In Atrial Functional MR can get “Hamstringing”of posterior MV... leaflet due to massive LA dilation;this “atriogenic” leaflet tethering is from displaced posterior annulus onto crest of LV inlet resulting in⬆️in annulopapillary distance restricting leaflet motion #echofirstshow more

PML retraction resulting in eccentric MR. A good example... from Oung Savly MD FACC FASE FESC FAAP FEACVI 🇰🇭 nicely demonstrating that the eccentricity can be caused either by hypermobility of one leaflet or hypomobility of the other one #echofirst Same MR jet direction, different causesshow more

Below is video of the vehicle fire from earlier... today in Crystal City. An explosion can be seen due to a BLEVE from the fuel tank rupturing. Please leave car fires to the professionals as things like this can occur. Get out, stay clear, and call for help!show more

We’re solving problems that aren’t problems in America This... is the new automated ketchup dispenser from Server Products at Raising Canes I think there is a bigger plan with these new dispensers, and they’re being rolled out at multiple chains. These dispensers are IoT-enabled in newer models, meaning they can monitoring usage and inventory This kind of tracking and quickly turn into new features like restricting the amount of condiments one user can get, similar to what’s being done with soda machines and QR codes It starts as convenience, and ends with restrictions and controlshow more

Development and good roads come due to good governance...this... is the Road from Rome to the North...imagine how our lives will Change for the better in Kenya if Ruto's cabinet and the PSs and Head of state Corporations don't steal our money for just 12 months?...Nairobi to Mombasa highway with 8 lines can be built in 2 years...we are slaves of a thieving goverment...you get ANGRY when you see how civilised countries live.show more

PLAX- PARASTERNAL long axis. One of my favs .... . . Here’s a great animation of the anatomy we can assess in the parasternal long axis view (PLAX). This is one of my favorite views (because it’s pretty easy to get) and can help you assess multiple structures in a pinch. . . To obtain this view put your probe on the 3rd-4th rib space with the probe marker facing the right shoulder. From there you can make a quick adjustment (turning the probe marker to the left shoulder) to get the parasternal short axis view (PSAX). Both of these views are great for assessment of wall thickness, the mitral valve, as well as for effusions (among many other things). . . . Even though I’m an interventional cardiologist echo remains one of my most favorite things about cardiology. It’s amazing to me that I can get all of these images myself with a probe and my phone. I encourage all cardiology fellows out there to embrace echo because once you start enjoying it many parts of cardiology become easy! . . . What’s your favorite echo view? . . Video: florina_stanley #cardiology #cardiologia #medical #medicine #med #doctor #cardiotwitter #nurse #medstudent #heart #echocardiography #echocardiogram #echo #pa #echofirst #md #do #foamed Echofirst Botshow more

The pump feels like growth. The muscle is visibly... bigger in the mirror. Brain says: "Look at it. That's why I came here." The pump is blood pooled in a muscle from repeated contractions restricting venous return. The veins fill faster than they drain. The muscle inflates. Growth happens when heavy load is taken close to failure, triggering protein synthesis over the next 24 to 48 hours. The pump is not part of it. You can get a massive pump from 30 reps of 2kg lateral raises. The growth stimulus is approximately nothing. You can get almost no pump from 5 heavy barbell rows. The growth stimulus is everything. The damage is in the template. Chasing a pump means high reps and short rest, which produces enormous junk fatigue for very little growth signal, and quietly trains you to judge a session by feeling instead of by the bar getting heavier. You walk out pumped. You walk out tired. The bar has not moved in six months. The mirror after the workout is showing you fluid. The mirror six months later is showing you load. Train for the second mirror.show more

🚨 AFRIKANERS & ALL WHITE SOUTH AFRICANS THIS IS... YOUR WAKE-UP CALL ‼️ Enough is enough. Look at this footage from a red-bearded white farmer in his green jacket is right there in the middle of it, marching shoulder to shoulder with thousands of Zulus against the ANC regime, its corruption, land invasions, and the flood of illegal foreigners destroying our communities. This is real unity in action not the fake rainbow-nation nonsense we’ve been fed for decades. Afrikaners, English, coloureds, every white South African who still loves this country it’s time to stop watching from the sidelines get of X and your TVs get off the farms, leave the suburbs, and JOIN THESE PROTESTS‼️‼️ Stand with the people who are already fighting Ramaphosa’s criminal government on the ground. We don’t need more polite petitions or empty social media posts. We need boots on the street, united voices, and massive turnout at the polls. Together black, white, Zulu, Boer we can crush this regime and WIN the next election ‼️ The ANC is terrified of exactly this kind of solidarity. Make them terrified. Share this far and wide. Get in the fight. South Africa belongs to all who are prepared to defend it. #WhiteFarmersStandUp #UnityToWin #VoteANCOut #SouthAfricaRisingshow more

