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Near-universal Mexican Healthcare Coverage Results From Science-informed Changes

NIckGorton Re:Here I come. (732 comments)

Here is an example of what is wrong. My son got hurt and didn't have any money, so he called a hospital to find out what it would cost to xray his ankle to see if it was broken. Because he knew if it was just sprained, there was very little anyone could do other than tell him to 'stay off it'. They hospital refused to quote a price, because there was no way they knew how much it could cost because they didn't know what was wrong. In other words, if all he wanted to get was an xray and have a doctor tell him if the ankle was broken, they wouldn't do it.

There are several reasons this is the case:

  1. 1) Hospitals that are subject to EMTALA (a.k.a. all except the VA) are prevented from telling you the cost of possible services prior to a medical screening exam (MSE) by a physician or a mid-level like an NP or PA. This is to ensure that hospitals don't use cost to dissuade people from seeking care. If a hospital answers that question they can be subject to a fuckton of fines. I am surprised they called back.
  2. 2) The real reason that a MSE is important (other than to avoid fines for violating EMTALA) is that not every sprain needs an X-Ray. The Ottowa Ankle Rules are very useful to eliminate the need for XRay in about 30% of people presenting with acute traumatic ankle pain.
  3. 3) The FDA and states regulate medical treatments and tests for a good reason. If you made medical test/treatments like a vending machine, you would harm way more people than you help. Full body CTs are a good example (though these still required a physician's order, they were essentially provided to anyone with the $ to pay for it.) The brochures showed you the father of 4 who had a stage 1 kidney cancer diagnosed and treated, but not the ten other people who had incidental findings that once discovered had to be followed up... landing people in the hospital, with invasive procedures, and sometimes disabling complications from these unnecessary investigations. If you look at the cost-benefit for tests like this, the cost weigh outweighs the benefit, but that doesn't stop people who have no concept of basic math, much less Bayes Theorem, from getting the test. That's the reason that lotteries are so so popular: tax on those who can't do math.
  4. 4) Without an exam the diagnostic value of an ankle Xray is diminished (also a Bayesian deal). The pre-test probability of disease effects the performance of the test. As an example, think of a test for HIV that has a 1% false positive rate (but for simplicity assume no false negatives). If you do that test in an individual in a population with 0.1% incidence of HIV, and it is positive, 90% of the time the person with the positive result doesn't have HIV. In a population with a 20% incidence, 95% of the time they really do have HIV. So there is an additional negative of testing not directed by history/exam in that its less accurate. (Which is why I am surprised that the Radiologist who volunteered to read it did... the malpractice vulnerability increases with decreased accuracy.)

Finally, if your son wants a cheaper option next time, try a NP staffed clinic. In some states you even will find them in big box stores or pharmacies. They are a better value especially if you have something simple like an ankle injury.

about 2 years ago
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Near-universal Mexican Healthcare Coverage Results From Science-informed Changes

NIckGorton Re:Here I come. (732 comments)

Your 10% figure is correct but misleading. It is correct in that insurance companies take 10% from the total figure we spend on health care in the US. It is misleading in that the total health care spending is a combination of private insurance AND public insurance.

If you look at the percentage that insurers add to the cost of health care FOR INSURED PEOPLE only, the figure is more than double that. In fact, part of Obamacare is limiting the percentage that private insurers take off the top for “profit and administration” to ONLY 15%. If you look at the percentage taken off for administration (obviously 0 profit) taken off VA healthcare, government employee care, straight Medicare (i.e. not Medicare that is administered through private insurers), etc that percentage is in the low single digits (varies between programs a little – the VA is the best bet and most efficient of all dollar for dollar).

Though even if you take your 10% figure at face value, that means that insurance companies are funneling off 1.7% of the total US GDP for doing work slightly less valuable than a wet kleenex. That amounts to 250 BILLION dollars a year.

Lets however compare that to the administrative cost for traditional Medicare plans (the CBO calls it 2% for traditional MediCare plans and 11% for those run through private insurance companies.) Lets even round that 2% up to 5% to account for arguments about whether its really 2% or 4.6 or whatever.

