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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Adam Wagner
Adam Wagner
@AdamWagner1
🚨New lockdown regulations just published, in force tomorrow

The Health Protection (Coronavirus, Restrictions) (No. 3) and (All Tiers) (England) (Amendment) Regulations 2021

https://t.co/L5jwlTDaIE

(Thread)


These are not a new set of regulations: they are amendments an old set of regulations

Which we thought were gone! But they are back

Welcome back No.3 regulations

A quick thing before we continue!

I have been analysing these laws for free for 9 months now - if you want to say thanks and have a few £ to spare please give to my @LawCentres fundraiser

They give free legal advice to people who need it

They also amend the All Tiers regulations

Oh god it's all amendments by paragraph references

Basically all of England now in Tier 4 and Tier 4 is amended but not by a huge amount

This really is a terrible way to make laws on the fly - who can possibly understand it?!


So, to explain, you need 2 documents open if you want to understand what is going on:

All Tiers regulations (Tiers 1-4, 2 December as amended) https://t.co/IraPQ112ak

And amendments https://t.co/L5jwlTDaIE

No sensible way of doing except by track changes, on it now, back soon
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James Salazar
James Salazar
@JamesSalazarMD
In medicine, reckoning with racism includes reappraising the very syntax we use every day. Proud to add my voice w/ @J_Ikeme and @RWGrantMD in this @JAMAInternMed pub addressing:

Does race/ethnicity belong in the first line of the patient

Some background: I’ve struggled with this question since early in medical school

Medical syntax is designed to communicate information in a predictable sequence with key elements prioritized to facilitate efficient communication and formation of an assessment and plan

2/

From preclinical lectures to Qbank questions to clerkship rotations, race/ethnicity was often prioritized in the same sentence as age + gender.

I grew accustomed to reading/hearing: a 70-year-old Black man w/ history of x, a 50-year-old Hispanic woman presented w/ y.

3/

However, when it came time for me to use race/ethnicity, there was always tension. Race/ethnicity are self/socially-ascribed identities that in clinical practice are almost always assumed by providers based on appearance. I was also concerned about the potential for bias

4/

I wondered how my own care would be impacted or not impacted by my ethnicity (Hispanic) – I have light skin so I’m not sure if my doctors would even identify me as such – but how would my care be different if I was presented as a 30-year-old Hispanic male?

5/
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So now we have a certified Serologic testing of Red Cross US blood donations to identify SARS-CoV-2-reactive antibodies, and that battery of testing shows widespread presence of SARS-CoV-2-reactive antibodies in donations made between December 2019-January 2020
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Pete Wharmby
Pete Wharmby
@commaficionado
Once again I'm reminded that every action has an equal and opposite reaction. The recent push by a large number of autistic people to 'own' their diagnosis and try to raise acceptance and dispel harmful myths has kicked up a minority of autistic people to fight against this.

This may seem bizarre - who fights against improved acceptance? - but actually has clear roots in the ongoing culture war the West seems engaged in. The identity positive autistic movement, of which I am a part, is viewed by some as another manifestation of 'wokeness'.

This is the right-wing definition of 'wokeness', of course - ie a modern equivalent of the pejorative take on political correctness, but it's definitely at the core of this 'neurorealist' movement - the idea the autistic community is being hijacked by 'woke lefties'.

They believe that the push for acceptance of neurodiversity and rejection of the medicalisation of autism is misguided and drawing attention away from those autistic people who, in their view, need more help and intervention.

The trouble is, this view is pretty much baseless. Firstly, there is little evidence that autistic advocates who push for acceptance are in any way harming autistic people who require more help and support. Second, the view effectively silences those of us who are able to share.
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Momentswithbren Consulting
Momentswithbren Consul...
@MomentsWB
Pathways to Public Policy Careers for those interested and looking for global opportunities

Public policy is made when a governing body attempts to address an issue of widespread public concern, such as health care. The process often runs in cycles and can take years.

■After new laws are created, Policy Implementation occurs, often involving federal agencies, state and local governments, bureaucratic entities, and NGOs. Courts get involved as laws and policies are challenged on a variety of fronts.

■Analysis and Evaluation occurs throughout the cycle and involves many players. Policies may be changed — and the cycle begins again.

What is the best advice for someone pursuing a career in public policy?

People often find their way to public policy careers because of an

interest in a particular substantive area. Public policy work can be found in virtually any subject area.

Your ears should perk up when you hear the words “Center for,” “Institute,” “Association,” and “Foundation” because they represent potential employers.

Public policy majors work in the public, private, and nonprofit sectors, such as a government agency or advocacy group.

Continuing education, such as a certification or fellowship, can also advance your career as someone interested in public policy and politics.
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The chorus of this song uses the shlokas taken from Sundarkand of Ramayana.

It is a series of Sanskrit shlokas recited by Jambavant to Hanuman to remind Him of his true potential.

1. धीवर प्रसार शौर्य भरा: The brave persevering one, your bravery is taking you forward.


2. उतसारा स्थिरा घम्भीरा: The one who is leaping higher and higher, who is firm and stable and seriously determined.

3. ुग्रामा असामा शौर्या भावा: He is strong, and without an equal in the ability/mentality to fight

4. रौद्रमा नवा भीतिर्मा: His anger will cause new fears in his foes.

