"Leadership is taking responsibility for the people around us" (Simon Sinek) - Part II

As expressed in my last post where I promised to publish one of the most, if not the most elevating motivational speech on management and leadership I ever witnessed; I hereby leave you with wise words from a very wise professional. Simon Sinek needs no introductions; his talks and seminars are profusely broadcasted on the web, and his teachings are pervasive for some, intrusive for others, but extremely relevant for all, i.e., organisations and the people they aggregate. So, in very thoughtful words, what does it mean for Simon Sinek, to be a leader?

"What does it mean to be healthy, what does it mean to be a great parent. I don't have five things to be a great parent, right?! It's a lifestyle and it comes number One, with the commitment that I am responsible for the life of another human being, the growth of another human being. The closest to leadership is parenting. You have to be an infinite student of parenting. You know, if you want to be a parent you ask your friends, you ask your own parents, you join groups, you read magazines, you watch talks, whatever it is you're constantly consuming how to deal with this constantly changing challenge of being a parent. And it's ups and downs and successes and failures, you know? And that's what it is Leadership. Leadership is the same. Great leaders are students of leadership, no matter how achieved they may be. They're still learning. And it's a lifestyle. It's the lifestyle of what I need to do to look after people which includes things like Listening, Learning how to Give and Receive Feedback, Learning how to have effective confrontations, how to discipline when necessary (in a way that's constructive); roam the halls, get to know people. Learning what it means to ask somebody questions. How do you ask questions? Some people are naturally good at being curious about other human beings and some people are uncomfortable because they're introverts or whatever, socially awkward, but we can learn. You know? How do you learn to remember people's names? 'Well, I'm bad at names' - No, you've just decided you're bad at names; we can learn to be good at names, so that when we walk down the hall and say - 'Hey Tom!' / 'Oh my God, he remembers my name?'. It's a nice feeling. It's a lifestyle. There are many many things we have to do and constantly work on to be a great leader, to create that environment.

Everything that we are talking about in the infinite game is really really really hard. it is so much easier to build a company based on short-term ambitions than it is an infinite cause. It just is, right? It's also fun until it's not. Less inspiring but sometimes hitting a goal feels good. It's much easier to just hire and fire people frequently. Hire fast Fire fast, as to hiring slowly and firing slowly because we try and take care of our people as best as we can. It's hard to build teams. All that stuff we talked about Leadership, like what am I supposed to do to build a trusting team? Well, I wish I could give you a list of five things. It's really really hard to be a parent. It's much easier to be an uncle or an ant, or not have kids. It's hard!!! So why do it? It's fun and exciting to be. To try and beat our competitors, but to have to face our own weaknesses every day, that's exhausting. Existential flexibility, I'd rather not. I'd just would rather not. So the reason this takes courage to completely change our mindset about the game that we're actually players in and how we want to approach these things, and do we want to shift our mindset and our organizations to prepare for the infinite game to be organized for the infinite game. It takes courage because we're going to be swimming upstream in a world that is very finite driven. You know the pressures on us are overwhelming from wall street, or our own egos, or from internal incentive structures bosses, whatever it is the pressures are overwhelming for us to play the finite game. And so how do you stand up to massive external pressure? Courage, and courage is something that comes from relationships, it's external. A world famous trapeze artist would never attempt a brand new death defying act for the first time without a net! They would never do it, so why do we think that we could do something difficult without external support too? I've had the opportunity to meet real heroes, people who've risked their lives to save the lives of others with the belief that they were gonna die... and they didn't. And when asked why did you do it they all say something similar which is they would have done it for me. It's external and so we have to take the time to foster and take care of people around us, to nurture our relationships because when we're going to be doing something difficult, when we're going to be swimming upstream, when we're going to be innovating and doing something different, there are days we're going to doubt ourselves, there are days we're going to get knocked in our ass, there are days that storms are going to rise, and we have to have people who say - 'I got your back'. You need to do this, world needs this - 'Keep going, I believe in you'.  

Courage comes from not only our willingness to do that for others, but then their willingness to do it for us, and if we commit ourselves to a just cause and we're willing to do those things, then you know the great thing is we take a lot of people with us, and change the world for the better and... isn't that sort of the point of an infinite life? To leave this world in better shape than we found it? To leave the companies that we work for in better shape than when we started? To leave our families stronger and better capable than what they can do without us? Isn't that what it means to live an infinite life that we can literally live on beyond our own lives.

[...] An infinite mindset means that, it is something I can't do but I can influence and take care of the people to the left of me and to the right of me. I can take care of the people who work for me, I can even take care of the person I work for. Sometimes we have a toxic boss not because they're bad but because we don't understand the pressure they're under. Sometimes to simply exhibit empathy to our boss - 'Hey boss you were really harsh on us today, is everything all right? What's going on, I'm worried about you!'. We can succeed together, - 'I'm here to help you'. No matter where we are inside our organisation, leadership is not about rank or authority, leadership is taking responsibility for the people around us. And so anybody, on any team at any rank at any level can be a leader. The first choice is that we have to want to be. A  dear friend of mine, lieutenant general George Flynn from the marine corps said that the first criterion to being a leader is you have to want to be one, so any of us can volunteer to be a leader and that's what you do, you commit yourself to seeing that the people with whom we work on a daily basis love coming to work, they feel that someone's got their back, they feel supported, they feel that they have top cover, they feel someone cares about them as a human being listens to them, knows their story, allows them to be themselves. We can be that leader and what you start to see is those teams become really high performing, those teams become super tight and you start to hear rumours across the company because everybody wants into that team because apparently it's a great team to work with, to work on, and before you know it, one of those people goes and moves to another team and they take everything that they learned because leadership is learned and they do it for another team, and if we take that infinite mindset then eventually the tail will wag the dog and it doesn't matter if it's this CEO or another CEO because we will outlast whoever is in charge right now and that's the goal we're doing this for, the good of the organization, we're doing this for the good of the cause, and the tail can wag the dog.

[...] Be the leader you wish you had, become a student of leadership, study it, read about it, watch things about it, practice it every day, be a parent, join the movement means -'I'm going to take care of my team. 'Sometimes I'm in a leadership position, and sometimes I'm not, and it doesn't matter. I'm going to practice leadership'. If I'm a salesperson, if I work at the check-in counter of an airline, I'm going to take care of the people I work with and take care of the customers as if as if they're my family. Practice leadership, learn about it, study it, because I do these things because I recognize I'm just a piece of a jigsaw puzzle, because when we do a jigsaw puzzle the first thing you do is lean the picture of the the box against the wall and then you start putting the pieces together to build that picture. My job in this movement, I'm the guy who points at the box, I'm the one who's pointing at the picture, pointing at the picture maybe pointing out a couple of the pieces and where they go, but I need lots of people to join me, we need lots of people to join us who say I have a piece of the puzzle, I'm willing to lead this way, I'm willing to abandon Milton Friedman ideals and and do something bigger, something more, follow that. Live with an infinite mindset, lead with an infinite mindset and put their piece down and say how can I help build that vision? We need the army and so, how people can engage in the movement is actually practicing all the stuff more than anything else, that's what we need'.

Post image by Matteo Vistocco on Unsplash.

