BC HEALTH
Saved by @CodyyyGardner

Dear #MedTwitter please, please, if you are a licensed medical professional and/or in school to be, do NOT delete your tweets or comply with anyone telling you to do so. It will harm you far more than leaving them up and explaining. Nothing is ever deleted. Can be used in court.

 When I was at Harvard Med School and at an esteemed children's hospital, a case against an esteemed professor, that NO lawyer would touch cuz this was someone who had WRITTEN the textbooks and trained every expert, was won ..based on "a document was deleted" - creating suspicion
"Sunlight is the best disinfectant" you will hear me say OVER and OVER - wins & losses *should* be on data/standards but unfortunately wins & losses are in the court of public opinion. So be reliable, credible, and trustworthy. Transparency is one way to achieve that reputation.
The tweets I delete typically have a typo or the link did not populate the image as I wanted and I *immediately* repost THE SAME tweet, corrected. That way if anyone with "dark web" capacity were to try to "find dirt", ain't none. What you see is what you get.
I have been around the block enuf times, been a public servant w/ strict COI & scrutiny of my every word, & have been "in the room" when we have been deciding billions of dollars of state funding in Medicaid

You can decide whether you trust my advice/PSA
https://t.co/21rQMi8ljS
In fact, in any job interview, I have now learned I need to *warn* any potential employer: I take ethics, safety, quality, transparency VERY seriously. Take it or leave it. If that ain't how you do business, this ain't gonna be a good fit. I limit my choices, but sleep just fine.
I mean, no, I don't sleep a lot, but that's another issue. LOL My conscience is pretty clean apart from the things I realize were secondary harm from my trust in the system & being, what I now know is the so-called "model minority." That being complicit DOES keep me up at night.
Many of us come from cultures of shame - medicine, nursing, religion, "family name", regional culture (say a culture of "grit")

Shame will whisper to you "delete, delete..hide it..be ashamed"

NO

WRONG knee jerk reaction from when we were living in primitive conditions.
This matters on SO many levels. Most on #MedTwitter #NurseTwitter #AcademicChatter #AcademicTwitter want to have an impact in the world, want to build relationships, want to do #SciComm

First step for ALL of that is trust

Be trustworthy
Do NOT react to your reptilian brain
If you get past "reptile brain", can pause.

Think it through. What is your purpose here? (see above)

What is in your LONG TERM best interest?

Hiding/deleting only makes you look not trustworthy, poor judgment, unreliable.

https://t.co/0jfLqo7xlF

https://t.co/k6UwYwV4e3
Not to be reverse ageist but please consider the life experience & matched professional experience of anyone from whom you take advice.

Now that I am at @MIT & @MITSloanFellows the classmates who "get it" are engineers who must maintain licenses.

Is a #mindset: accountability
If ANYONE tells you to delete, and EVER uses an "or else" threat..just listen to the recent recording of Trump to GA governor. First, even POTUS cannot seem to hide what he does so exactly how do YOU expect to succeed?

Most importantly, NEVER be goaded into being unethical.
Personally, my brain is SO fully of SO many more important things that, long ago, as a child, I realized lying/hiding was just a recipe to fail - I am transparent. Plus, my mom? OMG...NOTHING got past her. Plus am Muslim so a belief I can hide anything would make me delusional.
I'm old school, with my paper chart experience from having worked in community hospitals that were slow to onboard to #EHR as well as my having been an intern a while ago.

