people with low levels of Vitamin D to do worse - that has been shown multiple times - perhaps because higher Vitamin D levels are associated with less comorbidities.
Here's their Kaplan-Meier curve. It doesn't make sense. What do they mean by 'cumulative hazard' of mortality? What units are these? The overall mortality was 10% by their report.
I get frustrated with peer-review too, but this is why it's so important. This is super basic stuff - you don't call your study a randomized trial when it's a cluster randomized trial. And peer-reviewers would 100% have asked them to go back and redo the stats.
The authors could solve this, btw, by releasing a de-identified dataset (including the ward number) for this study. We could analyze it in about an hour at least for topline results using appropriate stats.
And again, is there harm from Vitamin D? Minimal honestly. The harm from promotion of studies like this is tweets like this that try to dissuade people from getting vaccinated and doing other protective measures.
https://t.co/XVmsiajpBr
So please, read skeptically. Pre-prints have been a boon in COVID times but this study is just... not well done. Be aware. (/END)

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Nurses, EMTs, veterinarians, etc are taught to respond this

The advice for a human biting you is to jam your hand or arm deeper into their mouth, and rub the spot under their nose back and forth.

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This vicious wolf attack illustrates proper technique.


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AAdhira 🌙🇮🇳...
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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.
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#Dentistry
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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
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Heart:
Since someone commented teeth can't stop heart!
Well! It can
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If a patient has a valve defect or
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Previous surgery, these bacteria colonize & cause blockage that is slow & fatal.
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Hence it's advised to get teeth treated before a cardiac surgery.

Brain:
Teeth have lymph drainage
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Into a Sinus called Cavernous sinus. That's also connected to brain.
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🧵 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

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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.

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Okay, let's start this hypersomnia thread!

[note - I am not looking for unsolicited advice.]

Idiopathic hypersomnia or narcolepsy (not the same, but similar) is very hard to describe to people.

When I say "I slept 10 hours last night and I'm still tired" I'm not bragging. 1/16

For me, the accommodations I need are about time. My body doesn't care what I want to do - when I want to wake up or be asleep. My body wants to wake up at 10-11am, and go to sleep at 3am, always.

Just a one hour shift in my sleep schedule can screw me up for days. 2/16

When I tell people that I'd really "prefer it" if we could meet at 10am or later, it's because getting up before that has consequences for me. Big consequences. Most people won't see them. Sometimes I still give in and say it's fine. It ruins 2-3 of my days, sometimes more. 3/16

Let me explain. When I am required to wake up at 9am, esp. in covid times working from home, my body pays me back for it later.

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Let's say this graph represents Day 1, the first time I am required to get up early. The y-axis is my level of Sleepiness. Any symptom listed higher up includes that symptom + every other symptom below it. Getting up that early means I can't listen or concentrate all day. 5/16
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Dr. Tory Eisenlohr-Mou...
@eisenlohr_moul
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).
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