HN user
We're on 400Mbps, and even then I manage to block internet for others when I download a large file at full speed.
That's more of a router/QoS issue. A large download shouldn't negatively affect quality for other uses, especially VoIP. If the place you're downloading from has a pipe bigger than yours and can saturate your bandwidth you're going to need to implement some kind of rate-limiting/queue management.
included alpha channels
I would be very surprised by this. Raster ops, yes. Alpha channel image compositing operations, no way - that's an entirely whole nother level of complexity.
What block layer cache?
Programmers are not commodities
But usually, they are treated as such. American companies have a hard time treating most of their white collar workforce as anything but. On the other hand, Stripe has been seemingly well managed up to this point - but they have only existed in happy times so far. Many companies change their tune when the chips are down.
It's also very expensive and difficult to hire new ones, even if you're hiring them at a cheaper salary than the last ones.
This may be true - but the average tenure of a tech worker shows most firms are not able to do act on this.
Stripe 100% wants to retain its employee base, just like any company would.
I wouldn't put it past Stripe, but "just like any company would" is pretty naive. Serious retention efforts are by far the exception in my observation. This also weakens your argument - is Stripe not actively working to retain talent or are they just like "any company?" If really the latter, then they are fucked.
I think from the part of the sentence that you took out it was clear the point was about consoles.
The Atari Pong console was also successful but I tend to not count it as I was only considering programmable consoles.
and not when the console was still in production?
The "Atari 8-bit" refers to a line of 6502 based personal computers manufactured from 1979 until 1992! There was a commercially unsuccessful video game console, the 5200, derived from this general architecture - it's wild that for their illustrious place in video game history, Atari was a one hit wonder - they never really succeeded in a console release after the 2600.
Atari also had a line of 68k based 32/16 bit computers that sadly also discontinued in 1992 so that Atari could focus on their pathetic attempts to break back into the console market.
It’s a fair point but also back in the day - “everybody” (especially the younger BBS and hobbyist crowd) incorrectly referred to them as 1200 baud or 2400 or even 9600 baud modem - as evidenced by the numerous historical references.
219 bytes per second and with 98 percent accuracy.
Perhaps I'm a boomer, but 219 Bps is damn fucking fast - faster then the first few modems I used.
where do you draw the line?
Probably somewhere fucking much further below any point where human communication was deemed practical in the past 150 years.
Somewhat pathetic to me that people can't imagine 200 Bps as a usable bandwidth.
Wow, people like to shit on Apple, but this is yet another example of something that just works.
QR code is not particularly dense (like compared to something like a hard drive) - why waste space that could not be put towards more redundancy (error correction)?
But 40% of non-obese Americans are sick with metabolic syndrome.
40% of the non obese adult population in the US? More BS dude.
It should be easy to point to some relatively reputable public health agency or peer reviewed publication where this is substantiated.
Among non overweight individuals I’m going to peg it more around 5%.
this person has not reported any results.
Ironic since you are the one making the claim and have not produced any references. I can’t prove they don’t exist but you could easily counter if one did.
Furthermore I linked to one peer reviewed review article, again https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078442/
that is chock full of balanced references if anyone is so inclined to peruse them and takes a critical examination at the various publications and the arguments can be evaluated solely on merits alone. There is continued research in this area but so far no smoking gun as to causality.
There are no meta-analyses I know of on your specific claim as there is a lack of primary research in human subjects to even substantiate it.
Most likely they don't actually know any endocrinologists
I’m a practicing academic internist. I know endocrinologists both personally and professionally. This is absolutely irrelevant though as the literature is available for you.
Some people just feel compelled to jump up and defend sugar
I did nothing of the sort. I treat diabetes and hyperlipidemia on the daily - that would be ridiculous.
Edit: oh and I missed your edit - a reference to Perlmutter? A celebrity neurologist who has widely been debunked for making wildly unsubstantiated claims. You are not arguing in good faith. You have the entirety of PubMed and Google scholar on which to reference peer reviewed literature - some of it is also crap - but you aren’t even doing that - you are sticking to the lowest quality unsubstantiated celebrity bilge.
This is not an RCT nor does it point to one supporting your uric acid claims.
