davak

HypoNa --

I think you made a throwaway account for this reply, but I would really appreciate continuing this conversation with you. My email is available under my profile.

Added as a Kagi bang! Love it.

Agree. You could consider marketing to the DJ community where actually buying the music is commonplace.

This is likely related to COVID as well, just indirectly.

- Research has shown that recent COVID-19 infection increases risk of heart attacks, strokes, and a ton of other vascular diseases.

- Overwhelmed hospital systems will have poorer outcomes in emergencies such as sepsis where time-based care is a huge factor. Worldwide sepsis mortality has gone up over the last two years, for example.

The mayor has been begging* for funds from the state for a long time now to fix the problem though. That being said, I'm sure there is lots of local and state mismanagement that would go into causing such an embarrassment.

* https://www.wlbt.com/2022/02/17/jackson-faces-uphill-battle-...

Install failed. OS X 10.14.6. Happy to help debug with you.

I hate chart hacking. However, cases are up over 130% in the last two weeks. Hospitalizations up 80%. (1) The surge is unfortunately real.

(1) https://www.nytimes.com/interactive/2021/us/covid-cases.html

Good take.

Arterial clots with thrombocytopenia is incredibly rare. Additionally the PF4 activity in these patients is very abnormal and appears to be to immune mediated. Lots of science and focus going into the mechanism around this now. The other recent NEJM articles around clots associated with the other adenovirus COVID vaccines are likely a similar phenomena.

This was not testing against the South African and Japan/Brazil variants that are much more likely to escape vaccination antibodies. This UK variant is mostly problematic against the unvaccinated.

In the lab the South Africa and Japan/Brazil variants have severe reduction in neutralizing antibodies which is very concerning for vaccine escape. That being said, we don’t have a great way to test for T cell and other immunity which also plays a role. Getting the vaccine decreases severity of illness regardless of the variant.

The answer is get any vaccine as soon as possible. Then get the booster too when it’s available.

Probably too late for anybody's interest, but the risk of getting this from food is suspected to be incredibly low. Droplets being inhaled, entering through the eyes, or nasal mucous membranes are the likely real threats.

I dealing some on the distribution side of this. NYT has a pretty good article explaining all the infrastructure that is being rolled out. (1)

Even dry ice in coolers is low tech but gets you a lot of time considering storage for the second booster dose will be centralized.

The risk is real though. Breaks in cold chain storage have inactivated vaccines have been documented to leading to outbreaks in other disease states. Still, at this point, from my boots on the ground perspective -- so far, so good.

1. https://www.nytimes.com/2020/09/18/business/coronavirus-covi...

Some of the KN95s have been found to be counterfeit. Some of the ones we tested were no better than a cloth mask. When buying KN95s, please check that they've been validated by the CDC's list.

If it's legitimate KN95, it probably protects at least as good as a medical mask but probably not as good as a N95. This is because KN95s are not designed to form a complete seal so many folks will have some leakage around the edges. This is the reason that you see many systems 3d printing molded frames to improve the KN95 fit and decrease leakage.

"Disposable" medical masks cost pennies to make, can be worn for multiple days, and are highly effective. In an environment where some folks refuse or can't mask, they are the most effective way for people to keep themselves safe.

By the way, I don't make or sell masks. I'm just interested in keeping people out of the hospital and my friends/family safe.

The primary difference in a medical mask and an N95 respirator is the tight seal that doesn't allow air around the sides. Unless you are in a high risk aerosolized environment, an N95 is unlikely to give you much additional benefit.

Most medical masks are made of the same material out of China that filters > 95% of infectious particles. If you want extra protection, you can look for masks with an "ASTM Level" that gives additional support that the mask is medical grade.

I'm a critical care doc and directly involved with COVID administrative policies for my health system organization. I have recently told friends and family to start buying and wearing medical masks. Our experience is that medical masks are very protective in protecting the wearer from catching the disease. Hospitals have plenty of masks now. A cloth mask prevents spread away from the wearer, but a medical mask protects both the wearer and those around him/her.

Medical masks protect in two ways. One, they filter the air at an extremely high level. Two, they are fluid resistant, so the saliva droplets that are filled with virus particles cannot penetrate the mask.

Most health organizations, including mine, are noticing that COVID prevalence within their employees is less than the local population as a whole despite being around contagious COVID patients all day long. The major difference in these two populations is that health care workers are wearing medical masks.

Yes. Very easily.

IL6 is an inflammatory cytokine released due to a ton of stressors. Like fever, tachycardia, or tachypnea — this may be more a marker of sickness than sepsis.

Hopefully not, but let’s see the trial first.

As somebody that has this specific discussion regularly, I find that framing it as a group has helped in circumstances similar to yours. Framing it this way to your family and the health care team may help.

“This decision is so difficult, let us share this burden with you. If we have to make a decision to remove life support, you shouldn’t have to make that decision alone. If we decide the massive costs of long term life support which may drain the estate, we should make that decision together.

Dad would trust that we as a family would come together and make these tough decisions together.”

People go through various stages of mourning so sometime just time helps.

Remember that the family’s job is to be your Dad’s voice. What would he want?

Events like this bring out the worst in everybody. These are just a few strategies that have worked for me in the past. Good luck.

I am a nerdy physician desperate to work with somebody on decision tree based expert systems. Are there a bunch of existing projects that I’m just missing?

I am physician. Would love to work on a decision support tool...

Underrated reply for the chemistry pun.

As a physician we do occasionally see folks die from hyponatremia (low salt) from overly correcting dehydration with water. It’s a terrible tragedy.

Zillions of reasons. If you miss your meds, that stent can abruptly occlude and cause death. Maybe you open one large vessel but the downstream vessels are clogged—even microscopically. Place enough useless stents and you’ll hurt patients from dye, bleeding, infection, etc.

On the other hand, studies of procedures are done on very narrow patient populations. Our patients often don’t fit into those perfect boxes. What’s “needless” is difficult. As long as folks get paid per procedure, it adds bias that favors doing instead of not doing.

In our ICU data we found that missing fields also predicted worse outcomes. My theory is that in sicker patients nurses are less worried about collecting all the data. But who knows.

One brief clarification. Doc salaries are higher, but cost and length of training is higher too. Four years of college and four years of med school dig the hole very deep. Then three to eight more years often working below minimum wage as the interest on the debt compounds.

Do you have hardware or can you let me know hardware you are currently using?

Source or sarcasm tag. Needs one or the other.

Often negative results are never published. Great post.

Anybody found that any of the continuous feedback tools are actually helpful either as the employee or manager?

I don't have a downvote, but isn't this just spam?

Congratulations on breaking free. Humbly, I would suggest, however, that your incredibly difficult journey made your now better life possible.

Many of us have sacrificed multiple years of our lives for a better future. Four years of medical school and 6 years of residency/fellowship were my sacrifice.

Certain paths in life require some initial torture, unfortunately.