wathe
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Posts posted by wathe
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16 minutes ago, Acorn said:
Welland Canal. We could have skipped the falls and just watched freighters.
My kids loved this.
There is a museum in St Catharines with a lot of Welland Canal content
We would make a day of it: watch shipping and locks in the canal, then watch shipping go under the Hamilton lift bridge, then watch trains go by at a busy Hamilton rail bridge. My kids were easy to entertain 🙂
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Butterfly conservatory is year-round
There are loads of walking trails in the Niagara Parks system. Free.
The botanical gardens are very nice. Free. There won't be a lot of flowers in April, though.
You can get great views of the falls from the public sidewalk. Free. It's always busy, but not necessarily crowded.
Toronto is 1.5h drive if one avoid rush hour. Commuter train service from Burlington (45min drive) is excellent. There is also commuter train service from Niagara Falls, but fewer choices of trains/times. Toronto has all the things you would expect of a major world-class city.
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I have a cheapie drugstore-brand digital oral thermometer. It's great. Still working after 15 years.
The ear IR ones are sometimes unreliable because of earwax or a twisty ear canal blocking the device's "view" of the tympanic membrane.
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Re speculation on timing of tests and procedures and assumption of extensive diagnositics - this is all as seen through a US healthcare culture lens, I think.
US healthcare is an international outlier, with, relatively, much over-testing and much cultural medical anxiety as compared to peer nations.
Cultural expectations about what constitutes appropriate and best care that I see on this board are often strikingly different to my Canadian experience. Especially WRT testing/diagnostics and timeframes.
I'm sure King Charles gets the very best care, but what that means may be different in the UK than in the US.
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My kids still mask at school. There are very few others.
Of course masking is the right thing to do when ill with a contagious acute viral respiratory infection. Whether covid, flu, or other respiratory virus. Just like covering coughs and sneezes, and washing hands is the right thing to do. It would be much more effective if everyone did it, but just because most don't doesn't mean one shouldn't. For my kids and I, it's enough to know that we, personally, aren't making others sick.
(ETA: Covid is still landing plenty of people in hospital, and still killing some of them. In Ontario, we've had >6000 hospitalizations and >950 deaths since August. Flu disappeared for more than a year back when we were all masking. Now it's back, with more >3000 hospitalizations in Canada since August 2023. It's important to my kids and I that we, personally, aren't making others sick, hospitalized or dead, over a simple thing like wearing a mask in public when ill)
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On 2/2/2024 at 2:11 AM, BakersDozen said:
Last week, email sent out that 2 more players are being added - one very good; one playing for elite 18U team. As they are involved with another competitive sport, they can't attend practices until April, but they will be at tournaments starting in February. They will "help the team win games."
This tells me everything I need to know about the program culture. Blech.
16u age elite players who currently play on an 18u team, being sent to 16u tournaments as ringers to help win games and boost their individual stats, while still playing full-time on their 18u team. Displacing 16u developmental level players who have put in the work, and built a team of their own.
Does this program accept government funding or other non-profit org funding? This sort of funding usually comes with conditions that stipulate youth development goals: ie advancement of education, beneficial to the community, eg "focus on building participation and engagement in recreation and sport to enhance the broader health and well-being of the community". If the program is in violation of its funding agreement, then that's actionable
Is the program itself a non-profit or charity for tax purposes? There will be similar community engagement and youth development criteria. If the program's behaviour jeopardizes its tax status, that's very actionable.
Is the program under the umbrella of a state or national sports org? Most youth sports in Canada are, as it facilitates insurance and administration; I imagine the US might be similar. What are their org mission, vision and standards? Fair-play policies for developmental levels? and if it's anything like the sports we're involved with, there will be all kinds of diversity, inclusion, development of athlete-as-a-whole-person, sportsmanship, integrity, dignitiy, kindness, growth and development content.
Most of this info will be google-able.
