We finally realized a long-term dream and bought an espresso machine! It just came in this weekend and I spent most of Sunday wired on caffeine from trying it out. I am very surprised at how fast the thing heats up - that's probably the most unexpected thing about it. I think my shots are underextracted but am excited to practice and keep dialing them in. It's so nice to have stuff we normally have to go to a coffee shop for in the comfort of our own home.
That is true, the general trend of the area will be towards a more liberal stance. However, will that make the conservative-but-ashamed, "oh I don't watch the news it's not edifying" crowd vote Democrat? The skinheads certainly won't be changing their affiliations. And our binary voting structure seems to preclude any sort of change aside from R --> D or R --> no vote. FWIW I have little exposure to truly rural areas outside of the South.
I hope so. But my experience with people who have moved to smaller municipalities is that they tend to be pretty conservative - granted, most of those interactions were before the pandemic.
I am reminded of Mackinder's Heartland theory, which talks more from a purely geopolitical standpoint and also feels a bit outdated in the modern setting. That thread is a good read
Interesting. If someone tries to distill an explanation of the current structure of the world into one theory predicated on a single variable, I guess control of money is as good as any to use. Or maybe I skimmed that Wiki article too quickly lol
I just read that! Had trouble with the dialogue throughout, and with the pacing during the later half. He sure loves Switzerland a lot though. And some of the ideas were neat.
Hey all! Been a while. I've had this on repeat for about a week now. Banjo Guzheng Pickin' Girls
Damn, you beat me to it. Turns out telling other nations to dig up dirt on your political rivals is not allowed, who knew?
Snuck in these cute air plants into the deliberation room. Let’s get some life in here as we contemplate death. What are other mindful ways y’all deal with the burden of proof?
Well, if I'm not mistaken the prescription pad is still out of the domain of nurses. Urgent care is expensive and inefficient in comparison to Europe's model, but are their community care clinics run by NPs? Genuine question. I don't know much about European healthcare. In terms of being able to run an urgent care facility without doctors, I think the majority of centers in the US still keep a physician on site. Nurse practitioners, in our current model, function best to help multiply care access but are still linked to physicians. Whether we should change this is a different discussion, though. I'm not sure if you're saying that primary care physicians are too expensive or something else, but I think there's a theoretical model that ensures high pay for all medical professionals (nurses, doctors, technicians...) while keeping costs low for the patient. It involves drastic moves in the world of admin, insurance and pharma, though, so - not gonna happen.
Right on about Halstead, dude was crazy. It's a ridiculous model that definitely contributes to the rate of errors and burnout. So the obvious solution is easing the burden of care currently on US resident physicians, which will require hospital systems either to supplement heavily with midlevel practitioners or take on more residents. Midlevels still have to get physician oversight in most states, so even a solution pursuing strict midlevel expansion will require more residency spots. And after residency positions are expanded, there has to be some sort of incentive to ensure that the new attending doctors get to areas where they are needed, i.e. poor and rural communities. This will be a multi-decade transition process, and only tackles a part of the train wreck that is the American healthcare system.
I agree that the AMA is an organization opposed to the individual goals of its members. I don't think that this is an active effort to keep doctors' pay high. It's a provocative headline and I guess it got me, so here comes some word vomit: From what I see, there are 3 main bottlenecks; acceptance into college, acceptance into medical school, and acceptance into a residency program. This article appears to suggest that we combine the first two hurdles, college and medical school, into a single six-year program probably added on to the offerings of an undergraduate institution. I have no idea how this would look in terms of testing, attrition rates, or overall learning experience, but it does sound pretty similar to some pre-pharmacy and pre-physical therapy programs I've heard of. The LCME, although controlled by the AMA and lambasted by the author, is instrumental in determining which institutions are meeting important criteria and would still need to be retained under this model. The decrease in investment time would be considerable to the future doctors, however, and that could be good. My main bone to pick is that the doctor positions that we really need in the coming decades are "primary care" roles - doctors that have a clinic and help patients avoid having to go to the hospital if possible. The type of doctor one becomes is decided by the third hurdle; acceptance into a residency program. Graduating medical students compete against their peers both domestic and international for a limited number of training spots which are required to progress to board certification. The most highly contested spots are generally for surgical or radiological specialties, meaning that primary care is implicitly de-emphasized. Of course, that wouldn't be a problem if there were more residency spots, but that part is actually not controlled by the AMA. Residency programs are funded by the federal government through Medicare [(Wikipedia, I'm lazy)](https://en.wikipedia.org/wiki/Residency_%28medicine%29#Financing_residency_programs) and this funding has been FROZEN FOR 10 YEARS, against the stated desire of the AMA. Add to that the fact that hospital systems use residents as underpaid, overworked, powerless versions of doctors that are "only" required to work 80 hours per week on the books, and you can see the abuse potential here. There's a whole bushel of problems surrounding medical education, and this article touches on a few facets of it but I feel that it points fingers the wrong way, for the wrong reasons, and offers a nonstarter as a solution. Expanding the number of residency slots is absolutely essential to help weather the demographic shift that we are undergoing now, but without careful oversight an expansion will just expand the number of burned-out physicians making life-threatening mistakes after their 20th hour on call. The need for a 4-year college degree is debatable and I could be persuaded on that point, but the 4-year medical school track is the best model we've got right now, and the residency programs are also an essential phase of the training.
