BC HEALTH
Saved by @WebbDarrrel

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)
Unfortunately, we're not seeing any improvement in QOL w axi/pembro. This is a bit concerning - if balanced between arms, are we prolonging PFS at the expense of the patient's overall well-being? Inc tumor regression should be accompanied by some symptomatic improvement. (6/15)
Okay, now on to one of the headliners at @ASCO #GU21 this past weekend. The CLEAR study presented by @motzermd @DrChoueiri @DrTHut @tompowles1 @CPRT65 et al. Simultaneously published in @NEJM - congrats friends! (7/15)
Just one point on the curves, which I heard @tompowles1 bring up on a @Uromigos podcast w @DrChoueiri (of note, I also saw @manuelmaiamd bring this up during @motzermd's presentation in the @ASCO #GU21 pres). Why do the OS curves merge? Not so in #CheckMate9ER! (8/15)
Regardless, some may be swayed by the 16% CR rate with len/pembro. Now HERE is where we need to dive into baseline characteristics. Nearly 10% more fav risk in CLEAR, and also, more pts with prior neph. So, the odds of getting CR (or even PR) stacked against #CheckMate9ER (9/15)
I'll next make the point that LEN IS HARD TO TOLERATE. I'm glad @SoaresAndrey highlights the rate of discontinuation in #CLEAR, which appears much higher than in #CheckMate9ER. I've seen 7al versions of the data, but no matter how you slice it, d/c rate⬆️with len/pembro. (10/15)
What's my experience with len? I ran a RP2 study w @DrDanielHeng @hipsytips @docjavip et al. We tried to lower dose from 18 to 14 mg & preserve efficacy, but with the caveat of this being a small non-inferiority study, it didn't appear feasible. 👀rates of d/c due to AEs! (11/15)
Remember, I was comparing 18 and 14 mg. The dose in #CLEAR even HIGHER at 20 mg! This is one of those settings where QOL data ESSENTIAL. Remember, our pts are thankfully doing better & will be on drug longer - we need to look out for their GLOBAL well-being! (12/15)
Now THIS is what we need to see. Improved QOL with cabo/nivo, as @DrChoueiri presented at #ESMO20. Remember, the dose of 40 mg is used in #CheckMate9ER - LOWER than the dose of 60 mg used in #METEOR, with cabo as 2L/3L tx. (13/15).
Confession: I was skeptical when @DrChoueiri @motzermd @tompowles1 @apolo_andrea & the brilliant team for #CheckMate9ER chose 40. But @neerajaiims & I have since reported data from #COSMIC021 (cabo/atezo across multiple settings). Efficacy at both doses seems quite good (14/15)
SUMMARY: In 2021, we are blessed w gr8 data from mult 1L trials in #kidneycancer. I feel that cabo/nivo is the way to go; the goalpost is shifted beyond just PFS/RR/OS, we now need QOL! Thx to the amazing data summaries that facilitated this thread. Open to all comments. (15/15)

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If you have #ADHD & are struggling please know you’re not alone. This week on @Overview, we're talking about living w/ ADHD & Anxiety during the pandemic & many the stigmas & misconceptions that making things worse.

I was diagnosed w/ ADHD when I was 7. And in so many ways it’s been a blessing. I love my energy, the hyper-focus, the calm I feel in chaos, the ability to & feel emotions so intensely. It’s allowed me to to see the world differently be in a constant state of wonder.(2)

But realizing all that has been a long, difficult journey so figured I’d share some of my own struggles as well as the resources from @HowtoADHD because Jessica's channel has been a game-changer for me.(3)

First off, #ADHD Attention Deficit Hyperactivity Disorder is a dumb description. It implies a deficit in attention & always hyper people. ADHD is a spectrum, & what we all have in common isn’t that we can’t pay attention. It’s that we have trouble controlling our attention.(4)

There are amazing analogies out there, like trying to watch 6 TV’s at once when someone else controls the remote. Or like driving a race car on city streets and spinning out whenever you try to turn.
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\u2744\ufe0fI'm A Fuckin' Princess\u2744\ufe0f
❄️I'm A Fuckin' Prince...
@Just_ReneaR
I'm not pro-murdering babies.
I'm pro-Becky who found out at her 20 week anatomy scan that the infant she had been so excited to bring into this world had developed without life sustaining organs.
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Patrick Strudwick
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I’m deeply saddened to learn that Dr Joseph Sonnabend, one of the most important figures in the history of AIDS, died yesterday. I spent time with him in 2018 for one of the last interviews he ever gave. Let me tell you about this man and what he did:

Sonnabend was one of the first doctors to raise the alarm. In 1979, while running a sexual health clinic in Greenwich Village, he wrote to the NY Health Dept to warn them of the symptoms he was seeing: low white blood cell counts, enlarged lymph nodes. He didn’t get a reply. 2/