You all training on electronic only may feel it is easy to just hit "undo"/delete.

https://t.co/veFz4j1Pqg
Please know that hospital-employed NON-LICENSED HR or communications people will give you BAD advice. I have seen it SO many times. A relative of mine, was asked ("asked") to delete her EHR note documenting the processes to led to a patient discharged from care service.
I can't go into more details and have enough relatives in my extended family in healthcare that I have left that sufficiently vague. That said, this is a CLASSIC example of how a business/communications person will tell you something AGAINST ethics - what attorneys DREAM about.
Never, ever, EVER protect an institution's "reputation" or any boss's/faculty member's pressure on you at the risk of your own credibility. You have tremendous power as a licensed professional that others WILL use for themselves AND leave you to go under the bus when 💩 hits fan.
I know life is complicated & you get a ton of mixed messages. There are people with clear COI who are selling their advice either directly to you and/or to administrators who buy "reputation management" services (in house or consultants). I don't envy today's students/trainees.
Stay very clear in your own head. You are here for your patients. Your credibility & your license are YOURS. Employment or student status, institutions, do NOT define you (you are a mere cog in their system).

YOU define you.
Your credibility is based on consistent data points.
The last needs to be unpacked. You can and will make mistakes. Leave those mistakes up.

The data points I mean are of being factual, using vetted/verified/validated facts, leaving UP when you make a mistake.

Have a "paper trail" that shows transparency & honesty.
Not that we should be here for the "clicks" but if you need a metric of success of documenting failures, this is probably my single most popular tweet > 7K likes. You can look at the metrics yourself. I'm kinda a numbers shmumbers kinda gal tbh.

https://t.co/umWeKEtieT
Meaning, numbers not what excite me. Impact does. Metrics are important but we all know they are not the whole story yet we overfixate on numbers/metrics, often withOUT questioning their value, definitions, or true impact.

That is the other thing, please refocus on impact.
If you follow me you likely already are a "change the world" type and/or seek to have an impact & likely seek to destigmatize. You also likely are trying to show some kind of leadership. Leaders MUST lead by example. Be the leader who can leave any error up with confidence.
You can always respond, retweet with an explanation.

Will some people do "gotcha' screenshots? Yes.

It is impossible to avoid all misinterpretation or bad faith misuse.

If that worries you, then just post less or not at all. No one *has* to have a social media presence.
I know there is a lot of talk these days on #cancelculture. Everyone hates it (yet people who are most vocal about it seem to be super inconsistent with their words & actual actions).

That is just the world we live in.

It's not easy.
Titrate your exposure/risk to your comfort.
Personally, being Muslim, if I breathe = a "terrorist." I will ALWAYS be "gotcha" vilified by immutable things about my identity. This has made me more risk tolerant.

Gave me A LOT of practice early in life about navigating these complexities prior to social media screenshots.
I think some others did not have this experience of constant bullying from your earliest memories like I do. Bullying affects people in different ways. I finally saw thru it - it is about the other person's insecurity, fear, need for power, manipulation. https://t.co/5dqZ373fJh
I would not wish the multitude of experiences that give me "grit" on anyone else, tbh. I would LOVE you all to spend your energy/time on not just surviving but going out and making this world better (not developing chronic illnesses from chronic stress).

https://t.co/YoextwHK2u
It has made me skilled effective in high profile, high risk roles: where I when I am an expert witness in a Grand Jury trial for the AG's office, when enforcing quality standards going toe-to-toe with another CMO, when I negotiate out of a bad employment situation, etc.
In ALL of these types of leadership & many others, they WILL try ad hominem

If you lose your cool, you lose
If you get nervous about an "error" or by an overt or an implied threat, you lose
If you doubt yourself & backtrack (delete), you lose

Don't set your own self up to lose
Failing fast & failing often is different from setting yourself up to lose/fail. First is driven by #improvement #mindset of #engineering and #systemsthinking to identify vulnerabilities and correct. Latter is poor #strategy, preparation, or poor decision making under pressure.
The #narrative is taught as the goal by so called #SciComm or #communications or #marketing folks who are bad at what they do. Those good at this do #valuesbased "marketing." A non-negotiable must be ethics, credibility, reliability. https://t.co/wb2vgDImqz.
The #narrative, in fact, is how you tell the story of the #data points that are REAL of your consistent commitment to your #values. The other thing you find with low ethics/bad at their job people is manufacturing "evidence" posthoc to craft a fake narrative. Don't be that.
I am intentional on what "record" I create. This had value on many levels. I do genuinely want to provide a free resource, vetted & validated by @AAMC standards to #MedEd

these are my values: marginalized populations, multidisciplinary, #mentalhealth, etc https://t.co/tVjZNbgsVY
This is another intentional use of my time/talent for #AI #futureofwork #diversity #policy #healthcare #innovation

