I hope this won’t affect the mural

Actually, I fixed it.

Major innovation in medical education: the dyspnea pyramid is now the dyspnea rhombus

No, no. Wells is the scientist’s name, you’re referring to Wells’ monster. #emimcc

Statistical significance aside, let's consider clinical significance. From VITAL: using events from the analysis excluding the first 2 yrs and the number at risk from the KMs: ARR would be 149/12,567 - 112/12,567 = 0.294% or 340 ppl needing to take vit D daily for 5 years to prevent 1 death.

An updated meta-analysis (pmc.ncbi.nlm.nih.gov/articles/PMC...) included this new RCT and showed no difference in cancer mortality. But with subgroup analyses showing possible decreased lung cancer mortality as well as a difference between daily and monthly dosing-- with daily vit d showing benefit

Forest plot from their MA pubmed.ncbi.nlm.nih.gov/31733345/ -- similarly shows no decreased incidence of cancer or CVD but with decreased relative risk for cancer mortality (13% RRR rather than 25% shown in the VITAL secondary analysis and cited in the new review). Another then published same year..

Great graphic in the NEJM case this week (7-2025) for pancytopenia. Posting so I can find it later.

More on Temporal Artery US:

Suggestive findings are halo sign (superficial thickening of arterial wall) and compression (normally TA fully compresses)

pmc.ncbi.nlm.nih.gov/articles/PMC...

In figure 2 they compare LRs of ferritin in inflammatory disease (includes kidney dz, liver dz, infection, malignancy, etc) and 'mixed' aka less-inflammatory disease states. For the inflammatory conditions, ferritin is expected to be very elevated, so has a higher LR for IDA at any given value.

Their Table 3 shows likelihood ratios for IDA across ranges of common test results. As you can (hopefully) see -- it's all about the ferritin! They found a ferritin of <15 ug/L had an LR of 51 for IDA which is essentially diagnostic.

And importantly, even what labs call "normal" can suggest IDA.

Remarkably, these POCUS findings are somewhat similar to what McGee reports in Evidence Based Physical Diagnosis for POPE (AKA Plain Old Physical Exam) findings of neck vein assessment with respect to measuring CVP >8cm H2O (>10cm was used in the POCUS study).

The simplest method they describe is measuring jvp in a person seated upright at 90-degrees, placing the probe just above the clavicle, and assess as a binary: positive if the IJ is at least as wide as the CCA and not collapsing through respiratory cycle. Left would be positive, right negative:

Here is the full table if interested, but I find the 2/5/10 - 15/30/45 paradigm the easiest to remember.