Then lets take your figure of 255 billion – but we will use the correct denominator. Forty-five percent of US expenditures are (prior to Obamacare) are from public programs. So 255billion/(GDP * percent of GDP spent on health care *percent of private insurance) = 255billion/(15trillion * 0.17 *0.55) = 18%. This 18% is (shockingly) quite similar to the percentages quoted by people not wanting to obfuscate the data. Its actually a bit of a low ball figure for that, but again to give you the benefit of the doubt. In addition, that's the reason why the limit on profits/admin of 15% that is part of Obamacare was fought by health insurers. If 15% is less than what they were taking off the top already, why did they fight it?

So lets say the entire US expenditure on health insurance were administered through a MediCare for all plan versus an average private plan. Fifteen trillion*17% of GDP*18% admin/profit = 459 billion is the cost for private companies administering it. Fifteen trillion*17% of GDP*5% admin = 127 billion is the cost for private companies administering it.

That's a lot of zeroes in between those numbers. 332,000,000,000 to be exact. Plus, Medicare is good insurance. Most seniors on Medicare LIKE their insurance – whether or not its traditional Medicare or more expensive Medicare Advantage plans.

So why not just offer that plan to everyone? Its a simple solution: if you like your insurance that you have, fine. If you don't have insurance and make too much for the Medicaid programs, you have a choice: any one of many insurance plans on the exchange, or to buy into Medicare for the average cost of traditional Medicare for existing Medicare recipients. So if Medicare costs $7,000 per person per year, anyone could buy into it for $7,000 per year.

Why do you think the insurers fought that – the Public Option – tooth an nail? Because they knew they could not compete unless they brought their margins down to match Medicare. Its the simplest math in the fucking universe: If you only spend $0.82 for every dollar you take in, you will spend less than if you paid $0.95 for every dollar you take in. And that expenditure – whether 82 or 95 cents is the actual payment for doctors, medicines, hospitals, etc. If you can't understand that, go refresh your algebra on the Kahn Academy.

about 2 years ago
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Wikipedia Bans Church of Scientology

NIckGorton Excellent family culture my ass (665 comments)

Take mormonism..Horrible theology, but an excellent family culture.

Er, no. They have an excellent family culture as long as you adhere to 'Leave it to Beaver' cultural norms.

Kid misbehavin'? Send 'em for some re-edukashun.

Fags next door creeping you out by getting married and adopting unwanted children? Make sure their relationship is prevented from legal recognition and that their kids don't have the legal protections of married parents.

Pro family my ass. If they were truly pro-family then my family would present no threat to them. However as an organization they spent millions last year fighting against the right for myself and my husband's marriage to be recognized. That money could have been spent subsidizing all the kids in CA who will lose their health insurance now that our state budget is circling the drain. Instead of those millions being spent for something good like treating a kids asthma, diabetes, or leukemia, they spent it on divisive PR campaign to keep me a second class citizen. And don't even get me started on how 'pro-family' they are when their kids turn out to be gay.

more than 5 years ago
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Church of Scientology On Trial In France

NIckGorton Sky fairy moderation (890 comments)

Wow, apparently Christians moderate based on their religious beliefs rather than the validity of the comment. Shocker from the same folks who brought you "creation science".

You said something bad about my magical sky fairy or good about someone else's magical sky fairy. Mod -1 troll!

more than 5 years ago
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Church of Scientology On Trial In France

NIckGorton Re:Shame they can't do it for other religions (890 comments)

You assume (wrongly) that I am being an apologist for the CO$. I'm not. I'm an atheist just like you are: we both believe that there is no Xenu, or Odin, or Zeus, or Anu, or Hacha'kyum, or Eagentci, or Vishnu, or any number of the gods of other religions. The difference is that I am an atheist for one more than you are.

Kill yourself.

...and apparently that one extra god I disbelieve in makes me more fun to have at parties. I had heard your god was kind of a buzzkill, but dude, lighten up: http://www.youtube.com/watch?v=MyE5wjc4XOw

more than 5 years ago
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Church of Scientology On Trial In France

NIckGorton Re:Conspiracy theory alert! (890 comments)

Oh... you haven't? Why not?

