Duke Duncan MD

2023 July 13 @NEJM Clinical Decision section on Treating Intermediate Risk PE: CDT and thrombectomy not even considered. They are arguing systemic TPA versus heparin! I had to double check the date to make sure it wasn’t the 2008 issue

@r0ck3t23 Great post

Mark Cuban just described the largest wealth transfer of the AI era. Almost nobody understood what he said. Cuban: “There are 33 million companies in this country. Aren’t going to have AI budgets. Aren’t going to have AI experts.” Not tech startups. The shoe store. The regional trucking outfit. The accounting firm with 12 employees. The businesses that actually run the physical economy. They know AI is coming. They have no idea what to do with it. Cuban: “You’ve got the head of Microsoft saying software is dead because everything’s going to be customized to your unique utilization.” Software is dead. The SaaS era ran on one rule. Build a generic product. Force millions of companies to bend their workflows around it. Charge rent forever. AI ends the contract. The business stops bending to the software. The intelligence bends to the business. But customized by whom. The third-generation manufacturer cannot tell Claude from Gemini. The county hospital is staring at a reactor asking where the light switch is. Cuban: “Who’s going to do it for them?” That question is worth more than the frontier models themselves. Hundreds of billions are being burned to build the foundation. The smartest engineers alive are locked in a bloodbath over who owns the base layer. Let them fight. Let them burn the capital. Let them drive the cost of raw intelligence toward zero. Because the wealth does not collect where the brain is built. It collects where the brain meets the business. Every ambitious kid in college right now thinks survival means a seat at OpenAI or Anthropic. Cuban is staring at the other 99 percent of the economy. Learn the models. Then learn the messy, unglamorous reality of how a 50-person company actually operates. Walk through the door. Understand their problems. Wire the intelligence directly into their revenue. That is not a job title. That is an entire economic class being born. You do not need to build the brain. You need to build the nervous system. The biggest winners of the electricity era were not the engineers who built the generators. They were the ones who walked into dark factories and showed the owners where to plug in. 33 million companies are standing in the dark right now. Silicon Valley is racing to build the god. The fortunes will belong to whoever teaches him a trade.

@SenWarren This is not correct unfortunately.

Let's be clear: the U.S. had a deal that could have prevented Iran from getting a nuclear weapon. Trump ripped up that deal. Then he started a war instead of doing the hard work of diplomacy to stop Iran from getting a nuclear weapon.

@digijordan Because they have nuclear weapons already.

North Korea is the most oppressive regime in the world. They have nuclear weapons. They constantly threaten the US. Yet… We don’t ‘liberate’ their people. When you realize the answer to WHY, everything happening in the Middle East starts to make sense.

@david_parker It’s a very bizarre combination

Donald Trump the man is very flawed, he undoubtedly knows it, and really, I don't think he cares. Donald Trump the President is one of the greatest leaders of a nation that the world has ever produced.

@Rajatsoni Because a rental property is tax-free income and often times has appreciation on the equity. STRC has capped upside and unlimited downside. Google “what are the risks of investing in STRC” and you will find out immediately

Why would you buy a rental property when you can earn 11.25% owning $STRC

@buckethatbtc @Strategy Hey @grok what are the risks of investing in STRC

you could literally - put $200k in a STRC paying 11% interest - live off the $1800/mo. interest payment why are people not doing this @Strategy cooked

@compliantvc Typical leased car is $500 month. And driving in your own car is often preferable to taking public transit for most people.

went out to a restaurant last night ate a delicious meal for only €12 drank one of the most beautiful wines I've ever had in my life (just €7) at the end of the night, the waiter didn't beg for a 50% tip instead, the restaurant paid him a respectable living wage without having to rely on charity from the diners on my way home, I enjoyed a free ride on public transit instead of paying $3,200 a month for a leased car that costs an additional $750 a month in petrol just to operate The American mind cannot comprehend the beauty of living in Europe

@cryptopunk7213 Tuition is same as an elite school, this if an elite school just with a different curriculum

this school used AI to teach kids and outperformed the top 0.1% of schools globally, the stats are insane: - average student is the equivalent of a valedictorian at a top 15% elite U.S. private school - in mathematics “students perform at a level that breaks the standard calibration of the test with averages projecting to near-PERFECT SAT scores” 😂 - students learning rate didn’t plateau it got FASTER. meaning they weren’t just smarter - they got smarter FASTER - kids only used AI for 2 hours PER DAY. that’s it. that’s all it took to outperform 99% of the nation. - 5 year olds performed at the level of 9 year olds. teenagers performed at college level and beyond.

