medimikka
It's 2026, social media has to be flashy, go right to the gut. We've become dulled to the realities of the world, so harder hitting content is the only thing getting a reaction. And accounts/sites like this one provide that hard hitting gut punch, if need be by inventing a new narrative.
One can hold both thoughts at the same time and still understand, why a page like this causes concern.
I am not a fan of domain name cessation or any kind of blocking access to data, but I'd imagine NameCheap did have a particularly high amount of complaints and legal inquiries (one comes to mind, where the site posted pictures of a Hamas hostage in a tunnel as "Israel starves teacher and forces him to dig his own grave" that is in litigation), that at some point beg the question if $5/year is worth it.
There's nothing wrong with having LGBTQIA+ flags in your app to highlight marginalized groups. But to respond to a plea for extension of that list with "fuck you, Nazi Transphobe Sexist Scum" isn't the way to go.
The VAST majority of my LGBTQIA+ friends in health care agree. Your candle won't burn brighter if you blow out other candles. Adding more colors, adding more flags, adding more recognition, does not diminish the recognition of the original marginalized groups. If anything, it creates understanding, community, personhood, and normalizes LGBTQIA+ as not an outlier but one in a scary number of identities and groups that are being mistreated.
Which says a lot more about them than it says about Brave.
Any ED resident on their first week on the job should know how to diagnose sepsis: Temp >38°C (100.4°F) or <36°C (96.8°F), Heart rate >90, Respiratory rate >20 or PaCO₂ <32 mm Hg, WBC >12,000/mm³, <4,000/mm³, or >10% bands, Infection (suspected or present).
Double down on the blood work, take liquor, empirically give antibiotics (less and less useful, given resistances), drop temperature (paracetamol), add fluids (drops heart rate, ups blood pressure), wait for labs.
It's not hard, and I am so very sorry someone with sepsis signs was sent home. Sepsis is also a fast bastard. Meaning, from pathogen entering the blood stream to organ damage and conclusively death can be less than half an hour. That's the ones we can't catch. The guy with the ulcer, the person who injects things, the girl who didn't see a dentist about her developing abscess, the man who stopped his HIV meds... that's the ones I didn't in the past three weeks. I got them too late, or didn't see them until the ambulance unloaded a dead person.
Sepsis is a bitch. A total and utter bad player, something we drill into every resident from day one. Sometimes Mrs. Goodforall comes in with a light chest tightness and leaves on a hearse, sometimes Mr. Bluebird presents with nausea and crashes into a full on septic shock minutes later. Any one of those I can prevent, I will. I am, however, not God. Just a ED jockey with an infectious disease background. I'm probably the best hope my patients have, which isn't much, but it's something.
Some gets to where it needs to be, the rest gunks up the engine on the outside and in places it shouldn't be.
Almost any drug acting on 5HT (fk acts on 2C), acts on other receptors as well. Fk acts on α1, M1-4, and many more, it's not very selective. A venerable bucket of oil, indeed. This is, what also causes Long-QT, feeding disorders, diarrhea, shorter pregnancies, dry mouth, sexual dysfunction, and more.
Sure, dropping such a bucket of oil can also, via inflammatory pathways, elicit IL-10 activation and, more importantly, act against hypertriglyceridemia. But that should not be sold as a solution to a problem. Again, to stay with contrived comparisons, if I load the boot of a car with C4, I am sure that some parts of the car will reach more than the car's stated maximum speed. But that's not a desirabe outcome.
As a last ditch, I'd consider it. But "preventatively" as suggested... that's a far, far, reach.
Matt, literally (he turned 21 then), came of age in the 2004-2006 Silicon Valley climate of the post-Bubble "Trümmerfrauen" (https://en.wikipedia.org/wiki/Tr%C3%BCmmerfrau) movements that brought us things such as DHH and Rails, Matt and WordPress, Andreessen being himself, and others, all of which are now considered "problematic."
I don't think Matt has changed. The climate these projects operate in, has. To some it's an eggshell walk, to others a game of signaling the right virtues while acting against them in secret, and to some a chance to achieve relevancy or dominance. And for all of them, there's a day of reckoning. 2005s proclivities have no similarities to 2025 dogma, and why should they. Neither did 2005 have any with 1985. Feel old, yet?
Matt's Matt. That Matt was what was needed to kick a floundering piece of software (P2) into the kind of trajectory that helped transform it into the absolute unit of a social and communications portfolio, Automattic is today.
That kind of Matt is a dinosaur in 2025. As were 1985 coders and founders in 2005. Heck, 2005 didn't look too kindly upon 1999 Silicon Valley mindsets.
I guess Matt's "problem" is not, that he has changed. Matt's difficulty is, that he hasn't, and that 2025 is nothing like 2005. And, like DHH or Andreessen or Brendan Eich back in 2014, that can ... hurt. I'm too old to care, but I'd presume today's "golden child" will be a very problematic person in 2045, unless they learn to change or hide behind signals.
Even more, I can have split logic based on window size, window titles that show me who also checked out a file while I am inside an editor, even per-window color and font schemes.
All apps should use something like Lua for their config.
