To the ivermectin die hards asking "What about Uttar Pradesh?!?" Perhaps you can answer the question "Why *ONLY* Uttar Pradesh?"
You realize that IVM was tried and failed in Peru, Brazil, & elsewhere. Why have the benefits of IVM *never* been seen in RCTs or other countries?
1/
Alternatively, perhaps the "Uttar Pradesh Miracle" has to do with proven interventions: lockdown, curfew, mask mandate, testing/quarantine, & vaccines.

There's also major under-reporting in UP. (Unless you think IVM has decreased deaths from car accidents & cancer too).
2/ From https://www.nature.com/articles/s41562-020-01009-0 Source: https://www.medrxiv.org/content/10.1101/2021.08.04.2
To those saying UP "was only 5% vaccinated" when cases started to drop, realize that vaccinating frontline people can/does reduce transmission & vaccinating high risk people reduces mortality.

If you are looking for why cases REMAIN low, UP is >50% partially vaxxed right now
3/
Also recognize that we've seen an identical pattern of a spike in cased followed by rapid decline in places that never used ivermectin, such as New York City, Northern Italy, and Spain.
A decline in cases after a spike isn't a miracle. It's what happens in a pandemic.

4/4
For more on this see my updated post on Debunking Ivermania:
5/5
onepagericu.com/blog/debunking…
People seem very confused by this.

“Only 5% fully vaccinated” (w/ ~20-25% partially vaxxed) means that about a quarter of the population is less likely to be infected & infect others, and are at lower risk of dying or being hospitalized. This absolutely can make a difference.

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More from @nickmmark

7 Oct
Here’s an interesting ventilator waveform; can anyone explain what’s going on during this inspiratory hold maneuver?
Another clue:
Y’all nailed it! This is a large bronchopleural fistula (BPF) causing air leak.

See how airway pressure drops with inspiration hold?

The ventilator measures exhaled (or “returned”) volumes and is alarming “Low MV” b/c most of the air is going out the chest tubes not the ETT
1/
Read 4 tweets
6 Oct
Yesterday I shared a fun fact that black coffee cools faster than coffee with milk/cream.

Today I woke up early and decided to do an experiment. What followed was interesting & more than a little messy (🤷 that’s science!)

A short 🧵 on ☕️ science
1/
First some background:

Supposedly black coffee ☕️ cools faster for two reasons:
1. Black coffee radiates more heat because black objects have greater emissivity (due to Stefan Boltzmann)
2. Milk 🥛 increases viscosity & decrease evaporative cooling

Should be easy to test?
2/
Methods:
I made coffee & (tried to) warm the 🥛 to the same temperature as the ☕️.

I aliquoted the coffee and combined w/ or w/o 50 ml milk, bringing to the same volume (250ml).

Then I tried to pour both simultaneously into identical cups but managed to make a big mess. 🙊
3/ ImageImageImageImage
Read 7 tweets
5 Oct
When #VaccineMandates for healthcare workers (HCWs) were announced many "experts" warned that there would be a huge exodus of staff in protest.

So far this hasn't happened.

Instead we've just made staff and patients a lot safer.

A short 🧵 of examples
1/
MUSC lost 5 employees out of 17,000 (0.02%)

Indiana University lost 125 workers out of 35,800 (0.3%). Most were part time.

Inova Health lost 89 of 20,000 workers (0.4%).

CristianaCare lost 150 workers out of over 13,400 (that's 1.1%). Most were part time. Just 12 were RNs
2/
Novant Health suspended 375 employees out of 35,000 for non-compliance. 200 got vaccinated. 175 left (0.5%)

New York Presbyterian lost about 250 out of 48,000 employees (0.5%).

UCHealth lost 119 of over 26000 employees (0.4%)
3/
Read 8 tweets
5 Oct
Fun fact: if you make two cups of coffee, one with milk and one black, which will cool faster?
Counterintuitively, the black coffee cools off FASTER.

(Yes adding cold milk 🥛 to hot coffee ☕️ does cool it off somewhat but the question is about the RATE of cooling. Also the ☕️ will reach room temperature first.)

But WHY is this?
Buckle up for some cool morning physics!
There are two reasons:
1. Dark objects radiate heat faster (this has to do with the Stefan Boltzmann law & black body radiation)
2. Viscosity slows down evaporation (milk/cream thickens the coffee; evaporation is an important mechanism of cooling)

We’ll talk more about each…
Read 9 tweets
24 Sep
When asked if people should get the flu shot this fall, Paul Marik says “truth be told in the last few years, the risk of being hospitalized after the vaccine was the same as placebo. In recent years the flu vaccine has been completely ineffective...”
1/2 Image
Marik goes on “and indeed I’m not an anti-vaxxer. The risk of Guillian-Barre Syndrome exceeded the risk of being hospitalized … for influenza. So you know what? People need to decide for themselves.”

Yikes! Next these lunatics will be railing against tetanus vaccines.
2/2
For those wondering what Cochrane *actually* says on this subject:

In a population of healthy adults, influenza vaccination reduce influenza & influenza like illness. They may reduce hospitalizations.

For those over 65 yo or with comorbidities the benefits are likely larger. Image
Read 4 tweets
19 Sep
Time for part 4️⃣ of my comparative physiology series:

Case 1
You are called about an elevated blood alcohol level in an inpatient.
"That’s impossible," the tech says, "he’s been admitted to the ICU for a month!"
It’s totally normal, you say, because the sample came from a __
1/
Answer: 🐠
Under anoxic conditions vertebrates produce lactate. This accumulates causing acidosis.
Goldfish & carp are unique b/c they can convert lactate to ethanol, which diffuses out of their gills into the water. They can survive w/o O2 for months!
nature.com/articles/s4159…
2/
Other answers
Bats & primates are good ethanol metabolizers by necessity due to a diet that includes fermented fruit.
The Pen Tailed Shrew is an especially fast ethanol metabolizer: adjusted for size, it consumes the equivalent of 9 beers/day!
3/ URL: https://www.science.org/news/2008/07/now-thats-party-an
Read 24 tweets

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