But most animals don't leave it intact. They chew through it shortly after birth. You can't really have a tissue that is sturdy enough to survive tension during fetal development and vaginal delivery that then instantly falls apart, so it has to be manually severed after delivery. The vast majority of mammals don't let it stay attached for long at all, because their offspring are pretty mobile immediately after birth. From my reading of some of the random websites that recommend this, apparently it was based on the observations of a single species of higher ape (a chimp I think) that doesn't sever the umbilical cord quickly. But when we have been severing cords as a species for generations and the vast majority of other mammals sever the cord with their teeth, I think the evolutionary biology evidence points towards severing the cord quickly.

Now evolutionary biology isn't a solid basis for medical practice, but we don't really have much scientific data at all to base this on at this point. There have been reports of increased rates of serious infections from the practice, which has face validity with the fact that you're leaving a devascularized piece of tissue attached to the vascular system of neonate with an immature immune system. Outside of infection, there has been some case reports of polycythemia (excessively high red blood cell count) and jaundice in these infants. This makes sense physiologically. While attached to the placenta there is a greater intravascular volume available to the infant, which is the entire basis behind delayed cord cutting. It stands to reason that continuing to allow that extra blood volume to enter the infant would result in polycythemia and jaundice.

I'm not intimately familiar with the foundational literature by which the standard DCC cutoffs of 1 minutes or cessation of umbilical pulsatility were founded upon. There could be a very real argument for saying, should the time be 2 minutes? 5 minutes instead of 1? Or should we at least study it if it hasn't been already?

In summary, we have a piece of dead/dying tissue attached to a physiologically stressed neonate with an immature immune system. Leaving it attached for days is in contradiction to the vast majority of other mammalian labor behaviors, is inconsistent with the majority of human's labor history, and has a clear pathological mechanism by which the commonly reported complications can be easily explained. Without some legitimate evidence to actually support benefits or disprove the risks, I think this practice should be discouraged by healthcare professionals.

My table tends to not metagame at all, even in situations I really wish they would. I think of all the answers I've gotten, this is the most reasonable and actionable answer. Just remind the player more often. I'm gonna have to come up with a good way to not sound like a condescending asshole because this is the only player I'm going to have to do it to. It just sucks cause it's one more thing I've gotta do while running combat. But that's life I guess

I go back and forth on this. I feel like I'm enabling these choices by pulling punches. But it feels excessively anti-fun to just kill them and be like "sorry lol be better". I don't think I have the heart to just murder characters all the time.

As a general rule, yes. People who are able to better perform a task should be preferentially allocated towards those tasks. That being said, I think this should be a guiding rule, not a law upon which a society is built.

For one, there should be some accounting for personal preference. No one should be forced to do something by society just because they're adept at something. I think there is also space within the acceptable performance level of a society for initiatives to relax a meritocracy to some degree to help account for/make up for socioeconomic influences and historical/ongoing systemic discrimination. Meritocracy's also have to make sure they avoid the application of standardized evaluations at a young age completely determining an individual's future career prospects. Lastly, and I think this is one of common meritocracy retorhic's biggest flaws, a person's intrinsic value and overall value to society is not determined by their contributions to STEM fields and finance, which is where I think a lot of people who advocate for a more meritocracy-based society stand.

You're generalizing a specific phenomenon, and incorrect. Acid-base reactions only very rarely produce gases. The reactions produce heat and water, only in the case of bicarbonate being a base is a gas produced. This is because carbonic acid forms, which spontaneously decays into carbon dioxide. This is not a universal acid-base phenomenon. Soaps should not cause fizzing with vinegar.

You'll have to strike a balance between security and ease. Your two major options are reverse proxy and VPN (Tailscale is one option for VPN)

For reverse proxy, you functionally open the app to the internet. Anyone with the correct web address can access the login page. This is inherently less secure than VPN, but not irresponsibly so. Beyond the reverse proxy itself, you'll also have to learn how to configure an HTTPS certificate to increase security since it will be open to the internet.

For VPN, every user you want to be able to access the service has to be tied into the VPN and have the VPN running throughout their access. Tailscale is arguably the easiest way to configure a VPN right now, as you won't have to manually deal with VPN configuration files for every device. VPN use will functionally make it like you're on your home network. VPN access to your network should not be given to tons of people if at all possible.