And Lustig is well known, he's on the border of being a crackpot, unfortunately. Mehmet Oz is a professor emeritus of Columbia, and contributed some amazing shit to the field of cardiology, but now he is undoubtedly a crackpot, so just having some credentials and even a good history is not an automatic pass to get out of presenting high-quality scientific methods.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822166/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078442/
And.. this is not the first time this has come up here even: https://news.ycombinator.com/item?id=15760599
This is a non-response - or do you have a specific cite linking uric acid as causative of diabetes or cardiovascular disease? It can be in a colorectal journal for all I care.
Have to be, to do it at all.
Lol. Yeah bud, I have a ton of friends that are endocrinologists, all mostly great and intelligent folks, but I’m not letting them touch me with a colonoscope - or pretty much any implement. It’s not exactly a field for the procedurally inclined.
If we’re talking about sugar soft drinks in the US this is invariably HFCS.
Sucrose is hydrolyzed in the gut by the enzyme α-glucosidase into glucose and fructose. Without any other absorptive buffer, it's basically the same.
Most of these are products of high uric acid level
That's a very unsubstantiated claim. I'm not debating the association of hyperuricemia with metabolic syndrome or cardiovascular risk factors, but I don't think we have much evidence to establish a causal link between hyperuricemia and all the morbidities listed.
"medical failure"
Medical failure in the literature is a jargon term. (Internal) medicine and surgery are traditionally two distinct fields of, er, medicine. So it is just a matter of fact that a disease such as Crohn's that is refractory or resistant to treatment with medicine is a "medical failure" - no spin on it, that's what we call it.
Biases in referral across services is a complicated topic, and there is quite a bit of literature about it over the years. I am not sure about Crohn's/IBD specifically, but it's one of the well known co-management touch-points between surgery and GI, so there might be something written on the subject. There are many complexities at play here, some is definitely due to human factors, but the simple thought of "medical failure" doesn't have much to do with it. The average internists make thousands of consults to surgery every year, so that's really not it, there's much more to it.
You have actual Crohn's or IBS? Because your symptoms while distressing don't sound like Crohn's at all. Crohn's is an autoimmune inflammatory condition with actual tissue destruction. People with Crohn's flares don't show up to the ED with constipation, they often show up with profusely bloody diarrhea. Additionally weight loss and anemia. They may likely require admission for high dose steroids. People with Crohn's will often need surgery. What you're describing sounds more like IBS.
A bottle of kefir is unlikely to hurt. However, I am quite skeptical that such a thing has any prophylactic effect once a recurrent process like Crohn's is set in motion - like pissing on a gasoline fire. A bottle of kefir is not going to touch an actual Crohn's flare at all.
There's no good evidence that any specific diets seem to help the chronic course of Crohn's unfortunately, and it's not like no one has looked.
You are confusing Crohn's, an inflammatory bowel condition that is life long and can often be disfiguring and requiring surgery with IBS which is completely unrelated, non-inflammatory (if it were then it would not be IBS), with distressing but not usually life limiting sequelae. Do you even know what IBS stands for?
The fact is we do not understand the complete mechanisms of either Crohn's or IBS, but based on their presentation and treatment it is unlikely they are too closely related - and it is likely that IBS is itself due to multiple factors - hence it is a syndrome, not a disease.
Given this, it is hogwash to say all of any kind of condition is caused by one thing. And if there was a cure with 95% effectiveness, I am sure many of the affluent IBS sufferers on this site would have figured it out by now.
and the cure rate for fecal bacteriotherapy is about 95% in one shot. It's ludicrous that we're still studying this and acting as though it's such a mystery.
This is crackpottery.
There are actually biologic treatments for Crohn's/UC, not everyone responds but they produce remission which can spare or prolong time to surgery for many.
He wanted them to officially state that he didn’t receive compensation - that it wasn’t an official endorsement of any kind, compensated or otherwise.
Checking the extent of MVP is not really preventing or treating MVP, is it? The echo isn't preventing the mitral valve prolapse, it is also not an intervention - it is a diagnostic tool to guide further intervention. Yes, this could be considered a type of tertiary prevention - but hopefully it should also be clear how this is more usefully classified as diagnostic. Pretty much all medical care is to some extent preventive, even reducing the broken arm - so it becomes a meaningless word if it is loosely defined as any intervention that can potentially prevent sequelae. That means it’s ultimately going to be defined with some restrictive set of criteria. Is the US ACA definition very restrictive, yes, but that’s how it is.
