#april 5 2021

[hilaryduffwardrobe]

WHERE: Social Media

WHEN: April 5, 2021

Sablyn Phoenix Cashmere Sweater - Sold Out

[acquiescest]

irt the lrb what would you say if i said liam & noel spent new years 2023 together in paris

what would you say if i said liam bought the house in france (the one with noel's name carved into the walls) in march 2023 and that month noel talked about wanting to spend several months in paris

which could mean nothing

[wiiildflowerrr]

@xannyafi: i think everyone in 5SOS could definitely rock a mullet

@Calum5SOS: @xannyafi

24 April 2021

[itsvnllmlk]

how did my neuvillette pulls go this week:

(written by a person with an insanely bad luck in genshin gacha, who finally gets a glimmer of hope after 2.5 years of playing)

got him guaranteed on thursday, close to soft pity

kinda wanted to get his weapon bc i was close to pity on the weapon banner too (and also bc i didn't have anything good for him) but i got homa instead, a day later

on sunday, did a random single pull and got homa again (on pity 6)

less than a minute later i do another single pull and i (finally) get his weapon (thanks fate points for the guarantee)

and after that i pressed the wrong button on my gaming pad when i was on neuvillette's banner and got his c1 (also one wish later)

[mememan93]

those are rookie numbers past raven

[anniehathaways]

annehathaway: Plastic free is best when possible, but what about when it’s not? It’s a question that keeps me up at night (I’m not kidding), so please allow me to tell you about a company Adam and I have decided to invest in called #ZENWTR.

Each @ drinkZENWTR bottle is made from up to five ocean-bound plastic bottles*, which means less unnecessary virgin plastic created in our world. This also means that, over time, a tremendous amount of plastic will be kept from reaching and polluting the ocean-the company aims to “rescue”, recycle, and reuse 50 million pounds of plastic by 2025.

Make no mistake, this is not a magic bullet solution and I am not trying to greenwash you; plastic should still be avoided whenever possible. But in our imperfect world where plastic water bottles are seemingly inevitable-and for some, a very important necessity-I’m so relieved there is now a more sustainable option while we develop better solutions.

*check out @ drinkzenwtr for more information.

[booasaur]

I think that Miss Adair loves Ms. True, but Ms. True doesn't love her back. She's too afraid to. "And pain despises hope." Ms. True is too broken to allow herself to love. Will Miss Adair heal her?

I felt like I was forgetting something in light of The Nevers coming back and finally remembered these asks from like two years ago. D:

When you sent this, only three eps had aired, so we got three more eps of characterization, and I think eventually this was mostly borne out. Not romantically, and I do think Amalia loves Penance, but it's certainly true that she was also holding herself back, we later find out why. Hopefully in the remaining half of the season, that connection is still at the center of the show.

And another anon:

So I know that a lot of people are disappointed about True Penance and yeah it's shit that even tho there has been so much progress it's still not enough for a show like this to go there but can we talk about how funny it is that Bonnie is the only characters that has the guts to look at Penance, look at the rest of them and be like "Y'all realize that this girl is more dangerous than all of us combined right?" And every other character automatically goes "how dare you? Shut your dirty mouth!" And start thinking of 1000 different ways to kill her do even suggesting that sweet kind perfect Penance could ever be like them/worse than them even tho Bonnie is actually right and Penance has the ability to be super dangerous lol

Okay, so this was after ep 4... But still, it's about intention more than ability, right, so that's probably why everyone bristles. Even though it's true that sometimes the most protective kindest people are the scariest when let loose, Penance's mercy-first approach sort of defines her.

And another anon:

I just wanted to add something to the shippers. This is HBO. HBO literally sucks. Im actually thinking "Amalia" is probably something more pan sexual and just has sex and does love Pence, in the way a alien who has no prior idea of relationships would. With that being said as a shipper always look to what the actors say and to the best of my knowledge the actress who play Pence ships with Auggie a bit. Having been burned like all the times, thats where I am now. Look to the actors because they know the most. But again just because "Amalia" is pan doesn't mean Pence actually is either. In the end good luck, I hope all the shippers are happy. But seriously HBO is the worst and they arent invested in couples. After episode 2 my cold dead heart was like they are gonna kill Amalia and make Sarah the new lead lol.

