Controversial 3D. Probably none of you knows about Leber congenital amaurosis type 10, congenital blindness that affects 3 out of 100,000 children, condemning them to blindness for life. The only possible treatment is through gene therapy. 1/n

Thanks to Crispr-CAS9 technology we MODIFY the defective gene inside the patient eye ( they directly inject the treatment into the eye). Before CRISPR the treatment was based on Adenovirus carrying the correct form of the gene

In both cases, we MODIFY the patient DNA and that's the only way (today) to treat this disease. LCA10 is not the only genetic disease affecting kids unfortunately the list is long and the variety of diseases is terrifying.

Now think about a parent with a kid with a genetic disease, he/she would try and do anything to save him/her. ANYTHING and they would take some RISKS, gene therapy was a risk at the beginning, and any new experimental treatment shares a percentage of risk. 4/n

Now we come to #COVID19 and #vaccines. The new RNA vaccines are a HUGE scientific breakthrough, that may open new amazing therapeutic paths. And like ANY other human activity share a risk.

Things look dire in SoCal hospitals. Check out these quotes!

“We’ve never had so many patients,” said Adrian Cotton, chief of medical operations at Loma Linda University Health in San Bernardino County.”
1/

(read to the last quote please)

“...at least one hospital has set up an outdoor triage tent to handle the overflow of people”

“In Long Beach, hospitals have started visitor restrictions. In the South Bay, a conference center has been transformed into an ambulatory clinic.”
2/

We have signage set up all over the hospital to inform patients that, if they have any family members with even signs of symptoms, not to visit”

“Loma Linda emergency physicians are seeing about 60 more patients a day than usual, Cotton said.”
3/

“About 150 patients have so far been treated in the tent, which is staffed according to the number of people inside. It’s expected to be up through March.”
3/

“As the main emergency room gets full, patients are moved to the tent. For example, a patient who comes in with a broken arm is likely to be treated inside the tent, he said. Visitor restrictions have also been implemented.”

“The county saw a 300-percent increase”
4/

I’m going to tag this as a little tutorial for @MichaelYeadon3 who keeps saying that there’s no problem from the suppliers of medical ‘gasses’

Most hospitals in the U.K. run their O2 supply from a Vacuum Insulated Evaporator (VIE)

https://t.co/Lu9ktGFSSm

1/n

This VIE is essentially a large thermos flask/ vacuum insulated cylinder at -180C
O2 is supplied from (typically) BOC in liquid form; when required, allowed to evaporate into gas, & supplied to hospital outlets.

Most hospitals have a VIE big enough to meet their needs

2/n

The problem is the pipes

Most ~12 bed ICUs have pipes that allow ~400L/min flow

This is Ok because most ventilators don’t use >20l/min; giving useful buffer capacity

Modern non invasive ventilation systems- CPAP, NIV, and High flow nasal Oxygen (HFNO), however, need more
3/n

A typical patient on HFNO will have 60-80Lmin flow. If they’re on 90% O2, that’s 60L O2 for 1 patient

6 of these patients will come very close to triggering the O2 flow alarm for this 12 bed unit.

4/n

Aside from breaking walls and re engineering the O2 supply for the whole hospital there’s no easy way of solving this problem
5/n

There are some of us that don't have the pleasure of being able to consume milk products like we wish because when we do, it is accompanied by diarrhea, abdominal pains and bloating.

Sorry my dear friend, you're lactose intolerant. Let's talk about lactose intolerance today.

Lactose intolerance is a common disorder and is due to the inability to digest lactose into its constituents, glucose and galactose, secondary to low levels of lactase enzyme in the digestive tract.

So when you consume milk, it contains lactose. This lactose must be broken down.

Lactose in it's original form is a disaccharide, but for it to be absorbed by your small intestine, an enzyme called Lactase is required to break it down (hydrolysis) into a monosaccharide. In those with Lactose Intolerance, Lactase is absent. So Lactose remains a disaccharide.