My approach with a similar situation has been 1) put some parent skin into the game - attend annual meetings, get involved as a parent volunteer/manager, get onto the bench as a trainer. This gets you Street Cred. 2) establish myself as a Person Who Knows The Things and Is Paying Attention: familiarize self with org constitution, standards, values and mission, codes of conduct, all at the club and umbrella org level (provincial and national, if relevant), funding model, legal/tax status (non-profit vs charity), strings attached to funding. Go to annual meeting where budget is presented.
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We are big thermos users for lunch: chili, stew, soup, butter chicken, curry, hotdogs (in hot water, send bun separately), pasta etc.
You want a vacuum food jar. You get what you pay for with these. Cheapie "insulated" food jars do not keep food properly hot, which IMO is a food safety issue.
We have both the Thermos King, in 2 different sizes, and the Stanley Adventure. Both are excellent.
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I think this thread is specific to men with stay-at-home wives?
The men's economic blindness described in this thread isn't something I've experienced. But there are very few families with stay-at-home wives/moms in my personal bubble. I think I know more families with SAHD's than SAHM's, and the SAHD's all seem to keep a toe (or half a toe) in the work world, working at their own small work-from-home business projects and/or staying connected/networked with their before-kids work life still-working buddies. Men in my bubble know what things cost because they participate in the shopping and are involved in the household finances, and understand how much work it takes to run a household be cause they are sharing in the labour (not 50/50 necessarily, but at least enough to have a clue).
I don't think that my bubble is rare or unusual. Working at a hospital does mean that I know an awful lot of working wives and mothers, though, so maybe?
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Adding: doctor confidentiality is one way. MD can't share a patients information with family without consent, but can gather collateral history from anyone. Concerned family can share their concerns with their family member's doctor, who then has to make a decision about reporting.
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3 hours ago, Laura Corin said:
A doctor can break patient confidentiality in the public interest and contact the licensing authorities if s/he thinks a patient is unfit to drive who is refusing to stop.
Reporting by doctors, nurse practitioners and optometrists for prescribed medical conditions (including cognitive impairment, motor and sensory impairment, sudden collapse, visual impairment, substance use and psychiatric illness), functional impairment and visual impairment is mandatory here and duty to report prevails over confidentiality.
Doctors, nurse practitioners and optometrists also have discretionary reporting authority for "a person who is at least 16 years old who, in the opinion of the prescribed person, has or appears to have a medical condition, functional impairment or visual impairment that may make it dangerous for the person to operate a motor vehicle", which also prevails over confidentiality.
The medicolegal consequences are thorny. Mandatory duty to report means you have to report even if the person voluntarily agrees to stop driving. Even if the person doesn't have a license etc. In theory, we should be reporting pretty much every nursing home patient who comes through the ED. And the law does not distinguish temporary impairment from long-term impairment; we should in theory be reporting right lower limb injuries and upper limb injuries like sprained ankles and broken wrists. We use common sense, but in doing so, absolutely depend on our patient's common sense (which isn't always so common) and open ourselves to liability.
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23 minutes ago, Terabith said:
Not super relevant here, but I find myself wondering how cognitive tests that feature clock drawing are going to need to change in the next 25 years or so as people who have never really had exposure to analog clocks become eligible for these sorts of tests.
I've had the same thought. Analog clocks are still plentiful in public spaces here (hospitals, schools, train stations, city hall clock tower etc), but seem to be disappearing in private spaces. When our kids were toddlers, we realized that we didn't have a single analog clock in the house! Fixed that with a quick trip to IKEA 🙂
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On 1/19/2024 at 3:55 PM, KSera said:
Yet Tamiflu is still recommended in the US as a reason to get tested for flu so that you can get treatment right away. Is it that way in Canada? The Tamiflu thing is one of the things that undermined my trust in medical reommendations.