For the same reason that I don't have to read everything published by Kent Hovind and the Answers in Genesis crew to know that Young Earth Creationism is a load of whacknut loony flaming poo. At first glance Hovind's views are nuts so a second glance isn't required unless its morbid curiosity. Taking a first glance at things I have actually read (both during childhood indoctrination as well as during undergrad) in some of your source documents (albeit in translation since Medical Spanish is worth more time for me than Latin, however in what are considered reliable translations)... you believe that a Jewish zombie can make me live in eternity with him if I eat his flesh and telepathically agree to accept him as my master, so he can remove an evil force from my soul that is present in me personally because a woman created solely from the bone of a man's thorax was talked into eating a magical fruit by a talking snake over 6000 years ago.

Seriously. That wouldn't even make for a good acid trip.

more than 5 years ago
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Church of Scientology On Trial In France

NIckGorton Re:Shame they can't do it for other religions (890 comments)

FWIW, official Catholic Church doctrine is not Genesis-style creationism. Also, most Catholics I know take "official doctrine" to mean "food for thought".

The Catholic Church only came to (at least somewhat) support Evolution by Natural Selection post Vatican II. And in fact only finally in 1992 did JPII vindicate Galileo and his crazy Heliocentric theories. (Though not until after then Cardinal Ratzi stated in 1990 of the RCC that "Her verdict against Galileo was rational and just".)

Seriously. I ain't making that shit up.

more than 5 years ago
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Church of Scientology On Trial In France

NIckGorton Google Fact Check Fail (890 comments)

Um... Like that dude Benedict... the one who looks like Emperor Palpatine? He believes in them apparently.

http://news.bbc.co.uk/2/hi/europe/7131088.stm

Though admittedly I haven't actually talked to the man about it as you asked. But I am guessing if he digs it, at least a few other Catholics do.

more than 5 years ago
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Church of Scientology On Trial In France

NIckGorton Re:Shame they can't do it for other religions (890 comments)

I'm the council president and former treasurer, so I know of what I speak.

So the guy in charge of the money the church gets tells us about how the church practices getting its money. This is sort of like trusting Dick Cheney to tell us what we need to know about Guantanamo or trusting Bill Gates to tell you all the many ways that Windows sucks. (Not to intentionally compare you with two evil characters. I'm an atheist but I still don't think accounting-for-Jesus is quite up there with torture or releasing Vista.)

more than 5 years ago
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Church of Scientology On Trial In France

NIckGorton Re:The sources are public... the slanders continue (890 comments)

All the source documents for Christian theology are publicly available

Depends on what you call source documents. If you mean the Hebrew scriptures and the NT (including newer archaeological finds), sure. However since you are a dead language fan, three words for you: Archivum Secretum Vaticanum. But then the whole point of a secret archive is that its.... well.... secret. We don't know what source documents may be in it any more than people knew in the 80's about Xenu and the DC-8s.

However you might be one of the ones who argue RCC != Christian. But since they are the oldest school on the block for the most part I'll assume they have some goods the newer kids might not have. (Though as an atheist the goods in question are about as valuable to me as a wet kleenex or Vista.) However my original point was that there is just as much secrecy in Christianity (more now really since the Vatican has done a better job keeping their stuff off of WikiLeaks) than in the CO$.

And its just too unfortunate that you didn't go to school in West Virginia.... the potential for sheep rather than goat jokes would have been enormous. But I'm just not that lucky.

more than 5 years ago
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Church of Scientology On Trial In France

NIckGorton Re:Shame they can't do it for other religions (890 comments)

No, QuantumG has a very valid point. While the Bible may be readily available at the local bookstore for $10, so is Dianetics. However you can't really believe that the Roman Catholic Church doesn't have extremely classified information that is less accessible than NOT-VII (which you can download from Pirate Bay or WikiLeaks in a few minutes.)

In both fairy tale based cults information access is restricted. The difference with the CO$ is that if you have sufficient funds you can read the batshit crazee at some air conditioned Celebrity Center without spending 10 years in a seminary and blowing a goat for some sexually repressed cardinal's entertainment.

more than 5 years ago
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California Family Fights For Privacy, Relief From Cyber-Harassment

NIckGorton Re:You Can't Fight the Internet (544 comments)

1) Spouse doesn't work (or well, he doesn't make income.) He largely takes care of his elderly parents.
2) We do live in a place with very high real estate prices (on par with Princeton, though on the plus side we haven't had a bubble).
3) I work 2 days a week as a volunteer physician at a clinic that serves uninsured and underinsured patients. This costs me all totaled about $1000/month to do so. (Its in SF, so I share an apartment with a friend pretty much in the T-Loin, etc.)
4) I travel to teach medical students about LGBT health care and often pay for part or all of that travel.
5) As I said I donate pretty heavily too.

