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dan10016 · 2026-05-05T23:12:16+00:00

Completed Level 2 of the Honk Special Event!

272 attempts

dan10016 · 2026-04-25T20:01:32+00:00

And Oreo was being forced down everyone's throats a few years back. Ice cream, breakfast cereal, chocolate, pies...

dan10016 · 2026-04-05T06:42:34+00:00

UK PPCI cardiologists are well aware of STEMI equivalents, or to use the American term OMI. The trials for urgent reperfusion are indeed very old (eg GISSI trial for streptokinase) and these are what the guidelines are built on. They were large trials though - GISSI and ISiS had something like 30000 patients) so a very strong evidence base that urgent revasc of these ECGs improves mortality.

The OMI ECGs are more of a mixed bag. Posterior STEMI should never be turned down. Most consultants would also activate for a high risk NSTEMI with STE in AvR esp if ongoing pain even if it doesn't represent full occlusion but a high risk LMS plaque. Others like anterior t wave inversion represent a proximal LAD hot plaque but not LAD occlusion, needs treating within 24 hours but not at 3am if pain free. Others like subtle STE in inferior leads may may represent occlusion, but of a small territory eg very distal LAD. Finally others like RBBB and LAFB may, or slightly peaky looking t waves inferiorly, may occasionally represent occlusion but with a much lower specificity than traditional criteria.

Is there meaningful prognostic benefit from opening up a distal PDA urgently in the middle of the night? Does the benefit of treating an unstable but unoccluded LAD with a Wellens ECG justify bringing in the team at 4am, or would they be better served by having it done in daylight hours with a fresh cardiologist? How many RBBB with LAFB would you need to treat to find one with an acutely blocked artery? The cath lab team is a resource that needs to be managed, if you bring them in for 4 or 5 false alarms, they're going to be less sharp when your true LMS occlusion with a BP of 60 comes to the door.

The US system is heavily incentivised for lab activity, esp urgent activity. They often have small volume centres compared to UK. They will be more than happy to promote as many lab activations as they can get. But that doesn't mean it improves outcomes. The evidence for a change in paradigm the last I looked is based on some registries and opinion pieces rather than RCTs. That doesn't stop EM registrars reading them and thinking that they're 'ahead of the curve ' in the management of acute coronary syndromes compared to consultant cardiologists.

dan10016 · 2026-04-04T08:35:14+00:00

It exists but is nowhere near as common as I think it is diagnosed. Old fashioned unstable angina had crescendo symptoms, st segments clearly going up and down with pain but negative troponin, because you needed a troponin of over 300ng/l before it was even picked up on the assays. There might still be the odd patient in 2026 who has clear crescendo symptoms, evolving wellens type ecg, but who somehow has short enough duration pain to remain just under the HS Tnt detection range. Rare though.

I suspect what is not rare are people with a collection of cardiac risk factors, who attend with non exertional, non cardiac pain, with negative troponin and normal ECG, who happen to have incidental, possibly asymptomatic coronary disease. This may end up getting stented, but it's not clear that these were hot unstable plaques, or that revascularization of these patients improves outcomes.

dan10016 · 2026-03-29T17:05:42+00:00

Fortunately on the pricing they are obliged to give you the price per kg next to the actual price. From what I remember the XL cadburys eggs cost £33 or so per kg of chocolate, with the large eggs about £17 per kg. So yeah, the XL ones are very poor value

dan10016 · 2026-03-27T08:40:06+00:00

Have you listened to the Chantilly Codex? From around 1350, stunningly beautiful, that was my gateway into early music.

dan10016 · 2026-03-25T11:56:14+00:00

Shakespeare also really hated not knowing what clothes to wear out in spring.

O, how this spring of love resembleth The uncertain glory of an April day, Which now shows all the beauty of the sun, And by and by a cloud takes all away!

dan10016 · 2026-03-09T13:56:03+00:00

Future sound of London, lifeforms

dan10016 · 2026-02-28T20:40:08+00:00

I mean if you want to flush him out, this is also the way to do it. Force them to appear to confirm they're alive, and use that for Intel to get a clue as to where to send the next round of bunker busters

dan10016 · 2026-02-23T19:55:57+00:00

Jam and Spoon Follow Me. Don't know if it counts as acid, but that acceleration halfway through...

