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Dennis OConnor

The Coronavirus Conundrum: ACE2 and Hypertension Edition - NephJC - 0 views

  • Hypertension and COVID19
  • Are patients with hypertension more likely to get COVID19?For this, we need a well-designed cohort study with incidence rates of COVID19 in patients with hypertension (HT) and those without HT, in which exposure history is able to be carefully accounted for.
  • Amongst the patients with COVID19, it seems the prevalence of prior h/o HT is higher in those who develop severe disease than those who do not.
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  • Hypertension does seem to be a common comorbidity, even more so than diabetes - but these are all data from one country, so one should be careful before generalization.
  • Why might there be a link between high blood pressure and COVID19?As you can read so far, we are not convinced the data show a strong, robust link. However, the virus uses the renin-angiotensin system - hence all the speculation. Read about the science behind the speculation below.
  • Can ARB/ACEi use (and potentially increased ACE2) actually be beneficial in coronavirus and other viral pneumonias?This is an interesting question and has been looked at in both animal model and human studies (retrospective). This study looked at patients (humans) with viral pneumonia and demonstrated an association with improved outcomes in patients with continued ACEi use during viral pneumonia. However, you could argue that patients with viral pneumonia who had continued use of ACEi while hospitalized were not “as sick” as patients in which it was discontinued. 
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    Recommended by DeAunne Denmark, MD, PhD: "... this excellent international society and expert consensus site regarding anti-hypertensives and ACE2, the protein used by both SARS for host cell.
Dennis OConnor

Advice from Dr. Mimi Guarneri - Integrative Medicine - 1 views

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    "Thankfully, there are many things we can do as individuals and communities that may be helpful. It is important to remain calm and think clearly. Remember that our positive attitudes go a long way in protecting health, enriching our daily lives, and supporting the ones we love. Here is a list of things one can do at home to help in these uncertain times:"
Dennis OConnor

Don't "Flatten the Curve," stop it! - Joscha Bach - Medium - 1 views

  • What all these diagrams have in common:
  • They have no numbers on the axes.
  • They don’t give you an idea how many cases it takes to overwhelm the medical system, and over how many days the epidemic will play out.
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  • They suggest that currently, the medical system can deal with a large fraction (like maybe 2/3, 1/2 or 1/3) of the cases, but if we implement some mitigation measures, we can get the infections per day down to a level we can deal with.
  • They mean to tell you that we can get away without severe lockdowns as we are currently observing them in China and Italy.
  • nstead, we let the infection burn through the entire population, until we have herd immunity (at 40% to 70%), and just space out the infections over a longer timespan.
  • The Curve Is a Lie
  • suggestions are dangerously wrong, and if implemented, will lead to incredible suffering and hardship.
  • Let’s try to understand this by putting some numbers on the axes.
  • California has only 1.8.
  • The US has about 924,100 hospital beds (2.8 per 1000 people)
  • Germany have 8
  • South Korea has 12
  • Based on Chinese data, we can estimate that about 20% of COVID-19 cases are severe and require hospitalization
  • many severe cases will survive if they can be adequately provided for at home
  • by some estimates can be stretched to about a 100,000, and of which about 30,000 may be available
  • mportant is the number of ICU beds
  • oxygen, IVs and isolation
  • About 6% of all cases need a ventilator
  • if hospitals put all existing ventilators to use, we have 160,000 of them
  • CDC has a strategic stockpile of 8900 ventilators
  • number of ventilators as a proximate limit on the medical resources, it means we can take care of up to 170,000 critically ill patients at the same time.
  • Without containment, the virus becomes endemic
  • Let’s assume that 55% of the US population (the middle ground) get infected between March and December, and we are looking at 180 million people.
  • the point of my argument is not that we are doomed, or that 6% of our population has to die, but that we must understand that containment is unavoidable, and should not be postponed, because later containment is going to be less effective and more expensive, and leads to additional deaths.
  • About 20% will develop a severe case and need medical support to survive.
  • Severe cases tend to take about 3–6 weeks to recover
  • 6% may need intubation and/or ventilation
  • Once a person is on the ventilator, it often takes about 4 weeks for them to get out of intensive care again.
  • The “flattening the curve” idea suggests that if we wash our hands and stay at home while being sick aggressively enough, we won’t have to stop the virus from becoming endemic and infecting 40% to 70% of all people, but we can slow the spread of the infection so much that out medical system can deal with the case load. This is how our normally distributed curve looks like when it contains 10.8 million patients, of which no more than 170,000 are ill at the same time:
  • Dampening the infection rate of COVID-19 to a level that is compatible with our medical system means that we would have to spread the epidemic over more than a decade!
  • confident that we will have found effective treatments until the
  • reducing the infectivity of the new corona virus to a manageable level is simply not going to be possible by mitigation, it will require containment.
  • My back-of-the-envelope calculation is not a proper simulation, or a good model of what’s going on either. Don’t cite it as such!
  • Of the 180 million, 80% will be regarded as “mild” cases.
  • Containment works
  • China has demonstrated to us that containment works
  • lockdown of Wuhan did not lead to starvation or riots
  • made it possible to focus more medical resources on the region that needed it most
  • implemented effective containment measures as soon as the first cases emerged.
  • South Korea was tracking its first 30 cases very well, until patient 31 infected over 1000 others on a church congregation.
  • For some reason, Western countries refused to learn the lesson.
  • The US, UK and Germany are not yet at this point: they try to “flatten the curve” by implementing ineffective or half hearted measures that are only meant to slow down the spread of the disease
  • instead of containing it.
  • some countries will stomp out the virus and others will no
  • few months from now
  • almost all travel from red zones into green zones will come to a hal
  • world will turn into red zones and green zones
  • Flattening the curve is not an option for the United States, for the UK or Germany. Don’t tell your friends to flatten the curve. Let’s start containment and stop the curve.
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    "Flattening the curve is not an option for the United States, for the UK or Germany. Don't tell your friends to flatten the curve. Let's start containment and stop the curve." Strong article with data visualizations from a Phd working out of MIT/Harvard.
Dennis OConnor

