godzillabacter

You know I felt this way for years. I felt that way through psychopharmacology in pharmacy school, and I felt that way during our psychiatry and behavior lectures in medical school. I felt like psychiatry was minimizing behavior to these boxes was far too reductionist. Then I spent a month in an inpatient psychiatry facility as a third year medical student.

While I completely agree that each individual is unique and people are more than their diagnosis, you'd be absolutely shocked by just how similar patients' overall stories, maladaptive coping mechanisms, and behaviors are within the same psychiatric illness. I can spot mania from a doorway, and it takes less than five minutes to have a high suspicion for borderline personality disorder. These classifications aren't some arbitrary grouping of symptoms: they're an attempt to create standard criteria for a relatively well preserved set of phenotypic behaviors. The hard part is understanding pathology vs culturally appropriate behavior in cultures you don't belong, and differentiating within illness spectra (Bipolar I vs II; schizophrenia vs bipolar disorder with psychotic features vs schizoaffective)

I'm going to digress from the economics a tad and focus on the ethics of this. I feel like companies should be on the hook for this. You should invest in capital (including human labor) based on your confidence in its expected return. Companies should not be able to hire a myriad of workers for funzies and not have to meaningfully consider if that person will be necessary in 6 months. If it is a legitimate business venture, then the cost of potential severance for new hires should be folded into the economics of the decision to pursue that venture. Larger severance pay/worker protections encourage employers to not utilize exploitative hiring practices.

It's so funny because it is criminal activity for regular non-corporation people. Transferring assets to family/hiding assets for the purposes of declaring bankruptcy but not losing the assets is illegal. Functionally identical to what is going on here, except they're somehow transferring the liability instead of the assets.

You mentioned trying board games, any interest in TTRPGs like Dungeons and Dragons and the like? The game is basically designed to forge friendships. If you or your partner is willing to learn to be the Dungeon Master, you'll have no trouble finding players, in fact you may have so many interested individuals you have to do brief interviews lol.

Pharmacist and 4th year medical student here. Medical tests are ordered based upon their statistical ability to alter your likelihood of a diagnosis. No test is perfect in either direction (negative result meaning you don't have disease or positive result indicating you have disease). Tests cost money, take resources of the healthcare system, and have the potential to be wrong. When a test is wrong, it can result in financial, emotional, and physical harm to an individual.

Example: you're an otherwise healthy 34 year old and you feel a little under the weather and are coughing. It's only been going on a few days, mild fever, but you're worried and you go to the doctor. Your doctor thinks this is most likely a viral infection, recommends Tylenol and ibuprofen and sends you home. You imply to the doctor you'll sue if you don't get antibiotics and a chest x-ray just to be safe. The doctor, rather than argue with you when they have a dozen other patients to see, just orders the stuff and moves on. The chest X ray doesn't explain your cough, but there's a small lesion of undetermined significance on the X-ray. Now you need a CT. The CT says "probably a self-limited granuloma from a fungal infection, can't rule out cancer, correlate with biopsy". Then you have to go get sedated, put a camera down your throat, and have a pulmonologist take a sample of your lung to see if you have cancer. Maybe you end up with a complication from the sedation or a pneumothorax. Meanwhile the antibiotics you took didn't really improve your cough but now you have this uncomfortable itchy rash. Are you allergic to the amoxicillin? Or did you just develop the typical rash seen in people who have mononucleosis that also take amoxicillin? Will you get allergy testing for the amoxicillin? Just avoid amoxicillin, an awesome antibiotic, for the rest of your life?

We are restrictive in our prescribing of medications and tests not because we don't care about you, not because we want to save the hospital or the insurance company money (in fact the hospital prefers we order more things because they make money on testing). We are restrictive because we want to maximize benefit while minimizing risk, and everything we do has risks and benefits.