The osmotic load or weight of this undigested lactose disaccharide causes secretion of lots of fluid and electrolytes into your digestive system, and that's where wahala starts. This leads to enlargement (dilation) of the small intestine that induces quick movement of the...

undigested lactose into the large intestine. Now when this lactose gets to the large intestine, it becomes fermented by bactaeria and this yields short chain fatty acids and gas. The combined effects of increased water in the feces, movement of the poorly digested lactose, gas...

I am no psychiatrist or therapist, but I have been on the receiving end of verbal abuse, multiple times over decades, and managed to escape and recover from (most of) the trauma. I'm not sure that really "qualifies" me to say the following, in the academic sense, but...1/

I am seeing the press engaging in what I would call verbal abuse. When you invite a "guest" onto a program to present his or her POV, or to discuss their "expert" opinion on a subject, and then laugh at them, roll your eyes and talk over them, ask only rhetorical questions 2/

...and then accuse the guest of harming/doing disservice to the audience, you are behaving like an abuser. You are "informing" no one of anything other than your willingness to bully and abuse other human beings. Hosts with honest disagreements can and should ASK questions 3/

The hallmark of sincere disagreement is the listener who first checks for understanding of the speaker's POV, then asks why they say that. The host could challenge their arguments on the merits, with their evidence, then allow the guest to respond. This is how adults act. 4/

Immature, irrational, indoctrinated, and/or abusive, people talk OVER, mock, belittle, and accuse guests with different points of view of being "dangerous" or "harming" viewers/listeners. This is the behavior of deeply insecure people who know their ideas lack merit. 5/

They called it elephantiasis
A disease said to be caused by a strange mosquito
I was at the Bible College at the time
I had been sent for my Teaching Practice at a church located at Ogudu Ori-Oke
The pastor of this church was a gentleman
He and his wife were chartered accountants

and they were blessed
I was a personal assistant to another pastor and the coordinator of the Bible College had to practically beg my boss to allow me to observe the Teaching Practice at another church (He had insisted I do it with him and I would have spent the time carrying his

Bible and practicing nothing)
When I reported for duty, I was assigned the duty of follow up and evangelism
My primary assignment was to liaise with the follow-up lady and visit all the members who have not been to that church in weeks
I was also given the altar to minister one

Sunday a month (sermon) and other Sundays in various capacities like leading the church in prayer, taking testimonies, and closing prayer
We met this brother on the way to a member's house early one Sunday morning
He was sitting outside a building, wearing yellow slippers and

looking hopeless
We had walked past him but my spirit reached out to me, so I asked the sister to turn around with me so that we can minister to this brother
He was happy we came around
He said he had spent everything he had on the leg and he was desperate enough to accept any

Ankle joint is undertrained in a single joint means in both the frontal plane & in dorsiflexion 2 prevent lateral ankle sprains and shin splints. Single joint exercises allows you to evaluate the joint actions ROM & strength to understand injury risk & where development is needed

AJ Abduction (Cutting)

1. I pull the foot in2 dorsiflexion 2 stabilize the joint

2. I pull against the increasing tension of the band in2 abduction w/o losing dorsiflexion & also w/o externally rotating the thigh.

3. On the negative resist the bands pull eccentrically.

AJ Adduction (Cutting)

1. I pull the foot into dorsiflexion and I pull the foot into adduction against the tension of the band w/o medial rotation of the thigh.

2. I resist the negative movement of the band pulling the ankle into abduction eccentrically.

"Public health" isn't just about vaccinations, clinics and urgent care: it's a holistic discipline that encompasses all the contributors to health outcomes, which include things like housing, employment, transportation, pollution and more.

1/

A new working paper from @nberpubs estimates the number of US covid deaths that could have been prevented with a coherent, effective eviction moratorium and a ban on utility cutoffs:

The paper, written by a multidisciplinary group of Duke researchers from medicine and economics, found that housing precarity (a risk of losing your home) drove risky behavior that increased the spread of the disease and the resulting deaths.

