stuckindoors

Amen…Bring a lantus pen.

Lantus alone is going to keep do a majority of the work from keeping going into DKA.

Insulin pumps are going to fail. They are mechanical devices. Batteries fails. The connected phone can fail. At some point in a diabetic lifetime…it is going to break.

The entire reason most patients are taught with subcutaneous insulin is at the start is that there is good chance complex tech will break.

As healthcare providers we get this - we see these patients on the weekly. As patients you may only get experience it once in your lifetime…. Technology will always break at the most inconvenient time. You need to have a back up plan with your health. SQ insulin is the back up plan.

When reading the article I think he appears to be talking about car play/android auto connection not audio only connections. I think Bluetooth in AA and Carplay is used to configure a local network between the phone and the car to transmit the images to the cars screen. I would assume that that data capability can also be used for the car to communicate with the Internet.

'Winapps' and 'winboat' on Linux allow a windows image to run in a Linux docker container and permit just the app to be streamed to the Linux desktop (after initial setup). I haven't played with it yet..but you could theoretically set up a windows host on a different remote server via tailscale or netbird and have them RDP into the windows docker container remotely.

Unfortunately my parents run macos and these tools are not meant for Macos. But like you said there are apps like UTM that provide a nice shell for QEMU on macos. Not as nice as streaming just the app, but a good start. These work great on new macmini with apple silicon.

Enforcement on businesses hiring non legal workers - gets the root cause. Without fixing that we are just playing wack a mole - people will still venture to the US since jobs exist and ICE is better than what ever crap they are coming from. Sure you may dissuade a few on the margins.

We are not fixing the root cause here even if you believe that immigration is bad for the country. It’s just a farce.

The problem isn’t adequate number of doctors….it too many trainees.

Trainees training others is what happens at frequently at teaching hospitals. All these folks are too busy. Somethings the third year is inadequately trained to teach a first year - they teach them bad habits. And often academic facilities don’t value good patient care….they value national recognition and publications. It is the folks of the lecture course that get promotions.

This I’m sure happens in all fields…in medicine it leads to deaths.

There was a joke that you never want the visit an hospital in July, as that is when new residents were around. The fact is that there is an ounce of truth to that joke. It sure feels like mortality increases in July.

This need some clarification.Not all CRP should be put in one bucket.

Out of hospital/unwitnessed arrests - mortality is bad.

In hospital/witnessed arrests - CRP mortality was better.

Downtime (ie time without perfusion makes a difference) the longer it is - the worse the outcome. The difference between long and short is minutes.

That doesn't mean CRP isn't worth trying. The hard part is making sure families understand when futility begins. Some families never get there.

Bill Clinton ended up cutting staff throughout his time in office. Despite the cuts in government staff driven by the narrative that a smaller government is better by years of Reagan and Bush1. Despite these cuts, the sum effect was that costs significantly rose as they had to hire contractors to do the things that internal staff was doing.

Things are more complicated than they appear.

https://www.npr.org/programs/fresh-air/2025/02/26/fresh-air-...

I had taken care of patients with acute disseminated encephalomyelitis (ADEM) post influenza infection.

His neuro symptoms included sz, confusion.

On routine testing by the dietitian he was noted to have a very low vitamin d level.

Although very anecdotal- I have always believed that autoimmune conditions post viral syndromes are exacerbated by low vitamin D levels.

Have any you with long covid been tested for vitamin D levels? For any of you did vitamin d supplements help?

This. We need to stop admiring flashiness. We need to start admiring people that bring out the best in others. Our brains instantly turn to the glitteriest/loudest/fanciest object in the room. It is hardwired for some reason - unfortunately in this day and age that will no longer help us in the long run.

Turning to sports, Nikola Jokic is one of these people...you can see his quite leadership everyday. He is selfless on the court, bringing out the best in his teammates, he hates the lime light. He celebrates his rivals. This is such a poor example compared to that wonderful article linked, I but I truly hope my kids internalize some of the value that he demostrates especially in this day and age of awfulness elsewhere.

Then Starlink doesn't have to participate.

The market is flawed - hence the NYS government is trying to fix the issue that ISPs don't provide a minimum service at a low cost.

NYS is attempting to fix the issues with the market. Companies that don't love their rules can just participate in the regular market. Its pretty simple.

When companies go public - it’s no longer about running the store/company well or efficiently. It is an extractive process as much as possible at least in the last 20 years. Public companies think quarter to quarter and no longer think long term. Only smaller private companies are able to invest in the long run and invest in the future. The only group of public companies are that can swim against this tide are the tech darling like intel, apple, Microsoft, google.

I worry that the corporate quarter to quarter mentality is ruining American corporation that is taking American capitalism to a new low.

Maybe Nordstrom has a chance if they are private in the long run.

Just go to Mexico or an online pharmacy and get your meds at cost. /s

The US healthcare system is completely broken. Hospital systems and doctors offices in general lost a shit ton of money last year. There has been massive layoffs throughout this sector. There will continue to be this year. This year they all are going to try to survive by recouping their prior losses. Get ready for more fees.

In addition - there is consolidation in the physicians groups. Mom and pop groups are almost unfeasible at this point. Look for venture capitalists to scoop in. Guess what - you won't have better care with after those changes - I can promise that.

