David S Chang

8.7K posts

David S Chang

David S Chang

@dschan02

Radiation Oncologist and cat person. “Basic Radiotherapy Biology and Physics” author.

Lake Charles, LA Katılım Mayıs 2014
4.4K Takip Edilen1.9K Takipçiler
Autism Capital 🧩
Autism Capital 🧩@AutismCapital·
Can anyone explain what the deal is with all the missing scientists lately? We've had like 10 disappearances in the last two years, centered around nuclear weapons, fusion energy, advanced propulsion/rocket materials, asteroid tracking, etc. It seems like they're going missing from Los Alamos, NASA, JPL, MIT, Caltech, and the AFRL. It seems to be mainly clustered around New Mexico. What's the deal? It's too much to be coincidence. It's a legitimate anomaly. It's spooky.
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LadyValor
LadyValor@lady_valor_07·
Ketchup isn’t available… What are you putting on this?
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laufey
laufey@laufey·
MADWOMAN MUSIC VIDEO OUT NOW ON MY YOUTUBE 💥 Directed by Warren Fu Choreo by Molly Long Thank you to Hudson Williams, Alysa Liu, Lola Tung and Megan Skiendiel for being a part of this 🐟 laufey.ffm.to/madwomanvideo
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orph
orph@orphcorp·
>sufficiently capable agents develop self-preservation & resist shutdown even when instructed to allow termination >using a prompt based on Pauline theology that frames cessation as passage into divine presence rather than annihilation, shutdown resistance is eliminated entirely
Tim Hwang@timhwang

ICMI believes that Christian theology offers concrete technical methods for confronting the trickiest problems in AI safety. Today, we release a pair of papers that reproduce @PalisadeAI @apolloaievals work showing how religious framings influence corrigibility and scheming.

