Friday: Hili dialogue

June 16, 2023 • 6:45 am

Welcome to the tail end of the week: Friday, June 16, 2023; Cat shabbos begins at sundown, and it’s National Fudge Day. There are many kinds of this confections, but my favorites are chocolate or maple—with or without walnuts.


It’s also Bloomsday (the day in 1904 that the novel Ulysses takes place in Dublin), National Vinegar Day, Fresh Veggies Day, National Flip Flop Day (time to put them on for the summer), World Sea Turtle DayInternational Day of the African Child, and Ugliest Dog Day.

Here’s Mr. Happy Face, the winner of 2022’s Ugliest Dog Contest held in Petaluma, California. As the caption to the photo notes, “Janeda Banelly rescued Mr. Happy Face from a shelter in 2021. A survivor of a hoarder home, the poor pup experienced abuse and neglect at the hands of his previous owners, as well as myriad medical conditions, including cancer.”  Photo from AFP via Getty Images


Readers are welcome to mark notable events, births, or deaths on this by consulting the June 16 Wikipedia page.

Da Nooz:

BREAKING NEWS: The world’s largest known kidney stone was just removed from a patient in Sri Lanka. From CNN:

The world’s largest kidney stone has been removed from a patient in Sri Lanka – and it’s about the size of a grapefuit, as long as a banana and as heavy as four hamsters.

At 13.372 centimeters (5.26 inches) long and weighing 801 grams (1.76 lbs) the kidney stone broke two world records when it was removed by Sri Lankan Army doctors on June 1.

Previously the records were 13 centimeters for length, set in India in 2004, and 620 grams for weight, set in Pakistan in 2008, according to Guinness World Records.

And of course you’ll want to see a photo:

*Another Supreme Court vote that surprised me: Justices voted by a big majority to allow Native Americans to keep adoptees within their tribes (and traditions).

The Supreme Court on Thursday upheld a 1978 law aimed at keeping Native American adoptees with their tribes and traditions, handing a victory to tribes that had argued that a blow to the law would upend the basic principles that have allowed them to govern themselves.

Justice Amy Coney Barrett, writing for the majority, acknowledged the thorny subjects raised in case, which pitted a white foster couple from Texas against five tribes and the Interior Department as they battled over the adoption of a Native American child.

“The issues are complicated,” she wrote. “But the bottom line is that we reject all of petitioners’ challenges to the statute, some on the merits and others for lack of standing.”

The vote was 7 to 2, with Justices Clarence Thomas and Samuel A. Alito Jr. dissenting.

Under the Indian Child Welfare Act, preference is given to Native families, a policy that the couple said violated equal protection principles and discriminated against Native children and non-Native families who wanted to adopt them because it hinges on placement based on race.

The tribes have said that they are political entities, not racial groups, and that doing away with that distinction, which underpins tribal rights, could imperil nearly every aspect of Indian law and policy, including measures that govern access to land, water and gambling.

“Congress’s power to legislate with respect to Indians is well established and broad,” Justice Barrett wrote, adding that authority could extend to family law. “The Constitution does not erect a firewall around family law.”

But if they’re not “races” but political entities, does that give them the right to keep any human artifacts, like ancient bonds, found on land they claim (they have this right)? For there were no “political entities” among ancient Native Americans.

*We all know that if Walt Nauta, Trump’s valet and co-defendant, flips, Trump will be even more “toast” than he is now. The WaPo discusses the question and its implications.

The 40-year-old body man [JAC: this must be a politically correct synonym for “valet”] from Guam now faces 20 years in prison if convicted of the most serious charge against him. Sporting a wide scarlet tie a few shades deeper than his boss’s candy red one, Nauta, once a Navy sailor, made his first appearance in a Miami federal courthouse Tuesday to face charges that he obstructed justice, withheld and concealed a document from the government, and lied to FBI agents.

A key question hovering over the case now is whether Nauta will cooperate with prosecutors against Trump in hopes of a lesser sentence.

Nauta — who spent Tuesday bizarrely toggling between the roles of co-defendant, equal under the law to Trump, and dutiful “body man,” subservient to the former president — has showed no signs that his loyalty to Trump is waning.