Ejection fraction is not a disease, but let's call it heart failure. An echo evaluating for heart failure is a good example where we can use it as a diagnostic tool to prevent further progression - but again through other interventions - and if we're evaluating for abnormal ejection fraction we haven't prevented it.
Another example might be evaluating for a shunt to prevent stroke. However we don't routinely screen everyone for this.
Echo for inherited cardiomyopathies is a good example of primary or secondary prevention.
There are definitions within medicine that matter for defining appropriate use criteria, but all this preventive vs palliative is arguing loose semantics - the people you’re up against have already put in place the policy to avoid most of that.
As to the original question, unfortunately I don't know where you got the idea that all possible preventative healthcare interventions are covered under the "free" rule - ie no out of pocket - but in the US that just isn't a thing - the free coverage applies to the list I posted prior (ie ACA Preventive Care) - its a bunch of consensus primary and secondary preventative primarily screenings and medications that are thought to have the greatest impact on public health.
It's fully preventative in my case.
Fully preventative is not a term of art either for delivery or billing - but there is a difference in categorization between screening tests given to the entire population (ie colon, mammo) and screening given to those with personal risk factors or family history (LD chest CT, echo for congenital HD), and then further on surveillance for personal history of a pre-disposing condition (ie surveillance echo for prior potential fatal arrhythmia).
This is where it starts to get complicated - but the need for an echo every 2 years is not normal. I can't really divine your specific history from the information given - and it isn't necessary - but a history of cardiac arrest alone is not an indication for serial echocardiography. There are numerous specific circumstances where it is recommended, and then there are the cases where it is not consensus recommended but there is controversy. I assume because your insurance company is willing to touch it at all it falls in the former - but we are way off the ranch here in terms of the scope of routine preventative care/health maintenance.
As to whether it should be this way, probably not. If a surveillance echo is clearly indicated to prevent costly sequelae (unfortunately answering this question isn't nearly cut and dry as most think), then it makes sense that an insurance or public health agency would want to do this. Curious if you know if your indication for serial echocardiography falls under the European guidelines? Maybe move there /s. Is Stanford your only reasonable place to obtain an echo?
Minor point (well in this case at least) but you have an off by one error. Your G1 is G0.
Here is how it is defined in terms of basis vectors. https://people.eecs.berkeley.edu/~jfc/cs184f98/lec19/lec19.h...
There are two categories of healthcare right? Palliative and preventative.
The simple answer to this is that “preventative” in the case of billed medical services has a specific and clearly defined meaning - it does not even mean all services that ever would be considered preventative. This definition will be found in your insurance paperwork and corresponds at least to the site I posted - so a further philosophical discussion is irrelevant.
To your actual question - No, the echo is usually pallative. However, right off the bat I'll say this is an overly reductionist and not terribly useful schema for classifying the delivery of medical care. While it might be good as a way for the general public to think about prevention, it’s way too oversimplistic to be useful beyond that.
An aside, palliative has a specific and different meaning within medicine: roughly, treating symptoms without a goal of cure. Reducing a broken arm or removing an inflamed appendix is not palliative care in that sense.
But even if we widen the scope of palliative to be treatment an echo would be neither. An echo is diagnostic - it doesn’t prevent nor treat heart failure or disease. Often when an echo is ordered it leads to some form of treatment for some found disease, in which case if we’re going to stick to the simple classification would be “palliative” - we’re using it to guide treatment, we can’t prevent something that we already see.
If he had violent symptoms it would clearly be palliative
It's just not that simple. Echos are sometimes used to further evaluate or manage asymptomatic disease, for instance A-fib or a concerning murmur. We're using the echo to rule out suspected coexisting conditions, that's not prevention, and it's not treatment either at that point. Also, echos usually have some symptomatic indication - and they don't have to be violent, whatever that means.
it can only be preventative
Can you actually think of a disease that an echo would be used to prevent?
But again, in practice we don’t think of delivery of medical care in such grossly general terms - it’s doesn’t simplify in a useful way.
