ED boarding is when a patient is admitted but... physically remains in the ED. Unlike the floors or ICUs, there is no "capacity" in the ED. While nursing ratio recommendations exist, there is no method to enforce it given the nature of EM workflow. Is ED boarding really as big of a deal as he says? The short answer is: yes. My record for ED LOS exceeds a month, and the worst nursing ratios were 13 patients per nurse. The latter was in early COVID. One systematic review included 7 studies and over 75,000 patients. Here’s the gist of what they found: -higher rates of missing treatment interventions (9%) -higher rates of missing home medications (18%) -higher rates of missing lab studies (3%) -higher odds of orders not being filled on time (OR 1.84, 1.46-2.30) -higher odds of orders not being filled altogether (OR 2.58, 1.94-3.42 -higher odds of delirium in the elderly (OR 2.23, 1.13-4.41) -higher odds of drug-related adverse events (OR 1.04, 1.01-1.08) Another systematic review included 13 studies and focused on the elderly. Here’s the gist of what they found: -increased odds of death at 6 months (2.18, 1.10-4.31) #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #army #armymedicine #armyemdoc #resuscitation #research #data #medx #medtwittershow more

What is the 4-step cricothyrotomy method? This method uses... 4 steps: Scalpel-finger-bougie-tube 1. Scalpel to the cricothyroid membrane 2. Finger insertion into the trachea with downward traction 3. Insertion of a bougie into the track with the finger it in feeling for the tracheal rings 4. Insertion of the tube over the bougie It is a simplified method for performing the procedure that eliminates steps such as the use of trach hook. While this procedure was popularized by the US military through the Tactical Combat Casualty Care guidelines, it has been described for many years before the recent wars in Iraq and Afghanistan. There's obviously no RCT data on this method in humans, but cadaver, mannequin, and case series data demonstrate reliability and efficiency. PMID: 9950380, 8922017, 9774928 #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #data #research #army #armymedicine #armyemdoc #trauma #airway #military #tccc #navy #airforce #marines #medx #medtwittershow more

Then the map of power changes: the "Mihail Kogelnicanu"... base in Romania, one of the main strongholds of NATO in the region, comes within the range of Russian systems like "Iskander". And that changes everything. But the reality is that for now there is no quick way to Odessa. The Black Sea Fleet cannot carry out a large landing, and advancing by land complicates the terrain and the enemy's resistance. The key for Odessa is not in negotiations, but in a complete change of the situation on the ground. Or everything - or nothing. In any scenario, one thing is clear – if Russia gives up Odessa now, it will become hostage to the next crisis. And then the stake would be even higher, and the price – even higher. The question is not only whether it is worth fighting for Odessa. The question is: what is lost if one does not fight?show more

Tens of thousands Muslims gathered on the streets of... St Petersburg yesterday to celebrate Eid al-Fitr (the end of Ramadan). Some right-wing nationalists in the West believe there aren’t many Muslims in Russia, but the reality is very different. Next year, 20% of the 18-year-olds that will be drafted for military service will be Muslim. Around 2.5 million, or early 20%, of Moscow’s population is Muslim and their share is increasing every year due to immigration and higher birth rates. One of the cities that is changing most quickly is St Petersburg which just until a few years ago had a very small Muslim population.show more

🚨GOLD JUST CHANGED ITS PRICING MODEL! It's already pricing... huge crash - bigger than Dot Com bubble I've been trading for over a decade and warned you about this dump, but what's coming next is even worse: Iran conflict is what disrupted oil flows and pushed energy prices higher Higher oil means higher inflation and that is less room to cut rates, higher yields and that's why gold is dumping Also cause it was at peak attention, just overheated But what's interesting is that retail is skipping gold right now They prefer sending their money to cash or short-duration Treasuries As it is said: People buy gold when they're worried about the future People sell gold when they're worried about today And that's what leads us to further crash cause... Higher rates don't just affect gold, they determine the cost of capital for every long-duration asset Today's equity market is increasingly concentrated in a small group of AI leaders It shifts the market from AI to cash flows under higher discount rates War -> Inflation -> Higher real yields -> Gold reprices -> Cost of capital rises -> AI comes under pressure Like it or not, but I called you about this Gold dump exactly, you can see it in my old post below And now I am calling this too, many people are going to wish they followed me soon You'll understand why when it comesshow more