If I get one tweet or a few tweets wrong, will it end a career? It is possible. Anything is possible. Unlikely, given my track record.

https://t.co/qbUGmmkoQq
I worry about you all, tho, in early career

often getting bad advice from:

non-clinician “consultants”
or
faculty from this era of old boy network where they *could* delete, erase, and make inconvenient people disappear (kill someone’s career or professional reputation)
None of them will face the accountability that YOU face
“growing up” professionally in an era of high accountability & high transparency

You aren’t a gray-haired professor w/old boy network who can leverage contacts to do #MedBikini types of ethics shortcuts & gamble not caught
I know because I don’t get those kinds of passes myself

I have to check off every single box in exactly the right order = 100+ edits

if I don’t, my high-quality publication that gets glowing reviewer comments

still rejected/delayed

many women experience this @JulieSilverMD

More from Health

mf.
mf.
@redwineclouds
After therapy sessions, it is occurring to me how my parents and maybe most desi parents don't really grow as parents. For example, a person would be a very different to a baby and to a teenager because the needs and vulnerabilities are so different.

But here, I feel that growth for parents stagnants sometime around when a child is 12-13. None of our parents really talk to us about puberty and growing up. None of us are taught or can talk about relationships because of moral reasons. So what do you have?

You have parents who are still parenting their adult children like kids, not apologising to us but asking us to eat, reminding us to wear jackets, locking up cars. They care. But they are coming from a care where the parent is always concerned about keeping the kid safe and alive

which imo really reduces the kind of parental advice and care one needs as an adult. Because adults know enough about the world to no longer be infantilized but we still have parents who expect us to be the same children because they're still the same kind of parents.

This is why so many of our parental relationships are strained or just based on civilities. We're forced to hide a lot from them because parents refuse to grow as parents and acknowledge us as adults. How many of us are still lectured, have curfews, other restrictions?
HEALTH
Ary Serpa Neto
Ary Serpa Neto
@a_serpaneto
The #RELAx trial has been published today in @JAMA. It was coordinated by Anna Algera. This thread is to explain the rationale, what we did, the findings and the meaning.
The rationale of #RELAx is based on the following

First, there is NO adequate evidence on the level of PEEP in non-ARDS patients. Most of the studies are old, conducted in post-surgical patients (short-term ventilation), and were not powered to detect differences in patient-centered

Second, despite the absence of evidence, the levels of PEEP used in non-ARDS patients increased over years, from 5 to 7/8 cmH2O, probably as a reflection of studies and practice in ARDS

Third, one IPDM showed that higher levels of PEEP could benefit more severe ARDS patients. However, opposite trends (higher mortality and longer ventilation) were found in mild ARDS with higher PEEP (despite not powered to be statistically

Fourth, most of the weaning protocols include PEEP ≤ 5 cmH2O as a criterion for readiness to wean. Theoretically, a standardized liberal strategy of higher PEEP could delay weaning in some
HEALTH
Advertisement
Roscoe B Davis\U0001f396\u2b50\ufe0f\u2b50\ufe0f\u2b50\ufe0f
Roscoe B Davis🎖⭐️⭐️⭐️...
@RoscoeBDavis1
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
HEALTH
The Tycoon Mindset
The Tycoon Mindset
@tycoonmindset05
APL Apollo conducted their earnings con-call today at 2:00 pm

"Vision of capacity of 4 Million Tone till 2025"

@hiddengemsindia @gvkreddi

Here are the key highlights 😀👇

Business Updates:

• Net Working Capital Remains under 10 days which is best in the building material
• Continue expanding rural region.
• Added 15 new distributors.
• Value added products contributed 50-60% of the topline.