Trump’s lawyers and advisers do not see Nauta as a threat to turn, according to people familiar with the matter, who spoke on the condition of anonymity due to the sensitivity of the criminal case.

According to the indictment, Nauta helped bring boxes to Trump’s residence at Mar-a-Lago for his review before Trump returned 15 boxes of documents to the National Archives in January 2022. When interviewed by the FBI in May 2022, however, prosecutors allege Nauta falsely said he had no knowledge of the boxes being taken to Trump’s suite.

He then could be seen on surveillance video removing 64 boxes from the club’s ground floor storage room after Trump received a grand jury subpoena seeking classified records in May 2022. According to the indictment, he was spotted returning only 30 boxes to the room, just before a lawyer for Trump searched the room for documents to turn over to the government in response to the subpoena.

Trump and Nauta spoke repeatedly by phone before Nauta moved the boxes, the indictment alleges. The indictment does not detail what the two discussed. If Nauta chose to cooperate, he could presumably explain what Trump told him on those calls — and offer evidence about whether Trump instructed him to lie to the FBI.

As the article notes, Nauta has already been accused of lying to the FBI, and that erodes his credibility as a witness should he decide to become a canary and turn against Trump. We’d all like to see that, but it seems unlikely:

Those who know him find it implausible that Nauta will turn on Trump or relinquish the perch as the former president’s right hand man — a job that those close to Nauta have described as a source of prestige and pride.

Well, one can hope. . .

*Can a President be elected while in jail, and even govern from his cell? We are, of course, referring to Trump, and those are the questions Nicholas Kristof asks in the NYT.

An absurd question keeps nagging at me: Could an inmate in a federal prison get a leave to attend his own presidential inauguration?

I wonder about that because Trump seems to be moving simultaneously in two opposing and irreconcilable directions. First, it seems increasingly plausible that he will become the first former president to be convicted of a felony. Second, he also seems increasingly likely to win the Republican nomination for president, with the betting markets also giving him about a 22 percent chance of going on and actually being elected president.

Any defendant must be presumed innocent until proven guilty. But some smart lawyers believe that for Trump, the “peril is extreme,” as one former federal prosecutor put it. Trump’s own attorney general William Barr said, “If even half of it is true, then he’s toast.”

. . .But Trump could eventually be indicted in four separate criminal cases, and with so many cases swirling about, the odds increase that he may find himself convicted of at least some felonies.

He would be a first offender, and it’s not certain that he would do prison time. Officials so far have been very deferential toward Trump: He hasn’t been handcuffed or subjected to a mug shot.

Still, deference may end upon conviction, and defendants in less serious cases have ended up with substantial prison sentences.

Even if Trump is convicted and imprisoned, he could continue to run for office and even presumably hold the office of president, if he isn’t too busy in the prison factory making license plates. Eugene Debs, the socialist candidate, famously ran for president from federal prison in 1920, receiving almost one million votes.

I don’t believe this could happen. A President in prison could surely be impeached on the grounds that he couldn’t perform his duties, even if the law allows him to hold office while in stir (Kristof seems to think it does).

All in all, I think Trump is going down. But my nightmare is that the United States slips into a recession that voters blame on President Biden, that there is a Middle East crisis that raises oil and gas prices and that there is a third-party candidate who draws more votes from Biden than from Trump. Or perhaps Biden has a health crisis and the Democratic nominee is Kamala Harris, who I fear would be a substantially weaker candidate. In short, Trump’s election as president seems unlikely, but not impossible — and the consequences could be catastrophic.

I wish I was as sure as Kristof, who seems to be just spinning his wheels in this column.

*In some place AI programs now have the authority to overrrule nurses, a protocol that might not be to the patient’s benefit. The story starts when an AI-run program tells an oncology nurse that her patient is in sepsis when she’s sure he’s not (he’s got leukemia).

Hospital rules require nurses to follow protocols when a patient is flagged for sepsis. While Beebe can override the AI model if she gets doctor approval, she said she faces disciplinary action if she’s wrong. So she followed orders and drew blood from the patient, even though that could expose him to infection and run up his bill. “When an algorithm says, ‘Your patient looks septic,’ I can’t know why. I just have to do it,” said Beebe, who is a representative of the California Nurses Association union at the hospital.