"Don't give nitrates to right-sided 🫀myocardial infarctions" This is... a myth that continues to get taught due to the theory that right-sided MIs are sensitive to preload, which nitrates reduce. A recent systematic review (n=1113) failed to substantiate this purported risk. #emergency #emergencymedicine #foam #foamed #foamcc #army #armymedicine #armyemdoc #meded #icu #criticalcare #meded #science #research #data #medx #medtwittershow more

“In the modern world, man becomes a slave to... the feminine principle, seduced by images and illusions created by emotion and fantasy—decadent forms of eros.” —Julius Evola, Metaphysics of Sex The modern cult of equality has fixed its gaze upon the sexes. What had once been regarded as the polarity of man and woman, grounded in nature and consecrated by tradition, has been lowered to a counterfeit of sameness. Evola returned often to this inversion, discerning in it the same anti-hierarchical impulse that has disfigured every other sphere of life, and which, under the guise of liberation, has stripped both sexes of the dignity proper to their stations. What the age heralds as emancipation he judged to be a degradation, for feminism does not raise woman to her station but strips her of it, compelling her to abandon her essence in order to imitate man, while man himself, bereft of his higher path, sinks into a condition at once impoverished and grotesque. For Evola, culture was the victory of form over chaos, the conquest of the shapeless by order and measure. The city and the empire arose from the recognition of limits, of distinctions, of the rightful ranking of beings. Man attained his true stature as warrior and ascetic; woman realized her dignity as lover and mother. These types were not adversaries but counterparts, separate yet joined, each consecrated to the same principle of transcendence, each charged with its own path of heroism. In the sharpening of these forms, in the intensification of the masculine and the feminine, Europe attained its strength, and love retained its ancient dignity as a force at once generative and cosmic. There is also a beauty in the truth of form, for what is bound to nature and consecrated by tradition does not merely endure but shines. When the polarity of man and woman is clarified, when each fulfills the path proper to its essence, the result is not only strength but radiance. Beauty arises when limit is embraced, when form gives shape to matter, when order compels chaos into harmony. To behold such clarity is to glimpse truth itself, for truth and beauty are of one lineage, both testifying to the higher law that governs being. The modern age has broken this harmony. Bolshevism in the East proclaimed the equality of the sexes in the name of the collective. America in the West proclaimed the same in the name of emancipation. Beneath the opposing banners the result was alike: in one case, a promiscuous communality in which difference was dissolved, in the other, the masculinized woman of the factories and the salons. The poles collapsed, the bond was neutralized, eros was reduced to sterile companionship or the fleeting diversions of appetite. Evola named this impulse a radical pessimism, for beneath the assertion of equality lies the confession that woman, as woman, has no worth. She is compelled to take on the guise of man in order to claim value, and in so doing she forfeits the possibility of fulfillment. Man, in turn, is brutalized into a creature of appetite and utility, stripped of the higher forms once embodied in the ascetic and the warrior. Love itself, which depends upon polarity as fire depends upon the tension of elements, is extinguished, and with it the very possibility of renewal. What rises in its place is the gray world of neuter beings, uniform and without grandeur. Woman no longer appears as lover or as mother, but is driven into labor, into agitation, into pale imitations of intellectual life. Man no longer ascends as ascetic or warrior, but sinks into the tradesman, the showman, the brute. Thus the order of life is betrayed in its most intimate relation, and what once gave depth and height to being is consumed in the twilight of sameness. To revolt against this perversion is not to diminish woman but to restore her to her dignity. It is to affirm that difference and hierarchy are the ground of order, that polarity is the essence of love, that the higher destiny of mankind rests upon the distinction of the sexes. In defending this truth one does not merely preserve a passing custom, but upholds the principle of form itself. For in the bond of man and woman is mirrored the eternal strife of order with chaos, and in that strife the fate of the world is decided.show more

Missing #Indian Student Found Dead in #Finland; Body Recovered... from Sea The body of an Indian student, #Manideep, who had been missing since early May, has been recovered from the sea in Finland. Manideep’s parents in #Hyderabad were waiting for the update about his whereabouts since last few weeks. Authorities confirmed that the body, found during a search operation on July 9, 2026, along the Kruunuvuorenranta shoreline, has been identified as that of the missing Indian student. Finland’s National Bureau of Investigation is examining the cause of death. However, investigators have stated that there is no suspicion of foul play or any criminal offence in the case at this stage. Officials said the investigation is ongoing and that no further details will be released for now. The discovery of Manideep’s body has brought a tragic end to the search that began after he went missing in early May.show more