So he kept speaking out. When a patient of his developed a very rare cancer – Kaposi’s Sarcoma – he linked up with a dermatologist at NYU who said that over a dozen gay men had it. Sonnabend knew there was something very wrong. He started working at the lab at NYU — for free. 3/

It was soon after this in 1981 that the New York Times famously reported “Rare Cancer Found In 41 Homosexuals”. The next decade would kill most of Sonnabend’s patients and friends — and all of his lovers. What Sonnabend did was to fight for every single of them. 4/

Want to know who was the first to publish advice to wear a condom? That was Sonnabend. In 1983 he co-authored the first safe sex leaflet to fight AIDS: “How To Have Sex In An Epidemic”. 5/
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(Cyriac) Abby Philips
(Cyriac) Abby Philips
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On 18.12.2020, computer engineer @FitTuber shared @YouTube video titled "10 Safe & Useful Ayurvedic Tablets to Replace Allopathic Pills (Instant Relief)". The drugs he promoted were by @baidyanathgroup, not sure if it was paid promotion. I bought them:
https://t.co/w6Sh2pMvJf


10 drugs, details, batch numbers R given in pic👇. All by @baidyanathgroup exept 1 by https://t.co/tg46sBhJr2
We did GCMSMS, ICP-OES and FTIR analyses on these samples. Here are my 10 safer modern medicine alternatives 2 @FitTuber's untested, potentially harmful #Ayurvedic drugs


Kanthsudharak Vati by Unjha Pharma
@FitTuber: 4 sorethroat, cold, cough
Analysis: Lead 0.54 mg/kg, Cadmium 0.4 mg/kg, Thallium 0.71 mg/kg and industrial phenols.
Low values, but not ideal.

Safe alternative: Levocetrizine & non-sedative cough syrup Levodropropizine


Baidyanath Rajbati
@Fittuber: for bloating, gas
Analysis:
Mercury 1.2 mg/kg
Arsenic 2.25 mg/kg
Male anabolic hormone - hydroxy testosterone+
Curcumin
Talc powder

Safer alternative: activated charcoal+simethicone (non-absorbed, no side effects) or short course esomeprazole.


Baidyanath Bilwadi Choorna
@Fittuber - 4 diarrhoea
Analysis
Thallium 3.68 mg/kg
[fun fact: 10-15 mg/kg is lethal dose for humans. Death can occur at lower dosages] https://t.co/9ozOKROhCK
Fenretinide - synthetic anti-cancer drug
Liver toxic chromium phosph.

Safer: Racecadotril
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David Fisman
David Fisman
@DFisman
I do want to talk a bit about connections, conflicts and information during a pandemic. Since @fordnation insinuated I have COI which I don't, let's take a look at a single instance where @fordnation and Hospital for Sick Children are both making interesting decisions.

Both share a powerful supporter in Peter Gilgan, who has been a great supporter of Sickkids

But his company, Mattamy Homes, has also substantially bankrolled Ontario Proud, which I have reason to believe pushed the Postmedia hit on my reputation.


Sickkids and Mattamy have very close ties. Here is Mary Federau, a longtime Sickkids exec who has moved to Mattamy but remains involved with the Sickkids foundation:


Mary's bio is too modest. It looks as though it has been scrubbed a bit over the last 72 hours. Here's the google cache from Jan 25:
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SRI CHAMPAKADHAMA SWAMY, BANNERGHATTA HILL, BENGALURU (KAR)
#bharatmandir

The shrine is dedicated to Sri Vishnu along with Devi Lakshmi and Bhoodevi.
It is built in an area full of Champaka trees.
As champaka flowers are offered to Sri Vishnu here, it is called Champakadhama.


It is believed that King Janmejaya had sarpa-dosha. To get rid of it, he took bath in the nearby pond. He emerged with a golden body and sarpa-dosha was also removed. The pond is called Swarnamukhi and believed to have curative powers.
Sri Vishnu murti was consecrated by him.


It is also believed that this forest area was the Dandakaranya where Sri Ram stayed in exile.
Some believe that the original shrine was built by Pandavas.
The pushkarni/pond is emptied once a year so that the rock at the bottom (which has image of Anjaneya) may be worshipped.
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Laurie Voss
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The 2018 State of JavaScript survey is out. They got 20,000 responses and have some delicious, delicious data. I'mma thread in some highlights:

First up: JavaScript flavors. There's TypeScript at 47% adoption, a tad higher than npm's own survey results (which said 46%). npm's survey is coming up again soon and will ask about TypeScript in a lot more detail.


I really, *really* like SoJ's "would not use again" question, which lets people who've abandoned a tech self-identify. This is noticeable in the graph above with Flow users -- 41% of people who've used Flow say they wouldn't use it again.