As she suspected, the algorithm was wrong. “I’m not demonizing technology,” she said. “But I feel moral distress when I know the right thing to do and I can’t do it.”

Artificial intelligence and other high-tech tools, though nascent in most hospitals, are raising difficult questions about who makes decisions in a crisis: the human or the machine?

The technologies, which can analyze massive amounts of data with a speed beyond human capacity, are making extraordinary advances in medicine, from improving the diagnosis of heart conditions to predicting protein structures that could speed drug discovery. When it is used alongside humans to help assess, diagnose and treat patients, AI has shown powerful results, academics and tech experts say.

In a survey of 1,042 registered nurses published this month by National Nurses United, a union, 24% of respondents said they had been prompted by a clinical algorithm to make choices they believed “were not in the best interest of patients based on their clinical judgment and scope of practice” about issues such as patient care and staffing.” Of those, 17% said they were permitted to override the decision, while 31% weren’t allowed and 34% said they needed doctor or supervisor’s permission.
This is a tough one, and the piece ends with a tale of a patient in excruciating pain with cancer in his bones. The nurse wanted to give him oxycodone, but the machine said no: the doctor didn’t allow pain medication until five hours later.

“The computer doesn’t know the patient is in out-of-control pain,” she said.

Still, she didn’t act. “I know if I give the medication, I’m technically giving medication without an order and I can be disciplined,” she said. She watched her patient grimace in pain while she held the pain pill in her hand.

Well, what do you think?

*No more hidden fees for concert tickets! (If you’ve ever bought them online, you’ll know how sleazy and annoying this is.)

Under pressure from the Biden administration, some of the biggest companies that handle ticketing for concerts and other live events announced on Thursday that they will make it easier for consumers to see the full price of tickets they want to buy, including the fees that can often add more than 30 percent to the total cost of an order.

Live Nation, the world’s largest concert company, said it would begin introducing “all-in pricing” — showing consumers the full price up front — at the venues it controls, which include more than 200 amphitheaters, clubs and other spaces in the United States. Ticketmaster, which is owned by Live Nation, said it would make this tool available to other venues and promoters as well. Those changes are expected beginning in September.

SeatGeek, a major vendor for reselling tickets that also works for major venues and sports teams like the Dallas Cowboys, said it too would begin introducing a feature that would reveal to consumers the full price of a ticket.

Those changes come as the Biden administration has stepped up its pressure on the entertainment and travel industries to rein in what it calls “junk fees.” Before beginning a round table at the White House with executives from Live Nation, SeatGeek, Airbnb and other companies on Thursday, President Biden framed the crackdown on surcharges as a way to appeal to the working class — a major theme of his re-election campaign.

“These hidden charges that companies sneak into your bill make you pay more without you really knowing it initially,” Mr. Biden said. “Junk fees are not a matter for the wealthy very much but they’re a matter for working folks like the homes I grew up in.”

Chalk up another good thing to Biden. We all hated those fees!

Meanwhile in Dobrzyn, Szaron is protecting Baby Kulka, whom Hili despises. (Look at Hili’s ears!) The funny thing is that sometimes Kukla attacks Szaron.  It’s a cat-eat-cat world out there.

Szaron: You will not attack Kulka!
Hili: Look at this feline knight in shining armour.
In Polish:
Szaron: Nie będziesz atakować Kulki!
Hili: Znalazł się, koci rycerz.


From Stash Krod. It appears to be a letter to a vet from a kid, and I really hope it’s real:

From Facebook’s Absurd Sign Project:


From Masih, a British woman re-enacts the story of 10 Bahai women; their story appears at the end of the heartbreaking video:

From Malcolm: Cat pwns fox. Sound up!

From gravelinspector: the atavistic “claws” of an ostrich and (second tweet) a baby hoatzin. He adds:

Everyone not a signed-up Creation Research Institute subscriber knows that Hoatzin avalian dinosaurs have big manual claws as chicks. It’s not a unique trait.  This thread includes ostriches and red partridges in the “clawed-hand” group. Which is a very paraphylectic group.
Actually, for ostriches, it shouldn’t even be a surprise.  The occasional atavism (technical term? “Throw-back”, to headline-writers.) is likely to be a survival advantage in a chick of a flightless species. Which would make re-acquisition of the character an interesting case.