✦ Name: Hinata ✦ ···························································· Allow us to introduce... 📝 Hinata, the chief secretary in charge of finance at a massive corporation! Capable of organizing over 500 documents in a single night, Hinata has already reached the level of a true specialist when it comes to office work. However, for Hinata—who hardly even knows how to get angry, and who can rarely refuse when someone asks her for a favor— there is said to be one very girlish dream hidden deep inside her heart: to devote everything she has to the person who will one day save her from this endless hell of paperwork. #MAkeDrama #MAD #Hinatashow more

✦ Name: Hinata ✦ ···························································· Allow us to introduce... 📝 Hinata, the chief secretary in charge of finance at a massive corporation! Capable of organizing over 500 documents in a single night, Hinata has already reached the level of a true specialist when it comes to office work. However, for Hinata—who hardly even knows how to get angry, and who can rarely refuse when someone asks her for a favor— there is said to be one very girlish dream hidden deep inside her heart: to devote everything she has to the person who will one day save her from this endless hell of paperwork. #MAkeDrama #MAD #Hinatashow more

The Titans did a lot of good and looked... like a functional team. But a clinical finish by the Eagles meant a late loss. Jalen Hurts hit Darius Cooper open in the back of the end zone from 3 yards out with 9 seconds left for a 24-20 Philadelphia win. TEN (0-2) is at the Giants next week. Can prepare feeling a lot better about itself than after that first loss to the Jets, but let this one get away.show more

Diamond Harbour Model The dangerous chaos in Budge Budge... at the Indian Oil Corporation Ltd's LPG Bottling Plant is a glaring example of the TMC's syndicate culture spiraling out of control! The ruling party's factions, in their greed to dominate loading-unloading operations, have pushed workers to the edge. Yesterday’s protest, where enraged workers released gas from cylinders onto the streets, could have turned catastrophic. A single spark could have ignited a massive fire, potentially engulfing the entire bottling plant, nearby Budge Budge Institute of Technology (BBIT) College, Jagannath Gupta Institute of Medical Sciences and Hospital, and surrounding areas in a deadly inferno. Lives, property, and livelihoods were at stake due to TMC’s unchecked syndicate raj. This is not governance, it’s a reckless power grab that endangers innocent lives. The people of West Bengal deserve better than a ruling party that thrives on exploitation and chaos. It’s time to dismantle this syndicate culture and restore justice for the workers and safety for our communities.show more

Cuff mediated airway alignement 🎥👇🏼 Paediatric nasal intubation, tube... 4.5 RAE. McGrath VL. Tube impingement on arytenoids, easily fixed by airway alignment. An “old airway trick revisited” Cuff-mediated airway alignment is an advanced intubation technique where the cuff of a tracheal tube (TT) is temporarily inflated to mechanically adjust and center the tube tip with the glottic opening. This maneuver is primarily utilized during difficult intubations—such as when utilizing a videolaryngoscope in patients with restricted mouth opening or an anteriorly positioned larynx—to lift the tube off the posterior pharyngeal wall and direct it smoothly into the trachea. How the Procedure Works: The technique relies on a structured, step-by-step sequence to prevent tissue trauma: [1] Initial Advancement: The clinician advances the TT into the oropharynx using visual guidance from a device like the C-MAC Videolaryngoscope. [1, 2, 3] Cuff Inflation: If the tube tip hinges on local anatomy or misaligns with the glottis, air is gradually introduced into the cuff. Alignment: As the cuff expands against the surrounding pharyngeal structures, it physically pushes and centers the tube shaft, aligning the TT tip directly with the laryngeal inlet. Deflation and Passage: Once optimal alignment is achieved, the cuff is completely deflated so the tip can safely pass through the vocal cords without causing mucosal tearing or laryngeal injury. Final Positioning: The tube is advanced to its proper tracheal depth, and the cuff is re-inflated to establish a definitive ventilatory seal. Clinical Advantages: Navigates Difficult Anatomy: It overcomes "extreme anterior" laryngeal positioning where standard stylets or maneuvers fail to center the tube. Reduces Posterior Hinging: It stops the ETT from getting trapped or scraping against the posterior pharyngeal wall during nasotracheal or videolaryngoscopic intubations. Disadvantages & Safety Risks: Visual Obstruction: Overinflating the cuff within the upper airway can expand the balloon so wide that it completely blocks the clinician's view of the TT by the uvula or cuff. Blind Advancement Risk: If the clinician attempts to push the tube forward before deflating the cuff, it can cause severe friction, mucosal trauma, or nerve compression within the laryngeal space. First publication In Ghana medical Journal in 2011 📖 📖 #airway #nasalintubation #airwayalignement #foamedshow more

