TranscendentalEmpire

Growth doesn't mean revenue over cost anymore, it just means number go up. The easiest way to create growth from nothing is marketing tulips to venture capital and retail investors.

blocking puberty has some crazy side effects.

I'm a provider at a children's hospital. I specialize in orthopedics and rehabilitation, so I mostly deal with the musculoskeletal system. I have colleagues who would be able to provide a much better and more in depth explanation, but I will do my best.

Even in orthopedics "hormone blockers" are used fairly frequently. For example the same drugs that people use to transition are utilized to moderate the epiphyseal fusion of growth plates. Puberty is also frequently delayed to moderate the hormone levels of juvenile cancer patients. Or even more increasingly common, to halt the symptoms of precocious puberty in young women.

The vast majority of juveniles prescribed hormones to delay puberty are for non gender affirming care like cancer. The problem with moderating what medical providers can and can't treat is that you are assuming you know more about medicine than the a person who went to medical school.

You may be trying to protect kids, but what ends up happening is an interference of medical care, and usually not the type you intended. If hormone drugs become more monitored, providers may be hesitant, or have a more difficult brine prescribing it.

The dangers of delaying puberty are very small, when you stop the prescription puberty begins again. Usually the only side effect is excessive growth due to a delay if epiphyseal fusion. In regards to gender affirming care, I will remind people that their providers are looking at total outcomes. Meaning they are factoring in things like the higher potentiality of self harm and suicide.

The crazy thing seemed fairly relaxed until she said she "rebuked him unto Jesus". Seemed like it went from "haha I don't want to be around a person carrying boiling water", and she seemed to respond jokingly with the Jesus thing, which immediately made the cop respond as if she just pointed a gun at him?

Does this guy think this lady is some kind of biblical sorcerer?

Just ran into this like a week ago with a wood working video. "How to flatten a board without a planer!". The whole premise was that planers are expensive, so here a little trick for hobbyist........ The next scene was them using a router table jig that's like 5x more expensive then any planer.

The goal is clear, but the system was designed to withstand the blow.

The system was largely designed over two hundred years ago, and fascism was designed to take advantage of its inadequacies.

The Weimar Republic was modeled after the American government, and fell to the same gridlock and political schisms we are seeing happen today.

The system does not have a way to hamper fascism because fascism is a revolutionary force. The goal isn't to command the current government, but to destroy it and replace it with another.

As I see it, their only real goal is to make the government so dysfunctional that the people will demand a strong man to come and fix it all. And I think most people will say they've been doing a fine job at that.

This is unfortunately not super uncommon. Older patients, especially women in palliative care are sometimes so close to death that the transition can be hard to detect. Things like heart rate and breathing can be so faint and slow that it can be extremely difficult to detect without equipment usually not found in most nursing homes. And when the patient is in this state, they can physically appear to be deceased.

That, and end of life care is horrible in America. It's so profit driven that the facilities only hire the legally mandated amount of licenced professional to operate.

I work in orthopedics and rehabilitation, and a large part of my last job was providing specialty care at nursing homes. I've had the unfortunate experience showing up to a nursing home and finding my patient deceased when the employees just thought they were sleeping.

I don't know fuck all about the way these things work. But I do know I trust my doctor because she has been through all the education and has a decade plus of being a family health doctor.

Tbh this is the same reasoning that medical providers utilize for their own healthcare. I specialize in orthopedics and rehabilitation......

Yes I know more than the average Joe, but med school was a long time ago, and you aren't really proficient in a field you aren't actively practicing.

When I want to know if a vaccine is safe and medically necessary I look to my esteemed colleagues from the department of infectious disease. I don't really see how anyone with an MD behind their name can really attempt to fool themselves that they know more about a disease and how to treat it than the entirety of specialized departments.

If my buddies from infectious disease are taking a vaccine, I'm not going to second guess it. To me, it's the equivalent of seeing a bomb tech sprinting away from a ied, and then deciding that there's no rush because you've never seen a bomb go off before.

The problem is that Elons con man routine is the only reason Tesla is so overvalued. I'm sure they are afraid that if they let him go the stock price would readjust to a reasonable market price.

No matter what you think of him, he is brilliant at conning a tech enthusiast's money out of their wallets.