60% of contracts filed to the SEC contain mistakes.... Spellbook Labs ran 60,000 pages of contracts from 500+ public companies through AI to answer a question: How often do human lawyers hallucinate? Accidents from self-driving cars get headlines—and they should. But human drivers have a higher accident rate. We wondered if something similar might play out in contract drafting. Reviewing 100 page contracts line-by-line is inhuman. Mistakes are inevitable. AI is very good at spotting issues like missing definitions and broken section references. There are risks to using AI in law. But we also need to ask: what is the risk of *not* using AI review as a second set of eyes? In the full report we show: 1. Top 10 public companies with the cleanest contracts 2. Error rates across industries (Media and Telecom were highest) 3. Error rates over time (we're not getting better!) 4. Error rates by contract type and length ... and a bunch more. Congrats IBM for having the cleanest agreements. 📌 Read the report here:show more

Society advances when the individual ceases to be merely... an extension of biological instinct and begins to exercise capacities that nature itself did not anticipate. Self-realization is a gentle transgression of nature — or rather, a step beyond it — which became the foundation of human civilization. : The author argues that genuine societal progress begins the moment the individual stops functioning as a mere extension of biological instinct and starts exercising capacities that nature never anticipated. Self-realization is not rebellion against nature but a gentle transcendence of it: a deliberate step beyond the limits evolution set for survival. This transcendence became the true foundation of human civilization. When people began to cultivate reason, creativity, ethics, and aspiration for something higher than instinctual preservation, they moved from animal existence to human becoming. Civilization is the collective record of that movement. The insight is profound. Progress is not merely technological or economic; it is the ongoing expansion of human possibility beyond what biology alone could foresee. Every act of art, justice, discovery, or compassion is a quiet declaration that we are no longer bound by the script nature wrote for us. Society advances precisely when enough individuals choose to write the next chapter themselves.show more

Strait of Hormuz over the last 24 hours: too... deep into the escalation trap or the cycle of stupid. The events over the past week should start to dissuade anyone from contemplating that the Strait of Hormuz is going back to normal anytime soon. The video from MarineTraffic illustrates that clearly with Iran's lane being the only active one. Today, IRGC said that 4 vessels were halted, while the US is saying that's fake. No one knows what's real anymore, but what is real is that shipowners will be reluctant to take the risk. He said, she said isn't good enough anymore when lives are at risk. We are now firmly in Robert A. Pape's escalation trap and Malcolm Nance's cycle of stupid. It is clear and obvious the US cannot give Iran the control of the Strait of Hormuz because it will make it the most powerful oil producer in the world. And since this conflict is all or nothing, we will either have to topple the regime, or Iran will come out victorious. There's no in-between. Let's see how this weekend goes, but from a flow perspective, nothing is going through. Zero barrels went through on July 17 and the last two days have not been revised higher by Kpler.show more

This family was at the beach. They got there... early and set up in front so they could watch their kids play in the water. Then this family shows up and they set up in front of them. 🤯 There was no one to the left or the right of them. Clear as could be. 😳 A lot of people said they should have moved closer so no one could set up in front of them. But many others said if the beach was open and there was no one to the left or right of them then that is just plain rude. I always leave a little sand in front in case my kids want to play or we usually throw our boogie boards in front. I’d have been irritated and would have asked them to move. 💯 What do you think? Was it rude of the second family to take their view away and set up in front of them or is it the first family’s fault for not setting up closer so no one could be in front of them?show more

🤡🇷🇺🇬🇪 “Your fate is being decided in Ukraine” —... a Russian occupier now tells this directly to the separatists. 🔻 This was personally stated to representatives of the so-called “sovereign” Abkhazia and “South Ossetia” by Maxim Vaskov, professor of the Department of Regional Studies and Eurasian Research at the Southern Federal University. 🔻 “It so happened that the fate of Abkhazia and South Ossetia depends on whether Russia wins or loses” — stated Maxim Vaskov. 🔻 For information: the mentioned Maxim Vaskov is an honorary academician of the so-called “Academy of Sciences of Sovereign Abkhazia” and is considered a distinguished figure in the science of the so-called “South Ossetia”. This unusually candid admission from a Russian academic underscores how deeply the occupied Georgian territories are tied to the outcome of the war in Ukraine. It treats Abkhazia and South Ossetia not as independent entities but as direct extensions of Russian power, whose survival depends entirely on Moscow’s success or failure on the Ukrainian battlefield. Such statements reveal the fragile and instrumental nature of Russia’s control over these regions. Video is generated by grok AIshow more

