Anil Rama, MD

A tip for interpreting sleep studies: It’s important to look at flow limitation in addition to arousals and oxygen desaturations when evaluating a sleep study.

@VigilantFox Why does he need donations?

Bill Gates looks visibly troubled as he says the money well for his global initiatives is drying up. He reports donations are down “over 20%” and some donors cut money in a “very abrupt” way. “This has real impact,” Gates lamented. He blames the recent rise in child deaths on these budget cuts. “From 2000 to 2024, we had record reductions in childhood death much faster than ever in history. In 2025, for the first time, more children died than the year before. 4.8 million versus 4.6 million. And that’s because donors cut money.”

@OscarWildeUK What do you think it means? Is the copy worth it?

This is by far the highest-priced copy of any edition of Salomé ever sold & one of the most expensive #OscarWilde-related artefacts on record. Christie’s Paris Livres rares et manuscripts sale (22 October – 5 November 2025) 🔹 Price realised: €825K (EUR) 🔹 Estimate: €100- 150k

@BarackObama No

California, this November 4th, the whole country is counting on you. Prop 50 puts our elections back on a level playing field, preserves independent redistricting over the long term, and lets the people decide. So return your ballot today. Vote yes on 50.

@DaveHcontrarian @GoldCore Are we in stagflation, moving toward deflation during the bust, and then stagflation again after the bust?

Here is my latest interview recorded 8/28/25 with Dave Russell @GoldCore.We discussed the big bull runs ahead for the stock,bond & metals markets this fall.Also the coming global bust & bear market & the big commodity cycle that will follow the bust. youtube.com/watch?v=o7XFqI…

@PalisadesRadio @DaveHcontrarian Hi David, Long time silent follower. Do you anticipate US Bank Bail In's during the global bust?

David Hunter: The Coming Melt-Up Before the Global Bust x.com/PalisadesRadio… @DaveHcontrarian #Contrarian #Macro #SecularBullMarket #MeltUp #InstitutionalInvestors #RetailInvestors #SoftLanding #Recession #FedPolicy #Inflation #TrumpPolicies #SupplySideEconomics #GlobalBust #MonetaryPolicy

Free speech is not negotiable. You shouldn’t need a billionaire to buy a platform just to speak freely. But thank God one did. Now imagine a government that protects your voice — not censors it🇺🇸

@pf_analysis Unfortunately, have been in them for nearly 3 years. My history is that I am usually correct but early.

Valterra Platinum $VAL is currently breaking out of important high volume zone. I marked the breakout zone on three different time frames.

@pf_analysis Great charts. Valterra seems to have lagged IMPUY in previous rallies and then catches up quickly. Possible it may happen again.

@RambusChart Keep up the great work. It builds slowly at first, then suddenly. You are the real deal compared to 99% of the less reliable voices on X.

Read my Substack article! I have made this article public ‼️‼️ Decoding the Precious Metals Charts: A Bullish Outlook. Have a read and let me know what you think . @davidtablish/note/p-161302507?r=54z2ew&utm_medium=ios&utm_source=notes-share-action" target="_blank" rel="nofollow noopener">substack.com/@davidtablish/… #preciousmetals #Substack #tradingcommunity #stockmarketanalysis

@RambusChart You will have quickly have thousands of subscribers once the X masses see the quality of your insights. Buckle up.

Just a quick update tonight so I can show you a few charts on why I decided to load up on the PM stocks today with 18 of 20 positions. This first chart is a weekly chart for the $HUI which we just looked at recently. The dominant pattern on this chart is the May 2024 triangle, which we were following for much of its development. The last reversal point low on the black triangle was the October 2024 and March 25th lows, which shows a double bottom reversal pattern, which isn’t unusual in big trading ranges. The first reversal point in the May 2024 triangle was strongly slanted double top, with the October low 2024 being a H&S bottom. The next rally stalled out with the formation of the double top reversal pattern at the top trendline at reversal point #3, which led to three more swings within the triangle creating the 4th, 5th and 6th reversal points, the final decline being the double bottom reversal pattern. After the breakout from the black triangle, the double bottom trendline held support on the backtest from above, which then led to the rally that began the formation of the current blue rising wedge in October of 2024. Earlier this week, you can see the bottom rail of the blue rising wedge was touched, with the price action actually moving slightly below the bottom trendline during the day on Monday before reversing higher to close the week at the top trendline. Most won’t view the blue rising wedge as a bullish rising wedge, but it has all the characteristics of one, as they tend to show up in a strong impulse move. Keep in mind the HUI and most of the other PM stock indexes have been consolidating for close to six months now. You can think of the blue rising wedge as a running correction, as it helps to reset the bullish sentiment. A negative divergence on the RSI usually takes place. It’s possible we could see a small decline before the breakout, which is pretty normal with any consolidation pattern, or we could see a breakout gap tomorrow. #preciousmetals #technicalanalysis #trading #goldbug

@airlovsky What is your price target for the next ICH?

