Jennifer Hamilton, MD PhD

Family physician, public health advocate, bicyclist and occasional maker of liquid nitrogen ice cream. Views are my own, and not medical advice. (she/her)

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Last Notes

2026-02-27 21:39:37 UTC

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On the CDC website, I did find the recommendation for those 65 and older to get 2 doses annually. However, but that everything there also says "shared clinical decision-making", you may want to check with the folks you'd be thing to fit the vaccine ( Clinic? Pharmacy? ) to see how they handle it before you drive to get it.

2026-02-27 19:55:05 UTC

#ACIP meeting slated for March 18 & 19 -- and they're going to be taking about covid vaccine injury.
If you were giving of getting a covid vaccine booster this spring -- maybe you get the vaccine twice a year because of health risks -- you might want to get it before the meeting.
https://www.nbcnews.com/health/health-news/rfk-jrs-cdc-panel-discuss-covid-vaccine-injuries-upcoming-meeting-rcna260694

2026-02-25 13:20:11 UTC

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I have several patients who got GLP1 meds through websites or specialty clinics who lost weight, stopped the meds, and had the weight come back -- and now complain that the meds didn't work.
"They're not like antibiotics. They don't cure a problem. They're like blood pressure meds. As soon as you stop them, the numbers go back up." I say as empatheticly as I can.

2026-02-14 14:50:57 UTC

An article on the BBC website, trying to explain why an actor on a US hit TV series in the 1990s would need to crowdsource money to pay for colon cancer treatment:
https://www.bbc.com/news/articles/cx2dw01p7k8o
They address "he wasn't wealthy" in detail, but sort of slide over the "US doesn't have national health insurance" part, which would explain more about why wealth is important.

2026-02-13 14:10:21 UTC

The FDA decided not to even review Moderna's mRNA flu vaccines for approval, even though the studies the FDA would be reviewing were conducted the way the FDA told Moderna to do them.
Now #Moderna expects that none of its other #mRNA #vaccines will be reviewed, and has halted studies on vaccines for EBV, HSV, and shingles.
A lot of people with herpes would be angry if they found out.
A lot of people who have family members with #MS -- now thought to be caused in part by EBV -- will be livid.
https://cdn.masto.host/medmastodoncom/media_attachments/files/116/063/701/098/021/963/original/09f8c492a027d70b.png

2026-02-13 13:47:07 UTC

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I find Breathertarian short internal training to be more effective. I break up my Breather sprints with dark chocolate.

2026-02-13 12:22:58 UTC

Great news in #Philadelphia: A group of clinics that provides healthcare services in low income neighborhood has had its funding restored.
🎁:
https://www.inquirer.com/health/fpcn-family-practice-fqhc-health-center-grant-20260213.html?utm_source=social&utm_campaign=gift_link&utm_medium=referral

2026-02-01 13:32:58 UTC

An article summarizing the new head of the ACIP's outlook on vaccination policy makes for a dispiriting start to the week.
https://www.theguardian.com/us-news/2026/feb/01/vaccine-recommendations-acip
Summary: he thinks we don't need vaccines anymore because we don't have the incidence we used to (BECAUSE OF VACCINATION!) and because we can better treat illness now.
The exchange rate between ounces of prevention and pounds of cure must have changed from what I remember.
#ACIP #vaccines

2026-01-28 14:09:57 UTC

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It looks like at least this time we'd be able to do an orderly withdrawal, so we can find each other on whatever different servers we migrate to.

2026-01-26 13:18:18 UTC

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Call it a "profitable" business model, instead of "good", and my comment will then be "both".

2026-01-24 14:00:47 UTC

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Somewhere nearby there's a raccoon thinking, "that could have been mine. "

2026-01-23 23:53:27 UTC

What would you do if, while you were in handcuffs inside an ICE vehicle being driven to a detention center, one of the agents in the SUV had a seizure?
Two women in that situation recognized the seizure, then asked the driver to pull over and uncuff them so they could deliver first aid.
After EMS services arrived --
-- the women were placed back in handcuffs and taken to the local detention center.
🎁: https://www.startribune.com/detained-by-ice-two-women-became-first-responders-during-agents-seizure/601569667?utm_source=gift
#USPol

2026-01-23 20:05:15 UTC

I don't want AI in my electronic medical record to try to summarize other clinicians' notes, or to listen in on my conversations with my patients to try to write my notes for me.
On days like this, with a big storm bearing down, I just want a plain old database to show me which of my patients will need their prescriptions refilled within the next 5 days, so that I can refill them now and patients can pick them up before the storm comes.
Guess which I don't have?
#AI
#EMR
#LLM

2026-01-20 13:03:21 UTC

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In my family it has always been, "when you're down, shine your shoes. "

2026-01-14 14:12:57 UTC

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With AI folded in to so much software these days, there may have been someone who just looked at their search results and didn't realize the results came from AI.