Lastly, the pharmaceutical industry is out of control. They hike prices on any and all medications that they are able to. They recently hiked flovent to a cost that no insurance companies or hospital will pay for it. There are limited alternatives at least for kids. This is medications that that has been out since the mid 80s. It is a controlled market, with high barriers to entry - you can either permit a wide west time of pharmaceutical environment or you can understand the need for a regulated marketplace and meet with with equivalent regulation in terms of pricing.

Finally the insurance companies are the worst. I don't know anyone with a good experience...the only ones that have a positive experience are those that don't use it. I try not to hate any single group but I hate insurance companies.

The system needs to be burned to the ground. It is fragmented and burdensome for healthcare providers and for patients. It benefits no one at this point. It creates additional workload for providers hospitals and patients alike.

I am afraid of what will come in it's place but can't we worse that this shit.

"The Halleck Creek find is reportedly high in two of the most in-demand rare earths, neodymium and praseodymium oxides, both of which are also low in radioactive byproducts. Exploiting the Wyoming find, along with other mines in Arizona and Nevada, could help power a new generation of American manufacturing, ensure a supply of military-critical materials, and further reduce American reliance on trade with China."

The YouTuber "thehookup" - an home automation guys - has a video worth watching.

It provides an view that the linux tech tips and the security researcher initially made the discoveries may have missed.

Long story short - EUFY was attempting to maintain a balance and use of use.

The hot take may not be the correct one.

https://youtu.be/a_rAXF_btvE

There was a massive southwest airlines IT failure compounded by weather issues over the weekend. This cancelled numerous flights but also snowballed into most of the southwest flights being delayed. We were lucky to return home. The news is only reporting weather delays yet for those at the airport this weekend...it was clearly larger.

If it is true that Netherland's and Italy's transport infrastructure were also down I wonder if Russian supported hackers are to blame.

After transplantation, these folks will be started on immunosuppressants. These patients are often re-vaccinated when they their cell counts improve.

If they state they wound take not the SARS-COV2 vaccines - what is yhe likelihood that they would cooperate with other vaccines.

This process is difficult for the patients and family. It is a limited resource. It makes an abundance of sense to be very selective in this process.

These "doctors" are not up to date with the current science.

Natural immunity does occur but it is extremely variable. Some get an very good response others get almost no immunity. Since testing immunity can only be performed in a research lab, determination of degree on immunity obtained can not easily be measured by a physician in a clinic. Also the Brazil data shows that good portion of people infected by the original variant are re-infected by the gamma variety a few months later.

Vaccines on the other hand provide consistent immunity across the board. They also appear to provide a broad degree of immunity against variants.

Natural infection followed by two doses of the mRNA vaccine appears to provide the ultimate in immunity. They state it provide a consistent degree of antibody titers up to 8 months post vaccination. It also provides extremely broad immunity even neutralizing the first sars-cov virus from 2000s.

It worth remembering that these vaccines are designed to stop severe illness and that they do well. We now are asking them to prevent all illness...something they were never designed for.

The following podcast summarizes the data well. Start at about 4:30 and listen to about 10 minutes.

https://youtu.be/nEB4oxO9F1A

The remainder of the podcast is well worth it also but very dense.

Finally it is worth remembering, that Rand Paul started his own board certification association so he could avoid regulations that require continued upkeep of knowledge. Since we just want medical professionals to practice like they were trained up to 30 or 40 years ago. I guess that is why he is now in the Senate.

Dietary studies have been largely been poor since they rely on food frequency questionnaires.

The pertinent sentence from the methods section of this study is "Questionnaires have been completed biennially to update information on potential risk factors and occurrence of new diseases." Poor data in leads to poor data out.

I'm not sure I can quantify what I ate accurately in a twice yearly survey -- can you? Bias also plays a role in how these questions are answered.

The other factor is hazard ratio for red meat and CHD was 1.11. Thr hazard ratio for tabacco and lung disease which is a known association was between 14-17. The effect that they found is small in magnitude.

Epidemiology studies like these need to ranked low on the totem pole of types of evidence.

The hospitals were overwhelmed, with reports of EMS having to wait with critically ill patients in ERs up to 4 hours.

Where were stable patients supposed to housed when they are better? Clearly the hospitals were not the correct place.

I recently listened to a pediatric ICU physician from Columbia/Morgan Stanley say that her hospital and other pediatric facilities in the city were forced to admit many adult patients. This clearly isn't optimal, but is was necessary.

NYC did their best to manage the situation. It was a shitty position they were placed in.

The larger problem remains that in for profit system, hospitals are not designed to massive influx of patients from a pandemic or a natural disaster. They are designed to be "lean and mean". Excess supply or resources is considered waste in normal times.

The question can also be asked were was the federal leadership in this. We unfortunately know the answer to that.

This essentially provides CPAP therapy. CPAP can be helpful but it is not a direct replacement for ventilation/intubation.

Initial info from the intensivists (ICU docs) from Kirkland Washington suggest that time should not be wasted with CPAP or BiPAP. These measures only postpone the inevitable in patients with COVID-19.

Also a good percent of medical personnel were becoming infected from the Italian data with SARS-CoV2 (10-15%). Measures like BiPAP or CPAP do can exposure others in the room, especially with the rapid progression of this disease and the likely need to intubate the patients and ventilate them.

That being said this is a great accomplishment and the variety of sizes these masks come in would be helpful especially in the pediatric population. I now have to fire up my 3D printer.