Okay, so this is after ep 6... Hmm, but I don't think Amalia is an alien? I do believe she's bi, though, but no, actors' feelings aside, I don't think the writers were intending anything romantic. And since they weren't, I'm not sure why HBO's stance on couples would matter or result in killing off Amalia, she's clearly the lead on which the show hinges.

[mariette-archive]

[xaviergalatis]

Aprilx mayx

15.38 or 26.74 or 30.76 thresholds

$1,208.37 3-17-21

MARCH ________

W3 $20.39

Th4$22.25 ^

F5 $9.75

S6 NA

Sun7 NA

M8 NA

TU9 $24.75

W10. 28.50

Th11 17.50

F12 36.87

Sat13 11.75

Sun14 $12.25

3/8/21-3/14 = $131.62

M15 $10.15

T16 $28.75

Wed17 $10.00

TH18 $7.25

F19 $47.94

S20 $58

SUN21 $19

3/15/21-/3/21/21 = $186.71

M22 $45.06

Tu23 n/a sleep

We24n/a heavy rain

Th25 $9.20

F26 $6.84

S27 $58.17

28SUN N/A

3/22/21-3/28/21 = $122.27

29M N/A

30T N/A

31W $26.63

April__________

1TH $3.00

2F$22.25

3S$11.75

4SUN$19.60

3.29-4.4.21 = $83.23

5M n/a

6T$17.13

7W $34.78

8TH $27.36

9F. $6.25

10S $7.50

11SUN $26.25

$123.27

12M $11.47

13T $18

14W $6

15TH $23

16F $21.25

17S $36.90. (4.17.21 - $715 cash)

18SUN

19M

20T

21W

22TH

23F

24S

25SUN

26M

27T

28W

29TH

30.F

[mostlysignssomeportents]

Epic Systems, a lethal health record monopolist

Epic Systems makes the dominant electronic health record (EHR) system in America; if you're a doctor, chances are you are required to use it, and for every hour a doctor spends with a patient, they have to spend two hours doing clinically useless bureaucratic data-entry on an Epic EHR.

How could a product so manifestly unfit for purpose be the absolute market leader? Simple: as Robert Kuttner describes in an excellent feature in The American Prospect, Epic may be a clinical disaster, but it's a profit-generating miracle:

https://prospect.org/health/2024-10-01-epic-dystopia/

At the core of Epic's value proposition is "upcoding," a form of billing fraud that is beloved of hospital administrators, including the "nonprofit" hospitals that generate vast fortunes that are somehow not characterized as profits. Here's a particularly egregious form of upcoding: back in 2020, the Poudre Valley Hospital in Ft Collins, CO locked all its doors except the ER entrance. Every patient entering the hospital, including those receiving absolutely routine care, was therefore processed as an "emergency."

In April 2020, Caitlin Wells Salerno – a pregnant biologist – drove to Poudre Valley with normal labor pains. She walked herself up to obstetrics, declining the offer of a wheelchair, stopping only to snap a cheeky selfie. Nevertheless, the hospital recorded her normal, uncomplicated birth as a Level 5 emergency – comparable to a major heart-attack – and whacked her with a $2755 bill for emergency care:

https://pluralistic.net/2021/10/27/crossing-a-line/#zero-fucks-given

Upcoding has its origins in the Reagan revolution, when the market-worshipping cultists he'd put in charge of health care created the "Prospective Payment System," which paid a lump sum for care. The idea was to incentivize hospitals to provide efficient care, since they could keep the difference between whatever they spent getting you better and the set PPS amount that Medicare would reimburse them. Hospitals responded by inventing upcoding: a patient with controlled, long-term coronary disease who showed up with a broken leg would get coded for the coronary condition and the cast, and the hospital would pocket both lump sums:

https://pluralistic.net/2024/06/13/a-punch-in-the-guts/#hayek-pilled

The reason hospital administrators love Epic, and pay gigantic sums for systemwide software licenses, is directly connected to the two hours that doctors spent filling in Epic forms for every hour they spend treating patients. Epic collects all that extra information in order to identify potential sources of plausible upcodes, which allows hospitals to bill patients, insurers, and Medicare through the nose for routine care. Epic can automatically recode "diabetes with no complications" from a Hierarchical Condition Category code 19 (worth $894.40) as "diabetes with kidney failure," code 18 and 136, which gooses the reimbursement to $1273.60.

Epic snitches on doctors to their bosses, giving them a dashboard to track doctors' compliance with upcoding suggestions. One of Kuttner's doctor sources says her supervisor contacts her with questions like, "That appointment was a 2. Don’t you think it might be a 3?"

Robert Kuttner is the perfect journalist to unravel the Epic scam. As a journalist who wrote for The New England Journal of Medicine, he's got an insider's knowledge of the health industry, and plenty of sources among health professionals. As he tells it, Epic is a cultlike, insular company that employs 12.500 people in its hometown of Verona, WI.

The EHR industry's origins start with a GW Bush-era law called the HITECH Act, which was later folded into Obama's Recovery Act in 2009. Obama provided $27b to hospitals that installed EHR systems. These systems had to more than track patient outcomes – they also provided the data for pay-for-performance incentives. EHRs were already trying to do something very complicated – track health outcomes – but now they were also meant to underpin a cockamamie "incentives" program that was supposed to provide a carrot to the health industry so it would stop killing people and ripping off Medicare. EHRs devolved into obscenely complex spaghetti systems that doctors and nurses loathed on sight.

But there was one group that loved EHRs: hospital administrators and the private companies offering Medicare Advantage plans (which also benefited from upcoding patients in order to soak Uncle Sucker):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649706/

The spread of EHRs neatly tracks with a spike in upcharging: "from 2014 through 2019, the number of hospital stays billed at the highest severity level increased almost 20 percent…the number of stays billed at each of the other severity levels decreased":

https://oig.hhs.gov/oei/reports/OEI-02-18-00380.pdf

The purpose of a system is what it does. Epic's industry-dominating EHR is great at price-gouging, but it sucks as a clinical tool – it takes 18 keystrokes just to enter a prescription:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2729481

Doctors need to see patients, but their bosses demand that they satisfy Epic's endless red tape. Doctors now routinely stay late after work and show up hours early, just to do paperwork. It's not enough. According to another one of Kuttner's sources, doctors routinely copy-and-paste earlier entries into the current one, a practice that generates rampant errors. Some just make up random numbers to fulfill Epic's nonsensical requirements: the same source told Kuttner that when prompted to enter a pain score for his TB patients, he just enters "zero."

Don't worry, Epic has a solution: AI. They've rolled out an "ambient listening" tool that attempts to transcribe everything the doctor and patient say during an exam and then bash it into a visit report. Not only is this prone to the customary mistakes that make AI unsuited to high-stakes, error-sensitive applications, it also represents a profound misunderstanding of the purpose of clinical notes.

The very exercise of organizing your thoughts and reflections about an event – such as a medical exam – into a coherent report makes you apply rigor and perspective to events that otherwise arrive as a series of fleeting impressions and reactions. That's why blogging is such an effective practice:

https://pluralistic.net/2021/05/09/the-memex-method/

The answer to doctors not having time to reflect and organize good notes is to give them more time – not more AI. As another doctor told Kuttner: "Ambient listening is a solution to a self-created problem of requiring too much data entry by clinicians."