Paxlovid seems like something that should be pretty easy at this point for us to get good data on. I hear a lot of anecdotes as well, particularly people who feel it helped their symptoms quickly. My own family member who took it didn't seem to improve any quicker than I expect they would have anyway (started improving about 48 hours after starting it, but still sick for many days after that and tested positive for about 12 days). I was quite disappointed with the most recent study indicating it didn't actually reduce risk of long covid, but a lot of people (me included) want to see if a longer course changes that, as if it's addressing viral persistence in a subset of long covid sufferers, it's widely thought it takes more than a 5 day course to clear that. There are some trials of longer courses to see if it can clear long covid in some people.
Regarding Tamiflu: Different medical culture, mostly. Tamiflu has only ever really been used here for high risk patients. Nursing homes and hospitalized patients, mostly. The official criterial were/are broader than that, but never really gained traction in practice. EBM trained MD's especially never really warmed up to it. Prescribing peaked in 2009 with the H1N1 scare, then trickled off. Patients almost never presented within the 48h window. Also, flu tests didn't (still don't usually) result in the lab until the next day, sometimes longer for community labs. We were advised generally not to test, and instead to make a treatment decision based on clinical presentation if flu was known to be circulating. (We did test inpatients so we knew who we could cohort, so circulation data did exist). Patients here hadn't been "trained" by the media or medical estalishment to ask for it either. Then, with covid, flu went away. We're only really seeing it back this season, and clinically it's impossible to tell the difference between covid and flu. Lab testing for flu is still slow.
The infuriating thing with paxlovid is that the good data already exists, but it's not accessible. It's being hidden. On purpose. For profit.
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In my province, senior drivers have to do a senior driver renewal every 2 years, starting at age 80, comprising:
• A vision test.
• A driver record review.
• A 45-minute group education session (GES).
• Two, brief, written (non-computerized) screening exercises.
• Taking note of and then completing any required follow-up items for the MTO driver improvement counselor.The "screening exercises" are cognitive tests: Clock drawing test and single letter cancellation test.
It's a pretty good system.
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Re personal anecdotes from individuals who believe that paxlovid worked for them: It's not actually possible to know.
The trouble with illnesses that are generally self-limited (like acute mild covid illness), is that the acute symptoms were going to go away on their own anyway; for most mild acute covid cases, it's a matter of when, not if. For any individual, it's impossible to know if symptoms went away when they did because of the paxlovid, or if they were going resolve on their own at that time anyway.
We really, really need prospective, properly blinded RTC to establish efficacy.
The trial has been done (EPIC-SR). Symptom alleviation was a primary end-point. It did not achieve statistical significance (the paxlovid didn't work to alleviate symptoms). Unfortunately, the trial outcome has been "published" by press release only. The trial has not been formally published or peer-reviewed. It was funded and run by the drug manufacturer --- who has $$$$$$$ to lose by publishing a negative trial. Maintaining a state of uncertainty for as long as possible is good for their bottom line.
This is a serious problem: this data is incredibly important, important on a population level, important enough to society that it should be a public good, yet it is being hidden by a drug company who stands to gain by hiding it, because that's just the way the scientific publishing and drug company research works in our system. IME, it's akin to fraud (Pfizer is promoting and selling a drug that I strongly suspect they know doesn't work), but it's business-as-usual.
It't all very reminiscent of tamiflu. My prediction: Independent research will eventually establish lack of efficacy (or maybe I will be surprised and they will demonstrate efficacy, but I highly doubt it). There will be investigations. Pressure will mount, and the EPIC-SR trial data will come out eventually -- perhaps it will require legal action to make it happen. Governments who spent $$$$$ on this drug (like mine) will seek damages. It won't matter, because it will all be tiny drop in the bucket compared to profits made. And the cycle will repeat.
Disclaimers:
1) I am talking about acute covid illness here. Long covid is a whole different discussion. For which the data pool is even worse.
2) EPIC-HR did show efficacy in preventing covid-associated hospitalization and death in patients who were high-risk and unimmunized and covid-naive (with lots of methodological tricks to favour a postive outcome, I might add). That population essentially doesn't exist anymore. EPIC-SR is the study we need to see published, because it the population it studied matches the population for which we prescribe paxlovid.
