Hello, I am doing a review and I need to export results from Cochrane library, but it suddenly won't let me through my university's access.
Can anyone with full access please help me and extract the data in RIS format.
This is the search strategy, I just need the last line that gives 2381 results. https://www.cochranelibrary.com/advanced-search/search-manager?search=7450287
Here is a tutorial, the steps are under "Exporting Citations for Multiple Articles from Search Results":
https://www.cochranelibrary.com/help/exporting-search-results
Thank you.

Using Zotero plug in for Word for Mac (v16.84). When switching citation styles (APA to AMA), one or two citations are not converted. This has been happening on a regular basis. Has anyone else encountered this? To answer an anticipated question, I use APA style when writing drafts since it shows me authors' names which helps me remember what I cited. Then switch to AMA format prior to submission.

Abstract Recent reviews of using therapeutic carbohydrate reduction to treat metabolic disease in paediatric patients have consistently made errors in the form of bias against recommending this nutrient-dense eating pattern despite strong evidence for its use in adults and emerging evidence in paediatric patients. The purpose of this perspective is to review these errors, which include conflating 4:1 ketogenic diets with well-formulated ketogenic diets and the needless medicalisation of using therapeutic carbohydrate reduction in paediatric populations.
Keywords: type 1 diabetes; type 2 diabetes; obesity; paediatrics; low carbohydrate; ketogenic.
Introduction The American Academy of Paediatrics’ (AAP) 2023 report on ‘Low-carbohydrate diets in children and adolescents with or at risk for diabetes’ endorsed low or very low carbohydrate diets, also known as therapeutic carbohydrate reduction (TCR), under close medical supervision for children with type 1 diabetes (T1D), type 2 diabetes (T2D), or at risk of T2D.1 It is important to ensure that medical nutritional therapy (MNT) remains as flexible as possible in the battle against chronic metabolic disease as support for a wide variety of eating patterns is needed to address the increasing burden of disease. From 2001 to 2017, the prevalence of paediatric T1D increased by 45.1% and the prevalence of paediatric T2DM increased by 95.3%.2 As of 2020, the prevalence of paediatric obesity had risen to 21.5%.3 The status quo still leads to significant morbidity as men and women diagnosed with T1D before the age of 10 see their expected lifespans reduced by 18 and 14 years, respectively.4 Approximately 13 years after a diagnosis of T1D, the prevalence of neuropathy, retinopathy and nephropathy is 59%, 27% and 5%, respectively.5 Children with T1D exhibit abnormal brain development with lower white matter and gray matter even if their glycaemia is ‘at goal’.6 The current standard of care is at fault for these poor outcomes.
In this report, we expected – but did not find – information that would highlight the unique benefits of using MNT generally and TCR specifically to treat metabolic conditions. We believe the AAP missed a crucial opportunity to help curb bias against TCR, which has demonstrated efficacy and safety in multiple settings for adults and paediatric populations in long-term studies.7,8,9 Unfortunately, even though the AAP endorses TCR for paediatric metabolic disease, they needlessly medicalise this eating pattern by recommending numerous blood draws and trending of 14 different laboratory measurements. This recommendation is despite TCR being a nutrient-dense pattern of eating that exceeds the minimum nutrient reference value thresholds for all micronutrients in children and adolescents.10,11 Our concerns regarding the report relate to four key topic areas: (1) the conflation of 4:1 ketogenic diets (KDs) with well-formulated TCR, (2) the effects of TCR on nutrition, (3) growth and (4) disordered eating.
Bias created by conflation of 4:1 ketogenic diets with well-formulated therapeutic carbohydrate reduction Firstly, the AAP authors conflated 4:1 or 3:1 KDs that are used to treat epilepsy with well-formulated TCR that are used to improve metabolic health. Therapeutic KDs for epilepsy are generally 4:1 or 3:1, where there are 4 g or 3 g of fat for every 1 g of protein and carbohydrate, respectively. For a 4:1 KD, this equates to 80% – 90% of calories from fat.12 This high-fat level ensures adequate production of ketones, which can be lifesaving for children with refractory treatment-resistant epilepsy who would have breakthrough seizures should their ketone levels fall below a critical threshold.12 These 4:1 KDs have never been recommended for the treatment of metabolic disease, which is the topic of this report. The TCR used to treat metabolic disease is based on a modified Atkins diet.12 This eating pattern contains 70% of calories from fat, which is far less than the 90% seen in a 4:1 KD. Indeed, one of the most popular well-formulated TCR allows for two cups of leafy vegetables and one cup of nonstarchy vegetables, which fulfils the AAP’s recommended five servings of vegetables per day through age 18.13
Bias created by fear mongering nutritional deficiencies not seen in therapeutic carbohydrate reduction The report recommends 14 different laboratory measurements with five different blood draws over the first year for children following TCR regardless of whether their underlying diagnosis is T1D, T2D or even if they are only deemed to be at risk of developing metabolic disease. Tests include magnesium, zinc, selenium, vitamin D, comprehensive metabolic panel, urinalysis, beta-hydroxybutyrate, free and total carnitine, complete blood count, fasting lipid panel, calcium, phosphorous, urine calcium and a DEXA scan if the patient has been on TCR for greater than 2 years. These recommendations are from a 2021 review of studies on the management of paediatric T1D subjects on a low-carbohydrate or KD.14 This review again conflates 4:1 or 3:1 KDs with well-formulated TCR. Out of 34 references, one study is an online survey of 316 respondents who support the use of TCR in paediatric T1D, one study is a six subject case series on the negative outcomes of using a KD to treat paediatric T1D and 18 studies are on 4:1 or 3:1 KD to treat epilepsy or rare congenital metabolic diseases (Figure 1). Therefore, following the lineage of data, the current 2023 AAP report cites concerns about using a KD for T1D, T2D and obesity from this 2021 review that itself is largely based on data from using a 4:1 or 3:1 KD for epilepsy.

FIGURE 1: The subject matter of citations in ‘Medical management of children with type1 diabetes on low-carbohydrate or ketogenic diets’. 

This misinterpretation of the data becomes apparent when these concerns are investigated further. For example, regarding the concern for carnitine deficiency on a KD, the 2023 AAP report cites this 2021 review, which then cites a 2002 article in which all subjects were inducted on a 4:1 KDs for epilepsy. There are no cases of carnitine deficiency in the literature on well-formulated TCR. Indeed, meat is the most common source of carnitine, and a well-formulated TCR allows for meat consumption ad libitum. This mistake is repeated for magnesium, zinc, selenium and vitamin D deficiencies; anaemia and bleeding risk because of platelet dysfunction; disturbances in acid-based status; liver and kidney function and calcium, phosphorus and urine calcium derangements.
Biases created by conflating growth issues of children with epilepsy and therapeutic carbohydrate reduction This conflation of the risks of a 4:1 KDs is repeated in the citations for growth, bone health and nephrolithiasis. Regarding growth, the largest study of TCR in people with Type 1 diabetes showed no associated growth reduction.15 The AAP report correctly points out that insulin is required for proper growth and development but omits the fact that people with T1D following TCR must use exogenous insulin to cover protein. Thus, TCR does not fully alleviate the requirement of exogenous insulin for people with T1D, and it is in the context of protein and insulin that growth occurs normally and normoglycaemia is possible.15 It is also worth noting the unprecedented efficacy with an average a1c of 5.67% in the participants who adopted TCR. We know from numerous studies that elevated A1cs that are typical of children with T1D following the standard carbohydrate emphasised diet are responsible for stunting growth and causing damage to a child’s developing brain.16,17,18
Biases created by implying therapeutic carbohydrate reduction causes eating disorders when no such data exist Finally, the authors cite concerns regarding eating disorders (EDs) and KDs. There is no evidence that clinician-recommended MNTs promote EDs. The authors cite a study on diet culture, which is nonspecific and would imply any MNT including Mediterranean diets are at risk for causing EDs.19 Another citation on the dangers of carbohydrate reduction inducing EDs states ‘the role of low carbohydrate diets per se has not been clearly established as a predictor of an eating disorder’.20 Indeed, the published literature shows that elevated A1cs typical of the standard approach to paediatric T1D is correlated with EDs and low diet quality.21 A critical feature of well-formulated TCR is improving diet quality through the reduction of ultra-processed, high-glycaemic foods, which are implicated in disordered eating.
Conclusion There is a reoccurring theme in the clinical report where the lack of evidence for well-formulated TCR in children is magnified while the lack of evidence for other dietary patterns, such as the Dietary Guidelines for Americans or the Mediterranean diet in children with metabolic disease is minimised. In adults, the AHA and ADA both recommend the use of low carbohydrate eating patterns to treat T2DM, with the ADA reporting that:
[R]educing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.22,23
There have been many large randomised and controlled studies on well-formulated TCR in adults and every point made in the clinical report that is salient to adults has been found to not be of concern. In adults, there is minimal to no risk of deficiencies of carnitine, magnesium, zinc, selenium, vitamin D deficiencies, anaemia, bleeding, poor bone health, nephrolithiasis or eating disorders. We must look to adult literature to temporarily answer these concerns in children as research in these areas is currently lacking for all eating patterns in paediatric subjects. For example, a 2009 Cochrane review found only six randomised controlled trials on dietary change alone in paediatric subjects with obesity.24 This absence of evidence does not indicate harm. These theoretical risks must be weighed against the possible benefits of improving glycaemia, especially when the current standard of care has such poor outcomes. Furthermore, as discussed earlier, a TCR meal plan can be created that exceeds the nutrient reference value thresholds for children and adolescents.11 Professional organisations have a remarkable opportunity to follow in the ADA’s footsteps and be innovative with MNT for diabetes and obesity in children. For that to happen, we need to have common ground with the correct terminology and stop conflating 4:1 KDs that are used to treat epilepsy with well-formulated TCR that is used to treat metabolic disease. Future reports on TCR should include practitioners and researchers who utilise TCR in their practice or research to avoid inaccuracies and confusion regarding the use of TCR for metabolic disease.