@RambusChart May I ask the target snd timeframe?

GOLD MINER RALLY ACCELERATES: $GDXJ Breaks Out, Sets Stage for Major Advance🚨🚨 A major breakout is underway in the GDXJ today. After forming a small double bottom at the beginning of January on the bottom trendline of the March 2024 uptrend channel, the GDXJ is breaking out of a #bullish falling wedge, accompanied by a breakout gap today. This move is similar to the March 2024 bullish falling wedge breakout and subsequent impulse move. This current move is just getting started. Are you watching this ? Share your thoughts below. #gold #preciousmetals #goldminer #stockmarket

@4xForecaster Are we headed to 2ish first?

@4xForecaster Not to sound ignorant. What is large tethering geometry?

The last time Sibanye broke out of a multi-year falling wedge, returns of 900% followed - we are at the start of something big here #sibanye #gold #platin #palladium

@ColinSt30481392 Hi Norvast. SBSW has been a multi year disaster. Does your charting indicate more pain ahead? It has not gone up with the gold miners.

On day 25 the $USD is closing in on a HCH in a right translated daily cycle 2

@PSSD_Info @sanilrege @psycheureka Nice analysis

@sanilrege @psycheureka Reading more about it, I'm now convinced that SDB probably plays a role in most chronic insomnia cases. The majority of ppl w/ chronic insomnia in this study were excluded for overt OSA S/Sx/risk factors & all 40 who were left were still diagnosed w/ OSA! thelancet.com/journals/eclin…

Thanks. Neurobiology will predict future subtypes. From a previous tweet 👉 “This distinction is particularly important when dealing with insomnia linked to depression. In moderate to severe depression, the underlying issue is much more complex, involving fronto-striatal-limbic dysfunction. 🧠 👉As illustrated, these circuits are critical for cognitive, motor, and affective regulation all 3 of which are involved in sleep 🧠✅” Tweet 👉x.com/sanilrege/stat…

@PSSD_Info @doctor_zeest @McAlpineLabYale @AzolaAlba @RenzPolster @BrockAnnaDr @MVGutierrezMD @bendymarsh @DeryaTR_ @ClagueNjc36 @FvRhijn @sujana94 @benh_mecfs @manruipa @CureLongCovid @ANKoppes @sjmnotes @FStevenChalmers @RobWust @tamararivc @Rivkatweets @StenHelmfrid CPAP is getting difficult to get insurance coverage. I am dubious BIPAP will be authorized first line.

@sleepandbrain @doctor_zeest @McAlpineLabYale @AzolaAlba @RenzPolster @BrockAnnaDr @MVGutierrezMD @bendymarsh @DeryaTR_ @ClagueNjc36 @FvRhijn @sujana94 @benh_mecfs @manruipa @CureLongCovid @ANKoppes @sjmnotes @FStevenChalmers @RobWust @tamararivc @Rivkatweets @StenHelmfrid Those are just my thoughts on sleep studies & CPAP vs. BiPAP but I'm not an expert. @sleepandbrain let us know if you have any advice on how ppl diagnosed w/ UARS could get their doctors to Rx a BiPAP machine & get insurance to cover it without having to "fail" CPAP first. 1/

I think upper airway resistance syndrome (UARS) will eventually be recognized as a common comorbidity w/ chronic complex illnesses (& may be the primary driver of illness in some cases). Symptoms of ME/CFS & UARS overlap with the exception of PEM.🧵1/10 researchgate.net/publication/27…

@ColinSt30481392 Please update SBSW if possible.

The $EURO is well advanced in its weekly cycle and so a "DCH" here, and a left translated daily cycle 3 may well indicate that the ICH has been set on 26 Aug and the $EURO is in intermediate decline.

@4xForecaster Hello 4xForecaster, Can you please update your SBSW model? It seems to be following a hybrid path of your two possible models. Thank you.

$SBSW Tech-Note • Reacting from Target as forecast • Note the internal series of 3-waves, suggesting pending continuation pattern to lower-lows, A-B-C-D-E as implied geometry • Model eyes relevance at 4.16 relative to this implied geometry #SBSW #silver #gold #platinum