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Many new starters in ICU struggle with mechanical ventilation - how does it work? What settings do you use? What on earth are all these three letter acronyms?

So this is module I made to help them understand

Please share it around with your newbies

osler.app.link/7PrBm1xRkvb

#medmastodon #icu #intensivecare #intensivist #juniordoctors #tipsfornewdocs #emergencymedicine #emergencyphysician #FOAMed #FOAMcc

So far, 520 people, and counting, are running for mayor of Denver. I don't know anything about any of them, but judging from the e-mails they're sending me, each one is absolutely terrific. The choice will be difficult.

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Some of the biggest questions we humans like to ask are, “Is there life out there in the universe?” and “Are there other solar systems out there with planets just like ours?” To answer these questions, astronomers have built larger & more advanced telescopes to try to find #Planets outside of our own neighborhood, specifically those similar to our own world.

*expand for photo info

#SpaceMastodon #Space #Astronomy #Astrodon #ScienceMastodon #Science #Exoplanets #ExtrasolarPlanets

Having run my own test mastodon server, I can tell you that boosting is REALLY important. That's how posts propagate between servers that are not federated together.

I may get a bit technical, and it can be hard to describe but it's something like this:

Let's say that you have 2 servers, A and B that are not connected. They have their own federated timelines that is vastly different.

let's assume they have their users @a@A and @b@B that are mutuals. If user @a@A sees something interesting on theirs federated timeline and boosts it, user @b@B will see that on their own home page. But more importantly server B will now know about and download that post, and everyone else on B server will be able to see that post on their own federated timeline!

And that's why you boost, guys! It helps posts to spread.

#FediTips

Our ancestors were not stupid, part the nth. Humans have always liked tasty food with a fair amount of variety, and we've been finding ways to make it tastier and more varied for a very long time. Link to open-access journal article in the story.

phys.org/news/2022-11-real-pal

Friends, hear me now.

If at any point in your online discourse, you find yourself about to write "according to science," or "statistically speaking," or Archimedes help me, "scientists now believe" ...

Stop.

Choose another phrase. Language is versatile. You can do the thing. I believe in you. Super great.

Please. I'm begging here.

Seen in the wild: "L. Ron Musk" and "Phony Stark." I can't decide which I like best.

Most statements of the form "I remember when ..." can safely be dismissed with "no you don't."

@freemo I heard a rumor that is getting blocked by a bunch of other instances because of a conflict about terms of service. Any truth to this?

Given 's almost unbelievable sloppiness since the beginning of the war, it was inevitable that sooner or later a strike aimed at would hit a country, with lethal results. was always the most likely target. I have no idea what happens next.

apnews.com/article/russia-ukra

"Kherson Occupation Deputy Kirill Stremousov claimed on the evening of November 8 that Ukrainian forces broke through Russian defenses and gained a foothold on the northern outskirts of Snihurivka (45km northeast of Kherson City). Stremousov notably died in a reported car crash on November 9."

I guess falling out a window is passe.

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Meanwhile, in that *other* war, Russia has announced its withdrawal from Kherson. I've expected the withdrawal for some time—and now I expect it will be carried out with all the competence and professionalism that's characterized Russian operations from the day of the invasion—but I certainly didn't expect a press conference about it. This is extraordinary.

Hopefully they'll take Boebert with them. She'd be happier there anyway.

This is all over my feed at the moment. I'll preface it by saying that Spencer McDaniel is one of the best popular history writers in the field, and if you're not familiar with his work, you should be. But he's not perfect ...

I think he's half-wrong on this one. Right that there's no evidence for the defense hypothesis, and that the most likely reason is simple balance. Very very wrong about the idea that the attacker has an advantage fighting up a staircase.

Striking upward with a spear or a sword is exhausting, and with an axe it's nearly impossible. Whatever advantage the attacker would gain by access to the defender's ankles would be *vastly* outweighed by the defender's advantage in energy for strikes at the attacker's head, neck, and torso. There's a reason why holding the high ground was the primary tactical goal for most of recorded military history, right up until guns took over entirely—and it's *still* an advantage in most cases, because the poor bloody infantry still has to slog to the top of the hill.