I mean if the only way they're gonna have jobs is through predatory hiring practices that could leave them fired and without severance, then yeah. Because if the company is planning on hiring these younger workers for the long-haul, then this shouldn't be a significant change. I think overall national policy should discourage unnecessary high-turnover and predatory hiring. I'm sure there will be situations this is still unavoidable, but that doesn't mean we have to endorse it by way of law/policy.

EMS communication over unencrypted channels is limited by HIPAA, patient information must be kept vague to protect patient privacy. In the event that, say, an individuals name needs to be given to the receiving facility to facilitate review of records prior to arrival by the ER physician, some other method of communication has to be used.

If you were somewhere else you could use MakeMKV to break the region lock/DRM on the disc and give you playable files. Unfortunately, within the USA (depending on who you ask) cracking DRM is illegal. Though I am not aware of anyone ever being prosecuted for breaking DRM on discs for personal use copies of media they legally own. IANAL

I think the point is more so why are digital purchased DRM'ed and prohibited from local storage in so many ways. The historical argument is "well you're not buying it, you're buying a license to use it for as long as we wish to provide it", but why does it necessarily need to be that way. And more generally, from the standpoint of artistic/media preservation, as BluRay releases continue to decrease and console video game releases become continually more digital-only, these non-archivable or locked-without-server-license-validation media results in IP that at some point in time, this media could be permanently lost.

Personally, I feel this is unacceptable. The media we consume forms a huge portion of our culture, and is just as much an example of artistic expression as painting. While I thoroughly believe artists/companies should be able to charge for these properties, I do not believe that when it is no longer profitable for them to support the system, that these pieces of media should simply be discarded with no method for future recovery and preservation.

You make physics come alive!

Except these physicians are often completing something called a "peer-to-peer" on behalf of the insurance companies, not just making broad treatment decisions. This is a process by which an ordering physician is required to call a physician employed by the insurance company to justify a testing or treatment course to their "peer". Unfortunately these "peers" are often composed of physicians who did not complete residency and/or who do not currently practice, let alone in the specialty of the physician who is required to call for the peer-to-peer.

This leads to rather absurd results in which a board certified, practicing sub specialist (cardiologist, neurosurgeon, oncologist, etc) with 5+ years of specialized training after medical school has to convince a physician who may never have even practiced that they know what they're doing. I personally think if you're not a neurosurgeon, neuroradiologist, or neurologist then you aren't really qualified to cancel a neurosurgeons MRI, but hey, I don't get a bonus for denying claims.

• A Fourth Year Medical Student and Pharmacist

Works for PhD's, but try doing oral exams for 1000 Bio101 students.

You'll have to strike a balance between security and ease. Your two major options are reverse proxy and VPN (Tailscale is one option for VPN)

For reverse proxy, you functionally open the app to the internet. Anyone with the correct web address can access the login page. This is inherently less secure than VPN, but not irresponsibly so. Beyond the reverse proxy itself, you'll also have to learn how to configure an HTTPS certificate to increase security since it will be open to the internet.

For VPN, every user you want to be able to access the service has to be tied into the VPN and have the VPN running throughout their access. Tailscale is arguably the easiest way to configure a VPN right now, as you won't have to manually deal with VPN configuration files for every device. VPN use will functionally make it like you're on your home network. VPN access to your network should not be given to tons of people if at all possible.

Hello all, I'm a pharmacist and 4th year medical student with a passion for antimicrobial stewardship and infectious disease. Just wanted to share my overall thoughts on the article.

The author's point of "finding out if you really need an antibiotic" is honestly one of the central issues in modern antimicrobial resistance coming from two fronts: patients who demand an antimicrobial for a non-indicated reason, and doctors who for various reasons excessively prescribe antibiotics. I could wax on this for hours, but at its core, the single most important thing we can do to decrease antimicrobial resistance is decreasing total antimicrobial exposure. That means fewer prescriptions for shorter courses of narrow-spectrum antibiotics. Unfortunately every bit of this requires more buy-in from patients and more work from clinicians.