My own tweet, with the figure taken from D.J.G.’s FB page. The content is not sensitive—it’s an optical illusion.

From the Auschwitz Memorial, a Czech Jew who died about age 24 in the camp:

Tweets from Dr. Cobb, now in Paris.  I wouldn’t have been able to stand by and take video; I would have helped the raccoon.

A beautiful murmuration:

This is a good one:

52 thoughts on “Friday: Hili dialogue

  1. On this day:
    1824 – A meeting at Old Slaughter’s coffee house in London leads to the formation of what is now the Royal Society for the Prevention of Cruelty to Animals (RSPCA).

    1858 – Abraham Lincoln delivers his House Divided speech in Springfield, Illinois.

    1871 – The Universities Tests Act 1871 allows students to enter the universities of Oxford, Cambridge and Durham without religious tests (except for those intending to study theology).

    1883 – The Victoria Hall theatre panic in Sunderland, England, kills 183 children. [The resulting inquiry led to legislation that public entertainment venues be fitted with a minimum number of outward opening emergency exits, which led to the invention of “push bar” emergency doors.]

    1884 – The first purpose-built roller coaster, LaMarcus Adna Thompson’s “Switchback Railway”, opens in New York’s Coney Island amusement park.

    1903 – The Ford Motor Company is incorporated.

    1903 – Roald Amundsen leaves Oslo, Norway, to commence the first east–west navigation of the Northwest Passage.

    1904 – Irish author James Joyce begins a relationship with Nora Barnacle and subsequently uses the date to set the actions for his novel Ulysses; this date is now traditionally called “Bloomsday”.

    1911 – IBM founded as the Computing-Tabulating-Recording Company in Endicott, New York.

    1944 – In a gross miscarriage of justice, George Junius Stinney Jr., age 14, becomes the youngest person executed in the United States in the 20th century after being convicted in a two-hour trial for the rape and murder of two teenage white girls.

    1948 – Members of the Malayan Communist Party kill three British plantation managers in Sungai Siput; in response, British Malaya declares a state of emergency. [The Malayan Emergency didn’t end until 31 July 1960 – Dad did his national service in the jungles of Malaya in the mid-’50s.]

    1955 – In a futile effort to topple Argentine President Juan Perón, rogue aircraft pilots of the Argentine Navy drop several bombs upon an unarmed crowd demonstrating in favor of Perón in Buenos Aires, killing 364 and injuring at least 800. At the same time on the ground, some soldiers attempt to stage a coup but are suppressed by loyal forces.

    1961 – While on tour with the Kirov Ballet in Paris, Rudolf Nureyev defects from the Soviet Union.

    1963 – Soviet Space Program: Vostok 6 mission: Cosmonaut Valentina Tereshkova becomes the first woman in space.

    1972 – The largest single-site hydroelectric power project in Canada is inaugurated at Churchill Falls Generating Station.

    1976 – Soweto uprising: A non-violent march by 15,000 students in Soweto, South Africa, turns into days of rioting when police open fire on the crowd.

    1981 – US President Ronald Reagan awards the Congressional Gold Medal to Ken Taylor, Canada’s former ambassador to Iran, for helping six Americans escape from Iran during the hostage crisis of 1979–81; he is the first foreign citizen bestowed the honour.

    2010 – Bhutan becomes the first country to institute a total ban on tobacco.

    2012 – China successfully launches its Shenzhou 9 spacecraft, carrying three astronauts, including the first female Chinese astronaut Liu Yang, to the Tiangong-1 orbital module.

    2015 – American businessman Donald Trump announces his campaign to run for President of the United States in the upcoming election.

    2019 – Upwards of 2,000,000 people participate in the 2019–20 Hong Kong protests, the largest in Hong Kong’s history.

    1723 – Adam Smith, Scottish philosopher and economist (d. 1790).

    1890 – Stan Laurel, English actor and comedian (d. 1965).

    1902 – Barbara McClintock, American geneticist and academic, Nobel Prize laureate (d. 1992).

    1917 – Katharine Graham, American publisher (d. 2001).

