[THREAD] I saw a few of us saying that their 2021 resolution was to improve their mental health. So I decided to write this guide in terms of what steps we can take to improve our mental health for 2021 and beyond. The most important step is to start some form of treatment.
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I think @SamAdlerBell in his quest to be the contrarian on Fauci gets several things wrong here. 1/
First, the failure last year actually was driven by the White House, the #Trump inner circle. Watch what's happening now, the US' scientific and public health infrastructure is creaking back to life. 2/
I think Sam underestimates the decimation of many of our health agencies over the past four years and the establishment of ideological control over them during the pandemic. 3/
I also am puzzled why Tony gets the blame for not speaking up, etc. Robert Redfield, Brett Giroir, Deb Birx, Jerome Adams, Alex Azar all could have done the same. 4/
Several of these people Bob Redfield, Brett Giroir, Alex Azar were led by craven ambition, Jerome Adams by cowardice, but I do think Deb Birx and Tony tried as institutionalists, insiders to make a difference. 5/
— Matthew Yglesias (@mattyglesias) January 30, 2021
First, the failure last year actually was driven by the White House, the #Trump inner circle. Watch what's happening now, the US' scientific and public health infrastructure is creaking back to life. 2/
I think Sam underestimates the decimation of many of our health agencies over the past four years and the establishment of ideological control over them during the pandemic. 3/
I also am puzzled why Tony gets the blame for not speaking up, etc. Robert Redfield, Brett Giroir, Deb Birx, Jerome Adams, Alex Azar all could have done the same. 4/
Several of these people Bob Redfield, Brett Giroir, Alex Azar were led by craven ambition, Jerome Adams by cowardice, but I do think Deb Birx and Tony tried as institutionalists, insiders to make a difference. 5/
this simple, counter narrative fact keeps cropping up all over the world.
hospital and ICU utilization has been and remains low this year.
it's terribly curious that so few of these monitoring tools provide historical baselines.
getting them is like pulling teeth.
we might think of this as an oversight until you see stuff like this:
this woman was arrested for filming and sharing the fact that their are empty hospitals in the UK.
that's full blown soviet. what possible honest purpose does that
this is the action of a police state and a propaganda ministry, not a well intentioned government and a public heath agency.
"we cannot let people see the truth for fear they might base their actions on real facts" is not much of a mantra for just governance.
90% full ICU sounds scary until you realize that 90-100% full is normal in flu season.
staffed ICU beds are expensive to leave empty. it's like flying with 15% of the plane empty. hospitals don't do that.
and all US hospitals are mandated to be able to flex to 120% ICU.
the US is currently at historically low ICU utilization for this time of year.
61% is "you're all going to go out of business" territory as is 66% full hospital use.
can you blame them for mining CARES act money? they'll die without it.
hospital and ICU utilization has been and remains low this year.
it's terribly curious that so few of these monitoring tools provide historical baselines.
getting them is like pulling teeth.
It took a Freedom of Information request but @Covid19DataUK acquired 2017-2019 averages for England hospitalizations.
— Yinon Weiss (@yinonw) December 31, 2020
2020 had 18% fewer hospitalizations than prior years.
All around the world, using hospital data without context of prior years is just a fear generating lie. pic.twitter.com/DJDpqhIQuw
we might think of this as an oversight until you see stuff like this:
this woman was arrested for filming and sharing the fact that their are empty hospitals in the UK.
that's full blown soviet. what possible honest purpose does that
this is the action of a police state and a propaganda ministry, not a well intentioned government and a public heath agency.
"we cannot let people see the truth for fear they might base their actions on real facts" is not much of a mantra for just governance.
90% full ICU sounds scary until you realize that 90-100% full is normal in flu season.
staffed ICU beds are expensive to leave empty. it's like flying with 15% of the plane empty. hospitals don't do that.
and all US hospitals are mandated to be able to flex to 120% ICU.
the US is currently at historically low ICU utilization for this time of year.
61% is "you're all going to go out of business" territory as is 66% full hospital use.
can you blame them for mining CARES act money? they'll die without it.
1/15
Why can cefepime cause neurological toxicity?
And why is renal failure the main risk factor for this complication?
The answer requires us to learn about cefepime's structure and why it unexpectedly binds to a certain CNS receptor.
#MedTwitter #Tweetorial
2/
Let's establish a few facts about cefepime:
🔺4th generation cephalosporin antibiotic
🔺Excretion = exclusively in the urine (mostly as unchanged drug)
🔺Readily crosses the blood-brain barrier (so it easily accesses the brain)
https://t.co/rjYG1BfGPR
3/
The first report of cefepime neurotoxicity was in 1999.
A patient w/ renal failure received high doses of cefepime and then developed encephalopathy, tremors, myoclonic jerks, and tonic-clonic seizures.
✅All symptoms resolved after hemodialysis.
https://t.co/u7JLVitQpp
4/
Cefepime neurotoxicity is surprisingly common, occurring in up to 15% of treated critically ill patients (w/ symptoms varying from encephalopathy to seizures).
💡The main risk factors = renal failure and lack of dose adjustment for renal function.
https://t.co/nxbnzSq8AR
5/
What about cefepime induces neurotoxicity?
One clue is that it's not the only antibiotic that causes neurotoxicity, particularly seizures.
