jdmcnugent

Disinformation, misinformation, malinformation (whatever that is), and even hate speech are all just censorship in sheep’s clothing. These fact checkers end up being used by the big social media and news organizations as their basis to suppress (censor) information that, at least currently, always seems to favor one side of the political spectrum. Hunter Biden’s laptop was discounted as Russian propaganda in the last election, but was just entered in to evidence by the DOJ in his trial as verified and legitimate. Many of the issues around Covid were labeled misinformation and censored at the time only later to be found credible (lab leak, ineffective social distancing, vaccine efficacy, etc.). It has always been up to the people to openly discuss these issues and choose what they find credible. Although one side of the aisle is benefiting from the “misinformation” label currently, pendulums swing and the whole script could flip in the future so it’s in the best interest of both sides to stop this craziness now. There is no such thing as nonpartisan or bipartisan, and these organizations should certainly exercise their 1st amendment right and share their analyses, but when they are used to control the actual flow of information to the people it becomes dangerous and destructive.

Another scheme these PE groups have concocted is using their regional monopolies to force hospitals and surgery centers to pay an outrageous annual “stipend” for the “privilege” of letting them provide anesthesia. This is in addition to the traditional insurance billings mentioned in the article. However, I think (hope) we’ve reached peak PE intrusion in medicine with increased scrutiny like this article creates, coupled with laws passed to outlaw “surprise out of network billing” (a big tool they were using to boost their bottom line), and physician disillusionment as they realize they ended up working as a cog in the wheels of Walmart medicine. Medical practice is a weird market, revenues are pretty much fixed to Medicare with marginal flexibility in insurance contracts (you can’t just double what you charge), so the main way these firms extract value is through cost cutting (using their market power to pay physicians and mid level providers less, skimp on support staff, etc). Doctors, while typically not great business men, aren’t dumb and can tell when they are getting screwed. With upcoming ftc regulations to curtail noncompetes, a lot these docs can actually bail out, so hopefully private equity has had its day.

Orthopedic surgeon here. Outpatient total joint replacements have taken off like a rocket in the last few years, in part due to advances in due to pain control (pre operative peripheral nerve blocks, etc), accelerated physical therapy, and all around better management and prevention of all the common postop complaints (nausea, opioid induced constipation, etc), but I would say the number one driver has been that insurance companies (including Medicare) will finally pay for it to be done outpatient. 3 years ago you had to keep people in the hospital at least overnight to even get reimbursed. The same phenomenon has happened with many of the spine procedures that can now be done outpatient. The actual surgical techniques have not really changed much over the last few decades other than popularizing a few approaches (anterior vs posterior) or bearing surfaces (metal on polyethylene vs ceramic on polyethylene, etc).

We encounter a similar problem in the medical field: endless clinic and operative notes that are 95% repetitive but are critically important for recording medical care, medicolegal defense, and payment for the work done. There are surprisingly few commercial options out there (the ones included with EMR's suck) and I finally ended up making my own op-note templating program in python with pysimplegui that generates and submits a pdf so my op-notes take 20-30 seconds instead.

I'm running a synology 6 bay nas which in addition to hoarding data and time machine backups, its running pihole in a docker container, plex server for the kid's movies, and a linux vm for little python scripts and a mqtt server. I haven't run home assistant on it yet, but I think it should be able to handle it. Plenty of folks warned me that it lacked the computing power but for my purposes it has been pretty great.

1. Roland fp30 digital piano - coming from a guitar background, learning the piano has made my music theory knowledge grow exponentially 2. Ubiquiti unifi home wifi - fun project to learn some more in depth networking 3. Synology nas - runs my pihole, Plex, and time machine backup 4. Charlottes web cbd / melatonin sleep gummies - way better than melatonin alone, feel great in the am

Fox squirrel bones also glow under UV, it was the subject of my senior research elective. I remember freezing then crushing up a bunch of squirrel bones, doing some extractions, pumping it through the hplc machine and found it to be from porphyrin accumulation and some error in hemoglobin metabolism. Then I graduated before it was published .... end of story.

Mottos (or just quotes) I remember from medical training:

“There is no problem that can’t be made worse with surgery” - a cautionary phrase to counter “a chance to cut is a chance to cure”

“Never be the first or the last to do something” - in regards to the countless new widgets, fads, techniques etc that are all the rage at the time

“50% of of our current understanding is wrong, but we don’t know which 50%”

“A smart man learns from his mistakes, a wise man learns from the mistakes of others”

Similar: “cry once, buy once”

Blinding is a way to actually reveal placebo effects, and double blinding (blinding the examiner to which group the subject is in) helps negate observer bias.

They certainly do track it because Medicare will not pay for a second hospital stay in many cases.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Ass...

Beware of unintended consequences though, hospitals are less inclined to permit riskier surgeries on unhealthy patients if they think the risk of readmissions is too high. Good luck getting your knee replacement if you are a 300lb diabetic smoker.