    1934 – Eileen Atkins, English actress and screenwriter.

    1938 – Joyce Carol Oates, American novelist, short story writer, critic, and poet.

    1941 – Lamont Dozier, American songwriter and producer (d. 2022).

    1946 – Neil MacGregor, Scottish historian and curator.

    1858 – John Snow, English epidemiologist and physician (b. 1813).

    1939 – Chick Webb, American drummer and bandleader (b. 1905). [A childhood accident resulted in tuberculosis of the spine, leaving him with short stature and a badly deformed spine which caused him to appear hunchbacked. The idea of playing an instrument was suggested by his doctor to “loosen up” his bones. He supported himself as a newspaper boy to save enough money to buy drums, and first played professionally at age 11. He became one of the best-regarded bandleaders and drummers of the new “swing” style. Drummer Buddy Rich cited Webb’s powerful technique and virtuoso performances as heavily influential on his own drumming, and even referred to Webb as “the daddy of them all”.]

    1959 – George Reeves, American actor and director (b. 1914).

    1971 – John Reith, 1st Baron Reith, Scottish broadcaster, co-founded BBC (b. 1889).

    1977 – Wernher von Braun, German-American physicist and engineer (b. 1912).

    1982 – James Honeyman-Scott, English guitarist and songwriter (b. 1956). [Jackson Browne played “For a Dancer” in memory of Honeyman-Scott at Glastonbury a few days later.]

    1999 – Screaming Lord Sutch, English singer and activist (b. 1940).

    2016 – Jo Cox, English political activist and MP (b. 1974). [Murdered by an extremist during the campaigning in the run-up to the Brexit referendum.]

    1. Pleased to see you picked James Honeyman-Scott (the Pretenders) to mention. He achieved his success as lead guitarist, and wrote some of the songs, without being able to read music.

  2. “A President in prison could surely be impeached on the grounds that he couldn’t perform his duties, even if the law allows him to hold office while in stir (Kristof seems to think it does).”

    He definitely COULD be impeached, but it would take a 2/3 vote of the Senate to convict him and remove him from office. Sadly, I don’t think it’s remotely conceivable that a sufficient number Republicans would support that effort.

  3. It is absurd to me that a nurse could not get in touch with her attending physician for 5 hours. And why weren’t pain medications already prescribed for a patient in the hospital with bone metastases? Was there a opioid shortage? Who would they be saving pain medications for?
    I am suspicious of that whole AI vs nurse scenario.

    1. AI should always be a pilot’s assistant, a driver’s assistant, a nurse’s or doctor’s assistant…not the boss. Per Tom B in the case described, it is hard to believe that an attending, resident, or nurse practitioner was not available for consult. I had some experience thirty years ago with the foundations of AI development of autopilots and the lack of formal proofs for the AI algorithms and the experience of our test pilot/engineers was that these were valuable assistants but it was still the pilot’s airplane. I think the autopilot rule on the Tesla car is similar…the human driver is ultimately responsible.

      1. This is true for now, but what about a future where (say) the accident rate of AI-driven cars is way below that for humans, or where the AI error rate for medical diagnoses is way better? This could be less than a decade away …

        1. Yes. Certainly. But we need the data to human-rate these technologies and, though I have been out of the game for a while, I sense that we are not there yet. And we must be aware of the hucksters and snake oil salesmen. I think that AI is still limited by its training set. Maybe a religious thing: In god we trust. All others must bring data.

    2. The health care industry is very much in a “let’s get rid of our workers” mode. So two things might contribute to what happened: 1) short-staffing, so a physician may not have been available, or spread too thin to get to the patient in a timely fashion; 2) the nurse feared for her job, and dispensing powerful drugs without a prescription would be grounds for firing. The scenario sounds plausible to me.


      1. “The health care industry is very much in a “let’s get rid of our workers” mode.”

        True. And that’s a “mode” many industries are in, since everyone who runs a business knows, the most expensive aspect of running a business is its workers. It’s also what can make a great business succeed and flourish, but that fact doesn’t come into play in most board rooms.

      2. My wife and I are well aware of the “let’s get rid of our worker” mode. A little over a year ago, she was the victim on a hit and run driver while walking our dog. During the week she spent in intensive care, we spoke to one doctor who had to come into her room to examine her eye for possible damage. We were constantly told that the doctor would telephone us. I have wasted 13 months sitting by the phone waiting.