Misconceptions of Management and Leadership - Part I

I've held the opinion I am hereby sharing for quite a long time, due to not believing that it is indeed genuinely respected that almost universally-proclaimed freedom of speech. Everything in our lives comes at a cost, and every single action, professional and personal must be balanced very tightly and responsibly, especially in this day and age where whatever shows up in the web will forever claim its eternal footprint. However, there is a greater energy inside me that has always driven me to be as courageous and determined as my conscience demands; such does not have to come up with disruption to anyone's well-being, and I am sure that our entitlement to think and feel makes us ever more human and generates a proactive synergetic world... for the better.

I have been quite shocked about the displacement of realities between what several stakeholders claim about management skills, leadership skills, and the actual day-to-day reality of what is seen and felt by all of us in our professional experiences, in our professional involvement. It is incredible how social networks have become a public speaking platform for so many colorful diagrams and schematic presentations on the qualities of leadership and management. Don't take me wrong, it is important to have it discussed, it is relevant to have it uniformised and it is crucial to have it debated. What I suspect is not healthy is still the enormous present misconception that a manager and leader have achieved such level because of their professional qualities associated to their solid people skills. That is not true, and most of us who have put any thought into the rationalisation of this simple, yet extremely important problematics, have understood that management and leadership are still positions and properties that happen as consequence of professional progression, not a natural assumption by the system, of qualities that are integral for the role.

Some time back I experienced working with a manager in a certain project that was probably the least qualified human being, in human interaction, that I have seen in decades. The attitude of this person was almost like going back in time where arrogance, lack of sympathy and presumptuousness were obligatory in manager/leader and had to irrevocably be accompanied by a face that never smiled and a stern attitude of eternal discontentment. I am completely sure that said person was undeniably solid in their performance as a pillar, not because of the quality of their results but just because of the parallel built between what was delivered by their style of management and leadership and the dying ever classic idea of bossing around. No space for debating ideas emerged from the arrogance that their position is a clear reflection of an intellectual superiority.

Well, that old, very old-age incorporation of distance and unattainability, be it intellectual and even communicational (due to the lack of presence and availability said person assumed as part of their theatre of management and leadership), had to obviously claim their victims. The project was in shambles, there was a clear gigantic gap between the actioners and the thinkers, no adequate positioning towards the future with present brainstorming for success and harmony, and eventually people found dismay. Actually, here sits yet a very important concept that is still nowadays misinterpreted by many stakeholders, especially those that occupy positions of decision and leadership; i.e., that harmony somewhat resembles laziness, and that an entropic reactional work system delivers precepts of effectiveness based on anxiety. This incredible idiotic misconception can be called - Glorification of Stress -, and has claimed the professional vitality of many projects throughout the world because it is generated by people who do not understand the first thing about people and still understand the world as a system of owners and effectors, one that will operate ever more efficiently if the 'lower rank' agents are constantly under threat, limited in their access to information concerning the vitality of the projects and their own professional progressions.

This manager I am referring to had embodied the idea that scaring the others and maintaining a distance, using of proverbial arrogance and short messaging of direct orders was so effective that they needed to maintain that status quo, and swarm this approach towards other departments and other personnel. I eventually left the project due to the fact that I saw way too much disorganisation and lack of integrity, but in the back of my mind remained this bitterness that professionally we are so limited in our capacity to speak freely and engage in practical/useful conversation that can promote the betterment of our team spirit and the glory of our team achievements. And here lies yet another misconception, the last one I'd like to stress for the sake of time - the measuring of success is based on numerical goals, very few projects ever assess how happy were the professionals during the process of reaching said goals, and the effects such processes had in their mental/emotional and even professional health. This is ever more evident when corporations are managing employees that are not directly contracted to the organisation or are linked contractually for a temporary/short span of time. It generates detachment, it generates a human disconnection that basically uses people's greed or insecurity as a generator of intra-competitiveness rather that inter-cooperativity. This is even more a reality if management and leaders proclaim or use that typical insidious trick of announcing out loud the project is going poorly, not all will have their contracts renewed and people are under intense scrutiny. Once again the worst aspects of human nature surface and what should be gaining from team spirit will be exploiting professional survivalism. Do not be fooled. All loose! Only the corporation that makes use of such trickery will temporarily gain from it until the different people find dismay, understand they have been played and assume a posture of personal dignity by leaving at all costs, personal and professional. Big corporations then go about recycling the methodology promising other new inexperienced staff the same volatile and empty 'dreams', and the never ending circus of disrespect will keep claiming professional lives and producing stories of unfortune.

Management, Leadership, these active agencies of any team can only produce real holistic positive results if they act as immediate generators of Team Spirit. If they row towards their objectives as one and make sure that no one is left behind at all cost. It is in this ultimate defiance of hardship that any employee will strive to be the best version of themselves.

For Part II I will bring you what is perhaps the most iconic (and don't forget you are reading this from a known Iconoclast) speech I ever heard about reaching goals and the necessary elements of happiness and justice for all.

Thank you all for reading 'til this point. I hope I have enticed you enough to come and visit the 2nd part.

Post photo by Markus Spiske on Unsplash

What are 'The effects of plant-based diets on pancreatic beta-cell function'? - Part 2 of 2

On the second part of this analysis I would like to focus entirely and immediately on the study findings rather than dwelling too much on the strengths, limitations and possible confounders of the same. Anyone can read the paper and become aware of where further necessary investigations should go to account for reducing the limitations of this study, enhancing their strengths and rid of possible unnecessary confounders.

The results obtained in the study by Janko et al., 2021 objectivates certain information that, even though could and is also directly and indirectly related to additional variables, since the body is a holistic system, do attribute value to the plant-based diet in managing glycaemia:

1) The review used three randomised controlled trials which immediately offers an unbiased perspective on the study populations as it intends to account for significant heterogeneity between the different applied trials. However, the author is clear on a decision to not performing a meta-analysis that could have made the identified observations far more robust, but being allegedly the first systematic review covering this topic, a meta-analysis would be almost impossible, ergo the decision to not opt for such, I suspect. I assume I was not entirely sure that this was the reason behind the researcher's decision so I contacted my friend who confirmed that a meta-analysis was not a valid option 'because the individual studies weren't comparable, and didn't use the same intervention or biomarker". Makes perfect sense and it's a sensible decision.

2) The authors also observed that 'glycaemic control and beta-cell function, as measured by insulin secretion, can be improved by a plant-based diet' and that insulin synthesis pertaining to the period after dinner or lunch 'was significantly higher after a vegetarian burger compared with a meat burger' something that derives directly from a referred study by Kahleova et al, 2019 [1]. 

3) The reference normal levels of C-peptide (the endogenous pancreatic substance that informs one of the insulin secreted concentrations) in people without diabetes sits between 0.5-2.7 ng/mL. The observed reductions (see Kahleova et al, 2018) [2] of 0.5 ng/mL in fasting levels is  obviously  a medically significant one, especially when compared with an increment of around ~19-20% (0.5 ng/mL) (a possible indication of hyperinsulinaemia, as the authors infer from results obtained with the control group).

4) The reduction in glycated haemoglobin [HbA1c - see part 1 for more information on this indicator) 'at 24 weeks' as observed by Kahleova et al, 2011 [3] was also understood by the authors as clinically significant when compared to the control group. 'HbA1c levels and a reduction in diabetes medications may not be a direct measure of beta-cell function, but they are certainly a measure of glycaemia and diabetes management, and the plant-based diet groups experienced improvements in both measures in this trial'.

If you are interested in reading the first part of this post, please access HERE.