First of all, that guy looks like shit for a 34 year old. Doesn't look like the hair plugs took as well as he hoped.

Secondly..... This guy just went through like eight years of school and like ten of residency and fellowship to be a surgeon, and he just threw away his whole damn life to own the libs.

No hospital with an operating room is ever going to allow this guy to practice, even if he somehow gets away with a slap on the wrist. This is the exact type of scenario that hospitals dread. Texas Childrens is going to be sued, especially since they let him access patient information after he finished his rotation. I also think there are fines for the facility where a HIPAA violation occurred.

What a loser.

It wasn't even that long ago, I delivered for Papa John's in the late 00s. Some of the guys had tomtoms, but they were always out of date, and would lead you astray more often than not.

We mostly just used a giant laminated map of our delivery area that was attached to the heat shield of the pizza oven. You'd be surprised how quickly you can memorize the layout of a small city when your pay is dependent on it.

I haven't been back to that town since college like 20 years ago, but if you gave me an address there, I could still prob pin point it on a blank map.

Think of the opportunity for progress though...... first woman senator, and first corpse senator. I really think we can sell this bridge!

Nobody, which is why poly is exclusively for people with a scheduling kink.

But yeah, I've never met a poly person who would bring three of their partners to a single event and introduce them all as their girlfriends. In fact, I don't think I've ever met a poly who calls their partners "girlfriend".

Another useless prosthetic designed by 3d printing enthusiasts........

I work in orthotics and prosthetics, and the majority of the articles written about the "next gen" prosthetics are just marketing materials trying to wrangle up VC funding.

Nothing about this makes sense. First of all, no one intuitively knows how to usefully operate a "third thumb", so the learning curve on this is going to impede its adoption. We already have a hard time getting upper limb patients to use their prosthetics, and that's when we're purposely mimicking something they already know.

Secondly, the utility of thumbs in general is that they are opposable. With the placement of their "thumb" the only digit you can utilize with it is your other thumb..... Which means adding a thumb negates the advantage of thumbs in the first place.

Finally, and most the important aspect to any prosthetics is utility. If this is meant to help people missing their other arm.....how do they get the prosthetic on in the first place? And when you do manage to get someone to help you put this on, we're supposed to use our big toe as the action controller? Okay, so that means you can utilize this thing while walking?

Why on gods green earth did they not use myoelectrics? We've had them since the 70's, why is this "cutting edge" prosthetic going backwards in technology?

Oh wait, I can tell you..... Because it was designed by a 3d printing lab with no experience in actual prosthetics. 3d printers are successfully being used in prosthetics, but only when the person utilizing them has a background in prosthetics or biomedical engineering. Ends up it's a lot easier to have a prosthetist learn about 3d printing than it is to teach a 3d printing enthusiast about a field of study that requires education in physiology, anatomy, material science, and fabrication.....

A lot of people are going to connect this to trump, but it's really just a byproduct of the capitalization of medicine as a whole. This is more of an issue in conservative states who rejected the Medicaid expansion, but it's also happening in states that vote heavily blue.

Emergent care is a huge money sink, and the roll of money making departments like orthopedics or cardiovascular care's main job is to make enough profits to keep the lights on in the ER. When physician owned or private "hospitals" that don't feature a ER open, they are taking revenue out of the emergent care network.

I, too, have not been endorsed by Taylor Swift. I'm not so weird about it that I feel the need to fake it.

Hello fan and friend. It is I, famous singer Taylor Swift. Here today to endorse (insert name), a very good friend and fan. Please private message me for postage/payment information and to receive your signed endorsement from me, Taylor Swift.

Man politics has gotten so silly and commercialized that it's closest analog to me is professional wrestling. All of American politics is basically rich people trying to sell the kayfabe that their audience wants.

Libs pretend they're the good guys (face), and that they are here to save all the poors from the villains. But because they're all old rich people, it just seems fake and boring.

Conservatives get to do all the fun and cartoonishly evil (heel) shit. And because they're all actually evil fucks, it all sells as more authentic

My theory is that because there's a lot of Republicans trying to out heel each other, and because their kayfabe is more closely aligned with their political reality, a lot of them have forgotten that it's all kayfabe, or have grown up with it for so long they don't even know about the kayfabe.