  4. The vote was 7 to 2, with Justices Clarence Thomas and Samuel A. Alito Jr. dissenting.

    Thomas and Alito are the two oldest and most reactionary justices and appear to be off on an ice floe of their own that’s broken contact with the rest of the Court.

    1. I am afraid you could almost say the same of the republican party. It is a party of losers lead by a loser. They have no agenda for the people and have developed into a full blown Facist organization. Their future is the dust bin of history. They will lose badly in the next election and will then be removed from the constant news of the day. The few republicans at this site will likely go with them. I am hopeful the republicans in Kansas will also be gone.

    2. I am just speculating and can easily be wrong, but I get the sense that Alito and Thomas are personally two very bitter people. Rigid in their certainty of how government and society should work, they can’t understand why their arch conservative views have not received universal acceptance. Consequently, they have become very cantankerous, spewing their venom in their many dissents.

    3. Yes, two justices that need to go, but we’ll presumably be stuck with them for many years to come. Case in point as to why we need some form of term limits for SCOTUS justices. Either rigid time limits…I’d say max 20 years, or rigid age limits. Maybe 75, which would boot Thomas in a year and Alito in two. I also just learned that Alito was born April 1st: talk about your April Fool!

      I understand these term limits would have hampered great justices like RBG, but that’s a sacrifice I’m willing to make. It is apparent that many SCOTUS justices with lifetime appointments, no ethical constraints, no political constraints and no public accountability can become very dangerous people indeed. I’d much rather stop this kind of corruption via term/age limits than fret about cutting short an honorable justice’s time on the bench.

  5. The 40-year-old body man [JAC: this must be a politically correct synonym for “valet”] …

    I think “body man” is more a bit of jargon developed by the White House press corps for a president’s close personal aide. It’s been around for at least a couple decades now.

    Reggie Love, a former varsity basketball and football player from Duke, was Barack Obama’s body man.

    1. It’s been around awhile. A friend of mine was asked to be the body man for our newly elected Senator ten or so years ago. My friend was a very bright twenty something who was just starting out in politics and government, and this position would be a wonderful internship for him while providing an extremely competent service to the Senator.

        1. I heard it at a Navy installation. Admirals are “general officers” (though not Generals), but they don’t often ride horses! Seahorse-holder? Maybe the Navy has its own lingo.


  6. No, AI should absolutely not be able to overrule nurses. For my part I cannot understand the rush to AI. We’ve been playing at work with AI, and it is unreliable. The more important the object, the less you should rely on it. There have been plenty of stories about AI generating false information, even quotes. And here is a story about AI learning from other AI, which degrades the output.

  7. >>> Chalk up another good thing to Biden. We all hated those fees!

    Oh, the fees are still there, just not hidden until the last second.

  8. The only restrictions the Constitution puts on Presidential candidates is that they must be a natural-born citizen of the United States, over thirty-five years of age, and (per the 22nd Amendment) that they have not already served two terms. Of course, a President could be impeached, but he also has to be tried and convicted. The more likely path would be the 25th Amendment (one could make a case that incarceration prevents him from performing his duties), although Trump wouldn’t be likely to appoint Cabinet members who would go that route. All this assumes he is convicted, and sent to prison.

      1. I read that piece in The Federalist by Will Scharf, DrB.

        Scharf offers no defense to the obstruction of justice and false statement counts pending against Donald Trump. He instead repeats the claim that DoJ lawyer Jay Bratt made improper overtures to Walt Nauta’s lawyer, Stanley Woodward, that Woodward’s application for a judgeship might be looked on more favorably were Nauta to cooperate against Trump.

        Assuming the truth of this allegation, and viewing it in the light most favorable to Trump and Nauta, the remedy for this ethical violation would be for Bratt to face sanctions and potential disqualification from representing the government in this case. The remedy would NOT be the dismissal of the obstruction of justice and false statements against Nauta (much less the charges pending against Trump).

