Joscha von Rappard

60% Internal Medicine 40% Nephrology, 100% POCUS. If not working 🚴🚵‍♂️🧗‍♂️⛰⛺️🍷🍺

[Joscha von Rappard @JoRappard]

@neuralink @pocusmeded How not to wear scrubs…

[Joscha von Rappard @JoRappard]

@neuralink @pocusmeded How not to wear scrubs….

[Joscha von Rappard @JoRappard]

@StephenKing 💯! My teenage years would have been empty without your books. Wenn I think about it…I realise that some characters out of your books never left me and are still with me in my heart. Thank you, Mr. King!🙏

[Anil Makam @AnilMakam]

Things this author has gotten wrong, like royally wrong

1. Covid causes multisystem organ failure

Narrator: given 99% pf people have gotten covid, we haven't seen this after 6 years. Life expectancy increased. Employment is higher. Fewer heart attacks

2. Repeat covid infection is waaaaay worse

Narrator: its not. Immunity affords protection. People sick enough to land in a VA hospital twice, are sicker than those once. Rocket science, i know

3. Glps treat every disease, including mental health and dementia

Narrator: it is one of our great drugs. And it does not work miracles

Now enter this study

Editorial & journalism capture of ideology

Same as MAGA, just opposite direction

Except these are our "responsible" institutions

Why we need reform

Why we need randomization

Why people should not trust them without vetting

[Joscha von Rappard @JoRappard]

@MushtaqBilalPhD Cool! Are you willing to share the manual how to build this app? Would like to have one for myself as well….

[Joscha von Rappard @JoRappard]

So sad! Terrible news. I loved his BMJ journal club and the occasional twitter thought. RIP Richard. I will have a glass of whiskey for your remembrance.

[Louella Vaughan @DrLKVaughan]

One of the unexpected pleasures of Spring 2020 (an otherwise grim period) was getting to know @RichardLehman1.

I was familiar with Richard through his phenomenal column in @bmj_company and then through his twinkly presence on Twitter.

We bonded over a shared love of history.
1/

[Joscha von Rappard @JoRappard]

@MushtaqBilalPhD What goes around comes around….

[Joscha von Rappard @JoRappard]

@PulmCrit Since I read your wonderful post about the NLR some years ago, I forced my hospital to include it in the routine analysis. Works well for us. Another important puzzle piece!

[Joscha von Rappard @JoRappard]

@TobyRichardsUEL @WilliamAird4 @Bloodman @MorphologyAmigo @TheLancetHaem Interesting case. Please keep us updated!

[Tony Breu @tony_breu]

14/14 - Conclusions

ᯓ➤ Hemostasis and most thrombotic conditions begin with the extrinsic pathway and involve the endothelium
ᯓ➤ Thrombosis in the setting of mechanical valves begins with the intrinsic pathway and is independent of the endothelium
ᯓ➤ The result: (1) lots of thrombin; (2) loss of the usual checks on thrombosis; (3) failure of direct oral anticoagulants

[Ashley Miller @icmteaching]

Start here ⬇️
https://t.co/SU82nYsvbr

[Joscha von Rappard @JoRappard]

@Daractenus 😂He sounds like Darth Vader. I was waiting for the „you are my son“ phrase….

[Daractenus @Daractenus]

I believe it is worth revisiting just how utterly tragic EU accession has been for some of the most recent member states to join, and, in doing so, explain why all local anti-EU actors, for all the backing of Donald Trump and Russia, will always ultimately end up defeated. 🧵

[Christo Grozev @christogrozev]

Neo-autocracies are like business franchises: if the model works in one place, it's being copied in more and more markets. But failure (followed by judicial reckoning) in one place would make it unattractive for copycats.
I was hopeful the franchise owner would be the first failure. But it seems like its key franchise operator Orban maybe be the one.
https://t.co/xpTl2VDHv8

[Gandalv @Microinteracti1]

Let me explain something to the MAGA crowd, because clearly someone needs to.

They seem to think NATO is cosmic room service. You pick up the phone, say “hello, we’re having a bit of a war here,” and thirty-one countries march to your rescue. A continental Uber for military adventures.

