Gabriel Bosslet Profile picture
Father of 4 | married to @Bossletmd | IM Pulm/Crit Care fellowship director | Assistant Dean of Faculty Development @iumedschool | I run to stay sane.
20 Aug
mRNA injected into deltoid cells lasts about 72 hours and do not travel to distant sites in the body.

I get asked about this all of the time, so I went to find the primary science on this.

A couple of quick tweets

1/
The first paper I can find on this was in @ScienceMagazine in 1990 and showed the half-life of RNA in muscle cells to be less than 24 hours- RNA encoding the luciferase protein was injected into mouse quads and luciferase was undetectable at 60 hours. pubmed.ncbi.nlm.nih.gov/1690918/

2/
In 2007, a study agreed:

Luciferase-encoding mRNA injected into human ear dermis peaked transcription at 17h and was undetectable at 3 days (panel d).

They also looked for luciferase expression at distal sites in the ear and saw none (panel e).

pubmed.ncbi.nlm.nih.gov/17476302/

3/
Read 5 tweets
22 Jul
Earlier this summer I was adamant that school would be reasonable without masks, even for the ages for which vaccines are not available.

I have changed my tune. A quick 🧵as to why.

1/
Most data suggest that the SARS-CoV-2 virus affects kids in a generally quite benign way.

I know people get frustrated when COVID is compared to the flu, but for kids the data suggest the comparison is reasonable. And this accounts for "long COVID" and MIS-C.

2/
So when I suggest that masks should be mandatory in school for kids, I am not worried about the health of my unvaccinated 6 and 11 year olds.

I am worried about it causing widespread community transmission and overwhelming hospitals.

Again.

3/
Read 7 tweets
13 Apr
This week our manuscript on the role of in-person school on community spread of SARS-CoV-2 in Indiana was published online in Clinical Infectious Diseases.

This thread will outline our findings.

manuscript: bit.ly/3mIXvC5

1/17
This was a truly interdisciplinary effort.
@micahpollak (@iunorthwest): economics
Jeong Jang (@IUmedschool): biostats
@rebekah_roll (@IUmedschool): data gathering
Mark Sperling (@iunorthwest education): education
@deliriumkahn: analysis

I just sort of herded cats.

2/17
I’m going to target this thread to a wide audience, so my description of our work may leave some wanting more detail. The detail is in the online version and the supplement. Happy to answer any questions on the work as they come up.

3/17
Read 17 tweets
4 Apr
Over the last about 6 years I have adopted the practice of not checking email AT ALL on vacation.

When I mention this, many scoff and say that would never work for them.

I said the same thing when I started.

Join me for a 🧵 about my journey to vacation email freedom.

1/
I have a relatively busy job as a clinician, fellowship director, and assistant dean for faculty development/affairs.

I average 70-100 emails per day.

So committing to not checking it for a week (or 2!) away is admittedly no small task.

I adopted this practice in stages.

2/
My initial state was bad- there was one vacation in which I was answering emails on my computer on the beach as my kids were frolicking in the ocean.

This was when I knew I had to make a major change. This was my low point.

3/
Read 14 tweets
3 Apr
Bread and butter pickles are disgusting.
Also why don’t they make chicken broth with 33% MORE sodium?

I feel like they are ignoring most of the market here.
And cottage cheese is complicated. Matching curd size and %milk fat gets complicated. Like I need a 2x2 grid to figure that shit out.
Read 4 tweets
6 Feb
It's tax time!!

Today I sit down and slot through a bunch of forms and discover whether or not I win or lose the tax lottery.

A 🧵about online filing and the fact that is is free for most despite the fact that no one knows this.

Includes links with how to do it for free.

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IN 2003, the IRS partnered with a group of companies called the "Free File Alliance", which is a group of tax software companies to help Americans file their taxes ONLINE for FREE.

freefilealliance.org

2/
They intentionally deeply buried the links for the free filing software that most everyone signed up for the NON-FREE version of the software and assumed it wasn't free.

It is supposed to be 100% free.

@propublica wrote a terrific article on this bit.ly/3jnVSIt

3/
Read 7 tweets
4 Feb
Headlines about a recent study point out that a recent study of the Astra Zeneca vaccine appears to slow transmission of the SARS-CoV-2 virus.

nyti.ms/39HJ78f

I think it is important to show what this study does and does not imply.

1/7
You can find the manuscript here: bit.ly/3cF1Fbe

NOTE THAT THIS IS A PREPRINT AND HAS NOT YET UNDERGONE PEER REVIEW.

2/7
Vaccines are good at reducing symptomatic #COVID19.

What people really want to know is if they can take off their masks once they have the vaccine. After I am vaccinated, if I don’t have symptoms, could I be infectious?

I will refer to this as slowing asymptomatic spread.