The importance of pointing the AirFanta Wear personal air... purifier accurately. You need to point the center of the Wear's airflow at your breathing zone. Otherwise you won't get any benefit from the device. This is just a visualization using the mist from an ultrasonic nebulizer to stand in for unfiltered ambient air. In the demonstration the air is not completely still due to the output of the nebulizer. But the air flow may be similar to cross currents that might be found in indoor settings. AirFanta has shown a number of different ways to position the Wear, but hasn't given exact numbers for distance as far as I know. I'm using a distance of 2 inches or less as a rule of thumb, with the center of the device pointed at my breathing zone. The 3/4 position feels like it's one that people may be the most interested in because it can let you eat while at the same time maintaining a close proximity to the output. The Wear is not meant as a one-to-one replacement for a respirator grade mask. It's best for situations where you were not going to be wearing a mask at all, but would still like to breathe cleaner air. Avoid risk compensation, which is where you take on more risk because you think you are more protected than you actually are. For instance, visiting a nephew sick with measles without an N95 mask because you think the Wear will give you equal protection. Maintaining the correct distance and orientation between the Wear and your breathing zone requires conscious effort. The Wear can reduce your overall exposure to airborne contaminants, but it needs to be used very close to breathing zone and needs to be very accurately centered.show more

This man is jumping on the stomach of a... horse that has collapsed from exhaustion, trying to force it back onto its feet so he can make money again by making it carry people and luggage to higher areas. Just imagine how much pain this poor animal must be in. Animals used in the mountains are often made to carry heavy loads and people uphill every single day. Even when they become sick, weak, or completely exhausted, they are still forced to work. And when they finally collapse, instead of being allowed to rest, they are tortured and forced to get back up. They cannot speak. They cannot tell us how much they are hurting. They simply have to endure it. This is not a livelihood. This is cruelty. Animals deserve compassion, not a life of endless suffering.show more

Some kind organisations are posting messages urging people to... leave out water for our precious wildlife in this hot dry weather, which is brilliant, thank you. But this rumour doing the rounds that hedgehog mums abandon their nursing babies is utter nonsense. Hedgehog mums are the most patient, loving parents you can imagine. They are tightly bonded and would NEVER willingly abandon their babies. But they die. They die because lactation places a massive continuous drain on a mother's water reserves. If she is deprived of water, her body is forced to pull from its own tissues and blood supply to maintain milk production, resulting in rapid blood volume depletion and thickening of the blood. Producing milk requires a massive amount of calories and water. If resources are scarce, the mother's body goes into a negative energy balance, which drastically accelerates the depletion of her internal reserves. But they stay with their babies, protecting them, loving them, literally giving them their last drop of life. The starving dehydrated babies eventually stagger out of the maternity nest, instinctively seeking sustenance. By the time they are found by humans they are so near death and their dehydration so extreme that only subcutaneous fluids from an experienced rescue can save them. All this heartbreak and tragedy can be avoided, and rescues freed from bed-blocking babies, if only everyone simply puts out a dish of water. Right now. And tonight. Front and back. Under cover in the shade, if possible. A turn of the tap can save so many lives.❤️show more

It doesn’t matter what material you build your house... from, when a fire, fueled by high winds hits, it’s not being saved. This is from a “small” recent fire in Gatlinburg area that got close to a house I owned. Took out quite a few homes. The wind just carries the sparks everywhere and often the fires start at the roof level (not the ground or side of the house). Once the roof area is hit, it’s all over. The fire will burn the house from the inside out. And it doesn’t matter if it’s a metal roof…think of all the wood components that metal roof attaches to and the eaves, soffits, etc. Just one spark can start a fire. When the wind is blowing at 60-80 mph gusts, you’re getting millions of sparks. The fires also get into the tree tops (especially of pine) and then balls of fire can also start raining down in clumps onto houses below as well. ICF, poured walls, concrete block….all irrelevant when you have a massive fire coming your way.show more