2026-01-14 13:09:14 UTC

#AI news from England that US readers might not have seen: police banned fans of a particular soccer team from attending a game because of high risk of violence, citing their behavior at a previous match.
Except the previous match never happened.
Turns out the police used Microsoft CoPilot when hunting for info about the team's fans.
https://www.bbc.com/news/live/c394zlr8e12t
#MicroSlop

2026-01-12 16:40:55 UTC

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🍿

2026-01-11 18:38:44 UTC

"Hi! You can sign up for extra surveillance and targeted marketing while you're at our conference! "
https://cdn.masto.host/medmastodoncom/media_attachments/files/115/877/918/936/073/975/original/7d4358f320b2cb41.jpg

2026-01-05 19:57:26 UTC

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YES! Yes it is!

2025-12-27 16:07:38 UTC

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I sent an annoyed message via Doximity to the editor repeating back what the note said, then following with "in other words, you want me to fact- check your AI, doing the work you should be doing, for free. No, thank you. "

2025-12-27 00:36:36 UTC

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I had a similar Doximity message saying that their LLM AI had cited an article I wrote, and would I like to look over their summary? When I responded that no, I was not going to do their editing and review for free, I got a message back saying they of course they meant to pay me.
Heck no.
Interesting that they haven't improved their communication 🙄

2025-12-12 23:02:09 UTC

Last year I had a review article on strep throat published in _American_Family_Physician_. Today, I got email from Doximity letting me know that their #AI system had generated a summary about strep throat that cited my work, and asked me to review that summary for accuracy.
In other words: they're using a computer program to scrape my work, and they want me to double-check it out of the goodness of my heart.
I declined.
#UnpaidLabor

2025-12-09 11:49:16 UTC

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Right -- which is why I described my line as a counter-factual that anti-vaxxers might use anyway. There's a big difference between "an honest assessment of the study" and "what anti-vaxxers will say to discredit it."

2025-12-09 02:05:19 UTC

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Attack the randomization (note, what follows is counter-factual I can imagine and anti-vaxxer saying) : "In France vaccination is required. The icky reason people were asked to refuse the vaccine was if they were already at death's door from cancer or liver disease. So of course the folks who weren't sick enough to be excused from the vaccine lived longer. "

2025-12-07 04:30:31 UTC

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The boyfriend? The EX-boyfriend?

2025-12-06 16:06:26 UTC

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Here's a gift link to the article in The Atlantic, without needing to go thru Facebook:
https://www.theatlantic.com/national-security/2025/12/pete-hegseth-strikes-venezuela-congress/685156/?gift=d22D6h-Ryp8L2u-__iL2fQhbCpEuOPH_pxyaWc8PdTY&utm_source=copy-link&utm_medium=social&utm_campaign=share

2025-11-25 13:00:35 UTC

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But colonoscopy doesn't expose anyone to radiation (it has other risks, of course), and mammography is lower dose X-rays compared to CT scans for lung cancer screening. If repeated CT scans are expected to cause 5% of all cancers if we don't make a change (https://cancer.ucsf.edu/news/2025/04/15/popular-ct-scans-could-account-for-5-of-all-cancer-cases-a-year), how does the number needed to screen compare to the number needed to harm?
(Sorry - the article you linked to was paywalled.)

2025-11-22 04:36:56 UTC

Benjamin Mazer at The Atlantic understands the current moment.
🎁
https://www.theatlantic.com/health/2025/11/rfk-vaccines-dont-not-cause-autism/685026/?gift=d22D6h-Ryp8L2u-__iL2faN4v8zgFV7BAG5sV8A-bk8&utm_source=copy-link&utm_medium=social&utm_campaign=share
https://cdn.masto.host/medmastodoncom/media_attachments/files/115/591/481/042/422/790/original/7b60df500272e313.jpg

2025-11-16 20:11:56 UTC

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I don't have the luxury of making a stand unless I know my family will be safe.