Hi all! Welcome to the new ScienceBasedParenting, a place to ask questions related to parenting and receive answers based on science, share relevant research, and discuss theories. We want to make this sub a fun and welcoming place that fosters a vibrant, scientifically-based community for parents.
We are a team of five moderators to help keep the sub running smoothly, u/shytheearnestdryad, u/toyotakamry02, u/-DeathItself-, u/light_hue_1, and u/formless63. We are a mix of scientists, healthcare professionals, and parents with an interest in science. Let us know if you have any questions!
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Greetings CMS affiliates / CMS aficionado, healthcare insurance stakeholders, healthcare insurance investors, healthcare workers, and other stakeholders (hopefully no CEO of the big 4, or else Reddit might throw this in the dustbin. Don't let them in OK???):
Welcome to another episode of a very dry and boring topic discussion, which is the most recent release of "CMS Finalizes Payment Updates for 2025 Medicare Advantage and Medicare Part D Programs" discussion. The entire document is 194 pages long, and 165 pages of texts, whatever pages left of tables and charts and numbers, and a lot of excel attachments. I will be lying if I told you I read it all (I skimmed it, but my skimming skill is still probably better than 99.95% of degenerates from another reddit), and my job is to bring you some information from this beast of a document so that you may have a small % of the knowledge of what may come to pass. That being said, please note that I am NOT a CFO, COO, CMO, or any C suites member, and therefore my job is much easier. I only need to opine, as my job is not dependent on reading every syllable and figure out its meaning and the associated excel cells related to those, and Risk Adjustments / Quality Bonus Payment parts are for someone else to beat their head over with.
Before we get started on this multiple part DD - and trust me it needs to be in multiple parts or else I will not have a job by next week, we should first start with some history lessons, why Medicare Advantage (or part C for those who are geeks) exists, its original purpose (other than fattening UNH/HUM/Aetna/Centene/Cigna EPS), its evolution, and why CMS may have had enough and ergo released their 2025 finalized payment to the absolute horror of almost every Healthcare Insurance company except maybe Clover. To do this, we must first start with history lessons, which is where I start as part 1:
Medicare, and inception of Medicare Advantage - a very brief overview of history:

1. https://www.cms.gov/about-cms/who-we-are/history
2. https://www.commonwealthfund.org/publications/issue-briefs/2017/dec/evolution-private-plans-medicare
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117270/

For those of you who likes to read through links and be an absolute chad just like your good old grad school days, please use the above 3 links and some google searches, then proceed to skip the rest of the discussion until the next set of links. For all of you other folks who don't like to read think tanks, pubmed articles, and good old google searches to self educate, I will attempt to do some short and sweet broad-strokes using the provided links (don't sue me if I am bad at explaining history lessons, I didn't finish school to be like Indiana Jones for Medicare. And since I am in Reddit and not doing a real publication, please excuse the fact I didn't use AMA citation format, as I don't really want to do it unless I absolutely have to, so please don't make me do it, I have a real life now I think):
Medicare & Medicaid¹
On July 30, 1965, President Lyndon B. Johnson signed into law the bill that led to the Medicare and Medicaid. The original Medicare program included Part A (Hospital Insurance) and Part B (Medical Insurance). Today these 2 parts are called “Original Medicare.” Over the years, Congress has made changes to Medicare, and more people have become eligible.
In 1972, Medicare was expanded to cover the disabled, people with end-stage renal disease (ESRD) requiring dialysis or kidney transplant, and people 65 or older that select Medicare coverage. More benefits, like prescription drug coverage, have been offered.
Medicare advantage - beginnings, A Program in Infancy (1966–1982)²
Medicare has involved HMOs since 1966. Because these private plans use salaried physicians, they were originally paid on a reasonable-cost basis for services that Medicare otherwise would have paid on a reasonable-charge basis. Under the 1972 Social Security Amendments, preexisting plans could continue to be paid on a reasonable-cost basis, but new plans would operate on a risk-sharing contract. By 1979, 65 HMOs were contracting with Medicare, although only one had a risk-sharing contract.
The Rise of HMOs (1982–1997)^2,3
The 1972 Amendments gave the Health Care Financing Administration (HCFA) — subsequently renamed the Centers for Medicare and Medicaid Services (CMS) — the authority to conduct demonstrations of payment models that might reduce program spending, improve health care quality, or both. Demonstrations indicated that providers in HMOs seemed to take more conservative approaches to treatment and engaged in more preventive care and that, compared to people in traditional Medicare, enrollees in HMOs were more likely to be younger and lower-income, report themselves in excellent health, and indicate that a relationship with a single physician was not very important. However, HCFA estimated that it paid at least 15 percent more for enrollees in Medicare HMOs than for demographically similar beneficiaries in traditional Medicare. The Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) established a capitated payment system with prospectively set payment rates per enrollee for private plans. The Medicare Advantage (MA) program, formally Part C of Medicare, originated with the Tax Equity and Fiscal Responsibility Act (TEFRA), which authorized Medicare to contract with risk-based private health plans, or those plans that accept full responsibility (i.e., risk) for the costs of their enrollees' care in exchange for a prospective, monthly, per-enrollee payment.
Medicare+Choice: A Decline in Offerings and Enrollment (1997–2003)^{2, 3}
The Balanced Budget Act of 1997 (BBA) made significant changes to how Medicare paid risk plans in the new Medicare+Choice (Medicare Part C) program. It scrapped the previous payment formula and largely reduced payment rates to plans. In response to reports of favorable selection, the BBA established new risk-adjustment measures based on health status and an annual enrollment period, with only one switch allowed outside that period. It is also from this period that Meidcare+ Choice (which will become Medicare Advantage) dual mandate is formalized: MA program has pursued two stated goals. The first is to expand Medicare beneficiaries' choices to include private plans with coordinated care and more comprehensive benefits than those provided through traditional Medicare. The second is to take advantage of efficiencies in managed care and save Medicare money. As you can see, there isn't a specific section that says MA needs to fatten our HC insurance partner's EPS wallet, but then you wouldn't know that was the case if you read some WSJ lately, namely: https://www.wsj.com/health/healthcare/medicare-keeps-getting-tougher-for-health-insurers-52f6ad26
A Resurgence in Plans and a Surge in Expenditures (2003–2010)^{2, 3}
In addition to establishing Medicare Part D, the Medicare Modernization Act of 2003 (MMA) significantly altered how private plans (now renamed Medicare Advantage) were paid. The law limited enrollees to one switch per year during the open enrollment period and allowed plans to include the new drug benefit (MA–PD).
The MMA significantly raised payments to plans to counter the effects of the BBA. Everywhere in the country, Medicare offered rates to private plans that were at least as high as traditional Medicare spending per enrollee, resulting in a 10.9 percent increase in outlays to risk plans between 2003 and 2004. The big 4 would like to thank their lobbyists on doing a heck of a job. The MMA also established a bidding mechanism, under which each plan submitted a bid representing its estimated cost of providing basic Medicare benefits to enrollees for the coming year, including administrative overhead and profit. If the bid comes in lower than a county-level benchmark based on traditional Medicare spending per enrollee, the plan is paid most of the difference as a rebate or bonus. The big 4 would like to thank their lobbyists on doing a heck of a job The plan is then required to provide additional benefits that equaled the actuarial value of the rebate. Notice the nice wording on this. A coupon would do as an actuarial value of the rebate right?
With Parts A, B, and D available under one plan, as well as supplementary benefits subsidized by generous payments, enrollment in Medicare Advantage skyrocketed. In each year from 2006 to 2011, most new plan enrollees were beneficiaries who had switched from traditional Medicare, many of whom were relatively young. By 2010, enrollment reached 11.1 million, representing 24 percent of all beneficiaries.
A (Partial) Return to Original Goals (2010–2017)^{2, 3}
The Affordable Care Act (ACA), signed into law by President Obama in March 2010, included another major restructuring of the MA program and significant cuts in MA plan payments. Payment provisions in the ACA brought Medicare Advantage plan payments closer to traditional Medicare spending levels and reduced rates overall. Starting in 2012 the legislation reduces some plan payments while preserving broad access to plans across areas and rewarding plans that provide high-quality care. Many analysts predicted widespread plan withdrawal and dis-enrollment, as had occurred under the BBA. However, from 2009 to 2017, enrollment increased more than 80 percent, with 33 percent of Medicare beneficiaries enrolled in private plans by 2017. By 2017, approximately 50 percent of plans had a rating above four stars, and these bonus-eligible plans comprised 67 percent of enrollment, up from 37 percent in 2013. As you can see, ACA was the start of the STAR ratings system.
Medicare Advantage and the gaming of the STARisk Adjustment/Quality Bonus Payment system