This actually is a class effect w/ other beta-lactam antibiotics (including penicillins and carbapenems).
https://t.co/Lf4BhON9IY
Why can cefepime cause neurological toxicity?
And why is renal failure the main risk factor for this complication?
The answer requires us to learn about cefepime's structure and why it unexpectedly binds to a certain CNS receptor.
#MedTwitter #Tweetorial
2/
Let's establish a few facts about cefepime:
🔺4th generation cephalosporin antibiotic
🔺Excretion = exclusively in the urine (mostly as unchanged drug)
🔺Readily crosses the blood-brain barrier (so it easily accesses the brain)
https://t.co/rjYG1BfGPR
3/
The first report of cefepime neurotoxicity was in 1999.
A patient w/ renal failure received high doses of cefepime and then developed encephalopathy, tremors, myoclonic jerks, and tonic-clonic seizures.
✅All symptoms resolved after hemodialysis.
https://t.co/u7JLVitQpp
4/
Cefepime neurotoxicity is surprisingly common, occurring in up to 15% of treated critically ill patients (w/ symptoms varying from encephalopathy to seizures).
💡The main risk factors = renal failure and lack of dose adjustment for renal function.
https://t.co/nxbnzSq8AR
5/
What about cefepime induces neurotoxicity?
One clue is that it's not the only antibiotic that causes neurotoxicity, particularly seizures.
This actually is a class effect w/ other beta-lactam antibiotics (including penicillins and carbapenems).
https://t.co/Lf4BhON9IY
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@franciscodeasis https://t.co/OuQaBRFPu7
Unfortunately the "This work includes the identification of viral sequences in bat samples, and has resulted in the isolation of three bat SARS-related coronaviruses that are now used as reagents to test therapeutics and vaccines." were BEFORE the
chimeric infectious clone grants were there.https://t.co/DAArwFkz6v is in 2017, Rs4231.
https://t.co/UgXygDjYbW is in 2016, RsSHC014 and RsWIV16.
https://t.co/krO69CsJ94 is in 2013, RsWIV1. notice that this is before the beginning of the project
starting in 2016. Also remember that they told about only 3 isolates/live viruses. RsSHC014 is a live infectious clone that is just as alive as those other "Isolates".
P.D. somehow is able to use funds that he have yet recieved yet, and send results and sequences from late 2019 back in time into 2015,2013 and 2016!
https://t.co/4wC7k1Lh54 Ref 3: Why ALL your pangolin samples were PCR negative? to avoid deep sequencing and accidentally reveal Paguma Larvata and Oryctolagus Cuniculus?
Unfortunately the "This work includes the identification of viral sequences in bat samples, and has resulted in the isolation of three bat SARS-related coronaviruses that are now used as reagents to test therapeutics and vaccines." were BEFORE the
chimeric infectious clone grants were there.https://t.co/DAArwFkz6v is in 2017, Rs4231.
https://t.co/UgXygDjYbW is in 2016, RsSHC014 and RsWIV16.
https://t.co/krO69CsJ94 is in 2013, RsWIV1. notice that this is before the beginning of the project
starting in 2016. Also remember that they told about only 3 isolates/live viruses. RsSHC014 is a live infectious clone that is just as alive as those other "Isolates".
P.D. somehow is able to use funds that he have yet recieved yet, and send results and sequences from late 2019 back in time into 2015,2013 and 2016!
https://t.co/4wC7k1Lh54 Ref 3: Why ALL your pangolin samples were PCR negative? to avoid deep sequencing and accidentally reveal Paguma Larvata and Oryctolagus Cuniculus?
1/ Here’s a list of conversational frameworks I’ve picked up that have been helpful.
Please add your own.
2/ The Magic Question: "What would need to be true for you
3/ On evaluating where someone’s head is at regarding a topic they are being wishy-washy about or delaying.
“Gun to the head—what would you decide now?”
“Fast forward 6 months after your sabbatical--how would you decide: what criteria is most important to you?”
4/ Other Q’s re: decisions:
“Putting aside a list of pros/cons, what’s the *one* reason you’re doing this?” “Why is that the most important reason?”
“What’s end-game here?”
“What does success look like in a world where you pick that path?”
5/ When listening, after empathizing, and wanting to help them make their own decisions without imposing your world view:
“What would the best version of yourself do”?
Please add your own.
2/ The Magic Question: "What would need to be true for you
1/\u201cWhat would need to be true for you to\u2026.X\u201d
— Erik Torenberg (@eriktorenberg) December 4, 2018
Why is this the most powerful question you can ask when attempting to reach an agreement with another human being or organization?
A thread, co-written by @deanmbrody: https://t.co/Yo6jHbSit9
3/ On evaluating where someone’s head is at regarding a topic they are being wishy-washy about or delaying.
“Gun to the head—what would you decide now?”
“Fast forward 6 months after your sabbatical--how would you decide: what criteria is most important to you?”
4/ Other Q’s re: decisions:
“Putting aside a list of pros/cons, what’s the *one* reason you’re doing this?” “Why is that the most important reason?”
“What’s end-game here?”
“What does success look like in a world where you pick that path?”
5/ When listening, after empathizing, and wanting to help them make their own decisions without imposing your world view:
“What would the best version of yourself do”?