Update on the water bottles left sitting in the... sun before being sold to Americans 3 days ager they are still cooking in the summer sun. This is where they are stored Reminder: Just one day of sitting in the sun releases thousands, to tens of thousands of additional microplastic particles - A 2024 study found an average of 240,000 plastic particles per liter in bottled water, with 90% being nanoplastics (smaller than 1 micrometer) and 10% microplastics (1-5 mm) - Heat accelerates plastic degradation, increasing chemical and microplastic leaching. - Higher temperatures break down chemical bonds in plastics, causing more microplastics to shed - Based on studies, a 1-liter PET bottle left in a hot car (e.g., 120-150°F) for a day could release thousands to tens of thousands of additional microplastic particles beyond the baseline 240,000 per liter, especially if exposed to sunlight or mechanically stressshow more

Yesterday at Brown University ICERM's workshop on “Agentic Scientific... Computing and Scientific Machine Learning” I spoke about “Adaptive Swarms Across Scales”, making the case for scientific AI as systems that can create representations, stress them, fracture them, and enlarge the category in which future representations live. The category here is a composable and breakable working universe of science: data, hypotheses, simulations, measurements, tools, failures, figures, papers, provenance, and the transformations that connect them. Discovery happens when those transformations become executable, inspectable, composable, and capable of changing the world model they operate within. Atomistic modeling gives one category - states, forces, trajectories, observables, boundary conditions, conservation laws. Neural surrogates learn fast morphisms inside or between such categories. But discovery is higher-order: it changes which objects and morphisms are available in the first place: what variables exist, what operations are allowed, what evidence counts, what scale is active, what invariant is being preserved, and what kind of explanation the system is even capable of forming. This is scientific method as adaptive architecture: compression, stress, fracture, recomposition. Fracture matters here because it makes the logic physical: a non-commuting diagram realized in matter. The imposed load, material hierarchy, defect field, and assumed continuum description no longer map cleanly into the observed outcome. The crack is the obstruction and it identifies where the old morphism failed and where a new representation must be introduced. The physical crack and the categorical obstruction are the same event viewed in different substrates. ScienceClaw × Infinite is a machine for constructing and transforming a category of scientific artifacts. Each artifact is typed. Each operation has lineage. Each failed branch remains in the category as reusable structure. The “paper” is no longer the terminal object of science; it is one projection of a larger compositional trace, and it can be generated at any time for consumption by a human or an AI. With that the unit of scientific labor is changing. For most of the twentieth century the unit was the result (a measurement, a theorem, a synthesized molecule). It is now becoming the algorithm that produces results, and after that, the substrate of discovery itself. The static PDF is the wrong terminal object for this regime, and the role of the scientist with it. We now design algorithms that build algorithms, and eventually substrates in which such algorithms compose themselves. At that point, the scientist is no longer outside the discovery system. The scientist becomes one of the representations the system can transform. In that sense, the systems will eventually do science to us, and that is the structural consequence of the principle they are built on.show more

I feel sorry for people who believe in the... nonsense that this man preaches, now he is failing to understand a simple bible verse and its context, there is nowhere in the bible where children of God were ever instructed to submit to governments , Many false preachers like him always misinterprete Romans 13 v1 and 2 which says " Let every soul be subject unto the higher powers. For there is no power but of God: the powers that be are ordained of God. Whosoever therefore resisteth the power, resisteth the ordinance of God: and they that resist shall receive to themselves damnation in this verse Paul was writing to the Gentile believers in Rome to obey the God-ordained authorities of the synagogue, not Roman secular/pagan authority, What sense would it make for Paul to instruct believers to submit themselves to thugs and murderers who were tormenting them The Roman Emperor during the writing of Romans 13:1, and for a significant period afterward, was Nero ,he is known for persecuting Christians, particularly after the Great Fire of Rome in 64 AD, which he blamed on themshow more

🚨 RENTER LOSES IT OVER “MISSING DAYS” - SAYS... LANDLORDS ARE ROBBING US BLIND An American renter is going viral after calling out what she calls the biggest scam of adulthood: paying the SAME rent for a 28 day month as a 31 day month - with zero adjustment. In the video, she breaks down how February somehow ends up being the MOST expensive month per day… then adds insult to injury by revealing her lease conveniently renews the same month - meaning higher rent for fewer days. Is this a scam… or is this just how adulthood quietly robs you now?show more