They can "survive" autoclave cycles that render other pathogens dead/inactive, but there do exist autoclave cycles that seem to pretty reliably inactivate prions.
That article also makes it seem like patients in Pakistan are receiving what seems to me like a wildly high number of injections:
> An injection was provided during 53% of patient visits in Rawalpindi and 92% in Tando Allah Yar
> Patients from Tando Allah Yar reported a mean 3.8 visits to a healthcare provider by a member of their household during the previous month, compared to 2.5 by those from Rawalpindi (Table 2). During all such visits, an injection was given. Overall, 56% patients felt that an injection was necessary. Such perceptions were higher in Tando Allah Yar than in Rawalpindi (79% vs. 39%) (Table 2). Providers reciprocated such perceptions in that 44–56% of providers felt that an injection was required for common ailments such as fever, influenza, body aches or diarrhoea.
> Patients expect to receive injections for minor ailments such as fever or influenza-like symptoms and willingly pay for these, on the mistaken belief in the efficacy of injections to overcome common symptoms that eventually abate with time (10). Healthcare providers comply with such wishes and are convinced of the necessity of injections.
> We have previously demonstrated that the total national supply of syringes in Pakistan is sufficient to meet the demand for the ~1.1 billion syringes used annually for immunization, diabetes, laboratory testing and drug administration in clinics or hospitals
On the last point, I did a bit of a search to look for the total number of syringes used worldwide. I'm actually questioning whether that number is using similar methodology to arrive at the ~1.1 billion number, since I'm seeing numbers around 15 billion for the annual number of injections - meaning that Pakistan would be using over double the average per-capita number of syringes (and re-using many of them) while simultaneously having a population that's much younger (23 vs 31 median age) and poorer ($7k vs $26k median PPP/capita) than average.
If those numbers check out, the simple solution would just be to stop giving unnecessary injections, money would be saved, and there'd be no need to reuse syringes.
> > Patients from Tando Allah Yar reported a mean 3.8 visits to a healthcare provider by a member of their household during the previous month,
This seems like an excessive number of doctor visits, too. I can’t imagine a household where someone is going to the doctor almost every week. 45 doctor visits a year and they’re getting injections (of what?) most of the time?
I, as someone broadly healthy and who has barely used healthcare services, asked to see my health records recently.
I was shocked to see 500+ 'interactions' between me and the healthcare provider! However it turns out the majority of those interactions are very minor things - ie. "Patient received text message reminder about appointment". "Patient was sent letter with test results" etc.
When you count interactions like that, you can get a big number fast.
Antibiotic overprescribing was a problem in the past, but in my experience providers around me are very resistant to giving antibiotics at all.
My doctor’s office even has a big sign in the waiting room saying they don’t prescribe antibiotics for common infections.
The last time I got strep throat the urgent care clinic was resistant to testing me but finally gave in. When it came back positive the doctor acted oddly like he was reluctantly willing to prescribe antibiotics for it.
> The last time I got strep throat the urgent care clinic was resistant to testing me but finally gave in. When it came back positive the doctor acted oddly like he was reluctantly willing to prescribe antibiotics for it.
My dad in India gets prescribed antibiotics whenever he's sick. Despite my constant explanations, he insists that this is how it should be, because when you're sick your immunity is lowered.
On the other hand, the last time I got prescribed antibiotics was probably almost 10 years ago when I ended up in the hospital from an abscess.
Granted, my dad is old, but that part of the world still seems to expect doctors to do more for a common cold than just tell you to rest for a week and take an acetaminophen or phenylephrine if/when needed (even when that's really all you need).
> Granted, my dad is old, but that part of the world still seems to expect doctors to do more for a common cold than just tell you to rest for a week and take an acetaminophen or phenylephrine if/when needed (even when that's really all you need).
FYI phenylephrine is effectively a placebo and the FDA has proposed ending its use in OTC drugs. (There've been HN threads on the subject, with many comments.)