For me at least, it feels like there's a higher bar to contributing worthwhile content here, so I don't post or comment much. Life has also been busy. But it's still a cool place with cool people, and feels like a cozier, slower corner of the web to hang out and read.
Love me some hbomberguy. Stuff like this reminds me to take a beat and think about whether I feel something because it's a genuine reaction, or because I've been tricked into feeling this way by someone clever; and I'm guessing we underestimate the number of times it was a trick by someone clever.
Ooh, that looks like a good book. Gonna add it to the list.
I mean, it's a good idea if the end goal is to benefit the communities where asylum seekers end up. But even a good idea can be completely subverted or sabotaged by failures of execution at any step in the process, and the stated purpose in this case is for "punishment" of cities that have the gall to welcome others in need. The explicitly malevolent intent of the policy makes me think that the administration will try to make it as painful for every party as possible at every step in the process. It doesn't help that Stephen Miller seems to have set himself up as some sort of Bannon-like successor.
I was typing out my reply and realized that the Justice Department, as part of the Executive, has very little accountability even to the GOP constituency. Sure, those boomers who voted Trump may not be able to afford their insulin, but Bill Barr and Boofin' Brett aren't technically required to give two shits about those plebs. Although a Pyrrhic victory may cost the GOP their foothold in the legislature, I'm convinced that they've successfully grafted themselves into the entire judicial branch. It certainly won't be the end of the healthcare debate in America, and I could certainly see millions of people losing their insurance as impetus for a Medicare-for-All type initiative. But prior experience indicates that if the people who've hijacked our government don't want to play ball, they'll just throw a tantrum and hold their breath. And thanks to talk radio and Fox News it somehow keeps working.
How it works: A federal judge ruled in December that the ACA's individual mandate has become unconstitutional, because of the way Republicans zeroed out the penalty for being uninsured. If any Americans needed any more reason to vote this bunch of syphilitic ingrates out of office in 2020, here it is. Millions of people out of insurance. Biosimilars of all kinds left unfunded. All thanks to a Republican vendetta against an originally Republican healthcare plan, which has actually done some good for many of their constituents.Why it matters: A ruling striking down the entire ACA would upend major parts of the health care system. Millions of people would lose their health care coverage, and a host of seemingly unrelated policies — including new experiments in how Medicare pays for care and an entire class of prescription drugs — would also go out the window.
Name: BurnTheBarricade Location: The Bad South Age: Twenties I joined here a while ago, and it's been a nice little corner of the internet to go when I want some discussion or opining less dim-witted than Reddit or Youtube comment sections. Been away for a while cause of life stuff, but I expect I'll keep lurking here for as long as the site's up. Most of the time if I don't say anything it's cause someone's already said it.
From what I can tell, this sort of falls into the 1st category, along with a bit of the 3rd. They take the patient's cells and look for a type of rare white blood cell called [tumor-infiltrating lymphocytes]( https://en.wikipedia.org/wiki/Tumor-infiltrating_lymphocytes) that can hit the cancer cells specifically, then make a bunch more of them and put them back into the patient. It's promising because the treatment is effectively an extension of the patient's own immune system (it won't provoke an immune response or poison the person's own cells), the TILs can reach anywhere that the bloodstream can reach (helping to deal with metastasis), and because there is potential for this type of therapy to work on multiple different types of cancers (rather than a specific drug targeting a specific cancer's oncogene). I just finished The Emperor of All Maladies and it's a terrific read. The timing of this research result is pretty neat.
22 months and counting. This may be the most promising case in the trial, so we still need to see what the other cases yielded, but that's still pretty good for a metastatic, resistant breast cancer. Does anyone see any potential downsides to the treatment besides cost? I'm thinking some sort of possible autoimmune response and the researchers' aforementioned concerns about the tumors evolving resistant proteins, but don't know precisely how big of a concern that is combined with the standard regimen.
Like francopoli said, preventative medicine should be able to generate revenue even with healthy people. Goldman Sachs sounds like their ideal business model would be to give everyone cancer and then jack up the price of chemo and immunotherapy. No such thing as a line they won't cross. For some comedic relief, here's Mitchell and Webb predicting conversations like this in 2010.
Suggested listening to accompany this article:
I could see that.
Yeah that makes sense.
I contributed positively!!!! Sorry, it doesn't happen that often. Love the site, y'all do good work.
Also, when I hover over the little rectangle now, it still reads "Hubski 2017 Funding Goal." Not sure if you're the guy to talk to about that, or if it's an error on my end, but I figured mentioning it would be helpful.
True, I think otherwise there's potential for abuse in there to disenfranchise people even further.
I found this a couple of hours ago and was looking to see if anyone had posted it here! It almost perfectly encapsulates my thoughts on what actual progress might be possible. This is the solution, if we can get people to see it.
It's all part of a move to a sanitized social media platform. Which is a shame, since I tried for a long time to ignore the fact that it was turning into Facebook with strangers. Hopefully the niche subreddits will still keep their communities, which is really the only reason I go there now.