That is not how it works.
Article 5 is a mutual defense clause. The clue is in the word mutual. And it has been triggered exactly once in NATO’s entire history. After September 11. When America was attacked. Not Europe. America.

Every NATO member showed up. They went to Afghanistan. They fought. They bled. They died. In America’s war. On America’s behalf.

Now imagine they hadn’t.
Over 1,100 allied soldiers died in Afghanistan. British, Canadian, German, Danish, Polish. And yes, even Ukrainian soldiers, who had no NATO obligation whatsoever. Gone. Without them, those are American names on those graves. Sons from Ohio. Fathers from Georgia. Kids from Nebraska who never came home.

Then there is the money. NATO allies spent over 100 billion dollars on a war that started on American soil. Without that, Washington pays every cent. On top of the 2 to 3 trillion the war already cost.

And without allied bases across Europe and Central Asia, American supply lines collapse entirely. Without British forces in Helmand and Canadians in Kandahar, the Taliban reconstitutes in three years instead of ten. The gaps get filled one way. More American deployments. More American coffins arriving at Dover.

Afghanistan was bloody. But NATO took the hit. Without them, every single one of those casualties would have had an American name.

Trump called allies like these losers. Suckers.

If you are a certain kind of broken person, that probably makes sense to you. But for the rest of us, what those soldiers did has a different name. Honor. The bond between men who have been in the same dirt, under the same fire. Between Brits and Americans, Frenchmen and Norwegians, Canadians and Danes. Not a diplomatic relationship. A blood bond. Brotherhood forged in places most people will never see and cannot imagine.

In that culture, you do not mock a fallen ally. You do not sneer at the dead. It is the lowest thing a human being can do. Trump did it to a standing ovation.

If you are a MAGA supporter travelling to NATO countries, understand this. There are no friendly pats on the back waiting for you. No one will buy you a beer. The governments who share your worldview sit in Minsk, Moscow and Pyongyang. Brutal dictatorships where journalists disappear, elections are theatre and dissent is a medical condition treated in basements. Not London. Not Paris. Not Rome, Stockholm, Copenhagen, Berlin or Ottawa.

You have abandoned the open societies, the free press, the rule of law, the places where people actually want to live. You traded the best of civilization for a very small, very dark room. Frankly, it serves you right.​​​​​​​​​​​​​​​​

Gandalv / @Microinteracti1

[Illia Ponomarenko 🇺🇦 @IAPonomarenko]

You've probably seen the recent news about 20-year-old Dasha Sergiyenko, who was killed by a Russian artillery strike that hit her home in the Sumy region of Ukraine.

The girl died shielding her 6-year-old sister Yevheniya with her own body. Their parents, who were also in the house, were wounded as well.

Well, here's an update: 6-year-old Yevheniya died today from her wounds. The family has lost two daughters.

Now do with this new knowledge whatever you will -- knowledge of what fascist Russia is, and what it does to Ukraine, and what horrific atrocities and tragedies hide behind the dry headlines of the media.

And this is every day. Day after day. While some people still have the nerve and the filth on their tongues to smear Ukraine's heroic defense against the power that does things like this.

[Der Postillon 📯 @Der_Postillon]

Menschenrechtlicher Fortschritt in Israel: Palästinenser erhalten künftig Todesurteil, bevor sie umgebracht werden

https://t.co/gOmnqcg65S

[Brad Spellberg @BradSpellberg]

@ABsteward For people who read Surviving Sepsis guidelines, we recommend IN ketamine + midodrine within 60 seconds. Former to prevent rage assaults, the latter to prevent vasovagal syncope. If the reader agrees with guidelines, high dose IM haldol. Strong recommendation, moderate evidence.

[Covie @covie_93]

Marco Rubio on Tuesday: "Iran is run by lunatics, religious fanatic lunatics."

The White House Thursday:

[Joscha von Rappard @JoRappard]

@GlassockJ The universe is fundamentally probabilistic, not deterministic. The whole is built from non-deterministic parts, and it retains that non-deterministic character.