5.विजिटरीपुरु धीरधारा, कलोथरा शिखरा कठोरा: This is a complex expression seen only in Indic language poetry. The poet is stating that Shivudu is experiencing the intensity of climbing a tough peak, and likening

it to the feeling in a hard battle, when you see your enemy defeated, and blood flowing like a rivulet. This is classical Veera rasa.

6.कुलकु थारथिलीथा गम्भीरा, जाया विराट वीरा: His rough body itself is like a sharp weapon (because he is determined to win). Hail this complete

hero of the world.

7.विलयगागनथाला भिकारा, गरज्जद्धरा गारा: The hero is destructive in the air/sky as well (because he can leap at an enemy from a great height). He can defeat the enemy (simply) with his fearsome roar of war.
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Vibhu Vashisth
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THE MEANING, SIGNIFICANCE AND HISTORY OF SWASTIK

The Swastik is a geometrical figure and an ancient religious icon. Swastik has been Sanatan Dharma’s symbol of auspiciousness – mangalya since time immemorial.


The name swastika comes from Sanskrit (Devanagari: स्वस्तिक, pronounced: swastik) &denotes “conducive to wellbeing or auspicious”.
The word Swastik has a definite etymological origin in Sanskrit. It is derived from the roots su – meaning “well or auspicious” & as meaning “being”.


"सु अस्ति येन तत स्वस्तिकं"
Swastik is de symbol through which everything auspicios occurs

Scholars believe word’s origin in Vedas,known as Swasti mantra;

"🕉स्वस्ति ना इन्द्रो वृधश्रवाहा
स्वस्ति ना पूषा विश्ववेदाहा
स्वस्तिनास्तरक्ष्यो अरिश्तनेमिही
स्वस्तिनो बृहस्पतिर्दधातु"


It translates to," O famed Indra, redeem us. O Pusha, the beholder of all knowledge, redeem us. Redeem us O Garudji, of limitless speed and O Bruhaspati, redeem us".

SWASTIK’s COSMIC ORIGIN

The Swastika represents the living creation in the whole Cosmos.


Hindu astronomers divide the ecliptic circle of cosmos in 27 divisions called https://t.co/sLeuV1R2eQ this manner a cross forms in 4 directions in the celestial sky. At centre of this cross is Dhruva(Polestar). In a line from Dhruva, the stars known as Saptarishi can be observed.
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Techno Funda Investing
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Thread 🧵explaining #ROE & #ROCE and its use in #FundamentalAnalysis

(Must read for #FA learners)

🙏Like & RT to spread learning with all 🙏

Views Welcome 👉 @dmuthuk @Vivek_Investor @datta_arvind @caniravkaria @FI_InvestIndia @AdityaD_Shah

#FundamentalAnalysis #StockMarket


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Return on Equity (#ROE) and Return on Capital Employed (#ROCE) are two important Financial Ratios used in #FundamentalAnalysis of Stocks.

#StockMarket #Investing

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Return on Equity (ROE) is the ratio of Net Income (Net Profit) of a company and it’s Total Equity (Shareholder's Equity).

Here - Shareholders Equity = Share Capital + Reserves & Surplus.

#StockMarket #Investing #FundamentalAnalysis


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#ROE is a measure of how much net profit a company is making for every rupee invested by its shareholders in the company.

It can be said that higher the ROE, better it is for the equity shareholders. It tells shareholders about how effectively their money is being used.

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However, you should not trust high ROE blindly. Biggest drawbacks or weaknesses of ROE is that it completely ignores debt.

Hence for companies having high levels of debt, ROE will give a higher but misleading value & therefore we need to look at #ROCE along with #ROE.
ACCOUNTING , FUNDAMENTAL ANALYSIS , ROE VS ROCE ANALYSIS
Suhas S. Hardutt
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WHEN GH0RI TOOK TO HIS HEELS WHILST FIGHTING A HINDU QUEEN

THE BATTLE OF KASAHRADA (Kayadara)
1178 AD

Strategy! Bravado! Glory!

(Thread)


The narrative set by left historians about one of their favorite poster boys "Gh0ri" is that he went unchallenged upon entering the Indian subcontinent with one king falling after another.(1)

They conveniently deleted this event. Why? An agenda aimed at making us feel weak and inferior against the invaders in an attempt to glorify them. Simple strategy: To destroy a civilization tamper their history.(2)

Gh0ri defeated Prithviraj Chauhan at the 2nd Battle of Tarain in 1192 and laid the foundation of Delhi Sultanate. What is not well known is the fact that 14 years before he won this battle, he was defeated by the queen of Gujarat "Naiki Devi"!(3)

In 1173 Md Gh0ri had conquered the Ghaznavids in Afghanistan. A ruthless, persistent and deceptive Gh0ri was successful in conducting massive raids deep inside Indian territory.(4)
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Simon DeDeo
Simon DeDeo
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So, today, for the first time in 25 (!) years of Apple, I downgraded. From the 2016 MacBook Pro to my 2013, which I had kept in a drawer...


It was pretty simple to do—Apple Time Machine backups let me do it with one click.

That first tweet captures, in two pictures, how badly Apple has “lost the plot” (to quote @wylieprof). On the right is the Apple MagSafe adapter, from 2013. On the left, what I had “upgraded” to.

Thanks, Apple! I really was nostalgic for worrying about yanking my computer off the table.

Oh and I really appreciated not knowing if my computer was charging. What was great was the little whoop sound you used, so that the speaker before me could be informed I was charging my laptop.
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