Home - NORD (National Organization for Rare Disorders) - 0 views

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    ""This year, patients, families, caregivers, medical professionals, NORD staff and other stakeholders participated in over 25 Rare Disease Day advocacy events in 23 states.""
Dennis OConnor

Chasing My Cure: Dr. David Fajgenbaum Lessons from his Rare Disease and On Finding Cure... - 0 views

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    "David Fajgenbaum, MD, MBA, MSc, is the co-founder and Executive Director of the Castleman Disease Collaborative Network (CDCN) and one of the youngest individuals to be appointed to the faculty at Penn Medicine, where he is an Assistant Professor of Medicine in Translational Medicine & Human Genetics, Founding Director of the Center for Study & Treatment of Castleman & inflammatory Lymphadenopathies (CSTL). An NIH-funded physician-scientist, he has dedicated his life to discovering new treatments and cures for deadly disorders like idiopathic multicentric Castleman disease (iMCD), which he was diagnosed with during medical school. As common as ALS and more deadly than lymphoma, iMCD involves the immune system attacking and shutting down the body's vital organs such as the liver, kidneys, bone marrow, and heart. After spending months hospitalized in critical condition, having his last rites read, and having four deadly relapses, he is now in his longest remission ever thanks to a treatment that he identified in the lab."
Dennis OConnor

Meet Master Yuantong Liu - Hunyuan Qi Therapy - 0 views

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    "Master Liu is sharing Zhineng Qigong theories, principles and methods since over 40 years and was trained directly by Dr Pang Ming during the rigorous teachers' program in the Huaxia Zhineng Qigong Clinic & Training Center - globally renowned as the first "medicine-less hospital in the world"."
Dennis OConnor

Master Yuantong Liu - Posts - 0 views

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    Master Liu's Facebook Group.
Dennis OConnor

What is disulfiram and why is it sparking excitement in Lyme community? - 0 views

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    "What is disulfiram and why is it sparking excitement in Lyme community?"
Dennis OConnor

- FasterCures - 0 views

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    "FasterCures is an action tank that works to speed and improve the medical research system. 10,000 diseases. 500 treatments. We have work to do."
Dennis OConnor

Trials.ai - 0 views

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    "Optimize for Time, Cost, Risk, and Patient Centricity Think of Trials.ai as the best second opinion you've ever had. The result is an optimized trial that ultimately enables a new treatment to reach patients faster- all through the lens of time, cost, and patient centricity powered by our Patient Burden Index™. ‍ Our system also looks for potential pitfalls that might need to be flagged and adjusted. Get feedback about how each decision you make affects:"
Dennis OConnor

The Four Agreements - don Miguel Ruiz - 0 views

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    "The Four Agreements are: Be Impeccable With Your Word. Don't Take Anything Personally. Don't Make Assumptions. Always Do Your Best."
Dennis OConnor

DailyGood: One Love - 0 views

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    Koolulam mass singing event at Tower of David Museum joins disparate voices in a show of unity coinciding with the Muslim holiday of Eid al-Fitr.
Dennis OConnor

The Power of the Process: Creating Positive Outcomes with David Rakel, MD | The Institu... - 0 views