EHRs are one of those especially hellish public-private partnerships. Health care doctrine from Reagan to Obama insisted that the system just needed to be exposed to market forces and incentives. EHRs are designed to allow hospitals to win as many of these incentives as possible. Epic's clinical care modules do this by bombarding doctors with low-quality diagnostic suggestions with "little to do with a patient’s actual condition and risks," leading to "alert fatigue," so doctors miss the important alerts in the storm of nonsense elbow-jostling:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058605/

Clinicians who actually want to improve the quality of care in their facilities end up recording data manually and keying it into spreadsheets, because they can't get Epic to give them the data they need. Meanwhile, an army of high-priced consultants stand ready to give clinicians advise on getting Epic to do what they need, but can't seem to deliver.

Ironically, one of the benefits that Epic touts is its interoperability: hospitals that buy Epic systems can interconnect those with other Epic systems, and there's a large ecosystem of aftermarket add-ons that work with Epic. But Epic is a product, not a protocol, so its much-touted interop exists entirely on its terms, and at its sufferance. If Epic chooses, a doctor using its products can send files to a doctor using a rival product. But Epic can also veto that activity – and its veto extends to deciding whether a hospital can export their patient records to a competing service and get off Epic altogether.

One major selling point for Epic is its capacity to export "anonymized" data for medical research. Very large patient data-sets like Epic's are reasonably believed to contain many potential medical insights, so medical researchers are very excited at the prospect of interrogating that data.

But Epic's approach – anonymizing files containing the most sensitive information imaginable, about millions of people, and then releasing them to third parties – is a nightmare. "De-identified" data-sets are notoriously vulnerable to "re-identification" and the threat of re-identification only increases every time there's another release or breach, which can used to reveal the identities of people in anonymized records. For example, if you have a database of all the prescribing at a given hospital – a numeric identifier representing the patient, and the time and date when they saw a doctor and got a scrip. At any time in the future, a big location-data breach – say, from Uber or a transit system – can show you which people went back and forth to the hospital at the times that line up with those doctor's appointments, unmasking the person who got abortion meds, cancer meds, psychiatric meds or other sensitive prescriptions.

The fact that anonymized data can – will! – be re-identified doesn't mean we have to give up on the prospect of gleaning insight from medical records. In the UK, the eminent doctor Ben Goldacre and colleagues built an incredible effective, privacy-preserving "trusted research environment" (TRE) to operate on millions of NHS records across a decentralized system of hospitals and trusts without ever moving the data off their own servers:

https://pluralistic.net/2024/03/08/the-fire-of-orodruin/#are-we-the-baddies

The TRE is an open source, transparent server that accepts complex research questions in the form of database queries. These queries are posted to a public server for peer-review and revision, and when they're ready, the TRE sends them to each of the databases where the records are held. Those databases transmit responses to the TRE, which then publishes them. This has been unimaginably successful: the prototype of the TRE launched during the lockdown generated sixty papers in Nature in a matter of months.

Monopolies are inefficient, and Epic's outmoded and dangerous approach to research, along with the roadblocks it puts in the way of clinical excellence, epitomizes the problems with monopoly. America's health care industry is a dumpster fire from top to bottom – from Medicare Advantage to hospital cartels – and allowing Epic to dominate the EHR market has somehow, incredibly, made that system even worse.

Naturally, Kuttner finishes out his article with some antitrust analysis, sketching out how the Sherman Act could be brought to bear on Epic. Something has to be done. Epic's software is one of the many reasons that MDs are leaving the medical profession in droves.

Epic epitomizes the long-standing class war between doctors who want to take care of their patients and hospital executives who want to make a buck off of those patients.

Tor Books as just published two new, free LITTLE BROTHER stories: VIGILANT, about creepy surveillance in distance education; and SPILL, about oil pipelines and indigenous landback.

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/10/02/upcoded-to-death/#thanks-obama

Image: Flying Logos (modified) https://commons.wikimedia.org/wiki/File:Over_$1,000,000_dollars_in_USD_$100_bill_stacks.png

CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0/deed.en

[yeloenk]

5.