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Also, I just love that it incorporates the Birds Aren't Real satirical CT into its gameplay. Made me smile.
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This board game, "Lizards and Lies" was briefly shown on a recent national news segment on disinformation and deep fakes and concerns about how social media disinformation might derail elections specifically and democracy in general.
It is a PhD student creation, and looks interesting:
"As a research project that grew out of classwork, Lizards & Lies works to clarify the idea that social media operates as an ecosystem, with many different actors and many different spaces, each influencing the other."
"...the game explores the widely held supposition that the spread of conspiracy theories and misinformation online constitutes a new front in a global war on truth. It’s a precept that he feels is oversimplified and skims past the vitally important role human users play in propagating fake news, willingly or not."
The print-and-play version is free. Very nice-looking physical copies are also available, but $$$.
I thought it might be of especial interest to game-schooling boardies.
I think I might print it out and play it through with my teens.
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Paxlovid evidence: still very little reason to prescribe
A summary and analysis of the current state of the evidence, by one of my favourite Canadian emergency medicine EBM people.
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42 minutes ago, kbutton said:
Do you have to local to understand the first name (play on weatherman, hockey player, etc.)?
Fun contest!
Max Kermanator is named for a member of a local band, who campaigned for the name on social media.
Icekee Wee Wee is a play on the Hamilton Tiger-Cats Football team's traditional fan cheering chant "Oskee Wee Wee"
HAMBONI is a portmanteau or Hamilton and Zamboni ice surfacer machine.
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11 hours ago, kbutton said:
I remember when this was in the local news last year. The 10 winners of the plow naming contest.
There is a new plow naming contest open for 2024. You all have a chance to name a Hamilton plow :)
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My family is all boosted, and none of us have been sick. Plenty of exposure.
At the hospital, we are admitting lots of elderly for covid. Very , very much disproportionately unboosted (relative to community fall-booster base-rate of 47% for >65 yo in my community). From what I am seeing, this booster is definitely working to keep vulnerable people out of hospital.
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11 hours ago, Harriet Vane said:
I haven’t recently. When I looked into it a number of years ago for my hands, I vaguely remember reading that the injections include painkillers? A quick Google shows lidocaine is a component. That made me question the whole premise. But I didn’t really dig into the research, so it is a question worth asking.
I had never heard of prolotherapy for knee OA until this thread. It seems to involve injecting sugar into the joint in order to purposefully induce an inflammatory response.
I'm skeptical. Firstly, injecting bacteria-food into a space where bacterial infection can be catastrophic just seems like a bad idea. Septic arthritis is very, very serious. Secondly, inflammation is part of the pathology of OA; purposefully increasing inflammation seems backwards. Lastly, evidence-based clinical guidelines recommend against it.
(I had heard of it for tendinopathy - totally different indication)
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I thought that this treatment had gone out of fashion. It is my understanding that best available evidence shows that it doesn't work.
Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review of the Evidence
Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. " In patients with knee osteoarthritis, viscosupplementation is associated with a small and clinically irrelevant benefit and an increased risk for serious adverse events."
2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee "Intraarticular hyaluronic acid injections are conditionally recommended against in patients with knee and/or first CMC joint OA and strongly recommended against in patients with hip OA."
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'Try not to let moose lick your car,' warns Parks Canada
The article, of course, makes perfect sense. But the headline got my attention for sounding just ridiculous!
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Overkill, but absolutely excellent:
Leatherman Raptor Rescue: Glass-breaker, belt cutter, ring cutter (also works on fishhooks) and the best trauma shears ever.
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Things to see around Niagara Falls… other than the falls
in The Chat Board
Posted · Edited by wathe
If you like wine, Niagara is the premiere wine region of Canada. Load of wineries who do tours, tastings etc.
ETA one of the world's main icewine regions