To go along with my point above, asking your doctor to make sure you're getting the shortest possible duration is the single best thing you as a patient can do to help with these issues (other than just not demanding antibiotics if your doctor says no, but that's a low bar). The key word here is ask though. There's a huge amount of clinical experience and evidence that is used to determine when it is safe to stop antibiotics. And as much as I believe in patient autonomy and educating my patients, frankly antibiotic selection/course duration is not something the general public is capable of independently making decision on. Ask your doctor, and take what they prescribe for how long they're prescribed for, and if you have issues then call them to discuss it.

With regards to probiotics, it's an interesting topic that we don't have a ton of great data for and physicians are fervently behind or against them in my experience. The fact is we just don't know enough about them, and most aren't regulated well enough to give good information about them. Interestingly, there was a recent study which suggested higher rates of central line infections with the organisms in the probiotics in individuals given probiotics while they had a line in place.

Lastly, I think I have to disagree with Dr. Blaser. Medicine doesn't overvalue antibiotics. We certainly underestimate their risks, but antibiotics are some of the most effective and life-saving medications we as a species have ever developed. Countless lives have been saved solely from their development, and very very few therapies have a NNT as low as appropriate antimicrobial therapy. They truly are astonishingly good medications when they are indicated. The issue is simply prescribing them when they aren't indicated, which is a big part of why we're in the mess we're in, and is in large part driven by underestimating the risks they pose.

As a general rule, yes. People who are able to better perform a task should be preferentially allocated towards those tasks. That being said, I think this should be a guiding rule, not a law upon which a society is built.

For one, there should be some accounting for personal preference. No one should be forced to do something by society just because they're adept at something. I think there is also space within the acceptable performance level of a society for initiatives to relax a meritocracy to some degree to help account for/make up for socioeconomic influences and historical/ongoing systemic discrimination. Meritocracy's also have to make sure they avoid the application of standardized evaluations at a young age completely determining an individual's future career prospects. Lastly, and I think this is one of common meritocracy retorhic's biggest flaws, a person's intrinsic value and overall value to society is not determined by their contributions to STEM fields and finance, which is where I think a lot of people who advocate for a more meritocracy-based society stand.

4th year medical student. AI is not ready to be making any diagnostic or therapeutic decisions. What I do think we're just about ready for is simply making notes faster to write. Discharge summaries especially, could be the first real step AI takes into healthcare. For those unaware, a discharge summary is a chronological description of all the major events in a patient's hospitalization that explain why they presented, how they were diagnosed, any complications that arose, and how they were treated. They are just summaries of all of the previous daily notes that were written by the patient's doctors. An AI could feasibly only pull data from these notes, rephrasing for clarity and succinctness, and save doctors 10-20 minutes of writing on every discharge they do.

You're generalizing a specific phenomenon, and incorrect. Acid-base reactions only very rarely produce gases. The reactions produce heat and water, only in the case of bicarbonate being a base is a gas produced. This is because carbonic acid forms, which spontaneously decays into carbon dioxide. This is not a universal acid-base phenomenon. Soaps should not cause fizzing with vinegar.

Thank you for your insightful and well-researched response. I'll remember that as I continue to provide high-quality evidence based care to all of my psychiatric patients in the future while you bitch about stuff on the internet.

Yes, but most DRM has been circumvented in one way or another. DRM primarily continues to keep law-abiding citizens from easily acquiring a copy of media they rightfully own as opposed to preventing piracy.

Though if institutions insist on utilizing DRM for prevention of privacy, I do think that DRM should be built to fail after a meaningful timeframe, at worst the expiry of the copyright for the material. Unfortunately many pieces of media, particularly video games, are abandoned and unsupported long before their copywriter expires. Abandonware in general is not well handled by modern copywrite law.

tl;dr - Asking your doctor for the shortest reasonable course is a good thing that will both protect you as a patient as well as minimize your risk of antimicrobial resistance. But the key phrase is ask your doctor, do not take it upon yourself to decide when to stop them. Take whatever course you're prescribed.

Pharmacist and 4th year medical student with a passion for antimicrobial stewardship and infectious disease.