1. https://www.nytimes.com/2014/08/25/business/medicare-star-ratings-allow-nursing-homes-to-game-the-system.html
   
2. https://apl.utdallas.edu/2023/03/15/gaming-the-system-how-major-insurers-are-able-to-extract-big-profits-from-medicare-advantage/
   
3. https://www.urban.org/sites/default/files/2023-06/The%20Medicare%20Advantage%20Quality%20Bonus%20Program.pdf
   

I hope you read Rainy's discussion on Risk Adjustment and Quality Bonus Payment from the other subreddit? We won't be posting there anymore, so if you would like us to re-copy those posts back into this subreddit we could, so please comment if that is what you want. If you recall, the original reason why Rainy even wrote that post was because some degenerate started to ask me on if I can define the exact RA and QBP reimbursement rate for Clover within the New Jersey jurisdiction, and wanted me to infer this information from CMS data downloads. To which I replied nicely that I only deal with legitimate partners, not WSB, and I only use publicly available information. In any case, what the thread conversation led me to understand is that some of the big insurance companies actively game the RA and QBP depending on the patient's clinical condition, demographics, and geography. I think Upset Weekend got super upset that evening just for that. Please excuse his grumpiness, I don't think he is as jaded yet.
Now let us get into the meat of this:

1. The QBP has become a significant source of revenue for insurers participating in MA, totaling $10 billion in extra payments in 2022. Inflation in QBP costs has contributed to growing policy concerns that the QBP and the underlying MA star ratings are not achieving their goals of encouraging quality improvement among MA insurers and helping seniors make informed plan choices (MedPAC 2020)⁶.
2. Evidence also suggests that double bonuses available under the QBP in counties with low traditional Medicare costs result in inequitable MA spending and bonuses based on race or ethnicity. The QBP is also not aligned with the measures of quality that experts use in research to assess clinical quality in MA, including mortality rates for specific conditions, inpatient admissions and readmissions overall for specific conditions, or hospice use. Even a recent study by Optum, a subsidiary of United Health Group, did not use star ratings measures to assess quality in its MA contracts compared to care in traditional Medicare. Instead, it used alternative quality measures.⁶
3. Evidence shows that insurers combined contracts to boost star ratings before 2020, a practice that undermined the program’s purpose⁶.
4. Finally, the QBP also does not include measures that address the documented problems in MA, such as difficulty accessing high-quality postacute care, denials of prior authorization, and high rates of switching to traditional Medicare among seriously ill beneficiaries⁶. Or another way of saying it - Big 4 MA takes your money, screws you with prior authorizations, and the moment you are seriously ill, you have to switch back to traditional medicare. Your taxpayer money at work.
5. It is now well established that many MA organizations actively attempt to increase risk adjustment payments by “finding” diagnoses that would not be recorded for beneficiaries if they were in the traditional Medicare program⁶.
6. Research shows that beneficiaries do not use star ratings when making enrollment decisions Some research suggests that seniors do appear to respond to the lower premiums and cost sharing that highly-rated plans can offer because of star rating bonuses, but not to the star ratings themselves. This suggests that star ratings fail one of their two major goals—to provide actionable information to beneficiaries. Beneficiaries may not use star ratings to make decisions, partly because contract-level star ratings that cover multiple states or plans do not give beneficiaries much information about their experience in their local area. Similarly, combining preventive care, beneficiary experiences, and administrative effectiveness into a single rating does not help beneficiaries select plans based on important factors⁶. Combined in totality, STAR rating serves as a poor determinant of plan clinical effectiveness, value, and cost of the MA insurance plan (descriptive emphasis by Moocao).

If you have read through all this, congratulations! In the next parts we will delve into what I think is the reason for why CMS released its big April Fools day release and why all big Healthcare Insurances are quaking in their boots and why their stock took a nosedive, and what implications this may have for all Medical Advantage plans in the future. Hopefully you all had a fun read, because going through all this really makes me feel like Indiana Jones and the Last Crusade - the drying up dying guy who drank from the wrong cup.
Sincerely
Moocao
*** This is not financial advice, nor is there any financial advice within. Shout-out to the AMC/GME apes for forcing me to write this every dang time, especially when someone's lunch money can be involved ***
*** Please do not utilize this content without author authorization ***
**Edit: removed GWB prez 4 lyfe, the satire sauce was too thick and I didn't want the PC police to come and arrest me**

Vote Brigading

My posts are upvoted by people who can't participate, violating the Reddiquette on voting. This happens in lots of forums, where people from other forums [buddhism, meditation, new age awkening] come to Zen to upvote people who say Zen is buddhism, meditation, or new age awakening.
https://www.reddit.com/familyguy/comments/n1d2zh/announcement_updated_subreddit_rules_new/
Vote brigading is bullying strategy used for censorship: https://www.reddit.com/AmItheAsshole/wiki/faq#wiki_what_is_a_brigade.3F

Censoring Source Material

I am frequently harassed by racist and religiously bigoted people for simply referencing the books cited on these wiki pages: * www.reddit.com/zen/wiki/buddhism * www.reddit.com/zensangha/wiki/getstarted * www.reddit.com/zen/wiki/sexpredators and their messiah www.reddit.com/zen/wiki/secular_dogen
Why can't they speak up? I've written this stuff to explain my position and the evidence: https://old.reddit.com/useexpress-potential-11
One of the interesting things is what does it mean to "engage with the forum"?
Learn about the subject → Discuss what was understood Read the posts in the forum → Respond with questions/citations Consider the questions posed by tradition/rZenners →answer thoughtfully "Trumping the Evidence"
People who can't read/write at a high school level claim "no evidence" or "lots of evidence"
They can't cite sources or discuss the sources others cite
They are unable to engage in evidence-based conversations
Buddhists and new agers are awesome. They refuse to AMA, quote Zen Masters, cite sources even for their own beliefs. Even when they attempt to do this stuff, they are quickly caught being dope af.

ABSTRACT
Aim: To evaluate how effective a low carbohydrate ketogenic diet (KD) is for changing key physical measurements such as weight, waist circumference (WC), body mass index (BMI), and fat mass (FM) in women with polycystic ovary syndrome (PCOS) who were obese or overweight.
Methods: Several online databases, including PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science (WOS), were searched systematically to find relevant randomized controlled trials (RCTs) up until June 2023. The Q-test and I2 statistics were used to assess the level of heterogeneity among the included studies. The data were then combined using either a fixed or random effects model and presented as a weighted mean difference (WMD) along with a 95% confidence interval (CI).
Results: Of the 682 citations, 11 RCTs were included. The pooled results showed a significant decrease in the WMD of weight levels [WMD = −9.13 kg; 95% CI, −11.88, −6.39, P < 0.001; I2 = 87.23%] following KD. Moreover, KD significantly reduced BMI levels [WMD = −2.93 kg/m2; 95% CI, −3.65, −2.21, P < 0.001; I2 = 78.81%] compared to the controls. Patients with PCOS received KD demonstrated significant decrease in WC [WMD = −7.62 cm; 95% CI, −10.73, −4.50, P < 0.001; I2 = 89.17%] and FM [WMD = −5.32 kg; 95% CI, −7.29, −3.36, P < 0.001; I2 = 83.97%].
Conclusion: KD was associated with lower weight loss (WL) parameters, including weight, BMI, WC, and FM, in obese or overweight women with PCOS, highlighting the significance of physicians and nurses in taking care of the nutritional needs of overweight/obese patients with PCOS.

https://doi.org/10.29219/fnr.v68.9835
https://pubpeer.com/search?q=10.29219/fnr.v68.9835

Effects of ketogenic diet on weight loss parameters among obese or overweight patients with polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trails