3/7
Read 8 tweets
30 Dec 20
There is chatter about this study in @nature that "disproves" asymptomatic spread- ergo, lockdowns were unneeded.

Let's unpack this because I think this is a blatant misinterpretation of this amazing study.

go.nature.com/3rAmzgV

1/
First off, let's talk about what an unbelievable study this is.

The city of Wuhan, China had a SARS-CoV-2 screening program in which they set out to test all city residents- and were successful in testing 9,899,828 individuals (92.9% of eligible citizens).

IN 19 DAYS.

2/
Wuhan has the equivalent population to North Carolina.

As of today, North Carolina has only carried out 6,800,055 tests (and this is not individuals- this includes multiples).

Wuhan did in 19 days what North Carolina has not done in 10 months.

3/
Read 17 tweets
30 Dec 20
Gosh darn if the #instantpot hasn’t killed it three nights running.

I’m waiting for the other shoe to fall.

Even @BossletMD agrees.
@mcstarr1: Started with this taco soup. It was absolutely amazing. And fast. The leftovers were sublime. Honestly. I don't generally like taco soup. This was unreal.

facebook.com/17801224623780…
Then we did this salmon and potatoes dish.

I was nervous because the kids get suspicious of fish.

I need to increase the portions next time.

Even the spinach in the potatoes tasted great.

foodnetwork.com/recipes/food-n…
Read 4 tweets
11 Nov 20
Let’s talk about difficult conversations.

Difficult conversations are those that we tend to avoid because they suck. They usually include disappointing someone we don't want to.

A thread on difficult conversations, #COVID19, and leadership.
1/
Difficult conversations abound in COVID time. Examples include:

“I know you want to go to that soccer tournament, but 400 teenagers and their parents in an indoor facility seems unwise.”

2/
“Thanks for inviting me to dinner at Billy Bob’s low-ceilinged, poorly ventilated tavern. I am going to pass because of the pandemic.”

“Thanks for inviting me to your wedding. I am going RSVP no given the global pandemic.”

“Mom, we have to talk about Thanksgiving.”

3/
Read 10 tweets
23 Oct 20
Earlier this year, @bossletMD and I tweeted about how we were planning on handling the summer.

Winter is upon us.

As a critical care doc and a pediatrician with 4 school aged kids, and a winter of uncertainty ahead, here is how our family is approaching the coming months.

1/
I offer this as a point of reference for those struggling with how to handle the coming cold, not as a strict recipe others should follow.

This is OUR way- I don’t pretend it is THE way.

Some will think we are overly cautious, and others will think we are being cavalier.

2/
.@BossletMD and I discussed the underlying facts that will guide our decisions. They include:

Fact 1:
If I or my immediate family members (wife and kids) contract COVID, the odds are far in our favor that we would be fine.

3/
Read 18 tweets
23 Aug 20
Inspired by @ETSshow and @ChrisLMosher, a #medtwitter #thread on “6 tactics to improve difficult conversations”

The following can apply to conversations with loved ones, colleagues, patients, teenagers, and pretty much any other human.

Warning: this one is kind of long.

1/
I do not suggest that I am the best communicator in difficult conversations. @BossletMD may tell you the opposite. But this is something I reflect on and work hard at to improve.

I credit @vitaltalk for helping me notice my incompetence in these areas almost a decade ago.

2/
First, let’s establish that conflict is ubiquitous, usually unavoidable, and often is not pathologic.

Like a forest fire, it is often a catalyst for new growth.

So avoiding conflict at all costs is folly and a way to lead to let things fester.
3/
Read 19 tweets
8 May 20
Our Summer with Coronavirus

As a critical care doc with a pediatrician wife, 4 school aged kids, and a summer of uncertainty ahead, here is how our family is approaching the coming months.

Also, some GIFs.

1/
I offer this as a point of reference for those struggling with how to handle the dog days, not as a recipe that others should follow. This is OUR way- I don’t pretend that it is THE way. Some will think we are overly cautious, and others will think we are being cavalier.
2/
This plan operates under 4 assumptions.

(@BossletMD and I had to agree on the following, which was a discussion worth having)

Summer plan assumption 1:

If I or my immediate family members (wife and kids) contract COVID, the odds are FAR in our favor that we would be fine.
3/
Read 22 tweets
29 Mar 20
I have been chewing on the @SCCM @aarc_tweets @ASALifeline @APSForg @AACNme @accpchest “Consensus statement on multiple patients per ventilator”, published jointly on March 26:
bit.ly/2UIdrai

I disagree with the sentiment of this statement.
Here is why.
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The following come from a self-described medical minimalist and a skeptic when it comes to new medical technologies. I am far more likely to tell people to “slow down” than to “check out this new toy”. You can ask @GrahamCarlos @ryanboente @erinmcrowley @tjelle13
2/
The statement is not published in a format that allows for comment, or this would be a letter to the editor.