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    "In this podcast, IFM's Director of Medical Education, Dan Lukaczer, ND, interviews researcher, educator, and clinician David Rakel, MD, on the power of empathy, compassion, the placebo effect, and the patient story. In particular, they explore how empathy and sympathy can lead to burnout, while compassion can be restorative." shared by Vicky Newman
Dennis OConnor

NAD+ Science 101 - What Is NAD+ & Why It's Important | Elysium Health - 0 views

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    "NAD+ is essential to the creation of energy in the body and the regulation of pivotal cellular processes. Here's why it's so important, how it was discovered, and how you can get more of it."
Dennis OConnor

Health Literacy - CCMI - 0 views

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    "Empowering patients to have greater agency in, and control over health decisions. A patient's health literacy is their ability to read, understand and use health care information to make informed decisions and modify behaviours that affect their personal healthcare needs. Promoting health literacy among patients creates a more collaborative care environment, one that empowers patients to have greater agency in, and control over, their own care decisions. CCMI's Health Literacy programs introduce participants to concepts that support and emphasize the importance of being able to support patients and communicate clearly so that patients and family members can truly participate in care. Participants will gain an understating of Health Literacy concepts and learn practical skills for engaging with patients to ensure clear and effective communication."
Dennis OConnor

CCMI - Centre for Collaboration, Motivation and Innovation - 0 views

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    "Creating Partnerships, Motivating Individuals, Facilitating Change The Centre for Collaboration, Motivation and Innovation (CCMI) helps individuals and organizations create partnerships that improve health and well-being. We do this by working collaboratively to inspire new ways of thinking about helping relationships, teach practical skills that foster partnerships, and implement strategies for system-wide change."
Dennis OConnor

POONACHA MACHAIAH - 0 views

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    "Poonacha Machaiah is a global leader among a new breed of social entrepreneurs who is applying his corporate expertise from 25 years as a business leader in Fortune 100 companies as well as his background in advanced technological strategies to tackling social and environmental problems. Machaiah has collaborated extensively with Deepak Chopra, M.D., world-renowned mind-body medicine pioneer and New York Times best-selling author, in their shared mission of "personal transformation and societal wellbeing." Together they have designed and overseen the launch of wellbeing programs in corporations and communities around the world."
Dennis OConnor

Approaches to governance of participant-led research: a qualitative case study | BMJ Open - 0 views

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    "Prospective consent and governance principles for participant-led research Nine themes emerged from discussions and interviews relating to informed consent in and governance of PLR. As this PLR was driven by people with different backgrounds asking personal questions, we found that ethical reflection needed to be ongoing and tailored to the individual. For this reason, prospective governance principles were drafted rather than codified rules. Many of the themes were expressed over the course of our PLR as an ongoing informed consent. The process, fostered via frequent communication, helped to reinforce trust among participants and organisers.43 44 Transparency: All relevant information about the project should be actively shared among participants and participant-organisers, including the source of research funding, equipment selection, data management protocols, risks and benefits and conflicts of interest. Access to Expertise: Participant-led research (PLR) requires access to experts (eg, in experimental design, data analysis, research ethics) so that participants can rigorously carry out single-subject experiments.45 Data Access & Control: The participant has the right and ability to manage their own data, and has the final say in what they collect about themselves. Right to Withdraw: Participants have a right to reduce or withdraw their participation at any time. Relevance: PLR addresses questions of relevance to the participants. Beneficence: The participant actively reflects on the balance of benefits and risks of participation and freely choose whether to participate. Responsibility: PLR requires that the participant actively consider the potential benefits and harms of the project to both themselves and others. The responsibility to stay informed is an ongoing process, not a one-time decision. Flexibility: Ethical reflection in PLR should be tailored to individual needs and to the specific context, rather than be handled with 'one size fits all
Dennis OConnor

ASMscience | Building Research Integrity and Capacity (BRIC): An Educational Initiative... - 0 views

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    "While citizen science is gaining attention of late, for those of us involved in community-based public health research, community/citizen involvement in research has steadily increased over the past 50 years. Community Health Workers (CHWs), also known as Promotores de Salud in the Latino community, are critical to reaching underserved populations, where health disparities are more prevalent. CHWs/Promotores provide health education and services and may also assist with the development and implementation of community- and clinic-based research studies. Recognizing that CHWs typically have no formal academic training in research design or methods, and considering that rigor in research is critical to obtaining meaningful results, we designed instruction to fill this gap. We call this educational initiative "Building Research Integrity and Capacity" or BRIC. The BRIC training consists of eight modules that can be administered as a self-paced training or incorporated into in-person, professional development geared to a specific health intervention study. While we initially designed this culturally-grounded, applied ethics training for Latino/Hispanic community research facilitators, BRIC training modules have been adapted for and tested with non-Latino novice research facilitators. This paper describes the BRIC core content and instructional design process."
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