Others have tried to solve the intersection of new discoveries and daily reading workflows, but only Arc seems to present the latter in a way that does not get in the way of the former and does not require N keypresses to get there.
Sidebar plus floating URL bar means much less window chrome, which is (especially for people like me who haven't owned a monitor or a desktop PC for a decade) a welcome freeing experience that maximizes screen estate.
Having a baked in tracker stripper for a one-keypress URL copy is, especially for people like me who copy dozens of URL daily, a boon. No other browser seems to think, that this is something that is needed. And most users seem to have arranged themselves with two keystrokes to highlight the URL bar and copying the contents, followed by dozens of deletes to remove trackers.
Sure, it's small stuff and easily waved off, but if none of the other browsers wants to break with the Netscape early days paradigms, Arc it is[1].
[1] Zen Browser tries, but then, that Mozilla underpinning often sabotages the experience.
To correct this, though. You can buy all those in the US as well. Holter and FirstBeat are selling clinically validated and FDA approved mutli-lead ECG, Derxcom is selling an over the counter CGM, as is Abbott with the Libre 2, and a Chinese company has recently joined there, too.
Low calorie meal replacements are all over the store, too.
If you're a member of this orthorexia/orthovivia crowd, you have the same access to tools as you do in the EU, often more so.
Luckily, there's xDrip4iOS and xDrip++, not to mention Suggah and others, who will happily do the alarming part for you. Not to mention, that to many of us T1D, the CGM is just a secondary data point for our loop, which has a CGM already built in.
This life and death situation demands a certain decorum. Among others, to rise above the "hi I am coolwulf" stage of interpersonal interactions.
Let me go to a different topic in the same ballpark: imagine you had to build your SARS-CoV-2 response plan based on either a panel of women and men whose name and credentials you are privy to, or a single individual with a blog calling themselves "y0m0mm4" - which one would you, reasonably, choose to consider? Yes, the single individual may have, by chance or skill, happened upon the perfect plan. And, yes, the panel of experts may be completely wrong. But in medicine we call this a Zebra, a very rare event that, in a discipline of probabilistic empiricism, should not initially be considered.
I don't doubt, that all the above might come together to greatly improve treatment decisions. In fact, I know it, because as I said repeatedly, Bruker, Siemens, Tally, and others work on those solutions as well, and they are being used. Initially only in secondary verification, but with three FDA approvals expected this quarter, there might be much more coming.
I just don't think a pseudonymous account on Hacker News is the place to farm something that, not unlike many other medical interventions, has a massive potential of harm. As a somewhat related side note: the US was spared the horrors of thalidomide, because a single woman at the FDA (Frances Oldham Kelsey) refused to certify a medication that did not list the names of the inventors. When she did not get answers to her questions, largely because Grünenthal refused to let her speak to the drug's developers, she refused certification. In medicine names mean something, and if it's just the ability to verify background claims.
Yes, I know. I worked in Ghana. And, know what? Unless you're running a $5m/month Cyberknife or similar, you don't do those dual modality approaches. Most, literally all except five or six research hospitals in the US and EU, treatments still work (very well) with lead marker lines on patients. We image, we look at the image we stage, we localize, we take out a tape measure, we draw. It might sound archaic, but it works extremely well, especially in places like Ghana.
I'd seriously love to see "coolwolf"s experience in developing country cancer treatments. I mean, in developing countries we deal 95% with cervix, breast, liver and prostate. Neither are hard to image and localize/stage. In the case of higher stages, exploratory imaging is also done, but those lesions aren't of initially surgical or radioherapeutic concern. Those who are, can be localized by eye only. And that's the ones, that software outlines.
Pretty much. The thing, though, is that places like Ghana (were I worked, I am a bit less educated about other places) get second hand machines from the US, Israel, UK, and Russia, so it'll take a few years until serodiagnostic and serotherapy labs "trickle down." So here he's right, not everyone has those resources.
However, the _imaging_ and _localization_ of lesions was never the issue.
Neither is the radiotherapeutic treatment. If you don't have enough power to do both at the same time, you won't have enough power to do his approach, since neither AI nor human eye can see through tissues. Humans move. Humans breathe. Either you take those movements as given, and live with the wider consequences, or you spend millions of cyber knives (https://med.stanford.edu/neurosurgery/divisions/radiosurgery...) that detect movement and counteract it. Having a more colorful version of the initial imaging won't change that. A radiologist's eye can do the same, and unless I see compelling evidence that the AI can do it better, something I have not seen, yet, any of the now 30+ solutions for AI analysis (as I said, Bruker and others are also offering theirs for free and open, and behind them stand massive research apparatuses) should especially not be used in developing countries.
Seriously, finding tumors and staging them is the easiest part of this job. And the rest can't be done by AI (yet.)
No. Know how I know this?
Well, Thalidomide, the aforementioned cryo scalpel, Paolo Macchiarini, and others have taught us, that that's never a good idea.
It's 2024. We're throwing our lot in with serodiagnostics over anatomical localization, a PET scan being the only thing we need these days. If we know it's a lesion and we can FNA it, we will, else there's enough serodiagnostically we can do, to build individualized treatment plans (or determine if there's even a reason to use them).