Thank you for your insightful and well-researched response. I'll remember that as I continue to provide high-quality evidence based care to all of my psychiatric patients in the future while you bitch about stuff on the internet.

Hello all, I'm a pharmacist and 4th year medical student with a passion for antimicrobial stewardship and infectious disease. Just wanted to share my overall thoughts on the article.

The author's point of "finding out if you really need an antibiotic" is honestly one of the central issues in modern antimicrobial resistance coming from two fronts: patients who demand an antimicrobial for a non-indicated reason, and doctors who for various reasons excessively prescribe antibiotics. I could wax on this for hours, but at its core, the single most important thing we can do to decrease antimicrobial resistance is decreasing total antimicrobial exposure. That means fewer prescriptions for shorter courses of narrow-spectrum antibiotics. Unfortunately every bit of this requires more buy-in from patients and more work from clinicians.

To go along with my point above, asking your doctor to make sure you're getting the shortest possible duration is the single best thing you as a patient can do to help with these issues (other than just not demanding antibiotics if your doctor says no, but that's a low bar). The key word here is ask though. There's a huge amount of clinical experience and evidence that is used to determine when it is safe to stop antibiotics. And as much as I believe in patient autonomy and educating my patients, frankly antibiotic selection/course duration is not something the general public is capable of independently making decision on. Ask your doctor, and take what they prescribe for how long they're prescribed for, and if you have issues then call them to discuss it.

With regards to probiotics, it's an interesting topic that we don't have a ton of great data for and physicians are fervently behind or against them in my experience. The fact is we just don't know enough about them, and most aren't regulated well enough to give good information about them. Interestingly, there was a recent study which suggested higher rates of central line infections with the organisms in the probiotics in individuals given probiotics while they had a line in place.

Lastly, I think I have to disagree with Dr. Blaser. Medicine doesn't overvalue antibiotics. We certainly underestimate their risks, but antibiotics are some of the most effective and life-saving medications we as a species have ever developed. Countless lives have been saved solely from their development, and very very few therapies have a NNT as low as appropriate antimicrobial therapy. They truly are astonishingly good medications when they are indicated. The issue is simply prescribing them when they aren't indicated, which is a big part of why we're in the mess we're in, and is in large part driven by underestimating the risks they pose.

Except these physicians are often completing something called a "peer-to-peer" on behalf of the insurance companies, not just making broad treatment decisions. This is a process by which an ordering physician is required to call a physician employed by the insurance company to justify a testing or treatment course to their "peer". Unfortunately these "peers" are often composed of physicians who did not complete residency and/or who do not currently practice, let alone in the specialty of the physician who is required to call for the peer-to-peer.

This leads to rather absurd results in which a board certified, practicing sub specialist (cardiologist, neurosurgeon, oncologist, etc) with 5+ years of specialized training after medical school has to convince a physician who may never have even practiced that they know what they're doing. I personally think if you're not a neurosurgeon, neuroradiologist, or neurologist then you aren't really qualified to cancel a neurosurgeons MRI, but hey, I don't get a bonus for denying claims.

• A Fourth Year Medical Student and Pharmacist

Yes, but most DRM has been circumvented in one way or another. DRM primarily continues to keep law-abiding citizens from easily acquiring a copy of media they rightfully own as opposed to preventing piracy.

Though if institutions insist on utilizing DRM for prevention of privacy, I do think that DRM should be built to fail after a meaningful timeframe, at worst the expiry of the copyright for the material. Unfortunately many pieces of media, particularly video games, are abandoned and unsupported long before their copywriter expires. Abandonware in general is not well handled by modern copywrite law.

4th year medical student. AI is not ready to be making any diagnostic or therapeutic decisions. What I do think we're just about ready for is simply making notes faster to write. Discharge summaries especially, could be the first real step AI takes into healthcare. For those unaware, a discharge summary is a chronological description of all the major events in a patient's hospitalization that explain why they presented, how they were diagnosed, any complications that arose, and how they were treated. They are just summaries of all of the previous daily notes that were written by the patient's doctors. An AI could feasibly only pull data from these notes, rephrasing for clarity and succinctness, and save doctors 10-20 minutes of writing on every discharge they do.

Works for PhD's, but try doing oral exams for 1000 Bio101 students.