Speaking from an orthopedic perspective (though most fields are similar), there are literally thousands of ways to measure this, they are called (not surprisingly) outcome measures and they are basically the foundation of almost every medical study. Many are a collection of questions or items that add up to a given score which is how they are able to be statistically analyzed.

Some are subjective like pain (VAS or visual analog pain scale, “rate your pain 1-10”), ability to do daily activities, “would you have this procedure again?”, return to pre-injury activity level, etc.

Others are objective like range of motion, strength, bone healing noted on Xray or ct, tendon / ligament healing observed on mri, histiologic healing observed from follow up biopsy, rehospitilzation rates, revision surgery rates, infection rates, or mortality rates (the ultimate objective outcome measure).

There is hardly a shortage of outcome measures out there, and researchers propose new ones all the time, but they need to be validated as relevant and accurate by other studies before they are widely adopted.

http://www.orthopaedicscores.com

Very cool move. What does the communications tool specifically do?

I read the title as “association between intelligence and childishness”. Made it halfway though the abstract trying to see if my immaturity meant I was actually intelligent. Disappointed.

I’m right there with ya calderarrow. I’m a middle aged physician with no prior programming experience, but I picked this book up on a whim a few years ago and it changed my life. I started automating little thing a here and there and now I see opportunities everywhere that a “real developer” could capitalize on. For as expensive as EMR’s are, you will NEVER meet a doctor who loves theirs, they just hate some less than others. Patient portals are even worse. This industry is ripe for disruption.

Interesting side note about suicide among physicians (in the U.S. at least), every state license or hospital privileges (including renewals) I have applied for asks “have you been diagnosed with or received treatment for a mental health disease such as depression, anxiety, etc”. Obviously any rational person would at least hesitate to seek mental health treatment if it meant they could incur increased scrutiny just to continue to do their job, much less knowing that their peers (and sometimes competitors) on the hospital credentialling committee would be aware of their struggles. I have personally known at least 8 friends / coworkers in the medical field who have committed suicide since I entered the field and I cannot help but imagine that this contributed to at least some of them.

I just put the tags in the file name, like “2019-12-25_xmas_bob_grandma.jpg”. Obviously you can’t go crazy with a bunch of tags, but I think I can get by with 2 or 3 tags at most. I was afraid to use sidecar info or xattr because I think that data can be lost if the files get moved between file systems (ie eventually moved from the current hdd to the nas I have yet to buy, etc). I definitely kept my raw unorganized folder on the ext hdd for now, but I’ve run several scripts to make sure I didn’t inadvertently overwrite or miss anything.

I just dealt with this crap storm of a project last month. We had 40k photos scattered across three laptops, old hard drives, and sd cards. First I just crudely copied all of the folders on to an external hard drive and ran a freeware duplicate remover to clean out about 20% of them. Then I used a python script to go through this giant pile of pics and copy them in to folders by year and month based on the created date. It also added yyyy-mm-dd to the beginning of each file name. Now we are slowly going through month by month and adding simple tags in the file name (event, location, names). It’s far from perfect, but I didn’t want to deal with keeping everything synced in a database or locked in to a certain OS or app, plus it should still be searchable in 15 years when we are all running Windows 30 and Mac OS Ozarks or whatever.

The book "Moonwalking with Einstein" was my first introduction to memorization techniques. I had no idea these techniques existed, much less there were competitions for them. I drove my wife crazy trying to impress her with memorizing pi to 100 digits and memorizing a deck of cards. She was not impressed...I moved on to the next hobby.

Motion and loading is definitely integral to cartilage preservation. Unlike most tissues in the body, articular cartilage does not receive oxygen and nutrients from blood vessels, but rather directly from the oil-like synovial fluid that helps lubricate the joint surfaces. I imagine the thin squishy layer of cartilage behaves like a sponge, deforming compressive forces drive synovial fluid out and removing the load (taking weight off the joint) sucks synovial fluid back in, sort of like inhaling / exhaling.

Here is a pretty good basic science review article about articular cartilage:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445147/

Thanks for the compliment, I just lurk here on HN and I finally came across something in my wheelhouse. Happy to contribute. With private practice and a house full of kids I imagine my blog should be ready by 2029.

Orthopedic surgeon here. Articular cartilage regeneration is definitely the holy grail of my field, but for all of the promises of biologics (growth factors, stem cells, collagen matrices) it always seems to be “another five years away”.

The part of this article that I find most interesting was identifying a marker that can differentiate ankle cartilage vs the hip. This is certainly a phenomenon that we all observe clinically, hip and knee arthritis is vastly more common than ankle arthritis despite the weight bearing surface of the ankle being significantly smaller (meaning more force per square area). When we do encounter ankle arthritis, it is almost always the result of prior intra-articular fractures or instability from chronic ligamenous injuries, not the normal osteoarthritic age related degeneration we see in hips and knees.

Let’s find out what makes ankle articular cartilage so special and sprinkle it in our hips and knees.

If I hit a paywall on safari iOS I simply click "send to" button and open it in the Duck Duck Go app.

Bachelor’s degree in geography? I wonder if she went to school with Buster Bluth.