It's pretty fun to see the computer draw little circles around lesions. The Bruker solution (also Open Source and free, by the by) does this admirably well. But it's neither useful in diagnostics nor in therapy, since both don't really hinge on a circle around a lesion.
But, hey, you do you. If you're comfortable subjecting yourself or your loved ones to this, by all means, do it. Without a decent sensitivity and specificity review, without an actual review in general, and without a corporation whose jugular I can cut if they screw up and murder my patient through a misdiagnosis, I'll stay away from someone's home grown shoe box medicine as far as I can. And I know all my serious colleagues will and are as well. It's not like that's the first person this week (or even today) trying to sell us one of those.
And if Chinese single-individual solutions with gamer nicknames don't worry you, someone who frequents Hacker News and is probably not dumb, I understand many of the issues we have with medicine and medical communication much better. I'm sure you're confident that you, or a loved one, will be correctly diagnosed by this thing. I am not.
[1]: these hospitals are conglomerate hospitals who will buy things to try them out. I have dozens of bullshit solutions my bosses bought in storage. Why do you think you're getting raked over the coals for every small issue? Why do you think health care in the US is that expensive)
In addition, I'd never, ever, not in a million years, consider any interventional or diagnostic strategy from a blog post, most of which is written in a language, any language, I can not readily understand. Not to mention, I'd like to see names, not 1337 h4xx0r handles ("coolwulf" is great if you're 12 and playing WoW as a Worgen Deathknight, it's not cool if you'd like to convince me to add more tools to my workflow), when I consider modalities.
As a sidenote: modalities like this one are common in modern radio diagnostics. Harvard, MIT, Cambridge with King's, Paris Cité, and a few more are working on evidence based (and Open Source/Open Algorithm) approaches to AI diagnostics, all of which seem to have their ups and downs in outcomes. All their services are HIPAA compliant and certified as such, run in-house, do not require me to upload vast amounts of radiographic data to a website operated in a country I wouldn't trust with my daily egg consumption stats.
We're not talking funsies at the 7/11 here. We're talking diagnostic and therapeutic decisions. Basing those on a black box "pinky promise, it works" approach, is pretty much how people get killed. Not to mention, it's a 1980s view of things, the "if I can see it, I can cure it" approach. Modern oncology means to diagnose based on genetic and sequential markers, develop individualized strategies, long before imaging modalities become important. And if they do, there's plenty of hard- and software out there to make our lives so insanely easy, why send our stuff to a graphics card in China?
Comments are so 2003 pre-Trackback/Pingback.
Tea doesn't hurt, and there are some strong evidentiary ties of green tea extract in the easing of the effects of NAFLD, but generally it'd be dangerous to see it as a valid treatment option for viral Hepatitis or NAFLD effects.
A diagnosis of autism is not an easy task. Opposite to what the Internet might make you believe, it's not a matter of "listening carefully" or so, it's a multi-hour, multi-day, set of diagnostic tasks, that take time and energy. At the end of this journey, you'll have a label for what you are experiencing (or not). And then?
I tell my patients, that a label makes three things easier: medical billing, provider communication, and (in rare cases) medical intervention. The rest is, diagnosis or not, pretty much the same.
We define as clinically/psychologically relevant all those mental states that a) lead to a noticeable reduction in the person's ability to enjoy and function in life, and b) can not be addressed by the person reporting them without help.
So that brings the second question: what do you need help with to address your mental state?
Is it simply acceptance? Only the individuals involved can give you that. And while "I am autistic" works on 4chan as an excuse for all kinds of behaviors, in real life it generally doesn't. Or is it to change things? Only you can do that. There is no working therapeutic medication for autism, and therapy generally aims at improving your journey into overcoming the facets that are detrimental to your daily life.
Another thing I tell my patients is that social interaction and coping are skills that are learned. To some people, most in fact, those learnings come easier than to others. I am short, below the US average, and I run ultra marathons. I have a marked disadvantage compared to 6ft lunks, simply due to stride, which meant it took more energy and time to develop this skill. On the other hand, I cope well and quickly, seem to have a rather accepting attitude towards others and life, and am good at social interactions. Those skills were much easier to learn for me.
You might be taller than me, able to learn long distance running faster, while having a harder time honing your social and coping skills. Autism is such a barrier to skill development. It's hard to develop people skills, if the headspace isn't there. But it's possible. You're a coder, view it as a hard code problem. Approach it, broken down into smaller tasks. Same for your daughter: it's not easy for any new, especially first, parent to empathize with their kid's outbursts and odd behaviors. Some people have it easier, some don't. That's a reason to work harder, not an excuse.
If you need a diagnosis, a certified mental health professional can help. But just like without, once you have the diagnosis the next steps are the same: go the hard mile to develop skills you need.
After nine years in poison control I can remember one case in which we were stumped by the agent, an organic phosphate that had been accidentally rebased to have a structure that fooled Mr MassSpec. In all other cases, where there’s effect there’s an agonist or antagonist that can be clearly identified.
The mind is a miraculous place, much can happen in it, even a poisoning.
But for $35/month I can get Illustrator and a bored CS undergrad trying to get some actual impact points in.