Abstract

Aim: To evaluate how effective a low carbohydrate ketogenic diet (KD) is for changing key physical measurements such as weight, waist circumference (WC), body mass index (BMI), and fat mass (FM) in women with polycystic ovary syndrome (PCOS) who were obese or overweight.and#x0D, Methods: Several online databases, including PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science (WOS), were searched systematically to find relevant randomized controlled trials (RCTs) up until June 2023. The Q-test and I2 statistics were used to assess the level of heterogeneity among the included studies. The data were then combined using either a fixed or random effects model and presented as a weighted mean difference (WMD) along with a 95% confidence interval (CI).and#x0D, Results: Of the 682 citations, 11 RCTs were included. The pooled results showed a significant decrease in the WMD of weight levels [WMD = −9.13 kg, 95% CI, −11.88, −6.39, P < 0.001, I2 = 87.23%] following KD. Moreover, KD significantly reduced BMI levels [WMD = −2.93 kg/m2, 95% CI, −3.65, −2.21, P < 0.001, I2 = 78.81%] compared to the controls. Patients with PCOS received KD demonstrated significant decrease in WC [WMD = −7.62 cm, 95% CI, −10.73, −4.50, P < 0.001, I2 = 89.17%] and FM [WMD = −5.32 kg, 95% CI, −7.29, −3.36, P < 0.001, I2 = 83.97%].and#x0D, Conclusion: KD was associated with lower weight loss (WL) parameters, including weight, BMI, WC, and FM, in obese or overweight women with PCOS, highlighting the significance of physicians and nurses in taking care of the nutritional needs of overweight/obese patients with PCOS.
------------------------------------------ Info ------------------------------------------
Open Access: True (not always correct)
Authors: * Nan-nan Xing * Fang Ren * Hui Yang
Additional links: * https://foodandnutritionresearch.net/index.php/fnarticle/download/9835/16980
------------------------------------------ Open Access ------------------------------------------
If the paper is behind paywall, please consider uploading it to our google drive anonymously.
You'll have to log on to Google but none of your personal data is stored. I will manually add a link to the file in this post when received.
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In light of recent meltdowns from people claiming (and upvoting claims in violation of reddit voting policy) that Zen Masters did not instruct, Zen Masters did not write books of instruction, and that observance of precepts aren't a pre-requisite to engagement with the Zen tradition, I was thinking of all the different textual sources people turn to for instruction...IKEA manuals...Monopoly instruction booklets...The Bible...sutras.
Some of those textual sources disclose that they are instructions for a specific context in real life while others claim, or have claimed about them, that they are instructions on how to reap supernatural benefits/salvation/sacred-enlightenments. The owner's manual for my Corolla isn't anyone's sacred text.
Zen texts are a category unto themselves since they are not offering anyone a closed system for applying their instruction, like the makers of Monopoly and IKEA furniture do, yet at the same time reject any attempt to associate their teachings with religious doctrines and sacred texts.
One product of this neither-religion nor closed-system perspective, just in terms of the structure of their texts, is a whole bunch of citations to unrehearsed, unscripted, conversations involving the perspective and a whole bunch of accompanying direct instructions to you, the reader transmitting the perspective.
More conversation than Monopoly has ever produced and more real-life instruction than religion is capable of.
I'm going off of the dollar-standard of Gateless Checkpoint translations, J.C. Cleary and will reproduce the specific words of instruction ("do/don't do") from the Preface, Case 1, and Case 2 below.

• Just arouse a mass of doubt throughout your whole body, extending through your three hundred sixty bones and your eightyfour thousand pores, as you come to grips with this word “No.”
  
• Bring it up and keep your attention on it day and night
  
• Don't understand it as empty nothingness
  
• Don’t understand it in terms of being and non-being
  
• Bring up the word “No” with your whole life force
  
• [Huangbo]: If each and every reply is right then...[Baizhang:] come here and tell him."
  

Three cases in and we already have six instructions from Zen Masters. Or, in other words, six commandments.
According to LibreOffice, the preface and two cases clock in at 1,299 words.
Compared to a a sample with a similar word-count from the religious-zealot and woman-hater "Paul" in the 4th chapter of his letter to the Galatians we get a whole bunch of religious bullshit, rhetorical questions, and most pertinent here, no real world instruction.
The only kind of instruction he tries to give people is 100% religious in nature and 100% creepy "Become like me"
Not a Zen instruction. Not real life.
__
I think exercises like this are fun not because they are telling people that read Zen texts, that AMA, that don't lie about the compatability of a lifestyle of intoxication with Zen instruction but partly because they provide a record of the conversation that so many fakers pretend to associate with and frequently result in them trying to put their nostrils in my fingers to be lead around.

If you're reading this, statistically you've played Balatro. And statistically, if you've played Balatro you've played a lot of Balatro (citation probably needed). I currently have 36.5 hours on record with 3 wins, but I don't feel like that really illustrates how much this game has invaded my daily routine. Helldivers 2 has been amazing fun but it's not the sort of thing I can dip in to between breakfast and work/errands, while the TV is on, or any other unguarded 10 minutes during the day. God help me when they release this on phones.
I have thoughts and I don't know where else to put them. I might send this as an email to the question bucket but I don't think I actually have any questions?
​

1. The game isn't actually built on Poker so much as a Filipino game called Pusoy Dos aka Big Two. The only reason I know this is that an old high school friend who both strongly identifies with his Filipino heritage and plays a lot of games posted a link to a largely overlooked comment in the AMA with the developer. From what I can tell Pusoy Dos is like Gin Rummy using Poker hands so the confusion makes sense.
2. I think the idea that it's somehow easier to win during early runs makes sense mathematically (ignoring the possibility of the tutorial seed having better odds). At the beginning, there are fewer jokers unlocked. I presume this includes the basic hand modifiers and some relatively simple mechanics related to suit, face cards, etc. The synergies between these Jokers and the typical card draws are easier to harness, even if the potential for explosive, exponential chip totals is less. As more and more Jokers unlock, additional strategies emerge but only one piece at a time. By the time half of the Jokers are available, the player is pulling from a lot of different "strategy pools" that may not mix well. e.g. focusing on face cards, focusing on suit manipulation, focusing on pairs/straights, growth cards. It still takes a bit of luck but a simpler card pool might make it easier to find a winning combo.
3. This is a spoiler for a specific Joker: The Madness Joker is a delightful and immersive experience. I passed it up countless times before diving in on a run that was fairly aimless by the 2nd ante. Madness destroys one other Joker at random after selecting the blind and gains 0.5X multiplier every time it does. It's textbook exponential growth, but it requires a steady stream of victims to keep running. The result is a kind of random walk through cheap Jokers. After every round I found myself scraping the store for at least one new potential sacrifice. There is no real planning for the future. After a few hands I realized I had forgotten most of the Jokers that had come and gone. My strategy was in the moment instead of sliding into a steady groove like most other runs. I didn't end up winning the run, but I legit can't remember if it was due to a change in my Joker line up that I made myself or a random loss to Madness. A++ would Madness again.
4. Did Inscryption leave a permanent mark on my expectations for this sort of thing? I can't shake the feeling that there is some dark secret lurking beneath the surface of this game. It's truly OK if there isn't, but the vibes gestalt had me ready for a Her Story style twist from the very beginning. I haven't finished buying blank vouchers, so I'm holding out hope there.

Attention all hands.
Today we are formally rolling out a new feature of our community: Exemplary Contributions.

What are Exemplary Contributions?

Sometimes a post or a comment on Daystrom is so darn good that you want to do more than upvote it. Sometimes a brilliant comment is buried deep in the discussion, languishing in obscurity. Sometimes OP just took the words right out of your mouth and you have nothing more to say except “Wow, that was amazing!”
That’s when you will now be able to nominate a post or comment as an Exemplary Contribution.
To nominate something, simply leave a comment reply saying:

M-5, nominate this.

M-5 will then reply and ping the senior staff. After a brief review, the nominated user will then receive a commendation or promotion to the next rank of our flair system. Periodically, we will post digests listing all Exemplary Contributions and pin them to the Front Page.
So, what do we need from you? Simple: when you see something excellent, give M-5 a shout. Reddit, like other social media, can be a very cynical place; Exemplary Contribution nominations give us a way to inject some extra positivity into the discourse.

Why Exemplary Contributions?

Long-time community members will recognize that the Exemplary Contribution system is similar to Post of the Week. So, why institute ECs instead of PotW?
Setting aside reddit’s behavior last year, revamping Post of the Week was something we had been considering for a while. PotW was a wonderful piece of our community, and was instrumental in our early years, but had become less effective in recent years.
One reason for that is simply that engagement in PotW was very low:

• Only 1% of our user base was voting
• the vast majority of users never received a nomination over the 10 years PotW ran
• only 7% of users ever won PotW over those 10 years
• in a typical week, only about 1.5% of contributions were ever nominated
• in its last years, some weeks had almost no nominations at all

The Post of the Week system simply wasn’t touching most users. And I like to think that more than 1.5% of our contributions are exemplary.
The Exemplary Contribution system is designed to focus on the same positives PotW had:

• provide some structure for the community and create incentive to write quality comments and posts
• give visibility to contributions that might pass under the radar
• a fun way to celebrate your colleagues here at Daystrom

The EC system streamlines the process overall, and makes it easier to participate in, thereby including more members of our community.
So, bottom line: if you see something good, go ahead and call up M-5!