Historical treatment duration for most infections was truly quite arbitrary. Evidence for most infections, when it is actually tested, have pretty consistently demonstrated shorter treatment durations than were classically taught (10-14 days for pneumonia now generally 5-7, 14 days for Gram Negative Bacteremia now 7, etc). There is a subset of infectious disease doctors that are bucking the trend of historical "you have to complete your course advice" for some infections. In general, what I have seen is recommendations to discontinue antibiotics with significant clinical improvement AND a non-life-threatening infection in a non-sterile body cavity. So nobody is shortening course durations for empyemas or endocarditis.

The issue becomes expecting patients to know what constitutes clinically meaningful recovery and whether or not their infection is one of the "safe" ones to stop antibiotics earlier.

At the end of the day, I totally disagree with your premise, as we should always strive for the minimum safe antimicrobial exposure. However I do agree that telling patients "shorter is better" is bad advice because I don't want laypeople making these decisions when usually no-ID physicians don't make them.

Body-bag ice cooling has actually been pretty common practice across emergency medicine for some time. Legit body bags (clean ones obviously) are purpose built to be watertight and hold an adult human, and they're easily accessible to hospitals. It's a very effective and affordable method for controlling hyperthermia

No, in fact I believe very heavily in evaluating primary literature to re-evaluate decades-old dogma within medicine. I regularly disagree with my professors when they present outdated information in lecture. I have no income right now, and I have forgone substantial amounts of income by pursuing medical school instead of continuing to practice pharmacy. I'm not in this for the money.

If you would be so kind, I would love to know what evidence you present in contrary to the decades of peer-reviewed cohort, case-control, and RCT data which validate psychiatry as an effective field for managing psychiatric illness. I'd be happy to discuss any scientific data you have that I haven't seen, and would be happy to change my opinion if it is data-driven.

I can appreciate your skepticism towards medicine and psychiatry, but if you can't defend your position with anything but accusations and conspiracy, then I don't think we have much else to discuss.

It's not that we don't use mode, there are definitely times mode is used. It's just that mean (and median as well) contain a lot more useful information about distributions that we often care about. For a normal distribution mean, median, and mode should all be identical. So why do we use mean? Because mathematically, the mean is what underpins the formula for the normal distribution, not median or mode, and when you're talking about doing math with normal distributions mean is the thing to talk about (along with standard deviation).

We use median a lot too, you probably just don't hear it called median very often. The median is useful in non-normal distributions, and it defines the 50th percentile, so along with the 25%-ile and 75%-ile you've got your quartile distributions. We use these all the time to talk about grades in schools, or when we talk about home prices distributions in a given area, or salaries within a given field.

We use mode too, again just by a different name most of the time. Any time you've asked "what's the most common blank" you're basically asking for a mode. When we talk about "average" income in a country, we're usually actually talking about median or mode. Favorite animal? Answered as a mode.

You have to use the right statistical tool for your question: unfortunately English doesn't do a good job of conveying this without math jargon.

Then no, I don't agree with this specific implementation of the system, at least the second half. I do think more productive/effective workers should be compensated more. But being a good engineer does not make you a good manager, and the issues associated with promoting an excelling worker into management (a job requiring a substantially different skill set) are so common there's a name for their inevitable failure, The Peter Principle

Statistically? Cancer or heart disease.

Could you elaborate on what you mean?

I know, which is why my example was about providing the patient's name over the radio.

That's not exactly true. FMT isn't going to fix your MRSA colonization, and it doesn't inherently remove resistance genes from the population of bacteria in your gut. If those genes produce a survival disadvantage, they may be selected against and become a minor serotype in your GI tract, but that doesn't mean that it is eradicated.

Also, you seem to be sharing a lot of links from humanmicrobiome.info, which I would advise against. While I can appreciate the primary author's dedication to the topic and willingness to cite his sources, his website is not peer reviewed, and he explicitly states he is a proponent of FMT, introducing bias which is not being balanced by a peer review process. Not to mention he admits he is a layperson with no formal medical training/experience. I would direct you to IDSociety.org which is the home of the Infectious Disease Society of America, who publishes the actual guidelines used by infectious disease physicians in North America.