$IREN "we haven't disclosed the specific amount of GPUs"... 1. 🤮 reminds me of $NBIS 2. Setting a terrible precedent here for future deals 3. Making it purposely difficult, to not let analysts properly value your 2027 revenue 4. Increasing the polarized view on IREN by the market However: "approximately 60MW of air-cooled Blackwells" 1. You typically don't talk about gross capacity in a deployment like this 2. If it would be gross capacity, the GPU hour rate at IT level would be crazy high (at PUE 1.2, $680m / 50 = 13.6m/MW) 3. At 60MW IT load, and ~14kW draw at DGX server level, we can get to ~4,286 DGX systems with 8 GPUs per. 4. Based on this we can conclude that 60MW of IT load can run approximately 34k DGX B300. 5. 34k DGX B300 at $680m/yr, would represent a GPU hour price of $2.28 Now this is the problem with not disclosing your GPU quantity. You purposely make your business model look bad, because by approach, you get to a GPU hour price that would imply a payback period of 4 years, where only the last year of the contract is 100% margin. But of course, we can also take "the glass is half full" approach. IREN has ordered 50K B300s from Dell. They have 2 purchase orders for this, 1 between Dell Canada and IE CA Leasing Ltd for 4 phases, and 1 between Dell USA and IE US Hardware 1 Inc (amended from IE US Hardware 4 Inc on April 27, 2026). The order for Canada is divided in 4 phases, and are going to Mackenzie for 80MW of gross capacity, which happens to be 4 buildings of 20MW. The order for Childress is divided in 2 phases, and are going to DC35 and DC36, (as depicted in the earnings presentation) and those are 50MW gross. The purchase price of the order for Childress was $1.2B, and for Canada it was $2.3B If we go with 50,000 B300s for a total of $3.5B then $1.2 would represent 34.285% of the 50,000 GPUs, or 17,140 B300s rounded down. For this calculation I will consider that $IREN will deploy 17,140 GPUs in 50MW gross capacity in DC35 and DC36 of block 3 in Childress.. That would imply at 1.2 PUE, IREN can run 17,140 B300s in 41.67MW IT load. Now by that ratio, they can run 24,680 GPUs in 60MW IT load — a massive difference with 34k units through the Nvidia DGX reference calculation. If common sense is applied, you can still get to 2 completely different outcomes, that show a difference of more than 9k GPUs. The GPU hour rate at 24.68k GPUs would be $3.145 per B300, as MASSIVE difference from the earlier calculated $2.28. Sure, the DGX system may be a factor here. And I'm sure that the reality is somewhere in the middle. But I personally hate this as an investor, to be unable to calculate profitability on unit economic basis. After all, contracts are signed on a $/GPU hour basis. Why hide this from your investors? Not being able to calculate payback periods, unable to calculate ROIC. And most importantly, we cannot properly assess the $NVDA deal on a contract basis. I really hope the payback period of this contract is not 4 years. I want the glass to be half full, but by starting to censor the purchases, IREN is taking a step in the wrong direction. Not a fan of this.show more

One shouldn't just look at the #IOD index when... tracking the Indian Ocean Dipole. While it serves official purposes, unlike the ENSO index, it only maps 2 fringe regions and ignores changes occurring much closer to home, that are just as important. Below, one can clearly see how the warm pool of 29-30°C close to Lakshadweep developed over last month, inline with #positiveIOD event. Atmosphere is now responding as we have seen a marked uptick in rainfall along Kerala and Karnataka today. Furthermore, SSTs off entire west coast are in fact warmer than average for last few weeks, part of the same IOD response. This helps break the suppression barrier by adding an extra oomph to the monsoon winds, resulting in bouts of coastal rainfall even under harshest El Nino/suppression conditions. This is why I'm refering to it as developing weak positive IOD. #Monsoon is a complex system and gets influenced by the local players more often than you think! Restricting oneself to the "official" definitions will prevent you from noticing stuff in your direct line of sight. Monsoon winds don't just come from the officially tracked regions but rather sweep across the breadth of #IndianOcean, so always observe SSTs in the #ArabianSea off the west coast that are closest to us!show more