Promotions

And with that, I am pleased to announce the first round of promotions and commendations:

• AndscobeGonzo has been promoted to Ensign for
  
  • their Synopsis of the UFP system of government according to the 1975 Star Fleet Technical Manual
• builder397 has been promoted to Chief Petty Officer for
  
  • “The Dominion actually had cloaking technology all along, and avidly used it”
• CompetitionOdd1582 has been promoted to Ensign for
  
  • their recommendations for “intro” episodes
• FluffyDoomPatrol has been promoted to Chief Petty Officer for
  
  • “Replicators are limited by their data storage needs”
• FuckHopeSignedMe has been promoted to Ensign for
  
  • “Three reasons why Starfleet doesn't have or need an up or out policy”
• Futuressobright has been promoted to Ensign for
  
  • their analysis of Hoshi Sato as a linguistic superhero
• Lulwafahd has been promoted to Chief Petty Officer for
  
  • “Earth was human, now it’s better”
• Milfons_Aberg has been promoted to Chief Petty Officer for
  
  • arguing that impulse power was more liberating than warp drive
• queenofmoons has been awarded the Richard Galen Ecological Archaeology Citation for
  
  • “The galaxy is thick with M-class planets because the Genesis device keeps getting reinvented/rediscovered”
• Simon_Drake has been promoted to Ensign for
  
  • illustrating the range of potential variability among time travel methods
• toasters_are_great has been promoted to Lieutenant, Junior Grade for
  
  • examining the extent to which Starfleet crews are unquestioningly loyal to their captains
• warp-core-breach has been promoted to Chief Petty Officer for
  
  • imagining genres of Klingon punk

Captain out.

What up lads. I'm the creator of this AMA post and I could see how much it helped a lot of yall.
99% of you on SaaS are capable of doing this.
Imma show u how to do this step by step for free so u can literally take your product from 0 to $10k+/mo.
It ASTOUNDS me how many of you know how to code, call yourselves bootstrapped and "growth hackers", yet don't know what programmatic SEO (pSEO) is.
Before I break this down, couple things:

1. the client is an ai summarizer tool. No i cannot share the client. I asked him and he said no. Life is tough. get over it
2. No i don't have a course lol (also no one who actually makes money ever says something like this)
3. Not looking to hire anyone for my agency atm. unless it's something really cool you've built, not really interested in pms about this.

We're all in this together guys. Im just giving back. Let's grow.
--

The fxck is pSEO?

Programmatic SEO.
it's creating content at scale - thousands of pages targeted at hundreds/thousands of keywords without having to design, write, or publish pages manually.

1. you make a page template.
2. you connect a database.
3. you program an algorithm to populate the placeholders of that template page with info from the database.
4. it does that based on hundreds of user search queries that you feed it (keyword research element).

For example, Notion does this with [task or job] templates.
Targeting all sorts of queries for users to quickly solve their needs using their software. Here's a page on "event planning templates": https://www.notion.so/templates/category/event-planning
The overall structure of the page is (1). The database is simply their own database of community-made event templates (2). The algorithm connects and presents it with filters for free, paid, and popular options (3). And they do this for dozens of queries like event planning, expense tracking, content calendar, software development, business development CRM, user research, etc. (4).
Another example: Kapwing and memes. These mfs realized that ppl search for specific memes instead of just the keyword "meme generator", and they capitalized on it.
So if you or i googled some shit like "they're the same picture meme", trying to find the meme to, say, create our own version..
Here's what pops up: https://www.kapwing.com/explore/theyre-the-same-picture-meme-maker
To rank, they didn't just include the meme editor for a particular meme, they also added information, To rank, they didn't just include the meme editor for a particular meme; they also added information, in this case, a brief history of the meme. Then all the user has to do is click "Edit template" and bam, they've just become a user of Kapwing.
No content briefs. No writers. No chatgpt. When done right, it can EXPLODE your qualified traffic and customer base.
The caveat: It doesn't work for every business. It only works with specific use-cases.

So how do I know if pSEO is for me?

tbh it's not an exact science.
Some hallmarks i've noticed for great pSEO potential are:

1. If your product has a database that contains information that users could use directly, but it just needs to be presented clearly and in SEO-friendly formats

Example: sapling.ai is an ai grammar assistant that designed a pretty bare bones page template (1), connected it to some public dictionary database and/or their own (2), and created a program to pull the data from that database according to the search query - in this case - spelling variants of words like "tons vs tonnes" (1,2, 3, and 4 in action on this page).
The product angle they used to make the case for their product is: "Don't wanna google these spelling variants all the time? Download our grammar assistant for autocorrections based on your region"

1. If your product can generate unique or valuable content and make the case for itself (like the AI summarizer tool)

You can always pick ChatGPT's brain to see if there's an opportunity there for u. Or reply with your site and I'll see what I can do.

Step 1: Build a Page Template

This is basically web design.
But prioritize value over design. That doesn't mean you make a page look like it was made by a boomer but, here's something you want to ask yourself when deciding what to include on your page:
​

What can I add to this page so the user does not need to visit any other page from any other website? How can I make this as helpful and comprehensive as possible?

​
For example, for this AI summarizer tool, one of their customers was English students.
Side note on customers: If you have multiple segments, I suggest you dedicate a pSEO campaign to one customer first. This will simplify your keyword research, database retrieval, and internal linking processes. And if it's your first time, it's waayyy less headache altogether. My client served legal professionals, journalists, medical researchers, and English students with their ai summarizer tool. We picked one to start. You'll see in the coming sections why this made everything way simpler.
Anyway, in our case, since we were targeting English students, we looked for queries that related to "[book] summary".
The idea would be that when a student googled that, our software's summary would be presented on a web page ranking on the first page, making the case for our tool for future projects or assignments.
For inspiration, we looked at the current results for certain book summaries. Competition is everything in pSEO. We looked at:
- https://www.cliffsnotes.com/
- https://www.supersummary.com/
- https://www.sparknotes.com/
The idea here is to present the summary in a better way than the competition. So we created a template that is more visually appealing and user-friendly than the completion using a tool like Figma.
But remember, also more helpful.
So the next thing we did was look for complimentary informational keywords. Some other things English students looked for were:
- "[book] character analysis"
- "themes in [book]"
So we added space on the template page for summaries of these concepts too. Do you see how we tried to fulfill the quote I mentioned above at every corner?
​

What can I add to this page so the user does not need to visit any other page from any other website? How can I make this as helpful and comprehensive as possible?

​
These keywords also tended to be lower competition, so it was easier to rank them on the results page of Google.
We also added information on:
- The author and history
- Creation date
- Publisher date
- MLA citation
Once we built out the template design, it was time to find the databases.

Step 2: Identify the Databases

Pro tip: Make sure the databases in your niche/industry have public APIs before starting. If there aren't any that are publicly accessible, all of this will become significantly more difficult and risky on your behalf. Maybe not even feasible.
Now, for the database, you're either using your own or a publicly accessible one. In our case, our software did the summarizing, but didn't actually have a database of novels or other documents. So we had to rely on public databases. We used the following:
​

• Wikipedia: Wikipedia provides an API (the MediaWiki API) that allows for automated access to its content, including the ability to read and extract data from its pages. This API can be used to programmatically retrieve summaries, information boxes, full text of articles, and more.
• Project Gutenberg: Offers over 60,000 free eBooks, including many classic works of literature that are in the public domain. It's an excellent source for English novels.
• Internet Archive: A non-profit library offering free access to books, movies, music, and more. The Internet Archive includes texts from various genres and time periods.
• Open Library: Part of the Internet Archive, Open Library aims to have a web page for every book ever published. It offers millions of free eBooks and texts.

We made sure that summaries were compliant with copyright laws.

Step 3: Connect the Database and Use AI Summarizer

Time for the magic.

1. API Integration: Linked our template to databases using APIs. Ensured stable data flow for reliability.
2. AI Summarizer Deployment: Integrated AI to analyze user queries, fetch data, and generate summaries. Focused on efficiency and accuracy.
3. Dynamic Content: Template dynamically populates with AI-generated summaries, analyses, and citations based on queries. Tailored user experience.
4. SEO and Quality Checks: Applied SEO optimizations and conducted content quality checks for accuracy and originality. Prioritized user engagement and search rankings.
5. Feedback Mechanism: Implemented user feedback collection for continuous improvement of AI accuracy and content relevance.

Step 4: How does the system know which keywords to generate a page for?

Two ways to go about this.

1. You can do your own keyword research and upload the list to a backend folder where you manage the list. This is good for a starting point and targeted content strategy.

Here's how we did it:

1. Get the basic plan of SEMrush for 1 month for 129/mo (we obv have the agency plan, but this if for yall) - this more than pays for itself because you're finding and collecting HUNDREDS of keywords in one go.
2. Plug in competitor sites in the "Organic Research" tab. We used those summary sites I linked earlier which allowed us to tap into an existing database of keywords.
3. Filter for KD <29 (Keyword Difficulty is a 0-100 point scale one how difficult it is to appear on the first page for a keyword - so we're targeting the EASIEST ones to ensure success)
4. Typed in "summary" in the keyword filter bar. Then "themes" and "analysis". Separately. This returned dozens of relevant keyword searches for books. For example, "pride and prejudice (a popular english book) summary".
5. Added all of those keywords to a keyword list on SEMrush. (There's a "+" sign on the left of every keyword. Just click on it to save. Then export to a CSV by accessing the list in the Keyword Manager tab.
6. The system identifies which queries to process and generate content for through a combination of user input and predefined parameters.