Okay... listen to me. Very carefully.

5 is clearly an important number that relates to Ink Sans. His original AU, _____tale, has EXACTLY five letter spaces. Ink is also associated with prisms, which have 5 points.

Comyet posted and immediately deleted two posts—the first stating this:

This post had no tags or context to it at all. (the tags you see are from my reblog).

The second one answers an ask, that states this:

Again, a tagless post with no context that was deleted almost immediately after it was posted. She simply replied with a triangle—and, what I can only assume is meant to represent a prism.

The Prism Collection was officially announced on March 15th of 2021, exactly 1 month away from Ink's birthday, April 15th.

The original collection announcement post also stated that April 15th, 2021, would be Ink's 5th anniversary.

As of right now, it is December of 2024. next year will be 2025... 25... 5.

I don't know what Myebi is doing, but there are TOO many coincidences to string together, and it leads back to Ink and the Prism Collection. I think Mye is planning something, because these cryptic posts were most definitely intentional.

Perhaps confirming his original AU was meant to be called Prismtale? Or that Ink's true name is Prism? Or a secret 2nd drop of the Prism Collection?

...or she's pranking us and pulling our legs, lol 😭 I have no idea, but I wanted to just make a post pointing out what I've noticed and what this could mean.

Sincerely, your local diehard Ink fan 😛

(take this all with a grain of salt btw these are just theories)

[ace-with--a-mace]

silly little girls who fuck up their silly little hair when theyre overwhelmed with their silly little emotions

[michaelnordeman]

Eurasian bullfinch/domherre. Värmland, Sweden (April 5, 2021).

[dontmean2bepoliticalbut]

On 7/31/2019 Trump has a private meeting with Putin. On 8/3/2019, just 3 days after his private meeting with Putin, Trump issues a request for a list of top US spies. By 2021 the CIA reports an unusually high number of their agents are being captured and/or being murdered. During the search executed at Mar A Lago the FBI find more documents with lists of U.S. informants on them.

A Timeline

• FBI wiretapped Russian gambling ring headquartered at Trump Tower for two years - March 21, 2017

• Trump revealed highly classified information to Russian foreign minister and ambassador - May 15, 2017

• Trump, Putin Meet For 2 Hours In Helsinki - July 16, 2018

• Rand Paul Goes To Russia And Delivers Letter For Trump, Marking Our Era Of Irony - August 9, 2018

• Following the Money: Trump and Russia-Linked Transactions From the Campaign to the Presidential Inauguration - December 17, 2018

• The US extracted a top spy from Russia after Trump revealed classified information to the Russians in an Oval Office meeting - September 10, 2019

• Trump’s Loose Lips Force US to Extract Spy From Kremlin - September 10, 2019

• Was Mar-a-Lago Trespasser a Tourist or a Spy? A Judge Said Her Story Didn’t Hold Up. - November 25, 2019

• Trump downplays massive cyber hack on government after Pompeo links attack to Russia - December 19, 2020

• Russia has been cultivating Trump as an asset for 40 years, former KGB spy says - January 29, 2021

• There was Trump-Russia collusion — and Trump pardoned the colluder - April 17, 2021

• Longtime GOP operatives charged with funneling Russian national’s money to Trump, RNC - September 20, 2021

• Captured, Killed or Compromised: C.I.A. Admits to Losing Dozens of Informants - October 5, 2021

• Files Seized From Trump Are Part of Espionage Act Inquiry - August 12, 2022

• Ex-Clinton aide implies 'President of France' file found at Trump's home during Mar-a-Lago raid could be valuable to Putin as 'kompromat' - August 13, 2022

• Inventing Anna: The tale of a fake heiress, Mar-a-Lago, and an FBI investigation - August 22, 2022

• Russians used a US firm to funnel funds to GOP in 2018. Dems say the FEC let them get away with it - October 30, 2022