2025-11-16 15:30:58 UTC

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There was a time in the early aughts when the male residents in my FM program all had Viagra pens; the women all had Diflucan pens.
Ah, for the days you'd get samples of Imitrex at a (red) wine and (hard) cheese reception.

2025-11-08 00:04:09 UTC

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But also see https://electrek.co/2025/11/07/toyota-yet-again-delaying-ev-battery-plans/ for a different take: Toyota promising solid state batteries at same time as announcing delays and cutbacks.

2025-11-01 15:58:32 UTC

My work #EMR at now has integrated #AI that summarizes a patient's chart whether I want it to or not. This week it told me the wrong reason for admission, the wrong hospital course, and the wrong medications as compared against the human-written discharge summary. To review it and find the error took 3 minutes; to document the error and report it took another 10.
Anchoring bias exists. What we read stays with us, truth or lie, influencing decisions.
And I can't turn it off.
#LawsuitBait

2025-09-04 22:11:41 UTC

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Could you check for a typo? #40 years in US is not right.

2025-09-02 21:53:22 UTC

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If there's reason to suspect a child is at risk for #measles -- planned travel to an area with outbreaks of the disease, say, or a local outbreak nearby -- kids can get vaccinated at age 6 months. It doesn't replace the vaccination at 1 year, but it's temporary extra protection.
(Not saying that child's doc or family did anything wrong! Cases like that, though, are part of why the extra shot is available. )

2025-08-28 20:48:07 UTC

I haven't seen this on a Mastodon server yet, so forgive me for linking to a different social media site: As of 3:45 Eastern on Aug 28, #CDC employees stage mass #walkout to cheer on those in their leadership who were fired or who quit in the last 24 hours:
https://bsky.app/profile/newseye.bsky.social/post/3lxicgmgb3k2a
For those not familiar with the area, folks are lined up along Clifton Rd. One of the red awnings seen in the video there is likely the building from which nearly 200 shots were fired, killing a police officer.

2025-08-24 16:36:23 UTC

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Oh, I agree with you. My point is, my bike would be classified as a moped (pedals, throttle, could go really fast) because that's what I had to buy to get the features I want. When new classifications get made, let's develop an "adaptive cycle" with a top limit on speed, and a throttle that only lasts 10 seconds or so.

2025-08-24 16:20:56 UTC

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Here's my use case: i used to ride 400 miles in a week, until my knees complained. Now I have a problem generating torque. I use my ebike as a class one (pedal-assist, under 20mph) EXCEPT when starting from a stop: I use the throttle for a few seconds until I get rolling.
I've never seen a "just for a few seconds" throttle. Add on the fact that I still like long rides (so huge battery capacity) and I've got a bike that could terrify the bike path -- if I rode like a jerk.

2025-08-23 14:04:12 UTC

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The old "three wolves and a sheep vote on what to have for dinner" problem.

2025-08-18 10:43:39 UTC

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We saw it during the early days of covid, too: if you call them "heroes" you can stop caring about them. Heroes risk their lives. It's in the job description. Ordinary people we can have empathy for.
It's dehumanization in a different direction -- heroes aren't subhuman -- but it creates emotional distance and blocks empathy just the same.

2025-07-25 14:45:03 UTC

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Many of your toots today have used shortened URLs. These tools are often considered to be unsafe --readers can't tell what they'll be connected to, and whether or not there is tracking information attached to the URL. Please consider going back to long links.

2025-07-24 11:03:28 UTC

I don't wear a mask at home or when I'm outdoors, but I do mask up at work. Yesterday a patient I hadn't seen in years sighed "Covid, AGAIN?" I answered that I never stopped masking.
Now that we know how much masks (esp KN94/N95) reduce respiratory illness, why wouldn't you want your doc to wear a mask to see you? Odds are, I saw someone with a sore throat sometime in the last day or two. I don't want covid, or the flu, or a cold -- and I don't want to give any of those illnesses to you.

2025-07-18 14:13:31 UTC

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Part of EMTALA is a hairs-breadth and a state border away from gone: what if someone shows up at an ED with, say, hemorrhage or infection related to pregnancy that can only be treated by abortion? In the beginning of June, HHS sent out a memo rescinding Biden-era guidance; 3 weeks later another memo came out saying they don't want women to die. Which is it?
https://www.smfm.org/emtala

2025-07-18 11:48:13 UTC

More bad news on the health #insurance front: prices for #ACA ("Obamacare") marketplace policies are set to jump next year, by 50-75%. Tax credits passed in 2021 are set to expire...
which will lead to a rise in cost...
which will give healthy people a reason to drop insurance...
which increases the average risk level of those in the insurance pool...
which leads to price hikes.
https://www.npr.org/sections/shots-health-news/2025/07/18/nx-s1-5471281/aca-health-insurance-premiums-obamacare-bbb-kff

2025-06-28 22:18:18 UTC

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Huzzah!