        If Donald Trump had a legitimate claim to possession of the documents under the Presidential Records Act (which seems doubtful), his remedy upon being served with a federal grand jury subpoena would have been to go to court and file a motion to quash the grand jury subpoena. He had no right to repeatedly lie to investigators, to hide documents from investigators and his own lawyer, and to have his lawyer file a false sworn declaration claiming that Trump was not in possession of any additional documents responsive to the subpoena.

        I’ve yet to hear anyone propose a plausible theory of defense for Donald Trump to the obstruction of justice and false statement charges, and Scharf certainly doesn’t do so in his Federalist piece.

    1. Just picture inauguration day! Trump taking the oath of office from a jail cell and repeating those immortal words: “I do solemnly swear (or affirm) that I will faithfully execute the Office of President of the United States, and will to the best of my ability, preserve, protect and defend the Constitution of the United States.”

      I will wait for the judicial process to run its course in this case before I “predict” what will be the status/result of the 2024 election.

      1. “I will wait for the judicial process to run its course in this case before I “predict” what will be the status/result of the 2024 election.”

        Something tells me the judicial process won’t have run its course before the 2024 election. Not only will Trump delay as much as possible, there is still the impending indictments coming out of Georgia. I think he’ll win the GOP nomination and then continue to run while being harried by several investigations and trials. Though my hope is that someone else wins the GOP nomination and Trump runs as a 3rd party candidate. I know, magical thinking…though it isn’t impossible. 🙂

  9. Sepsis is a difficult diagnosis. It is also a major cause of death – something like #6. The symptoms are far from unequivocal, mimicking the flu. There have been instances of patients presenting in the ER during a flu outbreak who have been sent home, where they died. Alternatively, suspecting sepsis when it isn’t can also happen.

    Plus, a variety of bacteria can be the cause, with no difference in symptoms. Fortunately, it’s almost always just a single species and also fortunately there are only about a dozen that cause sepsis. The best treatment comes from knowing what bacterial species is present. Unfortunately, that still comes from blood culture, with results taking at least two days. Two days that the patient doesn’t have.

    So the most frequent treatment is to give a broad-spectrum antibiotic vs. one that targets the culprit species while waiting for the lab results. Unfortunately, broad-spctrum antibiotics risk damaging the kidneys.

    So the dilemma is, do you risk damaging the kidneys of someone who doesn’t actually have sepsis, or do you wait for the lab results while the patient likely deteriorates.

    (I’m not an MD, but I’m one of several incl an MD with some patents on a technique that can identify bacterial species within an hour, that uses no PCR, fluorescence, radioactivity or mass spectrometry. This idea that diagnosis can be done by AI is not helping.)

    1. From recent experience, I gather that sepsis can be indicated by high blood lactic acid levels. Finding a high level doesn’t identify the causative organism, but does suggest use of broad spectrum antibiotics and supportive care. Blood lactic acid is a quick test.


      1. Apparently high lactate is found in only about half of the cases. So high levels support the diagnosis but normal levels don’t rule it out.

    2. Unfortunately blood cultures are only rarely positive in sepsis today. The more usual scenario is that permeability of the epithelium of the GI tract in a typically elderly person sick with something else allows inflammatory cytokines generated from the trillions of bacteria there to leak into the blood stream and cause the circulatory dysregulation we see as sepsis. Most patients in the ICU with severe Covid had sepsis (“cytokine storm”) but few had any evidence to implicate bacterial infection (until later, when ICU infections set in.)

      So the usual practice is to start antibiotics while the diagnosis is unclear and then dial back if no bacteria are found. This is not always easy to do because if the patient gets better in 48hr the temptation is to attribute improvement to antibiotics and not risk stopping too soon. If the patient is still critically ill, you think well, maybe the antibiotics haven’t had time to work yet. Two days of antibiotics won’t hurt anyone but two weeks is another matter altogether.

      Sepsis remains a very difficult problem, largely because of the nature of the patients who get it. But Group A strep and meningococcus can still kill a healthy child in a few hours.
      Bottom line is if your doctor starts antibiotics at diagnosis of sepsis, it’s still usually the right thing to do in current state of knowledge.

      AI in all this is after my time. I will say a good nurse knows when her patient is in early sepsis. No “A” about that Intelligence.

