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brianleb

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pharmacist, clinical informatics

The perfect is the enemy of the good.

it's unfortunate but in this day and age, I would like to explicitly declare I am not an LLM.

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I share your hopeful optimism, but here's the reality of the mass-email campaigns targeting congress:

[email received 6/18/26 from the office of Steve Scalise, majority leader in the house, who is one of my representatives. I have trimmed for brevity.]

> Due to advancements in technology, many third-party organizations use their mailing lists to send advocacy letters like this on your behalf. With the increased volume of third-party letters being sent to my office, I want to be sure that I am able to more appropriately address your thoughts and concerns.

I will be sure to consider the views you have sent me, but if you have any additional thoughts on this issue, or need other assistance with a federal agency, please contact my office directly through my website scalise.house.gov or by calling (202) 225-3015

-----------

In case it is not clear to anyone reading, this is kosher political speak for "I am ignoring automated emails. Consider this your notice."

Honestly, I am surprised it took this long, although I'm quite certain it has been going on for a lot longer and generally they simply do not provide the courtesy of telling you they are ignoring you.

As others have pointed out, too many clicks per word. I am a sucker for a 'how many words do you know' quiz so I finished anyway. Overall I'm skeptical of the classifications. In broad strokes, the early words are easier and the latter words are more challenging, but the middle is pretty muddied.

Some of the words chosen are rather absurd/inappropriate: breviary (which I got wrong but felt like a vaguely religious word) was characterized as intermediate but I think it's much more obscure and less obvious than that; Hippopotomonstrosesquippedaliophobia was used as a word (I got that wrong as well) - any type of 'phobia' word is really the sort of thing a fourth grader opens up a page in the dictionary and points out, not a word that is used... ever; metamorphosis and kinetic were labeled expert, which I don't agree with (what elementary schooler doesn't learn about the metamorphosis of a caterpillar into a butterfly? what high schooler doesn't learn about kinetic energy?).

Most words were reasonably well defined in a way that most people would understand or recognize. A few words had poor definitions: lethargy ("the state of being lethargic" - obvious); complacent ("smug satisfaction with oneself" - I disagree that complacency is intrinsically smug); magnanimous ("generous toward a rival" - I disagree that a rival must be involved); gauche ("socially awkward" - this is sort of close but the given definition completely misses the idea of being tactless).

They call it scientific and give a hand-wavey formula, but they don't explain how words are stratified in the first place. If stratified sampling is a formally recognized method of doing this, it would be nice to have a link to a real reference. I think I know a lot of words, but I am skeptical of the estimate this app provided (north of 75k).

The AirPods Effect 1 month ago

This is a very un-nuanced and combative take on a lot of people's lives. It reminds me of it being socially acceptable for the extrovert to say to the introvert, "Why don't you talk more?" while it is not acceptable for the introvert to say to the extrovert, "Why don't you talk less?"

OP did not say anything about skilled workers who make things with their hands. You are describing an artisan or craftsman, or at the very least a tradesman.

The quote is talking about manufacturing labor. This is the guy on the assembly line who lowers the press, makes his thousandth widget for a day, and then lifts it up. Rinse and repeat.

33.1%: Nintendo's charge

29.8%: Retailer's margin

15.1%: Publisher's margin

14.8%: VAT

That's... 92.8%.

Developer's royalty: 4.6%

"Yikes" -me, just now

Ha, grew up in Harahan. When I left the LA for college, people were shocked to find out where I was from based on how I talked. I would hear areas of New England, 'no discernible accent,' and also Canadian. Apparently the Canadian comes out when I say words like out, about, and house. I can't hear it but my friends all swore up and down they could.

There are so many unique dialects hyperlocal to New Orleans, it's amazing.

Sizing chaos 5 months ago

Similar to a sibling comment,

>the advent of chemical non-sugar sweeteners, which in recent decades are turning out to be just as harmful as sugar, only differently.

requires citations. People lump sugar substitutes together as one class of drugs, but they very much are not. Some are sugar alcohols, some are glycosides, others are different molecules. Different molecules have different mechanisms of action and paths of metabolism.

Much like one might take a "blood pressure" medication, it is a large umbrella consisting of chemically distinct ACE-inhibitors, ARBs, thiazide diuretics, loop diuretics, calcium channel blockers (dihydropyridine and non-dihydropyridine distinctly), and more. These drugs generally do have class effects, but the class effects from an ACE inhibitor (bradykinin cough, angioedema, etc) are quite different from diuretics (hyponatremia, frequent urination, etc). One person's 'blood pressure medicine' is not the same as the next.

I agree that the prevalence of sugar substitutes in the western diet demands scrutiny, and I am concerned about their effects, however any current research lumping them all together without strict attention to pharmacological mechanisms supported by translational research is worse than useless - it is misleading.

In the sense of what we 'know' about modern medicine, we 'know' almost nothing about sugar substitutes. The body of evidence is vanishingly thin. I want more research into this topic, but right now, it's just not there.

Agree that it sounds 'close to correct.'

I think, though, that the underlying assumption is that the old virus hangs out, forever waiting for the moment to strike.