Personally I'm a huge fan of the Kepler Project font. I got hooked on it when I started writing papers in LaTeX.

http://luc.devroye.org/fonts-47327.html

Let's see if I can add something to this conversation. I'm a fourth year medical student in the United States, who in a few short months will hopefully begin training to be an emergency medicine physician. You are absolutely correct, that the government subsidizes health insurance, and that in a decent number of cases, individuals without insurance or the means to pay for healthcare are eligible for Medicaid. You are also correct that the ideal use of the emergency room is to evaluate for medical emergencies, I say this as someone soon to be an emergency room doctor. Lastly, there are certainly physician groups which are capable of providing cash pay based care.

However, the process to apply for Medicaid can be quite complicated, particularly amongst those with low medical or even just general literacy levels. This disproportionately impacts individuals for whom English is a second language. As I said above, in a perfect world, the emergency department is only for true medical emergencies. However, patients as a whole are notoriously bad at knowing if their symptoms are from an actual emergency or not. Secondarily, in many communities, the emergency department is the only reliable access some individuals have to the health system due to difficult difficulties with transportation and scheduling. With regards to your last point, while there are certainly clinics that can provide cash based care, the majority of individuals who cannot afford insurance are also likely the patient who cannot afford a cash pay clinic.

The fact is also that a large number of uninsured patients will simply have their ER bills written off by the hospital, and/or social workers within the ED will help sign the patients up for Medicaid if they qualify so they become insured can then have the visit billed for, as opposed to the individuals giving fake names.

Unfortunately, the current state of the US Healthcare system is that for many disadvantaged populations, the ER is their primary care physician. This is not ideal, but I will not admonish my patients for doing what they can to seek care in a system that otherwise leaves them abandoned and uncared for

All remote based typing is awful, T9 included. I can't speak for everyone, but I can type with swipe gestures on a virtual keyboard via remote faster than I can input T9 text. I'm unaware of any stock remote for a device with a full keyboard. I would argue Apple has text entry perfected at least as well as any other major manufacturer. You have virtual keyboard entry, solid voice-to-text, and it can be configured to push a notification to your iOS device when you enter a search bar which will auto-open to the remote app and pull up the keyboard. Because of this feature passwords can also be autofilled from Keychain to make logins easier.

You may personally prefer T9, but I've never seen anyone in the last decade input anything into a TV via T9. And you're asking why it doesn't have voice input, when it does. You admit to having never used an Apple TV yourself. I hate the idea of app-only interfaces features, but this isn't a case like that. Maybe you should understand the features of a product before you call it "fucking stupid".

If I was guessing, in general, I think people who advocate for a pure meritocracy in the USA feel the world should be evaluated in more black and white, objective terms. The financial impact and analytic nature of STEM and finance make it much easier to stratify practitioners "objectively" in comparison to finding, for instance, the "best" photographer. I think there is also a subset of US culture that thinks that STEM is the only "real" academic group of fields worth pursuing, and knowledge in liberal arts is pointless -> not contributing to society -> not a meaningful part of the meritocracy. But I'm no expert.

I self host a lot of shit, but after almost a year of using Obsidian I finally paid for their sync feature for one reason: iCloud sync to iOS is painfully slow.

I was sometimes waiting 30-45 seconds to jot down a note just waiting on the app to open with iCloud sync as my backend. Now, with Obsidian sync, the app is ready-to-go in seconds.

Now if you're only going to be using on desktop, I would definitely consider a git-repository based sync, but if you're gonna use mobile I'd recommend you at least consider Obsidian Sync

Yup, it's hard to have a good discussion about the changing tides in ID without feeling like you're causing a bunch of backsliding and non-compliance. I think being honest with people that the data is generally poor about how we select durations is the moral thing to do. But I do want you to just take your damn antibiotics as prescribed instead of going rouge because you heard "shorter is better" and your pneumonia recurring.