[1] Kahleova, H., Tura, A., Klementova, M. et al (2019). "A plant-based meal stimulates incretin and insulin secretion more than an energy - and macronutrient-matched standard meal in type 2 diabetes: a randomized crossover study". Nutrients, 11: 486.

[2] Kahleova, H., Tura, A., Hill, M. et al (2018). "A plant-based dietary intervention improves beta-cell function and insulin resistance in overweight adults: a 16-week randomized clinical trial". Nutrients, 10: 189.

[3] Kahleova, H., Matoulek, M., Malinska, H. et al (2011). "Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes". Diabet Med, 28: 549–59.

What are 'The effects of plant-based diets on pancreatic beta-cell function'? - Part 1 of 2

My good friend Robert Janko has published a systematic review on a very relevant topic for all of us in this day and age, especially because diabetes is still a recurrent topic for any age section, but also because vegetarianism has been the preferred punchbag for so many deniers out there; as if vegetarianism or veganism (perhaps fomented by the extremism of hipsters and their counterparts) was the monster who came to take over and impose, rather than just offer an optional view for a better life.

Robert researched intensively and published his findings in the Journal of Diabetes Nursing this year. The topic is ever so crucial and definitely adds on to the formula looking to partially contribute to the understanding of obesity, dietary habits, lifestyle behaviours and the row of physiological impairments caused by 'acquired' diabetes type-2. Plant-based diets have been linked to the betterment of blood glucose levels, glycated haemoglobin (complex of glucose + haemoglobin = HbA1c) levels, as well as improvements in insulin resistance. Through a systematic review of results obtained by three different clinical trials, Robert was able to show that, with intra-identified limitations, non-plant diets do not contribute as effectively as plant-based diets to a better controlled insulin secretion (healthy pancreatic beta-cell functioning) and weight loss.

But prior to jumping to the most relevant findings identified in Robert's review, it is important to define a few basic concepts beforehand. This will help us to better recognise, in a simple manner, the different implications of both diets in the human physiological system. The first question we should ask ourselves is...

Why is insulin secretion levels so important to one's health?

The higher the levels of HbA1c the greater the risk of developing diabetes-associated comorbidities [2]. If diet is directly or indirectly promoting higher levels of Hb1Ac then going back to the source and tweaking the physiological iterations, is a smart approach. For a healthy individual the levels of Hb1Ac should be below 42 mml/mol [2] and a slight change in obtained levels of glycated haemoglobin can have a huge impact even for people already diagnosed with Type-1 or Type-2 diabetes. Good management of glycated haemoglobin can contribute to reducing the occurrence of microvascular issues in about 25% [2]. Imagine being able to actually control the body to a point where one avoids retinopathy (that can cause permanent blindness) and neuropathy (that can cause permanent nerve damage) [3]. In  a nutshell, holding in one's dietary habits the power to not only control obesity and the extraneous emotional and physical burden to it associated, but also avoiding cataracts, heart failure, diabetic nephropathy, and even worse, the need for amputation as a result of peripheral vascular disease [2]. Another huge factor that needs to also be taken into account is the insulin resistance syndrome marked by the irresponsiveness of different cellular tissues (such as the muscular, hepatic and adipose) to effectively using insulin [4]. Glucose is left 'hanging' in the blood stream, more insulin is needed by the body for the necessary uptake of glucose by cells, and consequently the pancreas will have to work more to produce even more insulin to get the blood glucose levels within a healthy range.

Why measuring glycated haemoglobin?

The response is simple and direct. Whilst blood glucose levels offer an idea of the glucose levels in our blood at a precise point in time, Hb1Ac levels offer a more robust idea of the issue since it delivers an average over a period of time.

***

The second part of this post will dive deep into Robert's article in order to share observed conclusions. I hope you visit the blog to stay informed, and who knows, make an informed decision regarding your dietary habits.

[1] Janko, RK, Wilson, P., Nworie, C. (2021). "The effects of plant-based diets on pancreatic beta-cell function: A systematic review". Journal of Diabtetes Nursing, 25(2), pp. 1-7.

[2] Guide to HbA1c, Managing Blood Glucose, [https://www.diabetes.co.uk/what-is-hba1c.html#:~:text=HbA1c%20is%20a%20measure%20of,take%2C%20usually%20from%20your%20arm], last access on the 29th of March 2021, last update on the 15th of January 2019

[3] Mackay, JD and Page, MM (1980). "Diabetic autonomic neuropathy". Diabetologia, 18, pp. 471-478.

[4] Insulin resistance and Prediabetes, National Institute of Diabetes and Digestive and kidney Diseases, [https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance], last access on the 29th of March 2021, last update on May 2018

Photo by Markus Spiske on Unsplash

Opportunities, Challenges, and Considerations related to laboratory reporting of infectious diseases to Public Health England

Considering that Infectious Diseases, especially those deriving from zoonotic sources, currently contribute approximately 20% of the global annual death causes and 10% of the total disease burden in the European continent [1]; and that the likely losses of a pandemic influenza outbreak could reach 3 trillion American dollars (~5% of the global Gross Domestic Product) [2], the different states within the European Union decided to prioritise health areas that include proactive monitoring and reactive responding, with special focus on antimicrobial resistance (AMR), vaccine preventable diseases, tuberculosis, influenza, and sexually transmitted infections. 

In this respect, it is crucial to understand the pathway that takes data to realistically travel from clinical laboratories onto integrated-monitoring pieces of highly advanced software, as it is, the case with national governmental agencies (e.g., Public Health England). The disease surveillance program commissioned by Public Health England (PHE) covers 37 infectious diseases, including influenza. 

Clinical microbiology laboratories (CMLs) demonstrate their ability to:

o inform and improve individual patient care, 

o contribute to outbreak management and hospital infection control, and 

o provide accurate surveillance data on infectious diseases and AMR. This information can be subsequently used in the reviewing of local treatment guidelines and the designing and evaluating of national health policies. [1]

In that sense, In vitro diagnostics play an important role in the scrutinising process - There are at least three major areas where in vitro diagnostics can provide essential contributions to diagnostic reasoning and managed care of patients with suspected or confirmed infection:

o aetiological diagnosis, 

o patient monitoring, 

o and epidemiologic surveillance. [3]

With special interest in the Reporting of bacterial and viral infections - In general, we can segregate the detection of viruses into three main categories: 

o direct detection of the virus, 

o viral RNA/DNA detection, and 

o antibody detection. [4]

Data reporting feeds two very important surveillance systems, the UK Biobank (UKB) (an international health resource  with 500K subjects allowing research into the genetic and lifestyle determinants of common diseases), as well as the Public Health England’s Second Generation Surveillance System (SGSS) (a centralised microbiology database covering English clinical diagnostics laboratories) participate in the national surveillance of highly relevant notifiable infections, bacterial isolations, and antimicrobial resistance. [5]

Analysis of shared data fed into these systems allows an improved management of relevant epidemiological scenarios based on:

o Rapid early detection validated by a large number of samples with high accuracy diagnosis supporting an enhanced surveillance.