This is unbelievable, huge change is coming to media in the next three years.

@trentjhughes Takes more than one full day is the problem. We had our garage organized by someone who does this full-time and it took almost a week.

My wife's friend started a business organizing people's garages Charges $800-$1,200 per garage Takes one full day Only does it 2 days a week That's $6,400-$9,600/month She's booked out a month Zero investment Just before/after photos on Facebook Boring businesses blow my mind sometimes

Geniculate artery embolization for knee pain in an otherwise healthy 60's year old looking to delay knee replacement. Prior to treatment, was unable to exercise more than 15 mins with 7/10 pain. Now pain free at 6 months. #iRad #GAE

@YunTaTsai1 @elonmusk Significantly reduces the subliminal stress of driving, especially for trips over an hour

Testing the same route, I am now actually driving 15 mins slower in average on manual than Full-self Driving. Full-self Driving not only reduces stress but saves me time. That’s 30 mins of saving per day.

Features of the bill.

@ChengaziMD Good save, reasonable approach to start, do you think using different coil type would have helped?

Everyone loves the perfect angio shot But there’s lots to learn when things don’t go as planned Embo for high flow intrahepatic shunt>coil flies off>balloon trapped coil>snared in IVC>embo completed Crisis averted, case salvaged. How would you approach this case/complication?

@IRKhalsa @SIRspecialists @SIRRFS @SIR_ECS @_backtable @SDhandMD @TheRealDoctorOs @thegestgroup CARTO with gel foam slurry

Holy hemorrhoids … refractory hemorrhoidal variceal bleed. Post TIPS. Any embolic preferences?

@allenanalysis I picked these from my backyard in Florida this morning

DEAN: “What’s the tariff on bananas?” LUTNICK: “10%.” DEAN: “Walmart already raised banana prices by 8%.” LUTNICK: “Well, if you build in America, there’s no tariff.” DEAN: “You can’t build bananas in America.”

@DrJayMohan @t_intheleadcoat @AntoniousAttall @drochohan @IRKhalsa @RajWellnessMD @EricSecemskyMD @jcgeorgemd @HadyLichaaMD @SMPatelMD @JayMathewsMD Perfect spot for DCB trial, if fails within three months then stent

Pacemaker induced #DVT Placed 2 years ago for HCM. Surprisingly sudden onset left arm swelling. 8️⃣F Brachial vein access ✅Glide advantage/IVUS cross ⚡️CAT 7 Lightning 🎈DCB 12 x 60 Impact Cause of DVT: poor collaterals and lead fibrosis. Anyone used DCB in this space?

@thesurgerylife @_backtable Biggest issue with these IJ approaches in ESRD patients is that you are risking delayed thrombosis of the jugular access, thereby compromising the patients future access options, otherwise it works fine if you can tolerate the financial loss

IMO most efficient way to do graft/fistula thrombectomy. I go IJ approach then 12F sheath and CAT 12 typically 1-2 passes and the fistula/graft is all open, single stick, no hands under fluoro, cleaner thrombectomy.. Anyone else doing this approach? #IR, #vascular ? @_backtable

@anals_of_IR @PenVascular I posted a video of Inaris new sheath when it came out too, I am equal opportunity free advertising!

@RadDrDuke @PenVascular Dude we like you. But this is so brazen a conflict of interest. Are you at least getting paid by @PenVascular ? At this point, you can either get paid (which is cool) and declare COI or you’re basically giving a cash transfer to Jim Benenati’s obnoxious wife to buy more shoes

New @PenVascular venous sheath is looking fantastic, excited to put it to work: -hydrophilic distal w/atraumatic tip -Removable hub and adjustable inner valve, needed for huge lollipop thrombus -side arm injectable w/Flash16 in place (slender sheath design)