The Great Communicator @hikenwoodwork@social.cleverlibre.org

“Someone with a 1-hr car commute needs to earn 40% more to be as happy as someone with a short walk to work. On the other hand, if someone shifts from a long commute to a walk, their happiness increases as much as if they’d fallen in love.” #CityMakingMath
50 reasons why everyone should want more walkable streets & cities, in Fast Company:
https://www.fastcompany.com/3062989/50-reasons-why-everyone-should-want-more-walkable-streets
#cities #walking #walkablecities #urbanism

So I guess I should do an introductory post. I am a Professor of Microbiology at University of the Pacific, interested in using genomics and imaging to understand biofilm formation and horizontal gene transfer. I am also a passionate fan of most forms of football (Rugby, American, and the Beautiful Game). I have been known to get political on social media from time to time...

Had a great #silentsunday looking for #mushrooms. Sadly I couldn't manage a good composition with the gear I had with me, but I couldn't pass up at least a phone snap of this #mosstodon, #lichensubcribe, #mushtodon trifecta!

My kitten Myotis has learned a new trick. I don’t know who taught her. She takes her loud ball-with-bells-in-it and drops it off the top of the stairs. It hits every step, jingle-jangle-BANG-jangle-BANG-jingle-BANG. She fetches, goes back to the top of the stairs, repeats. I’m not going to take it from her because she’s clearly having the time of her life. Lord give me strength.

We went out in the rain specifically so my husband could show me the trees with moss, so I could take these photos. 😊 #Teamwork #Mosstodon

Starfish walk using hundreds of tiny tube feet on the underside of their arms, as seen in this fascinating timelapse by Juliette Horn at the Frost Museum of Science.

#animals #science #starfish #feet

turn off the news and your devices.
go outside.
breathe.
you were never meant
to carry the burden
of the entire world.

#peace #nature #matterhorn #zermatt #breathe

Today we were at Blakeney, Norfolk. The local #boat #wreck was on my ‘grab a #photo’ list, and as I walked up to it, suddenly, a golden sunset spread across the marsh 😀

If there were no grace and no kindness,
conversation would be useless,
and nothing we do would matter.
Listen to the new stories that begin every day.
If light were not beginning
again in the east,
I would not now wake
and walk out inside this dawn.
#Rumi

Finally, we need to consider the effects of PEEP on cardiac output.

Applying PEEP decreases venous return because of increased intrathoracic pressure (which reduces venous filling).

Depending on the patients volume status a decrease in preload *usually* decreases cardiac output.

(btw check out the great explanation at https://derangedphysiology.com/main/home )

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414045/#:~:text=Except%20from%20the%20failing%20ventricle,positive%2Dpressure%20ventilation%20were%20measured
12/

Decreasing cardiac output has many physiologic effects (hypotension, reflex tachycardia, decreased UOP, etc). But why does low CO worsen hypoxemia?

Recall that low CO drops the mixed venous O2 sat due to stagnant blood flow. If your SvO2 drops low enough it will worsen hypoxemia. This is the SIXTH cause of hypoxemia (which is often overlooked).

See my ICU OnePager on hypoxemia for more on this.
https://onepagericu.com/hypoxia

13/

So now that you're experts in the physiology of PEEP, let's put this all together.

There are 2 mechanisms where PEEP can improve oxygenation:
1️⃣ alveolar recruitment
2️⃣ higher mean airway pressure (Henry's law)

And 3 mechanisms where PEEP can worsen hypoxemia:
1️⃣ intra-pulmonary shunt (overdistension of alveoli and shunt into extra-alveolar vessels)
2️⃣ intra-cardiac shunt (via a PFO; in the 25-30% of people who have one)
3️⃣ decreased CO (particularly in people with low CO at baseline)

14/

Snow plowing
Had about 16 inches of powerdy snow at noon and went out on tractor for 3 hours or so to do our quarter mile drive. Felt pretty good about it but it was still snowing hard. Just went out at 9pm and did not look like I plowed at all, another 16 inches of snow and still coming down.
Snow, snow and more snow.
Crazy weather is all I have to say.
Stay warm and dry my friends.

The best (and fastest) way to evaluate for 2️⃣ & 3️⃣ is with point of care ultrasound.

Looking for bubbles in the LA after agitated saline can help spot a PFO. Measuring LVOT VTI at different PEEPs can be very helpful in titrating.

It's also worth remembering that anyone who worsens on mechanical ventilation, could have developed a pneumothorax. Yet another good reason to use POCUS in your workup of someone with worsening hypoxemia!

15/

This climate pattern in the tropical Pacific has a big impact on global temperature. We've had 2 years of La Niña now, which kept the global average down, but..

Kilchurn Castle, Loch Awe. It's done to death these days but you can't beat a little sunrise with conditions like this. #Scotland #castle #landscape #photography #reflection

I'm watching a Gardeners World from earlier in the year and saw this fence. It looks like it's made out of branches. I wonder what would be ideal to use for a project like that?

The United States owes a deep debt of gratitude to Dr. Anthony #Fauci. The states that made the best attempts to follow Fauci's advice in relation to the pandemic have a much lower COVID death rate than those states that did not. #TheDataDoNotLie, but the owner of the #BirdSite does.

Day 10 of #ArtAdventCalendar: I call this one "The Count"

#wildlife #owls