And this process will synergistically assist the:

o Review of local treatment guidelines, and the

o Evaluation of National Health Policies

There are many challenges associated to laboratory reporting within the public health surveillance system: 

o Data artifacts - missing, inconsistent and implausible data; gaps in data transmission;

o Constant change of guidelines and instructions – rapidly changing indicators; 

o Heterogenous procedures - systematic differences between labs and in the utilisation of services; patient linkages over time, different data sources, numerous registries, and indicators, 

o Time burden for busy providers

o Idiosyncratic +/- reporting - even though false positive/negative reporting is associated to (A) a low concentration of antibodies usually present in fluidic samples; (B) presence of homologous proteins; and (C) lack of sensitivity from the detection instrument, the fact that not all negatives are reported and that not all are reported via the same reporting systems and to the same surveillance agencies, enhances the monitoring difficulties associated to the process. [3] [4]

o Shortage of resources for high volume/frequency testing

o Incongruent shipment to reference labs          

o Numerator-Denominator Incompatibility - a systematic distortion due to a denominator that does not match the numerator, or vice versa.

o Difficulties in exposure assessment 

o Inadequate/Insufficient Environment/Equipment

o Culture of lax charting (e.g., ISO15189, ISO17025) - Regulatory standards demand clinical laboratories to establish and document their own performance guidelines for laboratory-developed tests in order to make sure the obtained results are done accurately and with precision results, even prior to implementation of the test. The relevant aspects that are to be considered are: accuracy, precision, reportable range, reference interval, analytical sensitivity, and analytical specificity.

 

But not all illations are challenges, as the present times offer enormous levels of learning that can be brought to practice. Probably, the most important lesson that businesses learned from COVID-19 is the need for adequate remote working opportunities and capabilities (arguably the greatest practical legacy left behind for business owners to read).

• The first and possibly the most important lesson that policymakers and hospital administrators MUST learn from COVID-19 is that the continuing cut down on human and economic resources generates a huge impact in the healthy functioning of structures that can easily lead to collapse of the public/private health system, including the clinical laboratories with their enhanced testing demand. [3]

• Established labs are an important resource 

• The linkage of COVID-19 test results to the UKB provides an invaluable resource to the international research community that has the potential to uncover new risk factors for severe infection. UKB is one of the largest and closest-studied cohorts in the world. [5]

• Biomolecular data exchange between databases - As is so well stated in Lenert and Sundwall (2012) "Clinical providers must exchange specified types of data with the public health system, such as immunisation and syndromic surveillance data and notifiable disease reporting. However, a crisis looms because public health’s information technology systems largely lack the capabilities to accept the types of data proposed for exchange. Cloud computing may be a solution for public health information systems. Through shared computing resources, public health departments could reap the benefits of electronic reporting". [6]

• IT infrastructural autonomy - It is understandable that each organisation wishes to maintain its autonomy, however and for the sake of a prompt positive intervention, such is completely impracticable in a diasporic multifaceted system. The idea is even considered to be OBSOLETE [6] and goes against the prominent technological inflection dictated by 'democratic' and very functional cloud services.

Ten final considerations are therefore learned and directly cited from the available literature (for sake of authenticity in origin), and hereby listed adding to the brainstorming of a surveillance system able to work effectively if so by all input sources:

• "Establishment of an efficient network of regional clinical laboratories, involving those which are not directly challenged by the outbreak and where samples can be conveyed, is a feasible solution, provided that a straightforward regulation for specimen transportation and biosafety is set and monitored. This, in turn, highlights an unavoidable need to place major efforts for allowing better and wider harmonization of laboratory results and information, encompassing both analytical and extra-analytical issues." [3]

• Efficient communication to appropriate stakeholders - "It is essential that the laboratory personnel be instructed to communicate test results to the appropriate stakeholders (i.e. to the people who are officially in charge of dealing with the outbreak), thus avoiding to spread information that could generate unjustified panic, or inappropriate reassurance, among the general population." [3]

• Accurate diagnosis VS Patient stigmatisation - "Achieving, maintaining, and improving accuracy, timeliness and reliability of test results are key deliverables of diagnostic laboratories. Late or false-negative SARS-CoV-2 test results will lead to delays in or even preclude correct diagnosis, jeopardizing timely isolation and prevention of transmission. In turn, false-positive tests will waste public health resources, will lead to incorrect epidemiologic data, and might even lead to patient stigmatisation. Quality control is a cornerstone of safe, consistent, reliable diagnostics, and many studies and frameworks outline the structure of quality-management systems suitable for diagnostic laboratories."[7]

• Integration into biorepositories - "The significant role of the CML networks should not be underestimated in the sharing of routine clinical metadata or data collected. Their potential integration into a common data set (biorepositories—as proposed by the Clinical Data Interchange Standards Consortium) would maximize the opportunities for patient contributions to be translated into therapeutic and diagnostic solutions. The consolidation process for example provides a tangible opportunity to extend the scope of pooled analyses of individual patient biomarker data from heterogeneous laboratory platforms and cohorts into population-level studies using merging algorithms." [1]

• "The availability of commercial diagnostic kits in peripheral centres shall be part of the strategy for early and accurate identification of the largest possible number of infected patients." [3]

• Locally - "Near-patient testing would include so-called 1- to 2-h “plug-and-play” nucleic acid amplification tests for which a rapid result can directly impact patient care. Centrally - More-complex/high-volume tests would be dispatched to a core facility. In addition, the ability of networked CMLs to access multiple different partners, geographies, and clinical specialties can enhance their capabilities to provide advanced disease surveillance and early outbreak recognition." [1]

• Harmonised SOPs - "Laboratory professionals may also be made available on-site, where they could help define standard operating procedures (SOPs) for specimen collection and transportation. The choice between these possible solutions will obviously depend on many economic, legislative, juridical, logistical, environmental, and technical issues." [3]

• Same-day direct assays - "A major advantage of the consolidated CMLs is the expansion of the range of activities, able to accommodate high technology and sophisticated tests with increased sensitivity and specificity (30), while the usual day coverage is extended through a second (and third) shift. Same-day, direct assays, including molecular assays for selected organisms, are performed as a matter of routine thus reducing time to obtain results." [1]

• Inherent system flexibility - "The availability of increased amounts of high-resolution data at a lower cost creates an anticipation, requirement, and downstream cost(s) for the accommodation, analyses, and interpretation of these data. The inherent systemic flexibility that is necessary to receive different types of data at different speeds and from different locations—and link all that to routinely collected clinical data and report back—is not an insignificant task by itself." [1] 

• Ethical implications of big data analysis - "A number of questions are raised regarding the new pathways that might be necessary, the different regulatory approaches within Europe to handling this data under the EU personal data protection directives, and data quality issues. If not correctly addressed by the inclusion of ethical design in the creation of big data, such ethical issues might become limiting factors preventing reaching of full potential." [1]

[1] Vanderberg, O., Kozlakidis, Z., Schrenzel, J. et al (2018). "Control of Infectious Diseases in the Era of European Clinical Microbiology Laboratory Consolidation: New Challenges and Opportunities for the Patient and for Public Health Surveillance". Frontiers in Medicine, 5(15), pp. 1-7.

[2] Gebreyes, W. A., Dupouy-Camet, J., Newport, M. J., et al (2014). "The Global One Health Paradigm: Challenges and Opportunities for Tackling Infectious Diseases at the Human, Animal, and Environment Interface in Low-Resource Settings". PLOS Negletected Tropical Diseases, 8(11), e3257, pp. 1-7.

[3] Lippi, G and Plebani, M. (2020). "The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks". Clin Chem Lab Med, 58(7), pp. 1063-1069.