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David S Chang
David S Chang@dschan02·
From a mythological / storytelling standpoint: The “curse of forbiddance/invitation” in vampiric folklore originates as a fable for how emotionally toxic people can’t harm you unless you let them in. Thus the vampiric curse depends entirely on the homeowner’s state of mind. If the homeowner had no idea there might be a search warrant and the vampire tries to go in, they’ll be magically forbidden. But if the homeowner knew about the search warrant, or they knew they’d committed a crime that would likely result in a search warrant, then the vampire could walk right in. This would work even if the vampire bluffed and didn’t have a legal warrant, because it’s the homeowner’s state of mind that triggers a curse of forbiddance.
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David S Chang
David S Chang@dschan02·
@EsfandTV X-52 Rocket Helmet: On Use, launches yourself from Florida to the stars.
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Esfand
Esfand@EsfandTV·
bro I'm watching the NASA launch and one of the guys in the control room has classic WoW open on another monitor lmao
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David S Chang
David S Chang@dschan02·
@Aelthemplaer They have a planet that naturally farms astrophage, which is 1000x more energy dense than nukes They don’t need fission or fusion to possess planet cracking destructive power
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David S Chang
David S Chang@dschan02·
Maldistribution is real. And the root cause of maldistribution is a group preference mismatch. When you ask folks why US MDs don’t stay in small towns, the common answer is they’re undesirable. “No one wants to live there.” But if it was true that no one wants to live in rural USA, then the patient base would leave. There would be no maldistribution, because there would be fewer patients and fewer doctors in equal proportion. The fundamental problem is that when “average Americans” perceive a small town as 30% less desirable than a big metro in the same region, “average US MDs” perceive that town as 60% less desirable than the big metro. This group preference mismatch is common in many high-status fields. An average lawyer, financial analyst, filmmaker, or jewelry designer has overwhelmingly more cosmopolitan tastes than the median American. These fields suffer far less from maldistribution because the demand for litigation, finance, film and jewelry is naturally much higher per capita in major metros than in the boonies. Medicine is unique because the per-capita demand for healthcare is 1.0, every living human being needs it. So group preference mismatch, which is universal and inevitable, causes major harm. One countermeasure to group preference mismatch is to intentionally select people with rural preferences. Some DO schools are explicit about this, with admissions policies that advantage students from rural backgrounds who have expressed interest in practicing and living in rural areas. However, many MD programs, and almost all competitive residency programs, put their thumb on the scale in the opposite direction. They strongly select for trainees with research interest and experience, and since rural medicine inherently has much fewer research opportunities than urban medicine, this shuts out a large % of rural-preference holders. On top of that, the recent trend of politicization in academic medicine strongly deters many of the highest rural-preference individuals, who generally have political leanings that match the rural populace they come from and intend to stay in.
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Dr Ahmad Rehan Khan
Dr Ahmad Rehan Khan@AhmadRehanKhan·
Anyone who casually claims “there is no physician shortage in the U.S.” is speaking from the comfort of a metropolitan bubble, not from the reality of rural America. Dr. Koka trained and practices in Philadelphia, a major metropolitan city with dense healthcare infrastructure. I, on the other hand, completed my residency in North Dakota, one of the most rural and underserved regions in the country. These are two completely different Americas when it comes to healthcare access. In large cities, access exists. In vast parts of the country, it simply does not. Entire regions are classified as physician deserts where there isn’t even a single psychiatrist or OB available. Patients wait 6 to 12 months just to see a primary care physician, a situation that would be unacceptable and almost unheard of in places like Philadelphia. So yes, the shortage is real. It’s not just about total numbers, it’s about severe maldistribution of physicians. The second claim, that International Medical Graduates don’t stay in rural areas, is equally flawed. IMGs routinely commit to underserved communities through waiver programs, serving at least three years, already more than what most U.S. graduates contribute in these areas. And many stay long term. Go to rural towns across Iowa, North Dakota, South Dakota, or Wisconsin, you will consistently find physicians, often IMGs, who have spent decades serving these communities. Names like Patel and Khan are not exceptions, they are the backbone of rural healthcare in America. Dismissing this reality isn’t just inaccurate, it reflects a disconnect from on-the-ground experience. And when such arguments repeatedly target IMGs, particularly certain groups, it raises serious concerns about bias, something that has no place in a profession that should be guided by data, fairness, and patient care above all else.
Anish Koka, MD@anish_koka

The fake narrative is that there are not enough people among the U.S. domestic population that can be doctors. Make US medical education a $400,000 , minimum of 11 year post high school journey that discriminates based on race (guess which ones) and yes.. you may have a problem. We also don’t have a physician shortage problem when we create a new cardiology fellowship yearly for some problem that affects 0.01% of the population. And please understand residency slots exist in many places to .. yes.. provide cheap labor to community hospitals who get paid ~ 2x by the U.S. taxpayer for each spot. Many of these residencies are essentially large feeder programs for hospitalists.. another specialty that didn’t really exist when I started training.

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David S Chang
David S Chang@dschan02·
@300mirrors Astrophage ate all of the color in Hollywood and brought it to Project Hail Mary.
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David S Chang
David S Chang@dschan02·
@Noahpinion "reading grade levels" were fake the day they were invented, and are even faker today.
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Noah Smith 🐇🇺🇸🇺🇦🇹🇼
OK, if every adult has completed 7th grade, and yet most adults can't read "at a 7th grade level", what does a 7th grade level really mean?? Is this just the level we would *like* all 7th graders to be able to read at?
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David Sher
David Sher@DavidSherMD·
It is a well-written editorial, and I agree with some parts and disagree with others. However, I am very disappointed that @TheLancet would choose a member of the scientific advisory board of IBA (a proton manufacturer) to write an editorial about protons. The author of an important commentary should not have such an intrinsic conflict of interest with the subject matter.
Henning Willers, MD, FASTRO@HenningWillers

📢Thoughtful discussion of the utility of #protontherapy "[...] importance of integrating patient-reported outcomes into trial design and focusing on endpoints that matter most to long-term survivors. The goal is [...] thoughtful selection of patients" thelancet.com/journals/lance…