It depends on the half life of the element in question. The most comparable concrete thing we can compare this to with real numbers because we know it works is an RTG. RTGs are solid-state generators, but people could colloquially refer to them as "batteries" and not be terribly wrong. They take a quantity of a radioactive material and allow it to decay, using the heat given off to establish a thermal gradient which is then converted to electricity via thermocouples. Most of these are "fueled" with Pu-238 (at least the ones for spacecraft), which has a half life of 87.7 years. That means in 87.7 years, if you started with 4kg of Pu when you built it, you'd have only 2kg of Plutonium left. If the Pu decayed only into stable isotopes (it doesn't) then your radioactive emissions/decay would also be exactly halved at this time. If the electrical system is perfectly efficient this would also halve the electrical power produced.

I provide this all as background because to answer your question you have to know three key factors about the device to determine the lifetime of the battery. The half-life of the isotope used, the minimum electrical requirements of the device you're powering, and the amount of radioactive material in the initial battery. The battery's lifetime is determined by when decay will decrease the ongoing energy output below the minimum current and voltage requirements needed by the battery. The longer the half life of the isotope, the slower this decrease is and the less initial overpowering that is required.

Ex. If you use an isotope with a 12.5 year half life for a "50-year" battery, you would need to start with 8 times the material needed for your minimum power output requirements. If you use an isotope with a 200 year half life, you only need 19% more starting mass than you minimum requirement. The first battery will produce 8x the power at the very beginning, while the second will only produce 18% more.

I'd be honored to be Mr. Shadowheart

That's not true. HIPAA covers anyone handling protected health information in a professional manner. If some office clerk at the VA is mailing out copies of HIPAA-protected information, they're bound by HIPAA. If a consulting IT firm has access to a hospital's servers as they're changing something about the EHR, they're bound by HIPAA. Protected information cannot make its way from a "covered entity" to a non-covered entity like a totally unrelated bakery who would not have an obligation to protect your information without either: 1) violating the law, 2) you personally disclosing the information to the non-protected party, or 3) you or someone authorized on your behalf signing a disclosure waiver permitting the covered entity to disclose

Awesome! Let me know if you have any questions about DM'ing. I highly recommend Matt Colville's Running the Game series. You absolutely don't have to watch it all. If you watch the first three real episodes (Your first adventure, Your first session, and Running your first dungeon) you'll be set!

Section 2, first paragraph. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956183/

At their core phages are viruses, there is no reason to expect the host immune system to not recognize them as foreign and attempt to eradicate them outside the GI tract, where most serious infections occur. The GI tract, skin, and to some extent the lower UG tract will likely tolerate these through mechanisms we tolerate colonizing bacterial flora, but colonization, even with antibiotic resistant organisms, is not a primary indication for empiric treatment for eradication. In fact there are some studies that attempting to sterilize the UG tract in colonized asymptomatic women promote symptomatic UTI.

These colonizations become problematic when growth becomes unchecked and infection develops, or they seed infection into another compartment. There is no reason to think something as foreign as a bacteriophage wouldn't be recognized as foreign in a sterile space (kidneys for pyelonephritis, liver abscess from migrated gut flora, endocarditis, etc) where these serious infections occur.

This ties in nicely with your suggestion of phage cocktail therapy. Yes, that can expedite the delivery of phages, however excessive use of phages could result in anti-phage antibodies, limiting future treatment in a method similar to the development of anti-drug antibodies in epoeitin analogues, insulin therapy, antivenin, and anti-inflammatory antibody therapies like adalimumab (Humira)

Not OP but loss of the Pi results in loss of network connectivity. A headache if you're home and never doing anything time-critical on the network. A disaster if you or anyone else is dependent on the network for anything time-sensitive (virtual doctors appointment, work call, etc), or you're away from home and unable to directly VPN to your router to reconfigure DNS settings.