[4] Bhalla, N., Pan, Y., Farokh, A. (2020). "Opportunities and Challenges for Biosensors and Nanoscale Analytical Tools for Pandemics: COVID-19". ACS Nano, 14, pp. 7783-7807.

[5] Armstrong, J., Rudkin, J. K., Allen, N et al (2020). "Dynamic linkage of COVID-19 test results between Public Health England’s Second Generation Surveillance System and UK Biobank". Microbial Genomics, 6, pp. 1-9.

[6] Lenert, L., Sundwall, D. N., (2012). "Public Health Surveillance and Meaningful Use Regulations: A Crisis of Opportunity". American Journal of Public Health, 102(3), pp. e1-e7

[7] Homolka, S., Pawlowski, L., Andres, S. (2020). "Two Pandemics, One Challenge— Leveraging Molecular Test Capacity of Tuberculosis Laboratories for Rapid COVID-19 Case-Finding". Emerging Infectious Diseases, 26(11), pp. 2549-2554. 

Differences between pneumonitis occurring with immunotherapy and COVID-19

I've recently took some new training courses as part of my professional role as a medical information specialist, and in one of these I was lucky to be clarified on a current and important aspect related to COVID-19:

On the differences between pneumonitis occurring with immunotherapy and that of COVID-19

The information we were provided relates to what was known by then and might not be the most up-to-date at the time you might be reading this post, so please keep that in mind before assuming the details hereby shared with you are still actual.

Why is it important to understand such differences?

Because as for any chronic patient and due to the impact on the immune system of cancer patients (especially lung cancer ones), their risk of developing lung complications is much higher than for regular patients. In addition, COVID-19 also has the potential to trigger pneumonitis, and therefore a clear diagnosis must be conducted to differentiate.

What are the symptoms of pneumonitis in these groups?

Typical symptoms reported by cohorts from China and Europe refer dyspnoea (difficult breathing), pain, and other symptoms like cutaneous, gastrointestinal or endocrine ones (related to hormonal release); but it is cough, the pain profile and pyrexia (increased body temperature above what is believed to be the expected normal) that sees increased incidence in COVID-19 patients (in comparison to the other group). 

Timing and onset of symptoms is a very important aspect to retain!

Even though, times are not to be taken as absolute indicators for any of the groups, cancer patients reveal peak points with the highest toxicity grade (namely, colitis and pneumonitis) at about 6 and 12 weeks, respectively), whereas for COVID-19 patients the incubation times sits at an average of 4 days.

What other differences have clinicians observed?

In immune-related pneumonitis, the radiological aspect is of peripheral ground glass shadowing that tends to affect the lower lobe specifically; and is almost universally bilateral. This scenario evolves as disease progresses to a more severe condition. Because there is no specific test to scrutinise for a immune-related pneumonitis it might be relevant to associate to all the reported differences a few other relevant tests, such as, a lymphocyte count expected to be normal or higher than normal values in immune-related pneumonitis; also the presence of more than normally expected values of C-reactive protein (CRP) (a protein produced by the liver in response to inflammation), and even more than normal values of sedimentation rates for erythrocytes (usually these red blood cells sediment quite slowly in a normal subject, but for a body fighting with inflammation the sedimentation rate would be faster than expected). Finally, cancer patients undergoing pneumonitis would present with a bronchiolar lavage displaying prominence of eosinophils and lymphocytes.

As to pneumonitis in COVID-19 patients the first line of testing would immediately be the genetic/antibody recognition of the presence of the virus, by means of PCR, after a nasopharyngeal test. But at best this recognises the virus up to a sensitivity of 70-80%. In case of a negative test, a false-negative cannot be ruled out, so subsequent tests are then applied in order to positively affirm of the presence of the virus in patients suffering of pneumonitis, namely, a battery of tests known as liver function tests:

- the LDH test that is typically used to determine in a more accurate fashion where a certain damage is organ-located and the severity of the disease progression, 

- the creatinine kinase test to assed whether the pathology is of a cardiac or skeletal muscle nature (that in association with the troponin test provides a better understanding as to whether damage of the cardiac tissue has taken place); 

- by also checking the aforementioned inflammatory markers described in the paragraph below (especially when considering that clinicians recognise typical values around 100-150 mg/L, 

- a D-dimer test to check on the occurrence of blood clots (where they have noticed that in severely sick patients this indicator is quite elevated - even though such is not specific of thromboembolic disease, but can indicate severe inflammation);

But be sure that the variety of tests available for diagnosis is large and I cannot immediately discuss them all in detail hereby. However, I'd like to add to the pool of exams yet another one the clinicians mentioned, the Beta-D-glucan test that helps them rule out (or not!) pneumocystis infection with fluid buildup in the patients lung.

In summary

Differences and similarities exist between pneumonitis in these two populations of patients, but clinicians have plenty of biochemical options to scrutinise the profile of a immune-related pneumonitis from that of a pneumonitis caused by the new corona-virus.

Photo by CDC on Unsplash

How easy is it for viruses to mutate?

It is a pleasure to be back, and believe me it hasn't been easy being away for so long. However, in all honesty, my absence wasn't result of my immediate choice. I have been flooded with work and the current world crisis didn't really help anyone. From having my children under my responsibility 24/7, plus all the extra work that results immediately from living, or better put, adapting to survive in a quarantined existence/lockdown-style, meets new thresholds that none of us had been exposed to before.

I have struggled to write a single line but I have struggled a lot more with reading the enormous idiotic and, sometimes, overtly ignorant information spread out in different platforms, covid-wise! I realised that for some questions the official sources out there are quite good, even though, and I remain with my personal view on it, numbers do no immediately add-up.

Information and counter-information got to such ludicrous levels of ignorant presumptuousness that I decided to educate myself directly form few selected sources and experts. But during my self informing I wasn't able to find an adequate simplified explanation that would respond to different aspects of all this covid-19 pandemics. One of such aspects emerged exactly whilst trying to understand how Italy, UK, Portugal and Spain met such different levels of infectiousness and lethality when presented to basically similar approaches and external/internal pressures/strategies. I just couldn't make sense of certain aspects but the one that caught me empty handed was hearing from a specialist in virology that the virus had just mutated from country to country. I can't easily recall who this person was or what organisation was he speaking from, but to be fair it is not my role to criticise these people, let alone try to play a role of key opinion leader on a matter I am not specialised at all. But because I am a curious person with a thirst for knowledge I researched further in order to try and understand how can that be feasible. How mutable is a viral strain? In even more simplified words....

How easy is it for viruses to mutate?

To be able to address this complex question with a simplified answer it is imperative to accurately estimate virus mutation rates, so then one can infer on the individual and particular evolution of the different object viruses. Only then applicable strategies can be designed to control spread, infectivity and foresee a plausible safe future ahead of any epidemic. That was the work of Sanjuan et al (2010) where different methods of estimation (that in their own nature are quite varied and usually fairly complex) were applied [1]. But how can one define mutation rate? Well, the authors defined it as substitutions per nucleotide per cell infection (s/n/c) (so to account for viability rather than just mutations with no biological meaning at all) and corrected for selection bias where applicable and deemed necessary. 