Phenylephrine is a placebo for nasal congestion, but it’s a solid drug for raising blood pressure. Used all the time in anesthesia (obviously not an OTC use).
I don’t know how widespread it is, but some people will beg for antibiotics when they definitely have a viral infection.
My friend who always used a naturopath would go on endlessly trying to diagnose herself with viral or bacterial to decide whether she should ask for antibiotics, but I definitely got the point.
I suppose many patients simply don’t know the difference.
I know antibiotics are really popular because killing bacteria seems really effective, but have you considered asking your doctor for a probiotic treatment?
Oral probiotics tend to work really well (similar effect to getting rid of bad bacteria) because they don't have to survive the stomach acid.
Is that true or just a rumor? All the family medicine people I know would not do that. Only in a case where it is 50/50 bacterial or viral like an ear infection in a young kid.
IME, most people (in the US) don't bother going to a doctor for a cold unless it lasts a long time or is especially bad, because you'll probably get better on your own and going to the doctor is expensive.
I was working in a church office when I came down with a runny nose and other cold symptoms.
My supervisor told me I could stay home for a day, but if longer than that, I would require a doctor’s excuse.
Now, that seemed fair from a labor perspective, but it is extremely unfair to someone like me. Because I do not own a vehicle, and seeing a doctor would involve boarding one or more buses and snorking the entire way there and back. Risking infection for everyone around me was exactly what I sought to avoid by staying home.
So what else could I do, but come into work and carry on? It is this sort of unreasonable requirement that fuels “presenteeism”.
> My supervisor told me I could stay home for a day, but if longer than that, I would require a doctor’s excuse.
You'd think the supervisor would realize it's in their own self-interest for you to not be around spreading infection (to them) by your mere presence.
There are of course people who abuse systems where doctors notes are not needed, and call in and then go have fun. It's not too hard to come across stories of people getting on short/long-term disability by know the correct doctor (I know of a situation where 3 members of the same family went to the same doctor and got a note for some condition).
I had a horrible tooth infection that anyone with a nose could tell was a bacterial infection yet I was massively gaslit and denied antibiotics until I went to the hospital at 11pm after a week of horrendous pain
Doctors very rarely do any kind of test in my experience (I would have thought oozing stinking green stuff would have been easy to test...)
Later
I am somewhat against antibiotics as I have a fragile/already destroyed gut. But there are times when I don't know what other solution there is after exhausting home remedies, other medication and waiting it out
A friend passed away few months ago in London from kidney infection.
UK seems very to be very cautious of over diagnosis, while my experience in Eastern Europe was opposite - my infant received 3 different kinds of steroids (potentially what stunned his growth).
IMO there is a huge amount of denial of treatment to save costs. The gaslighting over symptoms, the refusal to refer you to specialist, the refusal to order tests etc is all part of it. And they never ever say it's about costs - just a tight lipped, "I know what's best" attitude
Probably patient demand for *something*. The problem of antibiotics for viral infection is well known but the problem with needing to do something is far more widespread. I wouldn't be surprised if a lot of saline is getting injected.
> One thing the author does NOT see, however, is that the local folks doing all the hard work like mowing lawns, building furniture, etc. are in absolute panic over "AI" because their niche little lawn mowing/car washing/house cleaning business has been determined to be irrelevant by ChatGPT, etc.
How does what ChatGPT thinks about lawnmowing matter? Like, specifically, who's going to be mowing the lawns if it's not the people who are currently doing it?
Yeah, I get that, but I'm asking why that matters in the aggregate. Presumably there are still the same number of lawns that need mowing. Like, is chatgpt going to result in a significant change in who is mowing those lawns, or the frequency of lawn mowing, or the composition of yards?
> Instead, what I think has drastically changed over the past 40 years or so is the ability of a solopreneur to make real money.
Part of that was accurately diagnosed by the article in the bit about the dog walking business vs dog walking platform.