Cells senesce and die and get replaced, and the immune system is always active in the background. If the virus particles are released, the immune system is going after it and cleaning up. As essentially no new virus is being created, this is the body's opportunity to clear the virus at a slower, manageable pace where it doesn't have to contend with a rapid, expanding infection.

It feels like one of those ideas that's technically true in all the right ways, but misses one crucial piece that would make the whole thing accurate.

> I had some $115k at the time in it.

I'm sorry, but you are an order of magnitude out of touch with the average American consumer. Average savings balance under the age of 64 is below $73k.[1] Median savings is below $9k. Most people will, outside of their retirement savings, never have access to an account that has over $100,000 in it.

Never.

Not one day in their life.

Median household income is $80k/yr.[2] Personal savings rate is under 5%.[3] As is noted in the title of the article, there are two Americas.

[1] https://www.experian.com/blogs/ask-experian/average-savings-... [2] https://www.census.gov/library/publications/2024/demo/p60-28... [3] https://www.bea.gov/data/income-saving/personal-saving-rate

Haven't seen anyone mention this yet: there is a difference between "listed employees" vs. "full time employees" (FTEs) vs. "full time employee equivalents" (FTEEs). In this very specific case, physicians/providers often work 0.125-0.875 (i.e. one hour to seven hours of an 8 hour day) for one entity (say, their primary teaching hospital), and the remainder for another entity (the university where they are also an listed as adjunct professor, etc.).

You could have 10,000 employees, however 4,000 of them are physicians/providers, 3,000 of whom work less than full time for that entity. So you are looking at 10,000 employees, but some number between 7,000 and 9,999 FTEEs. These are very different, and very relevant, numbers when looking at healthcare organizations.

The sibling comments are very relevant, but I wanted to provide a marginally different perspective. You have to take not only what is being said, but _who is saying it_ into perspective.

In this case, this is a government official speaking to the press (i.e. in an official capacity). If they were to say "this was sabotage," that is a definite declaration that the government believes - again, officially and on the record - that an outside party has deliberately done material damage to their country. Given the general situation, it is not a huge leap to come to the interpretation that "this was an attack against our country, and possibly an act of war."

No government official would want to be within miles (or kilometers) of that sort of statement unless they have pretty much already internally decided from the top-down to escalate the situation. Almost no single government agent has the authority to escalate the situation in that manner. So what we end up with is "appears to be." This overtly says 'all available evidence points to this being the case, however something else cannot be ruled out.' (As a sibling comment suggests, it can also act as a type of propaganda). So it is not an official government declaration that another nation has damaged them, but they have reasons (probably both apparent and not) to believe what they are saying publicly.

Museum of Bad Art 2 years ago

>"We don't say negative things about the art or the artist. Our stated goal is to collect, exhibit, and celebrate this art that would be appreciated nowhere else."

Perhaps this is a 'whoosh' moment for me, but it seems that by simply housing the art in the Museum of /Bad/ Art, you are certainly saying something quite negative about the art and the artist.

Passport Photos 2 years ago

So I actually shave my beard every time I get a haircut (so, let's say every 8 weeks).

What does 'recent' mean, since you have already acknowledged that temporal recency is irrelevant? When am I traveling? What's accurate to my current appearance? What if I started a cancer treatment that renders me unable to grow a beard?

Your flippant reply ignores reality, and these aren't even edge cases.

I'm not a cuber or a puzzle guy or a math guy, but I am curious: how do you know when it's solved? Or is this a 'whoosh' moment and I'm missing the obvious?

>I wonder though what things look like with super high dimensions.

You need only look to healthcare in the USA. Many, many professionals (some of which you never interact with) handing off patient cases to each other in a very carefully choreographed dance designed to meet legal and regulatory requirements; quality, safety, and care standards; financial responsibilities; and each individual's own personal standards for the quality of care they believe they provide.

In healthcare, we often view risks using the Swiss Cheese Model [1]. Everyone makes mistakes sometimes, but the system of checks and balances catches most of them before they reach the patient. Prescriber ordered the wrong dose of medicine in the inpatient setting? Pharmacy intercepts and starts making calls or sending messages to verify. Pharmacy approves the order because "that's what they ordered?" Nursing lays hands and eyes to every medicine administered and can 'stop the line' if they deem appropriate. Not to mention the technical safeguards and guardrails (e.g., clinical decision support systems) that are also supporting everyone involved.

But still, failures happen, and they can be catastrophic.

https://en.wikipedia.org/wiki/Swiss_cheese_model

I understand how you came to your conclusion, however what you are quoting is journalism (and it is factually incorrect). I read the actual peer reviewed article.

The patients in the COVID group, _when they got COVID_ had already begun losing significant amounts of weight. The NYT article is 100% incorrect on this matter. See:

>The change in weight between randomization and reported COVID-19 in patients who died of COVID-19 according to treatment was −6.4 kg in the semaglutide group vs −0.9 kg in the placebo (P < 0.001) group and −8.4 kg vs −1.25 kg (P < 0.001), respectively, in patients who did not die.