Schizophrenic people still have a sense of humor.... To me it came off as if she recognized that the cop was afraid of her and made a snappy comeback, because it's generally offensive to be accused of wanting to mame strangers with boiling water.

Rebuke just means to criticize, it's not an attack, or even aggressive. To rebuke someone to God, is just saying your going to complain about their behavior to God. Tbh the moments before she was killed seem to me the most coherent and responsive she behaved during the entire encounter.

They've migrated to a wartime economy, which gives you a lot of command over the economy. They're currently doing a careful dance of increasing their money supply, while trying to stabilize inflation using what foreign currency reserves and income they have.

The biggest thing keeping their economy going is the price of oil, which is hovering around 80-90$ a barrel. The vast majority of this is being gobbled up by the government via their national wealth fund.

So long as heightened domestic productivity is maintained for the war, and the price of oil is higher than 60-65$ they could retain solvency for years.

A real economic collapse won't be felt until the price of oil bottoms out, or if they attempt to transition out of a war time economy.

You're buying into the story he spent years developing. SBF is a conman from a highly influential family, who used his familial connections to run what essentially was a ponzi scheme. He wasn't a particularly gifted individual, he was just manipulative and had a lot of connections in high places.

He didn't flee because he didn't think he was ever going to prison, and tbh I'm kinda surprised that was the eventual outcome. If it had been any other exchange besides crypto, he probably would have gotten away with it.

This is a classic western misinterpretation of East Asia. If you actually read Japanese history you would know that the Japanese have a vibrant and deep history of assassinating their Leaders.

Whether they are a leftist sympathizer, union leader, or simply not fascist enough, there are plenty of traditional and culturally appropriate ways to assassinate the leaders of Japan.

One might wonder why America feels the need to help escort an allied nation through their own exclusive economic zone in the first place? It's almost like there is a member of unclos that isn't adhering to international law or something?

Unfortunately the materials really matters with pedestrian motor vehicle accidents. When I first started working in orthopedics and rehabilitation, metal fenders and bumpers were still regularly on the roads and causing very specific injuries.

When a metal bumper hits you, it doesn't just cause blunt force trauma, it tends to shear muscle away from the bone. There was a specific ankle foot orthosis that was widely produced up until the early 2000s that was meant to replace calf muscles that were scooped off by metal bumpers.

This truck is basically a giant flying wedge of stainless steel, I don't see any pedestrian walking away from an accident with this monstrosity.

Anyone who says "screw your freedom", unironically and publicly, in a time of crisis, isn't an American.

Lol, anyone accusing someone as being un-American for exercising their constitutional right to free speech is both a hypocrite and an idiot.

I work for and teach for a University hospital located in the south, specializing in orthotics and prosthetics. I have built dozens of lifts for cowboy boots, mainly for people with severe limb length discrepancies.

He is 100 percent wearing a boot with around 3-4 inches of heel to ball internal lifts. The biggest giveaway in my opinion is that the boots are probably 2-3 sizes too big. The toe break in a normal shoe happens at the widest part of the shoe, you can tell his big toe is currently right where the first methead should be. This is why it looks like he's wearing genie shoes, the shoe is breaking closer to the toe box because there's nothing in them to prevent them bending backwards. .

Now if he wasn't wearing lifts he wouldn't be able to keep them on, as cowboy boots require a tight fitting vamp to stay attached. The lift raises the heels and thus the dorsum of the foot to press tightly against the vamp of an oversized boot.

The biggest thing I see that the article missed is that you can tell he is in hindfoot varus. Which is generally what happens when you do a sustained heel raise, enable to occasionally offload the posterior tibial tendon, moving some of the load to the peroneal tendon. This is why his foot is rolling over the lateral aspect of the boot.

This could occur naturally, but it's pretty rare outside of people who were born with clubbing in their feet. So I looked for other pictures of him walking in different shoes and found a pair of him walking in rain boots. In that picture he was over pronating and running over the medial side. So it's safe to assume that the supination in the boots are not a naturally acquired deformity.

If it makes anyone feel better, this guy is in some serious pain anytime he wears his lift. If he hasn't already done so, he looks like he's not to far away from a Jones fracture in his left foot. The left side looks like he's about 5-7 degrees of extra hindfoot varus than his right, which usually means he's damaged his peroneal tendon, or where it attaches to at the base of the fifth tarsal bone.