My partner bootstrapped a successful full-time cleaning business that she ran for a few years and the limiting factor was basically her ability to hire and retain good employees. A physical cleaning business has no path to scale like a tech company though.
It's easy and cheap to determine the original carrier (or its sucessor) for a US phone number. It costs money to do a porting lookup to determine the current carrier.
Most of the reason to deny voip users is that many voip services give phone numbers away like candy and then those phone numbers are used to abuse other services, so checking the original carrier tends to be enough for abuse screening.
Some use cases want more though. Banking KYC has some back channel to get subscriber identification or be alerted when ownership changes; those institutions may be willing to pay for current carrier lookups and deny usage of numbers where they don't have a back channel to the current carrier.
I thought that too but many carriers around me don't allow porting any VoIP-using number back to cellular. (Not sure if you were making a distinction between landline and cellular)
Unfortunately that means that my cell number which I wanted to temporarily park into VoIP while abroad is now permanently VoIP.
In the US, I belive there are three number categories in the NANP porting database (wireline, cellular, and VoIP), and SMS senders can definitely tell, even though it might take a while (presumably there's a lot of caching going on).
If you're lucky, the service you care about only validates at number registration time, not at text sending time, and you can get away with it indefinitely, I suppose.
Not the poster you're replying to, but I run an Acer laptop with an N305 CPU as a Plex server. Idle power draw with the lid closed is 4-5W and I keep the battery capped at 80% charge.
The N100/150/200/etc. can be clocked to use less power at idle (and capped for better thermals, especially in smaller or power-constrained devices).
A lot of the cheaper mini PCs seem to let the chip go wild, and don't implement sleep/low power states correctly, which is why the range is so wide. I've seen N100 boards idle at 6W, and others idle at 10-12W.
That's better than companies that have poor visions for growing the company where the money gets spent on projects that and don't generate an ROI for investors.
On a broader societal basis, it's often better for companies to stay in their lane, return profits to shareholders, and let shareholders invest in new companies with more growth potential.
> Incidentally I was disappointed that 90% of Costco Japan's goods are Japanese origin. You'd expect them to be full of American stuff but the majority is not. Even the imports are often the same items you can find in other supermarket import sections.
Huh, I get where you're coming from, but one of the things I really like about Costco Canada is how much stuff they source from Canada.
And it's fun to pop into Costco in other countries and see what they sell.
> More like, you don't sue a vendor and then expect the relationship to go back to status quo ante.
Depends on the specific relationship between the parties and the nature of the lawsuit.
If I sue Walmart, the only grocer in my town, for mislabelling the weight of their ground beef, we (as a society/government) probably shouldn't allow Walmart to retaliate by banning me from their stores.
I wasn't talking about what 'should be allowed,' rather what presently is. But your example goes rather more to my point, don't you think?
As with any tenant (owner or domicilee) of a private property in the US, the management of a store has broad privilege over lawful access to the premises, the legal theory at basis being that of trespass. Stores frequently use this power to exclude known shoplifters, check kiters, etc.
Not you, though, not after having prevailed in Marsymars v. Wally World - congratulations! Absent some novel obnoxious behavior on your part, the terms of the judgment are such that treating you as a trespasser would almost certainly result in a further finding of contempt of court, with penalties condign upon the franchise. (The general property right is not abrogated, but the specific judgment takes precedence where it applies.)
That relationship is materially different from the one which predeceased it, and the change was a direct consequence of your suit. Granted, Wal-Mart was not to you a "vendor" in the sense we mean it here but a retail store serving the general public, and you are not a "client" but a customer, and the parallel fails of establishment in several other obvious ways besides. I'm impressed it still goes so well to my point despite those flaws. Good work!
Obnoxiously that doesn't cover all the edge cases for consumers. Payments from my watch recently started failing with a generic "declined" error. After calling my bank I worked out that my credit card had been replaced some months ago in advance of a recent expiry - I updated my phone wallet at the time, but my watch's wallet didn't give any indication that it was trying to use an expired card.
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