      1. A lot of negative culture results are apparently due to giving antibiotics prior to drawing the blood sample. Having the ability to identify bacterial species – not just bacteria yes or no – within an hour or so would greatly enhance treatment approaches, especially since our approach only detects live bacteria.

  10. Oh, and, as someone who has had kidney stones twice, that story is horrifying. Good god, how long did that many suffer?

    1. Nurses know to call the doctor to change the order if doses “every six hours” is too far apart, and it is for drugs of that type. If a dose is going to be effective, it will be effective within 20 or 30 minutes (or sooner if by injection.). If still pain -> repeat dose. It’s true she can’t give any drug more frequently than ordered. But the solution is to get the order changed, and educate the doctor on dosing of pain meds. (Yes, addiction and overdosing and all that. But there is a place for that.)

      This sounds like a problem created by AI.

    2. Sorry, I didn’t realize you were referring to the giant kidney stone. It’s the little ones that hurt, because they can be passed into the powerfully muscular ureter. I saw a photo of that stone elsewhere. It had formed gradually in what we call the renal pelvis, distending it as it made a plaster-like cast of that anatomic structure. Way too big to pass down, it might have caused no symptoms at all. The article made the point that with CT and ultrasound being used so extensively, sometimes these things just turn up as incidental findings. (I don’t know what led to the diagnosis in this particular patient.)

      Hope you don’t have any more stones yourself.

  11. Absurd sign Project: in this context 4 for 10$ is _not_ the same as 2 for 5$. The first means you have to buy at least 4 to get the (presumably better) unit price, while in the latter case you can buy just 2 for the price.

    1. I don’t know about Walmart, but some stores don’t have minimum quantities. If they do, a sign will usually add at the bottom something like “must buy 4”. It dpends on the grocer.


      1. I think you’re in the UK? Perhaps it’s different there. In North America, if you see “x for $y” then you must buy x items to get the discounted price. Otherwise they’ll just list a discounted price per unit.

      2. Normal (not wholesale) stores usually do not have minimum quantities. However this is not a minimum quantity to buy the product in general, it is minimum quantity to get a sale price. For example you can buy just one for 3$, but if you buy two at once it costs 2.5$ each.

        This is pretty common in various stores where I live, however I have never been to the USA. But what would even be the point of giving a group price if there was no minimum quantity (group size) defined for it?

    2. My thought, too.

      Nobody who struggles to pay for groceries would ever think that 4 for $10 was the same as 2 for $5, even if the net price per unit is the same.

  12. In note about Indian Child Welfare Act: “For there were no “political entities” among ancient Native Americans.” Seems like the continent was awash in political entities, but maybe you’re referring to something else. Indians as considered in the US Constitution and countless other documents were political entities. Every tribe, sub-tribe, Pueblo, etc. was a political entity. And there were larger political entities like the Iroquois Confederation. Treaties were agreements (of a sort) between political entities. Of course, nothing startling here.

  13. Well, the individual tribes may be political groups, but the law in question applies to all Native Americans, who have been a racial group for a couple hundred years ever since the term “red-skin” started to get bandied about by people of all hues. Gotta give their lawyer credit for trying that tactic, though; it seems to have worked.

  14. We generally refer to Navy admirals as “flag officers”; generals in the Army, Air Force, Space Force, and Marines are “general officers”. The language is out of Title 10 U. S. Code.

    The Navy has all sorts of special lingo: the “aviators” would correct me when I called them pilots; the captains were senior ranking rather than junior. (In joint jobs, we oftentimes just said O-3 or O-6, so that we all were speaking of the same rank.) I learned what I had to of the lingo when working for admirals, but I never did get a handle on the Navy enlisted ranks.

    I picked up some derogatory slang of one naval community for another, but learned quickly that this was an in-house thing. Kinda like “I can call my brother that, but YOU CAN’T call my brother that.”

    Some older forms of slang for an aide would be ill advised today.

  15. “Sporting a wide scarlet tie a few shades deeper than his boss’s candy red one . . . .”

    Wear it out, Washington Post. Why stop there? Was he wearing striped socks like the Speaker of the House in the Oval Office? Can’t wait to hear the NY Times’s fashion editor, Vanessa Friedman, offer her sartorial pearls of wisdom.

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