Revenue breakup


• EBIDTA Margin Improvement: This was mainly because of cost structarize and better operational

• Working Capital Cycle as per mgmt should remain sustainable

• Blue Ocean: Company owns 100% subsidiary which contributes nothing but own property where corporate office is there

Improvement in Net Selling Realization:
• With expanding capacities at 2.6Million Tones and utlization of 75%, scalability has been affected.
• While the prices of steel has gone by by around 35%, due to shortage of steel.

• Apl Apollo being the dominant player past connection with steel companies worked well.
• Steel tubes supply from China is shrinking.
• Hence the discounting factor while selling the products has went away.
HEALTH
Dr. Joolz Denby\U0001f499
Dr. Joolz Denby💙...
@JoolzDenby
We’ve done menstruation, let’s talk about the menopause! Because only women however they present can have the menopause although men who have had treatments for prostate cancer can have symptoms mimicking the menopause. There’s nothing scary about

the menopause. It’s a perfectly natural function of the body but it’s tied up with a thousand stereotypes of women, ageism and ‘old women are frightening’. True, old women are often very frightening to young men because look! A woman who doesn’t give a rat’s

arse what you think of her now all her mating hormones have gone and with it your charm as a potential mate. Now you’re just another annoying lad. That’s gotta hurt. Menopause means Wisdom, like it or not and it’s not always nice or cosy. Old women

are encouraged to refer to themselves as ‘young at heart’ and ‘as young as you feel’ and other such crap and told to ‘never give in to age’ which is ludicrous. Cosmetic surgery is now a thing but I can tell you what the surgeons and marketing

men won’t - it does not make you look young. You’re just an old woman who looks like at best, she’s had a great holiday and at worst like she was was trapped in a wind tunnel. Old is good. Old is meritorious. Old is survival. Old means you didn’t die young
HEALTH

You May Also Like

Shalini Singh Sengar
Shalini Singh Sengar
@Maverickmusafir
Remembering Colonel Anil Kaul, VrC (Retd) on his 3rd Death Anniversary.

“It was October 12, 1987, exactly 5:55 pm as I was… coming out of the cupola of my T-72 tank on a steamy evening in an unknown place called Kokkuvil in the Jaffna district of Northern Sri Lanka.+


I froze in that confined space at what I saw. An LTTE militant stood at 60 meters aiming his rocket-propelled gun at my tank.

In a flash he fired. Probably having lost his nerve he aimed too low. The projectile hit the left mudguard of the tank, but for some inexplicable reason+


did not explode. It then hit the side of the main gun and then exploded on top of the turret, all in a fraction of a second. Before I knew, it seemed I had received a straight right punch so to say to my chin. I saw some blood appear on my left hand and there was a sharp drop in+

my eyesight.

Lt Colonel (now Lt Gen) Dalbir Singh, then Commanding Officer of 10 Para Commando, who was standing on the engine deck said to me, “Yaar what a close shave.”

He suddenly saw me and the look on his face told me that something was very very wrong with me. In that+

fraction of a second, as if it was a rewind of my entire life, thoughts raced through my life as to how and when I had landed myself in such a situation…

I asked my gunner to pull out a first field dressing (FFD) which is standard equipment in a first aid box carried in each+
HISTORY
Jim O'Shaughnessy
Jim O'Shaughnessy
@jposhaughnessy
I’m torn on how to approach the idea of luck. I’m the first to admit that I am one of the luckiest people on the planet. To be born into a prosperous American family in 1960 with smart parents is to start life on third base. The odds against my very existence are astronomical.


I’ve always felt that the luckiest people I know had a talent for recognizing circumstances, not of their own making, that were conducive to a favorable outcome and their ability to quickly take advantage of them.