Now JavaScript frameworks. It's been a full year since npm's survey, so these numbers differ from ours in the directions I expected:
React 65% (vs. 60%)
Vue 29% (vs. 24%)
Ember 5% (vs 4%, I was expecting a bigger rise)

But there's a shocker in here: Angular.


npm's survey had Angular at 40% last year and SoJ has it at either:
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Since npm's question didn't ask if they intend to *continue* using it I think that might explain this.
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Vibhu Vashisth
@VIBHU_Tweet
प्राचीन काल में गाधि नामक एक राजा थे।उनकी सत्यवती नाम की एक पुत्री थी।राजा गाधि ने अपनी पुत्री का विवाह महर्षि भृगु के पुत्र से करवा दिया।महर्षि भृगु इस विवाह से बहुत प्रसन्न हुए और उन्होने अपनी पुत्रवधु को आशीर्वाद देकर उसे कोई भी वर मांगने को कहा।


सत्यवती ने महर्षि भृगु से अपने तथा अपनी माता के लिए पुत्र का वरदान मांगा।ये जानकर महर्षि भृगु ने यज्ञ किया और तत्पश्चात सत्यवती और उसकी माता को अलग-अलग प्रकार के दो चरू (यज्ञ के लिए पकाया हुआ अन्न) दिए और कहा कि ऋतु स्नान के बाद तुम्हारी माता पुत्र की इच्छा लेकर पीपल का आलिंगन...

...करें और तुम भी पुत्र की इच्छा लेकर गूलर वृक्ष का आलिंगन करना। आलिंगन करने के बाद चरू का सेवन करना, इससे तुम दोनो को पुत्र प्राप्ति होगी।परंतु मां बेटी के चरू आपस में बदल जाते हैं और ये महर्षि भृगु अपनी दिव्य दृष्टि से देख लेते हैं।

भृगु ऋषि सत्यवती से कहते हैं,"पुत्री तुम्हारा और तुम्हारी माता ने एक दुसरे के चरू खा लिए हैं।इस कारण तुम्हारा पुत्र ब्राह्मण होते हुए भी क्षत्रिय सा आचरण करेगा और तुम्हारी माता का पुत्र क्षत्रिय होकर भी ब्राह्मण सा आचरण करेगा।"
इस पर सत्यवती ने भृगु ऋषि से बड़ी विनती की।


सत्यवती ने कहा,"मुझे आशीर्वाद दें कि मेरा पुत्र ब्राह्मण सा ही आचरण करे।"तब महर्षि ने उसे ये आशीर्वाद दे दिया कि उसका पुत्र ब्राह्मण सा ही आचरण करेगा किन्तु उसका पौत्र क्षत्रियों सा व्यवहार करेगा। सत्यवती का एक पुत्र हुआ जिसका नाम जम्दाग्नि था जो सप्त ऋषियों में से एक हैं।
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Mo Rajabifard
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👨‍💻 Last resume I sent to a startup one year ago, sharing with you to get ideas:

- Forget what you don't have, make your strength bold
- Pick one work experience and explain what you did in detail w/ bullet points
- Write it towards the role you apply
- Give social proof

/thread


"But I got no work experience..."

Make a open source lib, make a small side project for yourself, do freelance work, ask friends to work with them, no friends? Find friends on Github, and Twitter.

Bonus points:

- Show you care about the company: I used the company's brand font and gradient for in the resume for my name and "Thank You" note.
- Don't list 15 things and libraries you worked with, pick the most related ones to the role you're applying.
-🙅‍♂️"copy cover letter"

"I got no firends, no work"

One practical way is to reach out to conferences and offer to make their website for free. But make sure to do it good. You'll get:

- a project for portfolio
- new friends
- work experience
- learnt new stuff
- new thing for Twitter bio

If you don't even have the skills yet, why not try your chance for @LambdaSchool? No? @freeCodeCamp. Still not? Pick something from here and learn https://t.co/7NPS1zbLTi
You'll feel very overwhelmed, no escape, just acknowledge it and keep pushing.
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Pran Katariya
Pran Katariya
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The Straddle is my favorite trade these days. But more often than not, one needs to adjust to make a good return from it. There are many ways to do this depending on your view, psychology and imagination. Will discuss a few that I use

The Straddle is a delta neutral strategy and it is important to keep deltas in check during the course of the Trade and not let them run away from you. Of course Volatility is the elephant in the room- but not going there as that will require a separate discussion

The first and most common method is to go 'inverted.' That is to say to shift the untested side to generate additional Premium and increase the runway to Breakeven. So if you start with a Straddle at 700 and price goes to 740, you can move the PE up to say 720.

How much should you move the untested side? While again this is a matter of skill, experience and artistry, the rule of thumb is to cut deltas by half. Remember, prices will move and you have to allow sufficient room for them to fluctuate

The second method is to shift the entire Straddle in the direction of the move. So if you have a 700 Straddle and Price goes to 740, you can shift the Straddle to 720. If you time this right, it can generally be done at virtually no cost or minimal cost.
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