• Trump makes shocking comments about trusting Putin over US 'intelligence lowlifes' - January 31, 2023

• Russia's Prigozhin admits links to what US says was election meddling troll farm - February 14, 2023

• GOP operative sentenced to 18 months for funneling Russian money to Trump- February 17, 2023

• Trump allegedly discussed US nuclear subs with foreign national after leaving White House: Sources - October 5, 2023

• 'So appalled': What witnesses told special counsel about Trump's handling of classified info while still president - April 24, 2024

🤔🤔🤔

[doyoulikethissong-poll]

Lil Nas X featuring Billy Ray Cyrus - Old Town Road 2019

"Old Town Road" is the debut mainstream single by American rapper Lil Nas X, first released independently in December 2018. After gaining popularity, the single was re-released in March 2019. The rapper also recorded a remix with American country singer Billy Ray Cyrus, which was released on April 5, 2019. Both were included on Lil Nas X's second EP, 7 (2019). Dutch record producer YoungKio composed the instrumental and made it available for purchase online in 2018. It features a sample of "34 Ghosts IV" by the American industrial rockband Nine Inch Nails. The sample was placed behind trap-style Roland TR-808 drums and bass. Lil Nas X purchased the instrumental for US$30 and recorded "Old Town Road" in one day.

The song reached number 19 on the Billboard Hot Country Songs chart before the magazine disqualified it from the chart on the grounds that it did not "fit" the genre, sparking a debate on what constitutes the "definition" of country music. Though "Old Town Road" did not re-enter any country charts, both versions of the song collectively peaked at number 1 on the main Billboard Hot 100, remaining at the top for a record-breaking 19 consecutive weeks; the remix peaked at number 50 on Billboard's Country Airplay chart. "Old Town Road"'s overall run at number one is the longest in chart history, surpassing the previous record of sixteen weeks achieved by both "One Sweet Day" (poll #296) and "Despacito". One or more versions of "Old Town Road" have topped the national singles charts in Australia, Canada, France, Germany, Ireland, the Netherlands, New Zealand, Norway, Switzerland and the UK, and have charted in the top 10 in various other international markets.

The song was certified diamond by the RIAA in October 2019 for selling 10 million total units in the US, the fastest song to be certified diamond. At the 62nd Annual Grammy Awards, the remix featuring Billy Ray Cyrus was nominated for Record of the Year and won Best Pop Duo/Group Performance and Best Music Video. In September 2021, the song set the record for the second-highest certified song in history by the RIAA, at 16× platinum in the US - meaning it accumulated 16 million equivalent song units. The single has sold over 18 million copies worldwide, making it one of the best-selling singles of all time.

"Old Town Road" received a total of 80,6% yes votes!

[labbaik-ya-hussain-as]

1. Haifa Massacre 1937

2. Jerusalem Massacre 1937

3. Haifa Massacre 1938

4. Balad al-Sheikh Massacre 1939

5. Haifa Massacre 1939

6. Haifa Massacre 1947

7. Abbasiya Massacre 1947

8. Al-Khisas Massacre 1947

9. Bab al-Amud Massacre 1947

10. Jerusalem Massacre 1947

11. Sheikh Bureik Massacre 1947

12. Jaffa Massacre 1948

13. Deir Yassin Massacre 1948

14. Tantura Massacre 1948

15. Qibya Massacre 1953

16. Khan Yunis Massacre 1956

17. Jerusalem Massacre 1967

18. Sabra and Shatila Massacre 1982

19. Al-Aqsa Massacre 1990

20. Ibrahimi Mosque Massacre 1994

21. Jenin Refugee Camp April 2002

22.

23. Gaza Massacre 2012

24. Gaza Massacre 2014

25. Gaza Massacre 2018-19

26. Gaza Massacre 2021

27. Gaza Genocide 2023 is still ongoing.

28. DON'T LET ANYONE CONVINCE YOU THAT IT STARTED ON OCTOBER 7th***