I've never fought on a staircase, but I've done SCA melee combat on very steep ground. Zero doubt in my mind that it's better to be fighting from above than below.

Of course it's quite true that once an attacker was inside the castle, the defender had failed in the main goal: holding the high ground of the castle walls! But not every successful breach ended in victory. It's usually worth trying to hold whatever advantageous position you can ... compared to the alternative.

talesoftimesforgotten.com/2019

This is potentially very good news, via @Nephthys0xa. As with so many pieces of potentially good news, I'll believe it when I see it, but it's at least a place to start.

And now—try to contain your shock—a rant.

Do not respond to this post with bleatings about the "opioid crisis" or "alternative pain management" or "pain acceptance" or a link to a study sponsored by the makers of Tylenol. Seriously. Do not.

Over the last decade or two, I have watched several people I love, some of the people closest to me in the world, suffer from chronic pain. I have watched it chip away at their physical and mental capacities. I have watched it drive them to risky self-medication. I have watched it eat away at their very sense of self. I have watched it nearly kill them, and in a couple of cases I'm still not sure it won't.

I have also watched them get prescriptions for safe, inexpensive, easily available pain relief which dramatically improved their lives ... and then have that taken away. This is a story repeated millions of times. An almost unimaginable act of cruelty, made routine and mundane.

Listen to me very carefully.

A drug category like "opioids" which includes everything from tramadol and codeine on one end, to fentanyl and oxycodone on the other, is clinically meaningless. It may be chemically and biologically accurate. It may help us understand pain and the body's response. It may even be useful in new drug development. But it is not and never will be a guideline to what medication to give a patient who is actively suffering, right here, right now.

The blood of the thousands of people who deliberately committed suicide, who drank themselves to death, who overdosed on street narcotics, because they just COULDN'T TAKE THE PAIN ANYMORE—is on the hands of the people who decided to use the "opioid crisis" as an excuse to inflict agony on their fellow human beings, under the guise of concern.

So is the suffering of millions of people still living, every day, forever.

Those caring physicians and pharmacists and educators and regulators should be consumed with horror and self-loathing. They should know themselves for what they are, and take the possibility of undoing some tiny fraction of the damage they've done as their only motivation for staying alive themselves. They should beg for forgiveness, and accept whatever measure of it they get as unearned grace.

Of course they won't.

If anything I've said above makes you angry or uncomfortable or want to raise your hand and say "yes but" or "well actually" ... that's your problem. Go take a long look in the mirror and sit and think about what you've done. Then try to do better.

End of rant. I have work to do.

npr.org/sections/health-shots/

There is a meme, in the original sense of that word, going around that bought to destroy it. Firing 3/4 of the employees, removing effectively all moderation, the $8 blue checkmark special ... it's all part of a cunning master plan. After that he'll put on an iron mask and buy a small Eastern European country.

Naaah.

First of all, if he really wanted Twitter to go away, he could do that, you know? Fire *all* the employees, travel around the world personally pulling the plugs on every server, auction off the physical assets, and go back to cars and spaceships and flamethrowers. Nothing's stopping him. There would be lawsuits, but he's looking at plenty of those already: a few more should be no big deal.

Second, if there's anything bigger than his stock portfolio, it's his ego. Twitter is his most visible public forum. It's where he shares his semi-coherent ramblings with the world for legions of followers to repost like the words of the one true prophet.

Third, it's a rather large investment, and while I'm reasonably sure he'll lose a lot of money on it, I don't believe he *wants* $44 billion to disappear. His fan base might start experiencing seeds of doubt, and we can't have that.

A much simpler explanation is that he's in over his head.

He doesn't understand what makes Twitter valuable to its current user base. He has no grasp of how small his cult is in comparison to the internet as whole. He thinks his imprimatur is so magical that everything he touches will be a hit. He believes every word of his utopian babble, no matter how incoherent. Worrying about contradictions is for the little people.

Destruction will come, sure as the snowfall. But it won't be the work of an evil genius. That's *my* job.

Why despite all the advances in , I'm just not that worried about , part the nth:

I just coined the word "horrilarious" and I expect to be using it a lot.

A is crawling around on my computer while I am trying to . So .

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