He was asked about Puller, Yeager, and Audie Murphy, in the article. He back tracked and said it wasn't about individual skill or talent, but about troop morale?

This guy is a legitimate idiot, he claims his statements are all based on the psychoanalytical theory by Freud.....you know the thing that's been heavily disproven for decades. Oh and the cherry on top? He fucking left the service as a corporal.

More than likely it's not being performed by anyone with any real medical training.

I work in healthcare, I don't know anyone in my field who would think executions are something they would be willing to apply their skills towards.

Didn't you hear? Congress just expanded the definition of antisemitism, criticizing Zionism or the state of Israel is now doing hate crimes.

I mean you can still attack people of color while screaming racial epithets and get booked for a misdemeanor, but criticizing a state? Hate crime.

This is totally progressive because we have to protect all of our white passing minorities with deep pockets, they're clearly the most disadvantaged minority in America......

As a POC it's kinda disheartening to see just how quickly Congress can move to protect "minority" groups when it suits them. It took them a year of targeted violence against Asian people that culminated with a murder spree for them to attempt anything. Now Israeli nationalist physically attack peaceful protestors and they make it illegal to criticize an entire state?

I feel bad for the Jewish people standing up to their governments genocidal intent. The only logical conclusion of the American and Israeli government forced conflation of ethnicity and state is a rise in actual antisemitism.

The professional reviews are hilariously mixed, I'm pretty sure Coppola unwittingly made a movie that also serves as a litmus test to see how pretentious and up your own ass you are.

The honest reviews are basically, this made no sense, I don't know what he was thinking. The positive reviews can be boiled down to "if you have to ask, you're not sophisticated enough to understand".

It's insane how many Russians have volunteered to die for a few thousand dollars, for the past year. But allegedly it's getting way harder to get volunteers for the Russian military.

This is mainly a byproduct of transitioning to a war time economy. Before the mobilization they had a fairly large labour glut, now that they've geared to war time production they're having labor shortages.

The detrimental aspect to this transition is that they're going to have to rely on conscripts for their soldiers as they were already experiencing a really harsh population decline.

The most dangerous part of this whole war won't come for Russia until the war ends, regardless of victory or defeat. Their population decline coupled with the retooling of their domestic economy isn't something that can be undone without major consequences. So they're either going to have to continue the war footing to maintain their economy, or face an economic collapse similar in scope to the USSR.

To be fair, they may have signed an NDA as part of their workers comp agreement. The prosthetics he has are pretty rare to see on people, as most private and socialized insurances won't cover microprocessing knee units.

The vast majority of the time when you see a high end powered knee unit on a guy that young, it's because they had a workers comp case, or they got them at the Walter Reed veterans hospital.

The knee looks like a Genium x3, which alone can bill for around 100k. His prosthetic feet bill for around 10k a piece, and then there's probably another 50k for custom sockets.

Even if he did harbor a grudge against the employer, in his position it would be difficult to rock the boat and potentially be on the hook for his acquired medical cost.

It's unfortunate, but I've definitely had a patient who was successfully sued for losing their leg at work. Word to the wise, don't get hurt on the job in Kansas.

it would disentangle health insurance from employment.

Not unless there's a viable alternative..... If put into effect today it would just be the equivalent to a giant cut for 15 million people.

Well.....that and the thinly repressed racism that's been simmering in Europe for decades has finally boiled over.

Everyone in the US just kinda assumes that we're an outlier in the racism department, but that's just because they haven't ever heard a drunk French man pop off about Algerian or Romani people.

Someone at some point should have told you this, but it rarely gets communicated until its too late. If you have peripheral neuropathy, even if you are not a diabetic, you should be doing nightly foot inspections with the aid of a mirror.

It drops the likelihood of acquiring an amputation by around 70%. Pretty much all my patients who have had amputations acquired them because they didn't know about a foot wound before it became infected and spread to the bone.

Simply flashing your feet at a mirror kept propped next to a nightstand can significantly improve your overall health outcomes.

There is no such thing as international waters. China's exclusive economic zone is one of 17

I mean this is just definitionally wrong. You can't acknowledge the existence of exclusive economic zones without also recognizing international and territorial waters.