So its not sucking at money management, its more that we have a different perspective on what's important in life. The most expensive article of clothing I own may be worth less than $100, I bring my lunch to work, and I drive a car with 200k miles on it, but I also am practicing the kind of medicine I went to school to do and I am keeping my husband's parents out of a SNF. Though if we're talking money management skills, I certainly have you beat on the frugality front. I did my entire education in state at one of the cheapest schools in the US. When I started undergrad it was $381/semester and when I finished med school it was $2K/year (in 1998). I was not going to pay a lot for that muffler.

more than 5 years ago
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California Family Fights For Privacy, Relief From Cyber-Harassment

NIckGorton Re:You Can't Fight the Internet (544 comments)

Freedom of speech is not freedom from the repercussions of speech.

Absolutely, but the repercussions by definition should be limited. If you say gay marriage is an abomination. I can call you a homophobic twat. I can even make an awesome video showing precisely how much of a homophobic twat people who believe that are. I can also boycott your business (taking a page from the fundie handbook.) But I can't sue you for a million dollars because I am butthurt about your statement.

If what is said causes harm, then it is entirely valid and correct to punish the offender. That's why we have fraud, libel, harassment and other similar laws.

Fraud, libel, and harassment laws are inappropriate here. For fraud or libel to be operative, the speech must be untrue. If I say Ted Haggard had sex with a drug dealing gay prostitute, that's libel. If I say you did, it is (unless you have.)

Similarly for harassment to be operative, there has to be intended harm to the individual claiming harassment. If you take the report at face value, the idiots who released this were not harassing the family. Others may have taken those pictures and harassed them, but the original leakers and the vast majority of people who posted them have no intent to specifically harass the family.

You are right that there are limits on free speech. However the limits this family would like are not allowable ones.

more than 5 years ago
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California Family Fights For Privacy, Relief From Cyber-Harassment

NIckGorton Re:You Can't Fight the Internet (544 comments)

Just because they're well off does not mean their motivations are any different to yours: happiness, family, safety, achievements, fulfilment, etc.

Its not that they are well off that irks people. Its what they choose to do with that wealth.

I'm a physician and make about $250-300k a year. With this I pay off the debt I accrued in medical school (I put myself through undergrad and med school because I am from a very poor background. Poor as in welfare, foodstamps, and housing projects.) I also pay the mortgage on two adjacent (although modest) homes for myself and my partner's elderly parents. My partner and I share a 6 year old civic (hybrid) although he has 2 used motorcycles as well. We donate about 10% of our income, and I volunteer 2 days a week at a free clinic.

If I had ten times the money I wouldn't buy a porche. I also wouldn't spend my money on a quixotic quest for retribution through the legal system.

That said, the parents of this girl have every right to do so. And we have every right to say that their quest, while understandable, is dangerous in that it threatens the freedoms of speech rights of an entire country. And that statement is not from a place of class rivalry, but from an understanding of free speech and the necessity of defending even repulsive free speech.

You can't just say that censorship is OK when applied to douchebags. Arguably the people who post these pictures and link to them are supreme douchebags. However, I also think that Bobby Jindal, Karl Rove, and the entire membership of the KKK are also arguably supreme douchebags. However others would disagree with me. So we can't use douchebaggery as a bar for censorship. In fact its the very speech that repulses us most that we must defend because that's where freedom of speech is most easily chipped away. See Virginia v. Black et al. http://www.firstamendmentcenter.org/analysis.aspx?id=14776

In order for speech to be free, even the most repulsive speech must also be protected.

more than 5 years ago
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California Family Fights For Privacy, Relief From Cyber-Harassment

NIckGorton Re:You Can't Fight the Internet (544 comments)

It's not "censorship". To call it this is silly. The parents arguably have a case about their consitutional right to privacy being violated.