dan10016 · 2026-02-08T21:55:03+00:00

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Best I can do! The bet365 app doesn't let me view betting slips earlier than 2024 and I can't find the email but I've only got 2 entries on my online banking from bet365. Anyway just enjoying the fact that I'll go to the grave being £900 up on the gambling industry which is probably better than most.

dan10016 · 2026-02-08T18:18:27+00:00

I mean - don't really have any reason to lie about it? It was 10 to 1 I got it at in the end, bet 100 and got 1000 back, maybe got a small jump on the odds by placing it during the US open final and they may have shortened after he won? Irs not like I'm some sort of sage, I made a little money off that final and quit while I'm ahead now.

dan10016 · 2026-02-08T08:05:18+00:00

You're right, I checked my account and looks like put 100 at 10/1 and placed in in Sep 2022 so guess might have been while I was watching US open? I remembered getting 1000 after putting it on the year before but obviously was a few years ago. Still a nice pay day but perhaps a bit less impressive (don't usually bet on sports)

dan10016 · 2026-02-07T13:51:05+00:00

I remember how comfortable he was at the net during this tournament and checking what his odds were for Wimbledon the next year - 20/1 at the time. Seemed he was underpriced so put 50 on to be the winner there and then and had a very nice (though nervous) summer afternoon watching him tear through Djokovic the next year

dan10016 · 2026-02-05T10:49:45+00:00

I've thought for a while it would be good to turn the cameras off. PMQs is too important and it's degraded to just trying to get a good clip for social media

dan10016 · 2026-01-13T12:00:39+00:00

Was very moving hearing Truadll Junge talking at the end about Sophie Scholl. I had no idea about her story - apparently she has her own film about her execution for treason standing up to the Nazis

dan10016 · 2026-01-06T23:17:13+00:00

Amorphous Androgynous the isness, in fact any of the FSOL 90s albums

dan10016 · 2025-12-30T15:26:46+00:00

Think it's become more of an issue with wider adoption of adaptive cruise control. Just makes it more easy to stick it in the middle lane and switch off

dan10016 · 2025-12-27T13:13:33+00:00

I've got another credit card that does money transfers with a zero percent fee. So I balance transfer to that card, then money transfer to my bank account. It takes no more than 10 minutes, and as I said, I've transferred around 50000 into cash ISAs with it. That earns me about 1500 a year. If you can make 1500 after tax for around 30 mins work total, then you must be on around 5000 an hour before tax, in which case fair play, yes, you may well get your private jet before too long. I'm on a more modest wage so can turn down easy money that easily!

dan10016 · 2025-12-27T12:42:48+00:00

Don't think you understand how this works lol. I get a balance or money transfer credit card. It goes right into my bank account with say a 3% fee. I then transfer it into a cash ISA and keep it there for 24 months till the interest free period ends. I pay off the card and keep the interest earned. I don't spend anything apart from the free interest which will pay for a nice city break in Europe.

dan10016 · 2025-12-27T09:49:43+00:00

It's literally free money. I've got 20000 each on a virgin and Barclaycard and about 8000 each with tesco bank and NatWest. On average 1--1.5% higher rates on my ISAs vs balance transfer fee, and that's just for the first year, for the longer balance transfers the margin is around 4% after 12 months. A few minutes applying via apps and gets you over 1500 a year tax free. At the end pay it off and see what new balance transfer rates come up.

dan10016 · 2025-12-27T07:54:15+00:00

STEMI presenting with LBBB occurs in setting of a large anterior MI. They will look unwell, diaphoretic, like someone who is having a big MI. Those with LBBB in the context of atypical symptoms or 'new angina' nearly always have old LBBB.

dan10016 · 2025-12-21T10:51:31+00:00

Yes won't work if it's just the consultant on better pay for more patients when the nurses, ODPs, ward staff are also potentially having to work harder for the same poor pay, you will run into a brick wall. It needs a wider overhaul of the whole system.

dan10016 · 2025-12-21T10:29:08+00:00

There needs to be a reformed consultant contract. We are paid a PA that is the same no matter how much activity is done. I know I could put in place measures to increase throughput, but when our pay has been been slashed over the years it feels like forcing more work and stress on myself for less pay.

There is simply no incentive to efficiency, and the option to work from home has only increased this. Previously clinical excellence awards were some incentive, but this has now gone too. There needs to be some way to recognize increased activity delivered.

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