Here’s how it works:

1. User Input Processing: When a user types a query into the search box on your page, the system captures this input as the key for action.
2. Query Analysis: The AI summarizer then analyzes the query to understand its intent and relevance to the available data. This involves natural language processing (NLP) techniques to parse the query and match it with topics or keywords within the connected databases.
3. Predefined Parameters: Your system can also be configured with predefined parameters or rules that help identify which queries should trigger the summarization process. These parameters could be based on specific keywords, topics, or patterns that are relevant to your content strategy.
4. SEO Optimization: The system can also use SEO strategies to identify popular or trending queries related to your field, ensuring that it prioritizes content generation for queries that are likely to drive traffic.
5. Feedback Loops: Over time, the system can learn from user interactions and feedback, adjusting its parameters to better identify and prioritize queries that are most valuable to your audience.

Step 5: Don't sleep on Internal Linking

This is the only way google robots will understand how your site's content is interconnected and whether or not you're a subject matter expert.
Let's say u have a website that's organized into main categories based on diet types, such as "Vegan," "Keto," "Gluten-Free," and "Mediterranean." Each category contains numerous recipes, tips, and diet guides.

• descriptive anchor texts: Use informative, keyword-rich anchor texts. when linking to a recipe within the "Vegan" section from a blog post about vegan diet benefits, you use anchor text like "Easy Vegan Lasagna Recipe" instead of generic terms like "click here."
• deep linking: Focus on linking to specific, relevant content deep within your site. From a general page on the health benefits of a gluten-free diet, you directly link to specific gluten-free bread and dessert recipes, guiding users deeper into your site.
• hierarchical structure: Maintain a logical content hierarchy and reflect this in your linking. "Home > Diet Type > Recipe". Links follow this hierarchy, helping users and search engines navigate and understand the site's layout. Implement breadcrumbs for better user navigation and SEO by displaying the sequence of pages somewhere near the top of the page.
• prioritize key pages: Direct more internal links to important pages to signal their value. If your "30-Day Keto Diet Plan" page is a major traffic driver, you ensure it receives internal links from all keto-related content, highlighting its importance.
• balanced link quantity: Aim for a reasonable number of links per page to avoid dilution of value. On each recipe page, you include a moderate number of links to related recipes, diet tips, and ingredient guides, ensuring the page isn't overwhelmed with links (can dilute link value) but still offers valuable pathways for exploration.

Is your site eligible for pSEO?

If you make $20k+/mo, u can dm to work w me for a potential pSEO play. if u don't, drop a link to your website here publicly for everyone and I'll see if I can come up w a pSEO opportunity for it and then show you how to find keywords with a loom.
I'm very busy throughout the week though so u may want to save the post and wait for my reply.
Either way, hope this helped gents

I'm going to be assigned a writing test for an entry level position at an agency in the next few days. I know that they'll give me a journal article with data from a trial from which I need to create a 20 min presentation for HCPs. Most of the presentations I've created for med school and work have been case presentations or educational presentations on a disease.
I understand that my goal is to create a story showing the need for the trial, the basics of the trial design, the key outcomes, and safety/adverse effects. I will also focus on the most important points and keep the slides concise as possible.
As I haven't done one of these presentations, I did have a few questions about the logistics and general advice:

1. How many slides would you recommend for a 15 minute presentation? I was thinking 1-2 minutes per slide, so around 10 slides?
   
2. Does the main title have to be the same as the article, or should I condense it to the main point? Is there room for creativity here, or is clarity more important?
   
3. How image heavy should this be? I don't have the article yet, but if there are images, should I recreate the pertinent graphs, or copy them?
   
4. What is the usual expectation for citations? I couldn't find any clear guidelines for AMA citations in a presentation, but have used numbers to cite data and either listing the reference below or in a reference page at the end before.
   
5. I don't know yet how long I'll have to create the presentation. How many hours does it usually take new writers to create similar presentations?
   
6. Any advice on design would be great. I either had a lot of flexibility or strict guidelines (the sad blue background with yellow font) for previous presentations .
   

Other advice is also very welcome, especially any mistakes you often see new writers make. Thanks!

Basically the title, out of all of the medically evacuated contestants over the years how far do you think each of them would go if they never got injured/had to leave?
Redacted (The Australian Outback) - Likely goes deep (top 5 for sure), possibly wins and probably returns for all stars.
Bruce Kanegai (Panama) - I feel he probably gets voted out at final 7/6, definitely doesn’t go too far considering Danielle was pretty much his only ally.
Jonathan Penner (Micronesia) - Not sure if he wins, but there’s a good chance he goes relatively deep into the game.
James Clement (Micronesia) - High chance of being next boot here regardless.
Joe Dowdle (Tocantins) - Since he tribe dominated post merge I wouldn’t be surprised to see him end up top 5 or further but no chance he wins, his AMA says he planned to go to the end with JT and Stephen as his final 3.
Mike Borassi (Samoa) - Likely still a premerge boot but not enough of him to tell much.
Russell Swan (Samoa) - Was the best chance of his tribe succeeding come merge, I feel he would go deep, top 6/7 for sure, but likely too big a threat to be let to the end.
Kourtney Moon (One World) - I wanna say premerge boot regardless, but could’ve potentially slipped by to early merge.
Colton Cumbie (One World) - Considering his grip over the mens tribe and his idol, he sadly becomes the biggest opposition to Kim. Post game interviews however did state he intended to work closely with Kim meaning he likely gets blindsided mid/early merge.
Shamar Thomas (Caramoan) - I’d be amazed if he wasn’t a premerge boot.
Erik Reichenbach (Caramoan) - Honestly out of everyone on this list I feel he by far was the most likely to win his medevac season. I think he beats Cochran out in the remaining challenges, and would also perform well in a ftc scenario. Especially with him having previously been a fan, if he sits there without Cochran I’m pretty certain he beats the remaining 3, but assume he ends up against Dawn/Sherri.
Caleb Reynolds (Kaoh Rong) - Probably becomes the next Joe Anglim here considering his challenges dominance up until his departure. I’d guess he goes around 9/8 and we get some more of his cute bromance with Tai.
Neal Gottlieb (Kaoh Rong) - I don’t see him winning, but considering he had an idol and was in a decent spot I’d guess 8/7.
Joe Del Campo (Kaoh Rong) - This moreso just decided Michelle would win over Aubry.
Pat Cusack (David vs Goliath) - From the bit we did see, I think he still maybe goes premerge, however the big change here is of course Nick going from winner to first boot if the boat hadn’t literally been rocked.
Jackson Fox (42) - Still likely one of if not the first boot from his tribe.
Bruce Perreault (44) - Using 45 as a bit of a reference point, I think Bruce probably gets in with the Tika 3 just due to age and tribe strength. However, I also think his personality would’ve gotten on peoples nerves, particularly Carolyns. Prediction would be early to mid merge boot.
Matthew Grinstead-Mayle (44) - One of the few people I feel had genuine winner equity had they stayed. Considering how long his affect lingered in the season through his fake idol, I can only imagine how he does actually being there. He felt well insolated in his tribe, had a good head on his shoulders, and was pretty solid in challenges for someone who only used one arm. If anyone would give tika a run for their money this season I’d bet on Matthew. If only he wasn’t an idiot and stayed off the slippery giant rocks.

Nice! Let me add some of my own:

1. TGA report that shows that it was known before vaccine rollout that: 1. The spike goes everywhere 2. There are potential auto immune effects 3. Lung inflammation in vaccinated and control 4. Spike and RNA potentially long lasting 5. Protection is declining quickly and more. (See Table 4-2 for the biodistribution of the carrier lipid that went absolutely everywhere)

https://www.tga.gov.au/sites/default/files/foi-2389-06.pdf

1. A big review from the Cochrane library concludes that masks did little to nothing

https://doi.org/10.1002/14651858.CD006207.pub6
Assessments of the Cochrane library are usually seen as gold standard of clinical science.
https://doi.org/10.1016/j.jval.2016.09.142

1. This report (An Analysis of the Origins of the COVID-19 Pandemic Interim Report Senate Committee on Health Education, Labor and Pensions) shows that a zoonotic origin is extremely unlikely and hence the virus likely originated from a lab:

“Conclusion: As noted by the WHO Scientific Advisory Group for the Origins of Novel Pathogens, the COVID-19 Lancet Commission, and the U.S. Office of the Director of National Intelligence 90-Day Assessment on the COVID-19 Origins, more information is needed to arrive at a more precise, if not a definitive, understanding of the origins of SARS-CoV-2 and how the COVID-19 pandemic began.225 Governments, leaders, public health officials, and scientists involved in addressing the COVID-19 pandemic and working to prevent future pandemics, must commit to greater transparency, engagement, and responsibility in their efforts.
Based on the analysis of the publicly available information, it appears reasonable to conclude that the COVID-19 pandemic was, more likely than not, the result of a research-related incident. New information, made publicly available and independently verifiable, could change this assessment. However, the hypothesis of a natural zoonotic origin no longer deserves the benefit of the doubt, or the presumption of accuracy.”
https://www.help.senate.gov/imo/media/doc/report_an_analysis_of_the_origins_of_covid-19_102722.pdf

1. An article by the BMJ showing how the funding from medical regulatory organisations oft he world comes mostly from big pharma (often 90%+)

https://doi.org/10.1136/bmj.o1538

1. The CDC just deleted the claim (previously labeled as “fact”) that the spike protein and RNA does not stay long in the body without explanation.