Their observations were quite impressive as the obtained rates stretched from from 10−8 to10−6 (in DNA viruses) and from 10−6 to 10−4 (in RNA viruses) supporting the classic idea of a negative correlation (meaning one decreases when the other increases, and vice-versa) between mutation rate and genome size among RNA viruses and also DNA viruses. In addition, [1] shows that nucleotide substitutions are on average 4 times more frequent than insertions of nucleotides and deletions of nucletotides in the 'viral genome', the usually called 'indels'. But another very useful public tool they came up with is the regularly updated (so they say) virus mutation rate data that one can find at the url: www.uv.es/rsanjuan/virmut [2] with the main objective of providing an easily available, organised and professional data set on viral mutation rates. Just for the sake of curiosity and example, I can tell you that corona virus, as expected, is not part of the studied viruses, and that HIV-1 has a mutation rate of 4.9E-5 (s/n/c) whereas Influenza A virus sits at 4.5E-5 (s/n/c) - both these values are mutation rates per cell infection.

It is easy to understand that not all mutations are biologically effective and significant and that lethality power can actually undermine the relevance of the virus because a virus with a deadly mutation to humans, basically kills rapidly the host on which the virus itself depends on (for viruses are not living beings, they are merely simple algorithms of genetic code that operate not knowing very well in what overall program do they actually integrate - that is how funny and scary viruses are!!!).  If they kill the host quickly, let's say even faster than Ebola kills, the virus would require an immediate host to progress with spreading infection... and in that sense its associated lethality can undermine it's biological success. To avoid disappearing, a virus should be very infectious and lesser lethal! That is my understanding.

But what about their mutation 'strategy'? Apparently there are several types of consequential mutation 'strategies' if we can exaggerate and affirm these things even have a subliminal plan. Basically pure evolutionary and external pressures and forces shape their 'swarming' but apparently, at least in what relates to HIV and Influenza, their mutation is linked to antigenic drift and antigenic shift. The former occurs with a change in aspect of the outer surface protein where the host won't be able to identify the virus, hence an insufficient defensive response takes place; and the latter is defined by 'fusion' of different types of the same virus merging and becoming a new very different type from its root strains - that will catch the host by surprise and their limited antibodies will not be able to cope with the new profile of viral infection [3] - the 2003 zoonotic H5N1 influenza A virus epidemic that infected humans is a good example, but luckily one with limited infectivity/lethality correlation!

The mutational capability and profiling of viruses is a world of knowledge. And not only time is limited but also your patience. So allow me to save these last two short paragraphs to discur on two straight points:

What other factors participate on the mutational rate of viruses? Population density where the highest density (overcrowding) will find successful jumps of viruses from one host to another, more rapidly and more effectively. Also, a virus with longer incubation times associated to what I had explained in the previous paragraphs, lesser pronounced lethality. This will even allow a zoonotic virus to live freely in migratory animals and spread happily to distant geographical points. Biologically clever, isn't it?! But in a nutshell, the best answer to how easy it is for viruses to mutate, can be found in the work of Sanjuan and Domingo-Calap (2016) [4] where the authors state that impressive capacity of some viral strains to adapt to new hosts and environments is strongly determined by their capacity to produce newer viral proteins in a short period of time. As the authors state, the present knowledge of viral mutation rates shows that "viral genetic diversity is determined by multiple virus- and host-dependent processes, and that viral mutation rates can evolve in response to specific selective pressures", as discussed above. Viral mutation rates are programmed and performed by means of polymerase fidelity inclusion, at sequence context, at template secondary structure, at cellular microenvironment, through replication mechanisms, during proofreading and/or during access to post-replicative repairing,  by means of virus-encoded diversity-generating elements or even by host-encoded cytidine/adenine deaminases [4]. 

What is the mutational rate of SARS-CoV-2? The jury is unfortunately still out there and so will be for a long time, but I suspect that a recent article by Tang et al (2020) [5] offers the best most up-to-date original information we have accomplished so far (though naturally limited, as you may well understand). They propose that SARS-CoV-2 can be classified in two major lineages (L and S) defined by just two tightly linked SNPs (single nucleotide polymorphisms) at positions 8,782 (orf1ab: T8517C, synonymous) and 28,144 (ORF8: C251T, S84L). Their mutational load analysis reports that "the L lineage had accumulated a significantly higher number of derived mutations than S lineage". Moreover, they also found merely 4% variability in genomic nucleotides between SARS-CoV-2 and a used-for-reference "bat SARS-related coronavirus (SARSr-CoV; RaTG13)", and the identified "difference at neutral sites was 17%", pointing towards the idea that, as the result of different selective pressures, "the divergence between the two viruses is way larger than initially thought. 

[1] Sanjuan, R., Nebot. M. R., Chirico, N., Mansky, L. M., Belshaw, R. (2010). "Viral Mutation Rates". Journal of Virology, 84(19), pp. 9733-9748.

[2] Viral Mutation Rates, Institute for Integrative Systems Biology (I2SysBio), [https://www.uv.es/rsanjuan/virmut], last access on 29th of June 2020, last updated on 2010.

[3] Viruses and Evolution, The History of Vaccines - An Educational Resource by the Colleage of Physicians of Philadelphia, [https://www.historyofvaccines.org/content/articles/viruses-and-evolution], last accessed on 29th of June 2020, last updated on the 10th of January 2018.

[4] Sanjuan, R., Domingo-Calap, P. (2016). "Mechanisms of viral mutation". Cell Mol Life Sci, 73(23), , pp. 4433-4448.

[5] Tang, X., Wu, C., Li, X. et al (2020). "On the origin and continuing evolution of SARS-CoV-2". Natural Science Review, 7(6), pp. 1012-1023.

Post photo by CDC on Unsplash.

Interesting apps for the purpose of medical or scientific education

These past months have been extraordinarily complicated, work is pilling up, so are responsibilities, and my personal projects/hobbies have ALL had to be postponed to make ends meet. Nevertheless, I take this blog as an educational tool that actively works for myself and the readers who send me questions on different matters. My self-education is a matter that I take too seriously as this helps me on my personal evolution and my professional progression. Regardless of how employers see it, I will always thrive and take pride as being constantly seeking knowledge to support my professional awareness and for my own intellectual feeding up. I am sure this is what will always keep me up-to-date with new technologies, new approaches and new visions, as this world is in constant mutation and one MUST keep in tune with the new languages. 

Because online courses are often very expensive and lengthy, I recently took a different route. My approach is now quite straightforward and dynamic. To keep myself not only adequately informed , but also conscientious that I am using modern sources of information, I am nowadays resorting a lot to Android apps. I have found quite a few that are a disgrace, deserve no respect whatsoever and reflect how greedy the educational market has turned into. But some are quite impressive in terms of content, in terms of interfaces, in terms of language, in terms of simplicity and finally in terms of its educational acumen.

I'll try, now and then, to look into some of the applications that are out there from a user's perspective, and criticise it with keen eyes and day-to-day criticism. Today, I'll start this 'review exercise' with 3 apps that I recently came across with.

App: Medical Quiz (by Flaticon)

Content: Nine in-depth clinical topics, from general pathology to organ pathology, radiology lab diagnostics, biology anatomy, hygiene infectiology, neurology, nutritional science, pharmacology and ophthalmology.

Interface: Simple, sometimes resembling Visual Basic of the 90's, but its simplicity does not compromise the experience.

Language: You need to be experienced in medical science to understand most of the questions. Definitely not for the average aspiring curious, hence I Love It. Don't use it if you think 'Polysynaptic Reflexes' is a song by Muse!