In other words, dumb luck was just that, it required no awareness on the person’s part, whereas “smart” luck involved awareness followed by action before the circumstances changed.

So, was I “lucky” to be born when I was—nothing I had any control over—and that I came of age just as huge databases and computers were advancing to the point where I could use those tools to write “What Works on Wall Street?” Absolutely.

Was I lucky to start my stock market investments near the peak of interest rates which allowed me to spend the majority of my adult life in a falling rate environment? Yup.
ALL
Advertisement
Jaya_Upadhyaya
Jaya_Upadhyaya
@Jayalko1
JWALAMUKHI TRIPURASUNDARI, UTHANAHALLI, MYSURU (KAR)
#bharatmandir

Jwalamukhi Tripursundari is believed to be the sister of Devi Chamundeshwari, the presiding deity of Mysuru
It is also that she represents the flaming mouth of Jalandhara, the demon whom Shiva crushed to death.


When Devi Chamundeswari was fighting Mahishasura, she observed that from every drop of blood that spilled out of Mahishasura, another demon was born. So she created Tripurasundari to ensure that no blood dripped from Mahishasura.


Tripura Sundari means beauty of the three worlds.
The murti was installed during Wodeyar rule. An utsava murti made of pancha loha is kept in the sanctum sanctorum.
Another shrine here is dedicated to Siddeshwara / Shiva surrounded by a beautiful wooden Mantapa.
@GunduHuDuGa
ALL
Jaya_Upadhyaya
Jaya_Upadhyaya
@Jayalko1
AHOBILAM NARASIMHA SWAMY KSHETRAM: KURNOOL (AP)
#andhratemples

Ahobilam is the place where Prabhu appears in his fierce form, called Ugra Narasimha, who is Svayambhu (self-manifest).
Ahobilam is one of the 108 Divya Desams. It has 9 shrines for different forms of Narsimha.


Ahobilam was the exact place where Sri Narasimha appeared and tore apart Hiranyakashipu to save Prahlad. At that moment, all the Devas appeared and praised him as Ahobala (Aho is mighty and bala is strength). So the place came to be called Ahobilam.


Out of the 9 shrines, most famous is the Ahobila Narasimha Swamy where Prabhu is seen as Ugra Narasimha.
In another shrine, Prabhu appears as Malola Narasimha Swamy. Malola means beloved of Lakshmi. Here Prabhu is in peaceful mudra with his consort Ma ChenchuLakshmi.


Jwala Narasimha Swamy shrine is the actual spot where the fierce anger of Prabhu reached its culmination when he tore Hiranyakasipu.

Ugra Stambham is the pillar from which Narasimha appeared with such force that the entire hill split into two.
ALL
Anu Satheesh \U0001f1ee\U0001f1f3
Anu Satheesh 🇮🇳...
@AnuSatheesh5
Chennimalai Murugan Kovil
#Erode
#TamilNaduTemples 🚩

Chennimalai Murugan Temple is located  near Perunthurai in Erode District. Murugan is worshipped here as Dandayudapani. Temple is situated on the banks of Noyyal river also called Kanchima Nadhi. Temple is situated in a hill


Sthala Puranam says that, there lived a Landlord who had many cows in his farm. One among them was a Black Cow, which didn't give milk. Land lord observed that evening time, when all the cows came back after grazing, this cow used to go to a particular spot and gave all  the milk


by itself. He decided to dig the spot where the cow gave its milk

On digging a beautiful Vigraham of Murugan was found, but lower portion was very rough. So he called a great sculptor to soften it. Everyone was shocked to see that on the first chisel the vigraham bleeded.


Land lord realized that Murugan wanted the Vigraham the way it was.

Thus Prathishta was done on Chennimalai hill. It is believed that Sivalaya Chola got relieved from his Brahmahatti Dosha here. Kanda Shasti Kavacham was first offered here.

Muruganukku Haro Hara
🙏🕉🙏
ALL