So any time someone injures themselves in public, their right to privacy means no one can take and share pictures of it? Well FailBlog will be decimated then. And for that matter, written description of similar incidents should also be censored to ensure people's privacy. Why stop at just a picture? So the Darwin Awards has go to go by your reasoning.

And by the way, its spelled 'constitutional'. But you made my day by arguing a constitutional basis for unconstitutional censorship while misspelling the name of the document you are misrepresenting. Call me a moran, and you will complete the trifecta.

more than 5 years ago
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California Family Fights For Privacy, Relief From Cyber-Harassment

NIckGorton Re:You Can't Fight the Internet (544 comments)

Judging by the action taken by the CHP (suspending the two officers involved) they didn't have the right to release the images in the manner that they did.

How do you figure that? Just because something is distasteful or stupid that doesn't mean its not within your rights. See: Westboro Baptist Church.

Similarly, as an ER physician if I call a drunk douchebag who takes a swing at me... well... a drunk douchebag I may suffer disciplinary repercussions even though it was within my rights. So just because they were disciplined by CHP that doesn't imply they broke a law or did something they did not have a right to do.

That said, IANAL. So it may well be illegal, but that isn't demonstrated by CHP's internal disciplinary decisions.

more than 5 years ago
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Worst Censorware Blocks Cannot Be Fixed

NIckGorton Re:You have been unfairly modded (420 comments)

The point is that whilst we can't help our *feelings*, it's a different thing when you direct that comment about people - it's not just an honest description of what you can't help, it's reasonably read as a statement that the person intentionally posted. Moreover, if it's fair for him to express his feeling, why was it trolling for the other poster to respond? He was only stating how he felt.

OK, given your position how about this? I feel uncomfortable around black people. I will qualify the statement by saying that I don't mind black people, there is just some feeling of revulsion that I get when I am around one. And according to you I can't help my feelings. Its something about the hair and some bad associations I have. But I would never think that anyone should abuse them or subject them to discrimination. I just don't want one to sit next to me on the bus or marry my sister, you know.

Now I will also tell you I am an ER physician. If you were black, would you feel safe and comfortable coming to see me in the ER as a patient? Would you feel that you would get the same care that a white person would? Would you worry that you would get substandard care because of subconcious (or concious) biases that I posess?

If you don't you'd be a Pollyanna to the extreme. (And you'd be contradicted by good research that in the US at least black people get objectively substandard care on a regular basis in medicine.)

So yes there would be a problem with me feeling that way. However I agree with you that such feelings should be expressed, but to bring them out in the open and work on changing them. Irrational fear of another group (whether its blacks, gays, muslims, or whoever) simply for membership in that group (and presumptive status as a danger or worse a predator) is wrong. And we all have it. Its part of being human. Those of us who work hard enough can mitigate its effects. However you can't accomplish that by saying such irrational beliefs are acceptable because they are feelings which can't be changed.

And in the sense of full dislclosure, I will say that when I was 20 those statements that I made were probably pretty descriptive of what I felt. (I used to have a confederate flag and a pink triangle on my pick-up.... talk about being an ignorant hick. Wait - I deserve civil rights.... but... um, they don't. Or something.) Fortunately I had the life experiences necessary for me to see those biases for what they are and to try to change them. In some sort of cosmic irony my husband is mixed race (like Obama actually, African dad, white American mom) and his parents now live with us.

Of course I'm still sexist, racist, homophobic, transphobic, ageist, classist, and all the rest. Though I've made a concerted effort to minimize those feelings in myself and more importantly to minimize the effect that they have on my interactions with others. So while I think the OP should have expressed his feelings (since that's the first step to change) your defense of leaving these biases unchallenged because they are 'feelings' is what is truly dangerous in society. He doesn't need to be attacked. But he does need to be called out on his unconcious biases. Excusing such biases as 'only feelings' is simply being an apologist for homophobia.

more than 4 years ago
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Large Ice Shelf Expected To Break From Antarctica

NIckGorton Re:If the ice melts (278 comments)

Oooh. An anthropogenic global warming denier/minimizer and you're anti-stem cell research. If you tell me you're pro-Intelligent Design, you will have the trifecta of idiocy!

more than 5 years ago

Submissions

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FDA testing artificial liver

NIckGorton NIckGorton writes  |  more than 5 years ago

NIckGorton writes "Research is now underway in the US to seek FDA approval for an artificial liver. The Extracorporeal Liver Assist Device (ELAD) filters blood through a cartridge containing immortalized human liver cells with fiber tubes running through that allow the patients blood to interact with them. This allows the matrix of liver cells to perform both the metabolic (cleansing the blood of toxins/waste) and synthetic (producing albumin, clotting factors, etc) functions of the patient's failing liver. A small trial in China showed a statistically and clinically significant difference in 30 day survival with ELAD.