Before https://web.archive.org/web/20220721141049/https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mrna.html
After https://web.archive.org/web/20220723161304/https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mrna.html

1. On mRNA persistance

15 days in blod
https://doi.org/10.3390%2Fbiomedicines10071538
Up to 60 days in lymph nodes (with "up to" meaning after that their observation interval ended)
https://doi.org/10.1038/s41541-023-00742-7

1. On spike persitance

Persistence of SARS CoV-2 S1 Protein in CD16+ Monocytes in Post-Acute Sequelae of COVID-19 (PASC) up to 15 Months Post-Infection
https://doi.org/10.3389/fimmu.2021.746021
Spike persistence after vaccination and infection, may be linked to long Covid
https://doi.org/10.21203/rs.3.rs-1844677/v1
Circulating Spike Protein Detected in Post–COVID-19 mRNA Vaccine Myocarditis (in children)
https://doi.org/10.1161/CIRCULATIONAHA.122.061025

1. This gets its own point. It is about spike persistence 2 month+ after vaccination and infection and also possible DNA integration (in supporting info)

This citation comes from the supporting info document accessible from the downloaded paper download
"The PCR and Sanger sequencing analysis of genomic DNA from long-COVID patientsrevealed the presence of a sequence similar to the BNT162b2 vaccine spike protein sequence,possibly indicating potential integration (Figure S2)"
https://doi.org/10.26355/eurrev_202312_34685

1. Regarding DNA contamination and potential integration here are

Dr. Jürgen Kirchner before German Bundestag (in German)
https://www.youtube.com/watch?v=UObabOAJnck
Dr. Phillip Buckhaults before South Carolina senate
https://www.youtube.com/watch?v=IEWHhrHiiTY
Dr. Janci Linsay before South Carolina senate (same hearing)
https://www.youtube.com/watch?v=mjQQ7kkj3Bs
Regarding the same topic: Linearized DNA in Cells leads to integration in genome in 7% of cells
https://doi.org/10.1038/s41598-023-33862-0

1. Rate of vaccine adverse events is highly dependent on batch

https://doi.org/10.1111/eci.13998

1. Stuff about the igg4 shift that may imply increasing susceptibility to the virus long after vaccination

Class switch towards non-inflammatory, spike-specific IgG4 antibodies after repeated SARS-CoV-2 mRNA vaccination
https://doi.org/10.1126/sciimmunol.ade2798
Repeated vaccination lead to immune tolerance in mice
https://doi.org/10.1016/j.isci.2022.105479
Only mRNA vaccines generate long term igG4-responses
https://doi.org/10.3389/fimmu.2022.1020844
High iGG4 response only in previously mRNA vaccinated people
https://doi.org/10.1038/s41598-023-40103-x
Surprise finding: Higher number of vaccine doses taken implies higher risk of infection
https://doi.org/10.1093/ofid/ofad209
In previously infected individuals, a fourth vaccination was not associated with COVID-19 death risk, but with transiently reduced risk of SARS-CoV-2 infections and reversal of this effect in longer follow-up.
https://doi.org/10.1111/eci.14136
IgG4 Antibodies Induced by Repeated Vaccination May Generate Immune Tolerance to the SARS-CoV-2 Spike Protein
https://doi.org/10.3390/vaccines11050991

1. Increased sugar uptake in the hearth in vaccinated

https://doi.org/10.1148/radiol.230743
I have more (a lot more) but these here should be the more interesting ones for now.

I just want to mirror something we mentioned in our last transparency report about this year seeming to be relatively quiet in terms of subreddit reports. This seems to also be the case in the amount of votes being cast. Outside the top ranked post, the next top 4 posts this year have considerably less votes than even the top 10 posts last year.
We do not expect this to be the same moving into next year, because it's a major election year. As part of the routine ramp up we will be looking for new moderators. If you are interested please let us know so we can make sure you do not miss the open application.

What did we all discuss this year?

Topline: Republicans at war with themselves. From Ken Paton's spat with house Leader Phelan over his impeachment, the implosion of republican PACs after a meeting with a known white supremist and the continued targeting of more moderate party member's show's the Texas biggest obstacle are not democrats, but themselves. This is mirrored on the national stage with the ousting of House Speaker, Kevin McCarthy for working across the isle to keep the government open by his farther right-wing flank. The new speaker Mike Johnson was only elected after 3 weeks and 4 rounds of voting.
A shake-up in Republican Political Action Committees after Jonathan Strickland, a former Texas House rep, held an all-day meeting with prominent white supremist Nick Fuentes. Strickland was removed president of Defend Texas Liberty PAC and changed his own consulting firm's name from Pale Horse Strategies to West Fort Worth Management in the fallout. In 2015 during his first term, Strickland was named by Texas Monthly as one of the worst representatives, and in his last term Texas Monthly gave him the first ever "cockroach award".
Immigration. an evergreen issue in the Lonestar state - the bussing program continues, the erection (and ordered removal) of a floating barrier in the Rio Grande, Operation Lonestar expands with a "third phase" by deploying the Texas Tactical Border Force in May and signing a bill in December making illegal entry a state crime.
4 Special Sessions called by Governor Abbott to force the legislature to pass his priorities like school vouchers, property tax reforms and immigration. The lege meets typically for 5 months every 2 years. This year they worked into December spanning 106 days (minus Paxton's impeachment trial). The last time 4 separate special sessions were called was 20 years ago by Rick Perry.
Colony Ridge a predominately Hispanic development near Houston, which originally came to wide attention as a target of republicans for allegedly housing large amounts of undocumented immigrants and crime - a proclaimed conspiracy of it's critics that was likened to Jade Helm. In a recent twist of events, the U.S. federal government sued it's developers and outlined a scheme to attract, prey on, and ultimately foreclose homes of largely Latino immigrants. Colony Ride makes up 92% of all foreclosures in Liberty County dating from 2017 to 2022.
Failure to pass school vouchers, a key priority of Governor Gregg Abbott, calling 2 special sessions and likely to return again in 2025 after campaigning against his own party members who opposed it's passing.
The failed impeachment trial of Ken Paxton. Acquitted of all 16 article of impeachment consisting of disregard of official duty, constitutional bribery, false statements, conspiracy, and abuse of public trust. His long-delayed trial for securities fraud charges from 2011 is scheduled for April 15th 2024.
Abortion Rights - Continuing on 2021's 6 week abortion ban and last year's overturning of Roe v Wade (which re-activated previous 1925 regulations and triggered legislation passed in 2021 banning abortion after fertilization entirely) this year the focus has been on "abortion travel bans". These ordinances seek penalties to people who use public roads in the "trafficking" of people seeking abortion care in other states. Lubbock, Cochran, Mitchell and Goliad counties have passed them so far, with Amarillo currently considering their own.
The Women of Texas with Unviable Pregnancies.

• Women like Kate Cox, who sued the Texas Supreme court to get an emergency abortion after their child was diagnosed with trisomy 18, a lethal fetal abnormality, under the state's medical exemption. Kate ultimately left the state to seek care when the Texas Supreme Court ruled against her stating Cox's doctors "'good faith belief' that Ms. Cox meets the exception’s requirements" is subjective and not equivalent to the standards of "“reasonable medical judgment" as specified via the law. That determination is left to the doctors and not judges. It also points out that it is possible to have to a pregnancy of a non-viable child and still not produce a life threatening condition or impairment of the mother.
• Women like Miranda Michel, who also had a nonviable pregnancy of twins, (a situation that, again, does not have an exemption under Texas law) ultimately was forced to give birth conjoined twins with a series of abnormalities who survived only 4 hours outside the womb. Her lack of a choice, created by law, and a nexus of additional factors including sub-par rural education, access to traditional legal medical services or proximity to out-of-state abortion care led her to a state of indecision without any clear exits, forced to hope for a statistical and scientifically impossible outcome.
• The one-year anniversary of the deadliest school mass shooting in Texas History, the Uvalde Massacre at Robb Elementary School. Released this month is the PBS Frontline Documentary "Inside the Uvalde Response" developed in partner with ProPublica and the Texas Tribune. Kimberly Mata-Rubio, who's daughter was killed that day, loss her bid for Uvalde's Mayor spot in a highlighted special election to former mayor, Cody Smith.
• Texas attacks EDI initiatives, especially in public universities following Florida's lead. New legislation this year requires public universities to abandon their EDI (Equity, Diversity, Inclusion) offices particularly as it relates to the hiring of staff and teachers. In a similar episode of state reach into Texas Universities there was also the episode of Joy Alonzo, a Texas A&M professor and opioid expert who was allegedly disparaged the Lt. Governor, Dan Patrick, during a lecture. She was formally censured by the university and suspended during an investigation that ultimately found no wrong doing. With sparse details, the exact allegation was never disclosed, but was originally raised through a series of back channel conversations and text messages stemming from Texas Land Commissioner Dawn Buckingham, whose daughter was in attendance at the lecture.