They go on to say that there is a correlation between obesity and adverse COVID outcomes:

>There was an associated increased risk of respiratory decompensation and mortality in patients with COVID-19 and obesity16,17 and plausible biologic hypotheses associating obesity with adverse COVID outcomes, including impaired respiratory status, lower cardiometabolic reserve, or immune hyperreactivity or dysregulation.18

And they double down on the fact that the patients absolutely had weight loss at time of COVID.

>Accordingly, it is plausible that the decreased risk of infectious deaths is caused by weight loss, which was 5 kg greater in patients assigned to semaglutide compared to placebo by 1 year, the average time to COVID-19 diagnosis after randomization.

I will leave you with the note that nowhere in the journal article do they make any claims whatsoever about semaglutide's effect on COVID outcomes. They exclusively discuss outcomes as related to metabolic health. Semaglutide is a means to an end. The means is weight loss. The end is better health.

GLP-1 => weight loss => decreased obesity, improved cholesterol, improved blood pressure, improved glucose control, etc. etc. => better survival rates (all causes)

There is no presumed clinically relevant mechanism for GLP-1s to be protective specifically against COVID death. It is simply protective against all death, of which COVID is a type. Healthier people are less likely to die, statistically. The same benefit can be (and is being) said about GLP-1s and heart attacks, heart failure, stroke, kidney failure, etc.

My only commentary would be that these results do not read like clinical success, but rather something suggesting they should move on to phase III clinical trials.

This is the only publication I found in a quick search:

https://pubmed.ncbi.nlm.nih.gov/37976118/

> Abstract

Objectives: Nerve growth factor β (β-NGF) is a protein which is important to the development of neurons particularly those involved in the transmission of pain and is central to the experience of pain in osteoarthritis (OA). Direct NGF antagonism has been shown to reduce OA pain but is associated with rapidly progressive OA. The aim of the study is to investigate the ability of soluble neurotrophin receptors in the NGF pathway to modulate pain in OA.

Methods: Synovial fluid (SF) was obtained from the knee joints of 43 subjects who underwent total knee arthroplasty. Visual analogue scale (VAS) pain scores were obtained prior to surgery. Customised-automated-ELISAs and commercial-ELISAs and LEGENDplex™ were used to measure soluble low-affinity nerve growth factor (LNGFR), soluble tropomyosin receptor kinase (TrkA), proNGF, β-NGF, other neurotrophins (NT) and cytokines including inflammatory marker TNF-α.

Results: The VAS score positively correlated with β-NGF (r=0.34) and there was positive association trend with neurotrophin-3 (NT-3), BDNF and negative association trend with ProNGF. sLNGFR positively correlated with VAS (r=0.33). The β-NGF/soluble TrkA ratio showed a strong positive correlation with VAS (r=0.80). In contrast, there was no correlation between pain and the β-NGF/sLNGFR ratio (r=-0.08). TNF-α positively correlated with β-NGF (r=0.83), NT-3 (r=0.66), and brain-derived neurotrophic factor (BDNF) (r=0.50) and negatively with ProNGF (r= -0.74) and positively correlated with both soluble TrkA (r=0.62), sLNGFR (r=0.26).

Conclusions: This study suggests that endogenous or cleaved sLNGFR, but not soluble TrkA may participate in OA pain modulation thus supporting further research into soluble LNGFR as a therapeutic target in OA.

Probably referring to:

https://phys.org/news/2010-12-air-playstation-3s-supercomput...

>About the 33rd largest supercomputer in the world right now is the US Air Force Research Laboratory's (AFRL) newest system, which has a core made of 1,760 Sony PlayStation 3 (PS3) consoles. In addition to its large capacity, the so-called "Condor Cluster" is capable of performing 500 trillion floating point operations per second (TFLOPS), making it the fastest interactive computer in the entire US Defense Department.

>It will be used by Air Force centers across the country for tasks such as radar enhancement, pattern recognition, satellite imagery processing, and artificial intelligence research.

A super majority is a specified proportion that is in excess of a simple majority (e.g., where a simple majority would be 51%, a super majority might be defined as 60%). Per your link (which is admittedly interesting), military/defense only accounts for about for 770k of 2.2M full time federal employees. That is not a super majority, that is a plurality (the single largest group but not a majority).

Actually, I believe what you want is 3mm, which I believe they use in accounting. Lowercase m in this instance would stand for milli-, as in thousand. So 3mm would be 3 thousand thousand. 3M is technically correct, though confusing in this specific case. Capital M would indicate Mega, as in the progression from kilobit to megabit to gigabit.

To chime in with the others, my Chase card offers this service automatically as well. I think most major credit card companies are starting to offer these services because they want a piece of the pie that companies like Intuit (through Mint, now Credit Karma) are grabbing by just siphoning up financial data.

So after re-reading your comment a few times, I am left with this thought: either you don't understand what k-means clustering is, or I don't understand what k-means clustering is. I wouldn't describe myself as a machine learning expert, but I have taken some grad level classes in statistics, analytics, and methods like this/related to this.

So my question is... could you elaborate?