3/

For example, it forced people to double-up on lodgings, making social distancing impossible, to say nothing of self-isolating after an exposure. It also drove people to tolerate high-risk workplace conditions, including illegal conditions.

4/

The authors used regression techniques to control for confounding variables, and used like-for-like counties with different utility and eviction policies to estimate the effect that these had on infection rates.

5/

Anxiety resides in 4 spaces:

1. The space inside you
2. The space between you and another
3. The space between others
4. The space inside another.

A powerful de escalation tools is to first locate the anxiety. Where is it?

Often the answer is 'all 4.' Yikes!

1/

Anxiety is contagious, we spread it and escalate it unless we know how to manage it.

This was perhaps my biggest lesson as a trauma chaplain - the very hard work of not catching someone's anxiety.

2/

When I caught it, I was no good to them. I no longer saw what was going on, I was now 'infected' by my own triggers, assumptions, the story I tell myself. I was all wrapped up in myself.

But when I managed my anxiety, I was able to be calm, aware and fully present to them.

3/

Even in the very worst moment of their lives, even if they had me by the shoulders screaming, 'how could God allow this to happen?'

4/

Incidentally, early in chaplaincy, I thought this was an actual question. Because I was anxious, I was more infected by my need to answer than I was to simply be calm and present with them in their pain.

5/

1) Anyone injecting people with EXPERIMENTAL mRNA 'gene-therapy', FRAUDULENTLY labelled ‘vaccines’, WITHOUT informing them they're taking part in an EXPERIMENT with potentially very serious health risks, including death, IS BREAKING THE LAW. Nuremberg Code https://t.co/OY1Q3L3DwA

1. “Dr Tomas Ryan : Sociopath Or Psychopath : Or Both ?”

Answer = Both. Shortest Thread Ever. Only joking. Let’s jump in and try to see what makes Dr Tomas Ryan tick 🧵 1/21

2. Dr Tomas Ryan is a Neuroscientist at Trinity College Dublin. He has appeared on Claire Byrne Live, Prime Time & The Tonight Show in addition to radio appearances. He calls himself a Scholar on his Twitter bio.

3. He is part of the Zero Covid Cult Crew (ZCCC) out of that hallowed institute of learning, Trinity College Dublin. Other contemporaries of his in the merry little band are Luke O Neill, Kingston Mills & Aoife McLysaght.

4. Kingston Mills & Aoife McLysaght are staunch proponents of the Zero Covid strategy. Mills is an agenda contributor to the World Economic Forum and recently wrote an article for them entitled "Is reaching zero Covid-19

5. Did I forget to mention that TCD got funding from the Bill & Melinda Gates foundation for Vaccine development to the tune of $230,000. Tomas was also sponsored by Wellcome Trust Sanger Institute to complete his Phd in Cambridge. Let's just say he has connections to Big Pharma

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.

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)

This one is for the real stats folks.

Let's deal with some objections to the deaths after flu vax/deaths after Covid vax comparison.

1) I agree Covid vaccine deaths are probably more likely to be reported than flu vaccine deaths. Are they 900 times more likely? Very doubtful...

2) Here's one good reason to think the gap may be small. The ratio of non-serious to serious Vaers reports is far HIGHER for the flu vax than for Covid. In other words, people have basically STOPPED filing non-serious event reports after Covid shots, because they are so common...

3) If people were clogging VAERS with Covid vaccine side effects reports because they are so sensitized to them, we'd see the opposite - tons of reports in every category. We aren't, though.

4) Children aside (and children do receive a lot of flu shots), the idea that the Covid vaccine is going to a meaningfully different population than the flu vaccine is nonsense. Flu campaigns are targeted at the elderly and healthcare workers, just like the Covid vaccine...

5) The correct area under the curve at risk post-Covid vaccinations is not 41 million doses x 8 weeks of followup. It's more like 41 million doses x 3 days. READ THE VAERS REPORTS YOURSELF. I have. The "he was hit by a bus a week after being vaccinated" isn't what's in there...