[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.

While finances can be a huge barrier to getting treatment, there are a few things around that. Medications (especially those that have been around for a while) are generally much cheaper because they exist in generic form. They are safe, have decades of research behind them.
Antidepressants are not addictive at all and while there are a few side effects at the beginning, they tend to go away after the first few weeks. While it is hard to get rid of superstition and myths around meds, taking that first step of just taking it will help so much.
For therapy, there are always some free or low cost options. Sometimes, there are students about to graduate from their post grad who offer free or low cost therapy as experience (under the supervision of a fully licensed psychologist and legally).
They are the equivalent of a resident doctor, meaning they have the knowledge and expertise but lack the experience and both of you can benefit from working with each other. I remember when I was in that position and worked, I had my supervisor guide through every client.
Second, we need to be serious about our self-care. Everyday as much as possible, we take 2 hours a day for ourselves. It doesn’t matter what others may say or how they react about it. Our brains deserve that rest to be able to give us the best they can offer.
Also, let’s get into the habit of writing down a few lines to describe our day, emotions and some thoughts we went through. It can help your future therapist a lot with identifying patterns and will help you see whether things are getting better or not.
Having a few lines about sleep, food intake, thoughts, emotions, triggers, overall score of the day won’t take a long time but can be so beneficial down the line because we can’t remember how things went down exactly a week or month down the line.
Another way to help our mental health is to get into the habit of externalizing our experiences. There is no need to repress it or keep it all in. Talk out loud even if it is to yourself, scream in a pillow, write it down, whatever works for you is valid.
We need to reduce how much of that pain we carry with us and the best way to do that is to externalize it as it happens. We don’t want it to come back to bite us years down the line when we can’t even remember what we repressed.
Also, let’s be a little kinder to ourselves. Even if our thoughts tell us we are not worth it, we all need to be kind to ourselves and love ourselves a little more, regardless of work or study achievements. They are not rewards for achievements but appreciation for existing.
Finally, let’s make the year 2021 the year that we disconnect as much as we can from toxic people. We have all been through such a hard time, we don’t need to add toxic people who damage our mental health. Mute, block, anything that works for you to be able to move on.
I hope that you will be able to feel much better and appreciate yourself just the way you are because you are AWESOME. Maybe your parents or some people won’t see it, but I do. Whenever I interact with you all, I am in awe of what amazing you all are. You deserve the best 💚

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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/
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.
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

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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?
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”?