I am insured and it is preventative care
How or why do you think an echo is preventative care? While insurance plans are free to define any additional menu of services as preventative - an echo is not included in the minimum set required by the federal government - which are procedures based off of US preventative services task force guidelines - there are no published guidelines that include an echo.
I wish you luck on your billing problem but I think you’re going to hit a wall on your own definition of “preventative”.
you go into a scramble mode to try to get picked up unless you want to wait a year and try again. Those scrambled slots are almost all in family medicine,
There's some errors/gross oversimplification in this post. Most scrambled spots are one year prelims, not family medicine. Of the minority categorical scrambled slots more are actually internal medicine, next is FM (but again this is the minority), then neuro, psych, etc.
Also minor point, if you fail to SOAP ("scramble" is kind of outdated), you can find job openings outside of the match system entirely, so waiting a year is not inevitable.
and largely in toxic training programs or very undesirable areas.
Actually, most of these programs know this and they target FMGs - they tend to fill most of their spots through the regular match. Meanwhile numerous top academic programs SOAP/scramble their prelim spots.
very likely didn't dream of sitting in that seat the way a surgeon or ICU doc or neurologist very likely did.
IM, Peds, EM, rads, anesthesia, neurology (not competitive at all), PM&R, psych, even gen surg are all relatively non-competitive. You may be surprised about surgery, but all those surgical subspecialty hopefuls that fail to match - many of them end up in gen surg via a "scramble" to a prelim, some may make it on round 2, but many will not and they will go on to an open categorical gen surg program - ie amongst the relatively "competitive" there is the not competitive that doesn't end up where they want to be.
Meanwhile whether your doctor was bottom of the class/poor academic pedigree has more to do with region. The IM and FMs at the top academic major regional centers will often be AOA/top of class/top programs.
IM/FM is just a hell of a lot more variable - it's also very large.
If you have a disease or condition requiring specialty treatment.....
I dunno if this really has to do with academic pedigree/the process you're calling out as much as scope of practice. Even amazing GPs, unless they have a particular personal interest in something cannot faux subspecialize in everything.
So they if get rid of the drivers they contract who is buying and paying for the cars and maintenance? - are you suggesting Uber start carjacking their existing drivers?
Do you know what percentage of driver compensation effectively goes to car ownership and maintenance?
You seem utterly unwilling to believe that you can meet a healthy person on the internet, and even if you did, you assume it's purely genetic.
You seem to have some deep insecurities. I already acknowledged multiple times that your stats are overall consistent with good health. I lightly pointed out, pretty uncontroversially, that some of those results have a genetic component - so thank your parents even if just a little. "you assume it's purely genetic" is pure hyperbole.
You've sent me the distribution of lipids across all age groups, done for research purposes.
Yeah, exactly, why would that not be relevant? These are the distribution of lipid profiles in the NHANES dataset that is used to guide clinical care throughout the Western world. Modern medicine care is based on research.
In clinic you rarely test anyone in those younger age groups for lipids as screening starts at 40 for men and 50 for women.
In the US it starts a bit younger. And again, rare is a hyperbole. We routinely screen pediatric patients in the US - that is standard of care. So....
Are you ordering lipids on healthy 20 year olds?
Yes, of course - not that rarely.
If a healthy 20 year old has no record of being screened in childhood I will screen to rule out FH, obvi.
"healthy" is a nebulous concept - I consider it appropriate to order lipids on what I deem a healthy 20 something with risk factors (family history, certain childhood illnesses, HIV, diabetes - not all young folks with diabetes are unhealthy even if they are not as amazing as you, etc).
... My HDL was better than 95% of Dutch teenagers and my triglycerides were better than 90% of 20-somethings.... blah blah blah
Exactly. So, very good, as I already stated, even excellent. But not something that is super rare - 95%tile is 1 in 20, that is not rare.
You were that one that made this about an appeal to authority: "and having seen a lot of lipids/HbA1c I have to say I have never seen results this good in anybody else."
I quoted the literature to not make this some anonymous dick sizing contest - and also because the data is interesting. I admit lipid management is a personal interest - now you can look into why ordering lipids on 20 year olds is sometimes appropriate. You seem to be hung up on being butthurt that the entire conversation is not unconditional praise on your personal accomplishments.