2025-06-14 14:46:37 UTC

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When the squirrels went after the Brandywines -- that was an escalation in hostilities that demanded action.

2025-06-14 11:07:13 UTC

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Squirrel defense for deck planters.
https://cdn.masto.host/medmastodoncom/media_attachments/files/114/681/383/154/061/255/original/4badc7030aadfaa0.jpg

2025-06-13 13:15:58 UTC

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Haven't had those yet. You've given me something to look forward to.

2025-06-13 12:42:17 UTC

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I don't know. When the squirrels go for my tomatoes I would rather have them eat a whole tomato all the way instead of taking one bite out of each.

2025-06-05 13:53:21 UTC

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I'm not calling out machine learning techniques that went into, for example, radiological image interpretation. But I don't think LLM AI should have a place in the curriculum -- other than as a topic to be discussed in ethics classes. Theft of intellectual property and lack of consent from those whose work was used to train the models are unavoidable problems. "Hallucinations" (bullshitting by design) and energy use are also concerns.

2025-06-05 10:56:40 UTC

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If you're going to accept work from medical students performed in conjunction with #LLM #AI, remember to update your institution's policies on plagiarism and consent for consistency. Commercial AI products are trained by scraping copyrighted material without permission or even acknowledgement.
If you've ever cheered when a recording artist has told a political campaign "you can't use my song", ask how creators can enforce control of their material in training AI.

2025-05-29 14:04:26 UTC

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lthe link gives a 404 error

2025-05-22 20:13:44 UTC

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Meanwhile, a federal judge in California has issued a temporary ban on revoking the legal status of international students.
https://www.nbcnews.com/politics/immigration/judge-blocks-trump-revoking-international-students-legal-status-rcna208625

2025-05-18 00:33:15 UTC

Rolling Stone has a good summary of proposed changes to Medicaid: work requirements and paperwork requirements to keep people from getting health care, while still being able to claim that deserving people are eligible.
https://www.rollingstone.com/politics/politics-news/medicaid-cuts-trump-republicans-explained-1235341686/
Remember in the 1980s when people felt such pity for children with HIV, because they didn't "deserve" it -- as if other people did? This is the opposite of that. In a country as wealthy as the US, #EveryoneDeserves medical care.

2025-05-08 15:41:29 UTC

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"Scientific reviews that took days now take minutes" by replacing human thought with programs that are trained to give an answer that sounds right -- regardless of whether or not it's correct.
Truthiness is becoming policy.
How long before the USDA approves pizza glue?

2025-04-11 12:51:18 UTC

My favorite #SurgeonGeneral story is about Luther Terry, who in 1964 released the report showing that smoking was harmful to health. He was nervous, and lit up a cigarette on his way to the press conference. His aide pointed out that if he wanted to motivate change, maybe he shouldn't be smoking.
Press conference happens. At end, reporter asks, "Are you a smoker?" "No, I am not." Reporter checks his notes. "When did you quit?" "Thirty minutes ago."
And he stayed quit.

2025-04-09 14:39:03 UTC

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The last Confederate flag
https://cdn.masto.host/medmastodoncom/media_attachments/files/114/308/511/220/413/082/original/a0a0925be9f05872.jpg

2025-02-28 12:41:53 UTC

I try to keep my posts here focused on vaccines and similar public health measures, and to let other folks post about other health topics. But this is too egregious not to shout about: a bill introduced in the Texas legislature that would criminalize any provision of hormonal treatment except those that a 6th grade biology text would say goes with gender assigned at birth. At any age.
Dropping the pretense that this is about protecting children.
https://social.edist.ro/@CosmickTrigger/114078401848080372

2025-02-19 00:41:28 UTC

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According to that Washington Post article, the federal government is considering shutting down the website where people can request free covid tests (COVIDTests.gov) TONIGHT, Tuesday Feb 18.
Order tests NOW at https://covidtests.gov/ if you're eligible.
Details at https://wapo.st/42VLGQh
(Please consider boosting this for added urgency.)