This sounds like where renal dialysis was in the 70s: really expensive and dangerous and you will probably die anyway. However in patients with acute liver failure (ex: toxin exposure), ELAD might give them enough time to regenerate their liver and obviate the need for a transplant. At a minimum it may help transplant recipients survive longer and be healthier when they undergo surgery.

On a related note, if you haven't talked with your family about your wishes regarding organ transplantation yet, please do so! Just checking that box on your DL isn't enough, because your next of kin is the final decision-maker."

Link to Original Source
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Death of the consummate medical geek

NIckGorton NIckGorton writes  |  more than 6 years ago

NIckGorton (974753) writes "The father of modern heart surgery died this week at age 99. He was integral to the development of pretty much everything in modern cardiovascular surgery: bypass (heart-lung machines that made open heart surgery for the first time possible possible), coronary artery bypass surgery (he did the first one ever), carotid endarterectomey (again he performed the first one ever), the development of Dacron graft blood vessels, and the development of MASH units. He was a consummate geek and there are numerous surgical instruments that bear his name. He was also the first surgeon to videotape surgeries — in the 1960s. He was considered by the NEJM to be the single greatest surgeon alive until two days ago. In his career he performed over 50,000 heart surgeries and practiced medicine (though not surgery) until the day he died. Paradoxically in 2005, he underwent the Debakey procedure which he pioneered, to treat the aortic dissection he suffered."
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Jesus is coming.... You've Got Mail!

NIckGorton NIckGorton writes  |  more than 6 years ago

NIckGorton (974753) writes "Wired has posted a story about a website that will send an email to your loved ones excatly six days after the rapture (or when three of their staffers fail to log in to check their email for six days, whichever comes first.) For $40 yearly, they will send a post-rapture email to 62 people and maintain 150 megabytes of documents encrypted by something that could be as complicated as a decoder ring (to give the recipient access to your banking, brokerage, hidden valuables, and powers of attorneys). Otherwise, since there will be no bodies, your junk will be locked up in probate until the 7 year reign of the Antichrist is over. Which would obviously suck. http://blog.wired.com/27bstroke6/2008/06/service-lets-yo.html"
Link to Original Source
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The love that dare not squeak its name

NIckGorton NIckGorton writes  |  more than 6 years ago

NIckGorton (974753) writes "A sexually frustrated seal was caught on camera attempting to have sex with an unconsenting penguin. The description of this unusual behavior was published in the Journal of Ethology, complete with interspecies pron. According to one of the authors and witnesses to the event: 'At first glimpse, we thought the seal was killing the penguin, but then we realised that the seal's intentions were rather more amorous.' The researchers speculated that the seal, who was too inexperienced to get access to females, in a state of frustrated sexual arousal turned to a penguin for release."
Link to Original Source
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who gets the ventilator in a flu pandemic?

NIckGorton NIckGorton writes  |  more than 6 years ago

NIckGorton writes "A report, "Allocation of Ventilators in a Public Health Disaster," in the current issue of Disaster Medicine and Public Health Preparedness evaluates the ethics of deciding who gets (and who doesn't get) ventilator support (and hence who lives and dies) in a public health disaster like a flu pandemic. When a pandemic hits, it will not be pretty. On a good day we are using a large percentage of the vents we have. With even double the current usage, we will be in a crunch. With tens of thousands (if not more) of additional people potentially needing ventilator and ICU support, we will be hosed. http://www.nytimes.com/2008/03/25/health/25vent.html?ex=1364184000&en=af4c518e965534b8&ei=5124&partner=permalink&exprod=permalink"
Link to Original Source

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