I agree with much of the substance of the statement- they point out issues well worth considering that need worked out before splitting a vent is definitively safe.
3/
Read 14 tweets
27 Mar 20
THREAD
#MEDED and #PCCM ADVOCACY HELP NEEDED:
The U.S. Citizenship and Immigration Services announced on March 20 the suspension of premium processing for H1B visas.
@ATS_BSHSR
@accpchest
@acpinternist
@APCCMPD
@AmerMedicalAssn
THIS IS A MAJOR PROBLEM.
1/
Premium processing is THE WAY that these trainees are able to have visas processed in a timeline that best prepares them to practice at their place of employment starting in July. Disallowing premium processing means a delay in their visa status, which delays credentialing.
2/
This is likely to lead to a 3-4 month delay in their being able to see patients at the conclusion of their training. This will effect 1200-1500 physicians who are completing residency here in the United States, most of which will be practicing in underserved areas.
3/
Read 10 tweets
5 Aug 19
This weekend I posted a #thread about #PersonalStatements. It got a lot of attention- much of it good, some critical.

In the spirit of a #GrowthMindset I decided to lean in to the criticisms and try and improve it.

#Meded
#Medtwitter
#MedstudentTwitter
The content of the original #thread was true to my thoughts about the topic, but was written in a way that did not give proper context to the role of the PS in the process. It was also completely tone-deaf in that the voice I used was condescending and mean. And that is not me.
So I’m considering that thread what @ANNELAMOTT would call a #ShittyFirstDraft. The following draft incorporates feedback from the @Twitter #meded community into something I hope is a bit more useful (and a lot more friendly).
Read 30 tweets
3 Aug 19
I’m a fellowship director who just finished reviewing over 400 applications for 8 fellowship spots.

The following is a #thread on writing a personal statements.
(Spoiler alert: I find 99% of them to be TERRIBLE.)

#meded
#medtwitter
#medstudenttwitter
1/
The following are MY preferences and proclivities. Some will ring true for other PDs, some may not. And Turi McNamee wrote very eloquently about this in @AnnalsofIM in 2012. pdfs.semanticscholar.org/94f4/4d6b3da42…
2/
I’m going to tag @davidschulman , @jennifer_jwm , @KristinBurkart3 , @DrMCMiles, @GenevaTatemMD, who are PD colleagues in #pccm, and @sanjayvdesai , @TKapetanos , @MitchGoldmanMD, @abbyCCim, @jenchoi_iu and any others who are PDs. I’d love to hear from them on this topic.
3/
Read 28 tweets
16 Apr 19
THREAD
Recently in our #MICU, I took pics of the oxygen sats of patients on oxygen supplementation.

What is the optimal oxygen supplementation strategy for a clinically stable patient in the ICU?

Follow me down this #tweetorial rabbit hole. #medtwitter #pulmcc #AIMW19
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Given that population health improvements often come from small benefits in large populations, and the fact that #oxygen is one of the most commonly prescribed interventions in the #ICU, there is potential for benefit if we can correctly titrate our oxygen titration.
2/
I’m going to refer to hypoxia and hyperoxia in this #medthread, and I’d like to (somewhat arbitrarily) define these terms. I’ll call hypoxia anything below 90% and hyperoxia anything above 96%. This is based upon some of the literature I will discuss.
3/
Read 23 tweets
23 Mar 19
A quick #thread on the importance of #mentorship and critical #feedback in writing. I’m targeting students, trainees, and younger faculty who struggle with the #mentoring process- I’ll share some vulnerability to demonstrate a #growthmindset- I’ll also recommend 2 books.
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A couple of weeks ago I was invited by @AnnalsATS to write an editorial for a paper. I loved the topic so I quickly agreed and started ordering my thoughts. It was a quick turnaround- 2 weeks, so I had to get moving.
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I worked diligently on the draft and invited @vitaincerta to co-author- she is smart as a whip and a terrific writer and I knew she would really help to shape a well-written piece. She agreed and I sent her my #ShittyFirstDraft.
3/
Read 15 tweets
23 Feb 19
(Thread)
I’m going to discuss how physician payment rates in the US are set and suggest a reason why #primarycare is poorly valued from a salary standpoint in the U.S. I’ll also suggest how anyone interested can work to improve payment for #primarycare.
1/
I am targeting younger physicians and medical students - this may be too simplistic for some, and go into the weeds too much for others. But the whippersnappers are the ones that are more likely to lead change, and so that is the audience here.
2/
Disclaimer: I am an academic #pulmcc physician, not a #primarycare physician. So I’m in a procedure-heavy specialty. I'm also not an expert in health policy, so feel free to gently correct anything that seems off.
3/
Read 27 tweets