2025-02-16 00:07:00 UTC

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And remember, after transplantation people need to take medication to ratchet the immune system down; otherwise, the body will recognize the new organ as not-self and destroy it. So common infections become more deadly, and vaccinations BEFORE THE TRANSPLANT HAPPENS help prevent things like the flu from becoming fatal.

2025-02-14 14:01:40 UTC

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My old VW could get to 5,000 revolutions every minute! When that's the threshold....

2025-01-31 13:01:01 UTC

As discussion about #vaccine policy has been making national news this week, please remember that deaths from vaccine-preventable disease aren't ancient history. In the 1990s there was an outbreak of #measles in Philadelphia. Nine children died -- nine children who were deliberately left unvaccinated by their parents.
I called my senators this morning to remind them of the 9 constituents they don't have.
#BlockRFKJr

2025-01-03 17:10:05 UTC

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Now. Check to see if there are hybrid heat pump/conventional electric water heaters available in your area, and if your power company will give you a credit for getting something more efficient.

2025-01-01 04:04:59 UTC

Quoting @zlevymd.bsky.social‬:
"United Healthcare just denied a claim on one of my patients in the ICU with:
-- a brain hemorrhage
-- in a coma
-- on a ventilator
-- in heart failure
...because I haven't proven to them that caring for her in the hospital was "medically necessary".
Tear it all down."
https://bsky.app/profile/zlevymd.bsky.social/post/3lem5xtijek2c

2024-12-26 23:35:34 UTC

Several thoughtful letters reminding us about what life was like before the #polio #vaccine, and with polio:
https://wapo.st/3ZZPiOe 🎁
The world, through continuing effort, has already eliminated two of the three strains of polio virus. Stopping vaccination now would expose Americans to continuing risk. It really is only one flight away, until it's eradicated everywhere. That tantalizingly reachable goal won't be achieved if we stop vaccinating too soon.

2024-11-16 13:00:22 UTC

Childhood mortality -- death before age 15 or so -- used to run at about 50%.
Every second child born, died before becoming an adult, all over the world, for as far back as we've been able to track.
We didn't turn the corner until about 1900, when science got us the germ theory. That sparked sanitation and vaccination.
A cabinet nominee (RFK Jr) who questions vaccines is frightening. A nominee who brags about not washing his hands (Hegseth) is terrifying.
https://cdn.masto.host/medmastodoncom/media_attachments/files/113/492/726/240/693/709/original/8fc886b56456a8f8.jpg

2024-11-15 17:17:08 UTC

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And I doubt that the USDA will get much of a budget to track bird flu in cattle or pigs.

2024-10-31 11:36:00 UTC

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KitKats. (I would stash peanut butter cups, too, but I bought a small bag of those all for myself.)

2024-10-17 13:48:58 UTC

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If passkey are the answer, what's the question?
Passkeys are heavily dependent on biometrics: the computer system trusts that it's you logging on because of some ID code on your device, and the fact that you logged in to your device. A whole lot of people use biometrics to get into their phone or laptop. Under US law, you can be compelled to place your finger on a sensor or look into a camera -- but you can't be made to disclose a password.
Sticking with passwords, thank you.

2024-09-13 15:21:02 UTC

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Last year, after we switched to heat pumps for HVAC and swapped out our gas stove for induction, we were able to completely disconnect our house from local gas lines. It was a great feeling when the folks from the utility company handed us the old meter they took off the wall.

2024-08-27 22:35:48 UTC

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I haven't been out there lately to check for candles, but there was a commemorative 10(ish) mile roadrace. Spring in Philadelphia brings the Broad Street Run, and in the autumn, well....
https://www.inquirer.com/news/fraud-street-run-virtual-four-seasons-total-landscaping-trump-giuliani-philadelphia-20201112.html

2024-08-27 20:15:15 UTC

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Fahrenheit? Yes. Kelvin? Yes, but a different yes.
No riding today!

2024-08-22 18:25:45 UTC

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They've been approved.
https://www.washingtonpost.com/health/2024/08/22/new-coronavirus-vaccine-covid/

2024-08-02 17:37:00 UTC

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I've had #induction for about 3 years now. Love it! And the safety of it: it used to be that one of our cats could turn the gas on. 😬 We needed knob covers etc. Induction range turns itself off if there's no pot.
Highly recommended accessory: LoMi cooktop mat protects from scratches, spills.
My safety demo: put a little bit of water in pot, get it boiling. Pull pot aside, put hand on mat where pot had been. It's warm, but not burning hot.