Accessibility: Free of charge with little ads that can be easily ignored. But please, if someone went through the trouble of preparing this tool for your enjoyment, at least acknowledge them with a decent review or watch the ads now and then.

Educational value: Great for aspiring medical professionals, but could be extremely uninspiring and difficult for those who are looking for educational entertainment.
Play store ratings: 4.6, 39 reviews, 10K+ downloads.

App: Science Quiz (by Smart Quiz Apps)

Content: I am basically addicted to this game to the point where I must play it daily and try to beat my previous scores. Two types of game possible: Endless Mode and Time Mode with slightly different nervousness levels associated to the fact that for the former you have limited lives, but all the time in the world to answer the different questions, and for the latter you can make as many mistakes as you want but you have a defined time to deliver as many correct answers as you can. 

Interface: Colourful without being too infantile, simple but attractive. I like the fact that there's a blueish pallet square pattern that sets the background to an harmonious visual experience.

Language: General science knowledge that can sometimes be hard but never put you off! It is genuinely a great experience for learning as the questions are direct, meaning either you know it or not. The leader board is of easy understanding and the game rules couldn't be easier.

Accessibility: Free of charge but the number of ads that are attached to this gaming experience can drive you nuts. Now and then another and another and another add in between games and from the main panel will be a bit too much for those who are trying to genuinely enjoy the learning experience.

Educational value: Great for parties, great for when you are on your own, tremendously interesting information as science trivia, but nothing too fancy for professional development or the like.
Play store ratings: 4.3, 635 reviews, 50K+ downloads.

App: Nursing Exam Quiz Pharmacology Terms (by Speed Draw)

Content: I am by no means prepared to confidently state that the content of this course is in agreement with what nursing students do in fact learn at uni, so I'll blindly trust the developers in this case. However, I tried this app a number of times and I learned some stuff about they're degree (not so much on what I already knew about Pharmacology), nevertheless some of the answers provided as correct in the quiz I don't immediately agree with, so I'd take it with a pinch of salt.

Interface: Could it be more boring? Only if you could find a sloth singing the original lyrics of the Hallelujah poem by Leonard Cohen. Maroon, Brownish colors that can make your eyes tired very quickly are the immediate reason, but the lack of interactivity is also to blame.

Language: It is what it is... a quiz. A limited one where if you learn anything it's already fulfilling its educational value, but this app is not challenging nor promising.

Accessibility: Free of charge, a tiny rectangular add area on the bottom of the screen ? Not that bad, I'd say.

Educational value: Even for those who are to take a Pharmacology exam as part of their nursing degree, going through the same 25 or so questions over and over again will dismay any student. Nice first attempt but this app needs immediate developing if it is to survive a growing competition in the educational games/serious games industry. I don't think they had that initiative as it appears to me the developers were just trying to have a go at a alpha- beta- version for their own amusement.
Play store ratings: No reviews yet.

And that's it, next time I'll post a few more I am currently trying and if you have any requests or ideas for review on educational and serious digital games, please let me know!

Post Image - Photo by Rob Hampson on Unsplash

On the benefits of cold showers to the immune system - Final Assessment

Four months ago I changed my daily routine tremendously by adding a morning shock strategy to my physical system. After four months of not missing out on my procedures and with disciplined dedication in using myself as subject to my tests, I have finally achieved a point where I can compile an adequate interpretation. Nevertheless, due to limited time and measuring tools/practices, the ASTONISHING results obtained can only be considered anecdotal. However, even if they were entirely placebo, the matter of fact is that I have COMPLETELY resolved three big limitations my Sjogren's Syndrome was still upsetting me with.

What am I talking about?

Remember when back in November 2018 I wrote the very first post on how a daily cold shower therapy had improved tremendously on my energy levels (that due to my Sjogren's was to an extent debilitating and impacted on my quality of life), especially after 6 PM? If you don't, please check the original post HERE. In reality, Sjogren's Syndrome patients state tiredness/fatigue, nausea and reduced alertness has three of the commonest symptoms affecting their daily performance. For me, personally, alertness has never been a problem. However, for a person like myself that has always played football and exercised to a great level, the limitations imposed by Sjogren's on my energy levels were tremendously. Add to that the fact that I am the father of two very young children who extract from me the fuel my reservoir must contain to actively participate in their growth, education and well-being. 

After reading and watching so much about the Wim Hoff Method, I designed my own strategy soon after consulting additional literature on immune system modulation, by means of shock thermal therapy. The initial results vaguely reported this last November 2018 were impressive, as my strategy had resulted perfectly. Driven by such incredible results, I decided to go the extra mile and defined a more dedicated program that helped me achieve even more incredible ones.

What was the objective?

My uttermost objective was to reduce or eliminate tiredness and fatigue I was reporting on a daily basis, especially after 6 PM and that were occurring regardless of my metabolic discipline and dietary constraints.

In what consisted my personal program?

One must know itself and understand to what limits one's body can be taken without generating iatrogenic effects that can be detrimental to one's health, and that might also contradict the improvement desired. In that sense, for about two/three weeks in November 2019 I had been following the Wim Hoff Method by applying his breathing methodology followed by a warm shower (with the duration of 5 minutes) and finally a shocking cold shower for no longer than 25 seconds (in the first three days), 60 seconds (in the following 3 days) and then 90 seconds thereafter. Even though some of the literature states the duration of the applied cold shower does not impact in the outcome [1], I had my doubts. In that sense I decided to gradually increase length of exposure to cold as it would also allow me to stay committed and learn with my own limitations, as I gained experience. 

By then, and after three weeks I was a rejuvenated man. No kidding!!! I felt extremely energetic on a daily basis and the intense fatigue and tiredness I was going through in the evening was no more.

My current personal program:

However, I wanted to be sure that the extremely impressive results I had gone through weren't just a hype of the moment. So I decided to carry this program for an additional 3 months in order to better understand its impact. In addition, because the breathing part wasn't something I could be so dedicated to, on a daily basis, due to domestic and work obligations that regularly force me to very limited available time, I decided to abandon the breathing part and focus entirely on the cold shower therapy. Thus, I simplified the protocol to something that can be applied by any Sjogren's patient at home; nevertheless please bear this disclaimer in mind, it is important to be aware of your medical condition (especially cardiovascular issues) and to be sure that at all times you are either supervised or help's at reach, especially at an initial stage. I do not advocate what I have achieved, as medical treatment. This is a personal discovery that HAS CHANGED MY LIFE!

Everyday I take a warm shower for about four minutes (with soap and all that jazz involved). Right after I take a freezing cold shower for an additional two minutes by starting gradually by my feet, going up the legs, then hips, torso and head. It takes me 30 seconds to get to the head. That basically means all my body will be completely 'touched' by freezing cold water for at least 90 seconds thereafter.

And that's it!

Achieved Results:

Now the best part! I haven't had any tiredness, fatigue OR NAUSEA (yes, you read right!, as I was affected by intense nausea every single evening of my days since diagnosed with Sjogren's or even a little before that). NOTHING! I MEAN ZERO... FOR REAL!!!! Never again have I experienced that sense of incredibly intense will to just stop. I feel invigorated, rejuvenated and am currently attending two fitness classes a week at my local gym (aerobics on Mondays and fitness pump on Thursday) with the duration of 1 hour each. Do you think I get tired after these? No way, I want more and more and more. And this has been the trend for the past 3 months.

Nausea was a constant issue back in 2018. Never again had I any concerns about it. I haven't missed a single day of my cold shower therapy and nausea has just vanished from my life. I hope never to come back.