"The difference between the territorial sea and the exclusive economic zone is that the first confers full sovereignty over the waters, whereas the second is merely a "sovereign right" which refers to the coastal state's rights below the surface of the sea. The surface waters are international waters.[2"

The Dutch and Australians have violated this and are now complaining.

No, the Chinese government is trying to both have their cake and eat it. They are acknowledging the idea of internationally recognized law, but ignoring the aspects they do not want to adhere to.

By definition economic exclusion zones only apply to the resources beneath the surface, the surface itself is international waters. The water people are allowed to protect as if it were sovereign land is only territorial waters, which extend 200 miles from the recognized Continental shelf.

Brittney Griner was a celebrity stuck in a political dispute, Whelan is a totally different case. I don't think he was spying for the CIA, but he was up to some pretty sketchy stuff, and he has an even sketchier past.

He's claimed to work as a police officer in multiple places that say they have no record of him, or that he only worked there for a short time. He was court marshalled for larceny and given a bad conduct discharge. Even after his discharge he was hired as head of security for a global firm that did business in Russia. Even ignoring the fact that he holds like 4 different citizenships, just the information that he has provided himself is super sketchy.

I wouldn't be in any rush to to spend political capital on this dude either.

Democrats haven't touched this because they're spineless and don't want to be seen to be stuffing the bench after Republicans already stuffed the bench.

I don't even know if it's just that they're spineless. Part of me thinks that the majority of people in Congress don't really mind a conservative judicial system.

The vast majority of people in Congress are affluent white people, and they really have nothing to gain by replacing a conservative judge with a liberal one. A conservative judicial system isn't going to stop them from leaving the country for an abortion, or change what the private schools teach their children. While a liberal judge may increase their taxes, make it harder to accept bribes, or even ruin their businesses by implementing labor laws.

I just don't really see anything that would really motivate anyone in Congress to enact a more fair judicial system.

The more decentralized and "competitive" the system, the better for most individuals.

According to? If I recall some of the worst crimes in US history we're committed with the authority of individual states. In fact it took a more centralized authority to secure the civil rights we enjoy today.

but those inefficiencies might save us from fascism.

Again, this doesn't follow logic or history. Fascist don't work within the operational parameters set by the status quo. Fascist are revolutionaries, not reformers, they don't care about how centralized or decentralized a government is. Their entire purpose is to destroy the current hierarchical framework and replace it with their own.

Also if we take a look at the nations where fascism did arise like pre war Italy or Germany, they were highly disorganized and fractured governments. The factional deadlock and decentralization were the only reason fascist parties made any headway in the first place.

If you've ever played in the surf and can feel when a wave pulls you towards the ocean before another wave pushes you back towards the beach. It's like that, but just the undertow part. It's very noticable.

Maybe he just has a negotiation kink? The man knows how to wield his bargaining power, and knows how to close the deal. We need this kinda energy to arbitrate for labour agreements.

Because I try and give everyone the benefit of the doubt; even people who reply with a condescending tone. I also acknowledge that people make mistakes and people's personal lives and professional lives are different things.

Seems like you are more focused on giving that doubt to the officer than the boy who was shot.....

Plenty of people go to a range and practice shooting. You're making a lot of assumptions about skill here that are entirely your own bias.

Lol, I go to the range to practice. You know where they put the targets on the dummies......not on the hands. Firearms are not nonlethal weapons, anyone with any training knows this. When you learn to shoot, you are always told to shoot center mass.

You are not allowed to go around and point a gun (real or not) at buildings.

Any what evidence says he was pointing at building? A phone call from some random lady does not validate him shooting a child.

What if I randomly called the police on you and told them you pointed a gun at me, where would you like to be shot?

There is a big difference between eye witness testimony (i.e., remembering the facts and identifying people) and inaccuracies in reporting (I saw a car driving way too fast, I saw a person rob my grocery story, I saw a person shoot someone -- these aren't things people often get wrong).

That is semantic reasoning, there is no inherent difference between the two. Also, people file false police reports constantly.

not touching it's loaded with biases, condescending tone, and disregard for the particulars of the situation.

Lol, like you don't have a condescending tone to your writing? The difference being is that your claims actually deserve condemnation.