Top Posts of the Year

1. 1.3k pts Broken-Bastardo: I'm Done with the Republican party by u/Broken-Bastardo
2. 585 pts Texas Attorney General Ken Paxton impeached, suspended from duties by u/texastribune
3. 491 pts Former NFL player U.S. Rep. Colin Allred launches early campaign to push out Sen. Ted Cruz in 2024 by u/txchald
4. 467 pts Ted Cruz said Martin Luther King Jr. would be 'ashamed' of the NAACP's Florida travel warning. MLK's daughter, Bernice King, disagreed. by u/zsreport
5. 452 pts Bill to Force Texas Public Schools to Display Ten Commandments Fails by u/Arrmadillo

This Year's "Ask Me Anything" Series

• 3June 20 2022 — AMA: We’re the writers and editors behind Texas Monthly’s Best and Worst Texas Legislators List. Ask us anything.
• Oct 17 2023 — We’re Texas Tribune journalists covering the third special legislative session. Ask us anything.
• Nov 08 2023 — I’m Robert Downen, a Texas Tribune politics reporter who spent the last month covering white supremacist ties to influential Texas donors. Ask me anything.

This Year's Moderator Announcements

• Nov 27 2023 — TexasPolitics 2023 Part 2 Transparency Report
• Aug 03 2023 — TexasPolitics 2023 Part 1 Transparency Report
• June 26 — Mod Departures, Policy Transparency Update, New Flair, AI Content
• June 11 2023 — This Community is Set to Private for the Next 48 Hours (June 12-13)
• June 09 — /Texaspolitics supports the site wide blackout June 12-14 protesting Reddit's API changes
• May 15 2023 — Rule 6: Civility, Assuming Intent and Characterizing People Instead of Arguments
• March 13 — Welcome the latest Mods to TexasPolitics (2023)
• March 06 2023 — The 2023 Rule Overhaul is finished, the Wiki has been updated, changes and enforcement rolling in over the next week.
• March 01 2023 — 2023 New Moderator Finalists, Community Review
• Feb 08 — Become a Moderator at TexasPoltics! Link Attached.
• Feb 02 2023 — /TexasPolitics Moderator Applications are Open
• Jan 2017 2023 — Major Restructuring of the Rules imminent. Community Feedback Requested

What's Next

• Mod Applications
• Community Survey

​
Honorable mention to this comment by prpslydistracted who was/is "a medic in the AF, ER and rotation in L&D" on abortion as healthcare, the unscientific rationale of current legislation and the horrors they have witnessed first-hand from complicated pregnancies - some even from mothers who wanted their pregnancies; and the additional burdens that state continues to place on them.

Hey everyone, I’m back. For those who know me, hey again. For those who don’t, I’ve been around a while. I hosted an AMA here a year ago about my process of moving from a freelance writer to an agency owner.
Since I do run an agency that focuses only on human writing, I’m obviously super concerned with anything AI. As you can imagine, this last year has been a rollercoaster. Thankfully, we’ve built a solid company that has, so far, weathered the storm and has grown quite a bit.
My business partner and I decided to do a deep dive into the copyright issues surrounding AI because many people in the content marketing and SEO industries conveniently ignore them. The mad dash towards scaling content disregards the copyright infringement debate and doesn’t look at where the courts, regulators, or legislators could take this.
It will affect this entire industry and all others affected by AI.
We wrote a long-form article and published it on our website, but we can’t post that directly in this post. I’ve spoken with the moderators of this sub, and we’ve decided to summarize parts of the article here and post the link to the article in the comments if you so choose to delve further. We’re not selling anything. Our company website just happened to be the place where we published the article. And we’re not hiring (just an FYI upfront).
The article is long, and I’m only going to summarize the two headings that I think are most appropriate for this sub – “Does the AI Training Process Infringe on the Copyrights of Other Works?” AND “Do AI Outputs Infringe on the Copyrights of Other Works?”
Does the AI Training Process Infringe on the Copyrights of Other Works?
First, this isn’t an entirely new area of law. In fact, there have been plenty of cases that craft the backbone of examining whether AI infringes on copyrights. That said, the Copyright Office has already sent a warning shot in a copyright proceeding and through copyright registration guidance that it’s unlikely any generative AI program could receive copyright protections. The Copyright Act has always focused on only allowing copyright protection to “original works of authorship.”
The Copyright Office has previously gone to battle over what it means to be an “author,” having swatted down attempts to copyright photos taken by a monkey or works created by celestial beings.
*(If you want to see links to all data or facts I’m discussing, please refer to the link in the comments.)
So, does the AI training itself infringe on copyrights?
Probably.
LLMs like ChatGPT, though revolutionary, train from anything and everything they can get their digital fingers on, and now they have access to the internet. So, everything is a training ground, including protected works. There have been several lawsuits filed by creators against OpenAI, Google, Microsoft, and others who have admitted to using the works of others to train their LLMs.
AI companies argue that they’re not violating copyrights because the LLM training process constitutes fair use and, thus, not a violation. Fair use is defined as (copied from article):
​

1. The purpose and character of the content’s use, including whether the use is for commercial purposes or non-profit, educational purposes;
2. The nature of the copyrighted material;
3. The amount of substantiality of the used portion of the copyrighted material in relation to the work as a whole;
4. The effect of the use of the copyrighted material on the potential market for or the value of the work.

For each of those points, it can easily be argued that AI program training is NOT fair use. These companies ARE profiting from the works of others, and they often completely replicate the works of others in their outputs. The US Patent and Trademark Office recently said that the AI training process “will almost by definition involve the reproduction of entire works or substantial portions thereof.”
Do AI Outputs Infringe on the Copyrights of Other Works?
This is perhaps a more important question for those of us in this sub. If you use AI content to assist with your writing, you could violate copyrights.
As I mentioned above, there have been plenty of lawsuits from well-known creators and those we don’t know against AI/tech companies. They argue, I believe rightfully so, that fair use does not apply to the model training and that these models can undermine the market and value of the original works.
Two types of AI outputs are of concern here – the first has to do with AI creating works involving existing fictional characters in a way not intended or controlled by the group who has the copyright over the character. For example, imagine Yoda appearing in a Beyonce music video (I’m not opposed to the idea, tbh, with proper copyright protections).
The other area of concern is AI prompts (looking at you, you new-found Prompt Engineers) to request the AI output to mimic the style of other artists or authors. Now we’re in our wheelhouse because this is what is happening in our industry every day. For example, you can ask ChatGPT to mimic Stephen King when crafting a financial advice piece.
This is a gray area of law and regulation, but one that the courts and regulators ARE starting to deal with.
A Real Case to Examine
This isn’t only going to affect people using the works of famous or well-known individuals. Eventually, whatever decision is made concerning copyrights and AI will affect each of us.
In September 2023, a district court determined that a jury trial would be necessary to determine whether an AI company violated copyright law by copying case summaries from Westlaw. Westlaw, for those unfamiliar, is a legal research platform. The Court already determined that the AI company’s use of the content their program generated was for commercial purposes (a sign that this is likely a copyright infringement). However, the Court wants a jury trial to:
​

1. Resolve factual disputes about whether the use was transformative (as opposed to commercial);
2. Determine to what extent the nature of Westlaw’s work favored fair use;
3. Determine whether the AI company copied more content than they needed from Westlaw to train their models;
4. And determine whether the AI program could constitute a market substitute for the plaintiff.

Why does this matter to us, as writers?
If the AI output resembles existing works, this could be ruled a copyright infringement. Current case law shows that a copyright owner could prove that an AI model violated their copyright if it (the model) had access to their content and subsequently created “substantially similar” outputs (which is exactly what many people are doing with AI to scale content).
Defining “substantially similar” will be the key factor. The courts have already described what it takes for something to be “substantially similar” in terms of constituting copyright infringement. They do this by examining the “concept and feel” of the piece or the “overall look and feel” (citations in article). The courts have also looked at whether an ordinary person would “fail to differentiate between the two works.”
Other cases have examined the “qualitative and quantitative significance of the copied content compared to the overall content that includes the copied work.
What Does This Mean?
I don’t know. None of us knows. But, I could envision a situation where copyright holders use new AI systems (ironic) to figure out if someone else has copied their works and then submit takedown notices or, in serious cases, file a lawsuit. You could end up on the receiving end (or your clients could) if the works you submit infringe on someone else’s copyright.
I could see, a year or so from now, entire websites getting penalized by Google or other search engines, depending on how these cases play out.
This includes “spun” content.
But haven’t SEO writers always “spun” content?
Yes, but AI has allowed the spinning to happen at breathtaking speeds, and now the alarm bells are going off all over the place. People are looking, and creators are mad.
Ultimately, there will be new regulations and legislation. The courts will hear these cases, and the appeals will happen. One thing I do know is that copyright infringement is bad, and if any writer has to bend themselves five different ways to justify using AI to “help them create new pieces,” it could bite you down the line (or your clients).
There’s a difference between using tools and copying the works of others, and that line is currently blurred (some writers take off their glasses so it’s blurred on purpose, the equivalent of putting our heads in the sand).
Anyway, I’ll be back and forth today checking comments and responding. You can check out the link in the comments if you want to take a deeper dive. The article was co-written by myself and my business partner, a practicing attorney.
TL/DR – Copyright infringement is a thing, and your AI outputs probably do it.