Final Observations:

We're all different people and maybe my Sjogren's is not as harsh and tough as someone else's, however I did my research and found the solution for my energy problem. If clinicians consider it placebo, which I pretty much doubt as I presented enough scientific literature last time to validate this methodology,... So be it. If placebo works for me, it is in its own nature a great remedy for an issue that can be quite debilitating. With this very simple approach I corrected my own systems and improved so much that I can't believe why I hadn't tried it myself way earlier.

The number of available articles on hydrotherapy is incredibly good for you to go out there and do your own literature research. But I found a wonderful article (I honestly advise you to read it) that debates on the impact of water immersion under different temperatures [2] where one of the cited articles states that "regular winter swimming significantly decreased tension, fatigue, memory, and mood negative state points with the duration of swimming period; significantly increased vigor-activity scores; relieved pain who suffered from rheumatism, fibromyalgia, or asthma; and improved general well-being in swimmers" [3]. 

Mooventhan and Nivethitha (2014) also debate partially something that might possibly explain why it is important to shower the whole body, especially letting the water pour from above the waste line. In this article, two additional articles are cited when the authors state that "Walking in water at umbilical level increases the activity of erector spinae and activates rectus femoris" [4, 5], respectively the back muscles that extend the vertebral column and the thigh/hip inter-crossed muscles. So I think that if you also have the chance to do it at a pool , there might be some additional benefits there. Bear in mind muscle physiology is not my immediate science, I must say. Nonetheless, what we observe here is muscle stimulation, and that is primordial for achieving increased energy levels and better mobility.

In terms of having made nausea absent from my life, this was an unexpected plus from my experiment. But one that I am so happy to have mastered now :) I actually found some information that can indicate a reasoning behind cold showers eliminating nausea in Sjogren's. My suspicion is that it has immediately to do with the endocrine system, but until I find scientific consubstantiation I prefer not to come up with theories that could be simply wrong or distracting from the actual reason.

Any limitations?

Regardless of improvements on energy levels, having eliminated fatigue and tiredness altogether, and made nausea disappear from my life, literature out there states that cold shower therapies do not induce modifications of inflammatory and hematological markers. I do not immediately hold the screening tools to validate that, but at least I'll have a punctual opportunity to see that, as well as any other Sjogren's patient, during annual check-ups.

I hope this article does indeed help you regain control of your life has it has done with mine.

Cheers

The Toxicologist Today

[1] Buijze, G. A., Sierevelt, I. N., van der Heijden, B. C. J. M. et al (2016). "The effect of cold showering on health,  and work:  A randomized Controlled Trial". PLOS ONE, 13(8), pp. 1-15.

[2] Mooventhan, A., Nivethitha, L. (2014). "Scientific Evidence-Based Effects of Hydrotherapy on Various Systems of the Body". N AM J Med Sci, 6(5), pp. 199-209.

[3] Huttunen, P., Kokko, L., Ylijukuri, V. (2004). "Winter swimming improves general well-being". Int J Circumpolar Health, 63(2), pp. 140-144.

[4] Bleakley, C. M., Davison, G. W. (2010). "What is the biochemical and physiological rationale for using cold-water immersion in sports recovery? A systematic review". Br J Sports Med, 44, pp. 179–187.

[5] Bleakley, C., McDonough, S., Gardner, E., Baxter, G. D., Hopkins, J. T., Davison, G. W. (2012). "Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise". Cochrane Database Syst Rev. 

Post image by Alexei Scutari on Unsplash.

'The Laws of Thermodynamics' and the 'Contagion' of Entertainment Science

I am always trying to find great ways of communicating science. In my humble opinion that is the determinant factor in understanding the disengagement of people from medical treatments, from scientific advances and from all the science that surround us from all sides, but that many still consider appanage of few. 

Entertainment-wise, 'The Big Bang Theory' TV series has indeed done a lot for the way science became popularised; but at the same time produced an even more stressed idea that science is geeky, perpetrated by weird people lacking social skills, carriers of uncool styles, that intelligence can be softly erotic but also the distant zenith of boring minds with Utopian intellects.

Entertainment companies have discovered a long time back that science and its associated enticing powers can be popular and sell - Super heroes are the archaic exploited symbols of such branch. Nevertheless, no one has so far, in my opinion, yet decrypted the adequate miraculous formula to teach complex science subjects to bored young minds. In my personal perspective, the issue does not reside immediately in merely simplifying the topics and/or stupefying the vehicles of information. Many people tried different approaches and I will not derail here with corollaries and theorems. There are far more qualified people to explore and develop the educational abyss. What I do know is that after so many years with so many students failing so many scientific topics, one can't constantly complain that maths, chemistry, physics are far too complex for the basic minds of our students.

I consider that the basic mistake in teaching science, a mistake that ends up detaching young talented people from science, and consequently boring their minds to 'intellectual and emotional death', is the fact that science is not made real, quotidian and reachable. When one is 'forced' to learn something for the sake of a compulsory curriculum, one will immediately seek a mirroring of said science in his/her own life. A young rebel mind as the common young mind is (and should always be) will criticise the learning objects seeking validation of its realistic nature, day-to-day presence in life and above all, the power one has to manipulate, integrate or apply said science, to a certain extent.

What Serious Games and digital educational applications are unfortunately taking Eras to attain, movies have the capacity to perform successfully with a few adequately prepared actors/actresses, intrepidly written scripts and enticing turning points. - So difficult To Objectify!, some might cry, as for the entertainment industry the synergy between audience and digested product should be an easy experience for both parts. 

I couldn't agree more... But that might have changed when Mateo Gil delivered "The Laws of Thermodynamics" in 2018. 

Mateo delivered a ready-to-eat movie embedded with passionate thermodynamics, a physics topic on its won unreachable for most of us humans, let alone bored young minds. But he did it with such charm, with such appeal by intelligently using a circle of quotidian relationships whose characters are themselves reachable and readable in any of our lives. There's a beautiful model, there's a geeky researcher, a thriving lawyer and the guy still today I can't remember exactly what he did professionally apart from spending hours surfacing on the Internet looking for fit girls (that also very quotidian)... but I know he actively participates in all our lives as the one flirtatious person we all heard of and... well... envy, criticise or simply admire!!!

The explanation of how thermodynamics rules our lives, and is ruled by our lives and associated interactions, is so well displayed and explored that all together make me wonder! Why don't we have more intelligent directors talking about these hyper-intelligent subjects and bringing them down for the common people??? Mateo Gil brought it down with uncanny perfection.

You know, one thing is to be a common person, other thing is to be fed common ideas. 'The Laws of Thermodynamics' is a wonderful essay on physics and the incredible educational power that movies hold within and latent. A power yet to be appropriately unveiled by the mainstream cinema. 

It is easy to make movies such as Steven Soderbergh's 2011 'Contagion'. The desirable ingredients are all there, i.e., powerful unknown undecipherable organism, chaos, disease, death, direct causal relationships and the military intervention. Another thing is to deliver a much tougher abstract idea in the shape of lecture; an idea that due to its magic will 'force' one to be attentively watching to the very last minute. 

The Contagion of Entertainment Science is yet to happen, but we can feel its aura unbuttoning. I for one believe that movies and docuseries can deliver the most tremendous power to the masses - the successfully informational/educational simplified perceiving of complex things.