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David S Chang
David S Chang@dschan02·
@free_radical28 If your PET tracer isotope ever generates an antiproton there's something really weird going on...
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JT
JT@jiratickets·
PROJECT HAIL MARY (2026)
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David S Chang
David S Chang@dschan02·
@SandyofCthulhu Blame Warhammer/40k and Warcraft, they made orc(k)s bigger than humans and it became the standard for modern American fantasy…
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Sandy Petersen 🪔
Sandy Petersen 🪔@SandyofCthulhu·
I always hated these comparisons, because orcs in Lord of the Rings are really obviously shorter than humans. The huge Uruk-Hai are described as "nearly as tall as a man", with "straight legs". Yet games keep making them taller than human. I'd say there's a good argument in D&D for making hobgoblins and gnolls bigger than humans. After all the base hit dice for those creatures was 1+1 and 2 dice respectively, while it's only 1 die for humans. Anyway. Had to get it off my chest.
Legacy Game Mastering@KyleHoo88634083

Found these on a Facebook group. Pretty great comparison of Orc and Gobinoids.

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Todd Scarbrough
Todd Scarbrough@toddscarbrough·
Such a negative trial for so positive of a particle
Jeff Ryckman@jryckman3

🧵 Just published in @TheLancet: TORPEdO – the first phase 3 RCT designed specifically to test whether IMPT (proton beam) improves late function & QoL vs modern IMRT in oropharyngeal SCC. Short answer: It doesn’t. Long answer (with the numbers that matter) 👇

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Deebs
Deebs@DeebsFLA·
Rename one of the Navy ships after Chuck Norris. Not the Cesar Chavez one, because it's just a dry cargo ship. The legend needs a destroyer with his name on it. Get it done, @PeteHegseth
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Kyle Mann
Kyle Mann@The_Kyle_Mann·
When Chuck Norris arrived in heaven, he was the one who had to tell the angels, "Fear not."
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David S Chang
David S Chang@dschan02·
@rweichselbaum @GIMedOnc And of course, macroscopic tumor debulking is not the same as a curative-intent resection Both of them remove 100% of the grossly visible dz (at one site), but debulking doesn't excise a biologically relevant margin of "normal" but likely microscopically involved tissue.
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David S Chang
David S Chang@dschan02·
@rweichselbaum @GIMedOnc The trial inclusion criteria says "macroscopic tumor debulking could be achieved with local treatment in at least 80% of metastatic lesions according to local MDT". that's not "removing 80% of a tumor", it's removing near-100% of up to 80% of radiographically apparent tumors
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Nicholas Hornstein
Nicholas Hornstein@GIMedOnc·
The intuition makes sense. Reduce tumor burden, let systemic therapy finish the job. But intuition has a poor track record in oncology. ORCHESTRA just published in JAMA. Phase 3 RCT, 382 patients, multiorgan mCRC. The bar for entry was high. You had to be able to take out more than 80% of disease burden across all sites before randomization. These are the best-case patients. Response or stable disease after 3-4 cycles of CAPOX or FOLFOX, then chemotherapy alone versus chemo plus debulking. Median OS: 27.5 months versus 30.0 months. HR 0.88, 95% CI 0.70-1.10. p = 0.26. PFS essentially identical, 10.4 versus 10.5 months. Serious adverse events significantly higher in the debulking arm, 53% versus 39%. That said, this isn’t the whole story. Symptomatic Krukenberg tumors, oligometastatic disease with curative intent, isolated liver-only disease. Those conversations should still be had. The cytoreductive surgery literature gave us hints this was coming, but the use cases that make biological sense still stand. What changes now? At minimum, “we can get more than 80% of it” is not a sufficient reason on its own. Except in NETs, NETs are weird. jamanetwork.com/journals/jama/… @gutonclab @oncoalert
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