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Exploded Fruit Bowl by swissmiss
Wednesday November 6th, 2024 at 6:35 PM

swissmiss
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This Exploded Fruit Bowlby by Paul Cocksedge made me smile.

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cjheinz
28 minutes ago
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Nice!
Lexington, KY; Naples, FL
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Pluralistic: How to have cancer (06 Nov 2024) by Cory Doctorow
Tuesday November 5th, 2024 at 7:53 PM

Pluralistic: Daily links from Cory Doctorow
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Today's links


A hospital ward. Three gowned medical figures, two in hazmat suits, loom over the bed in the foreground.

How to have cancer (permalink)

I've got cancer but it's probably (almost certainly, really) okay. Within a very short period I will no longer have cancer (at least for now). This is the best kind of cancer to have – the kind that is caught early and treated easily – but I've learned a few things on the way that I want to share with you.

Last spring, my wife put her arm around my waist and said, "Hey, what's this on your rib?" She's a lot more observant than I am, and honestly, when was the last time you palpated your back over your left floating rib? Sure enough, there was a lump there, a kind of squishy, fatty raised thing, half a centimeter wide and about four centimeters long.

I'm a 53 year old man with a family history of cancer. My father was diagnosed with lymphatic cancer at 55. So I called my doctor and asked for an appointment to have the lump checked over.

I'm signed up with Southern California Kaiser Permanente, which is as close as you come to the Canadian medicare system I grew up under and the NHS system I lived under for more than a decade. Broadly speaking, I really like KP. Its app – while terrible – isn't as terrible as the other apps, and they've taken very good care of me for both routine things like vaccinations and checkups, and serious stuff, like a double hip replacement.

Around the time of The Lump, I'd been assigned a new primary care physician – my old one retired – and so this was my first appointment with her. I used the KP app to book it, and I was offered appointments six weeks in the future. My new doc was busy! I booked the first slot.

This was my first mistake. I didn't need to wait to see my PCP to get my lump checked over. There was really only two things that my doc was gonna do, either prod it and say, "This is an extremely common whatchamacallit and you don't need to worry" or "You should go get this scanned by a radiologist." I didn't need a specific doctor to do this. I could have ridden my bike down to the KP-affiliated Urgent Care at our local Target store and gotten an immediate referral to radiology.

Six weeks go by, and my doc kind of rolls the weird lump between her fingers and says, "You'd better go see a radiologist." I called the Kaiser appointment line and booked it that day, and a couple weeks later I had a scan.

The next day, the app notified me that radiology report was available in my electronic heath record. It's mostly technical jargon ("Echogenic areas within mass suggest fatty component but atypical for a lipoma") but certain phrases leapt out at me: "malignant masses cannot be excluded. Follow up advised."

That I understood. I immediately left my doctor a note saying that I needed a biopsy referral and set back to wait. Two days went by. I left her a voice message. Another two days went by. I sent another email. Nothing, then a weekend, then more nothing.

I called Kaiser and asked to be switched to another Primary Care Physician. It was a totally painless and quick procedure and within an hour my new doc's intake staff had reviewed my chart, called me up, and referred me for a biopsy.

This was my second mistake. When my doctor didn't get back to me within a day, I should have called up KP and raised hell, demanding an immediate surgical referral.

What I did do was call Kaiser Member Services and file a grievance. I made it very clear that when I visited my doctor, I had been very happy with the care I received, but that she and her staff were clearly totally overloaded and needed some kind of administrative intervention so that their patients didn't end up in limbo.

This is a privilege. I'm a native English speaker, and although I was worried about a serious illness, I didn't have any serious symptoms. I had the ability and the stamina to force action in the system, and my doing so meant that other patients, not so well situated as I was, would not be stuck where I had been, with fewer resources to get un-stuck.

The surgeon who did the biopsy was great. He removed my mass. It was a gross lump of yellowy-red gunk in formaldehyde. He even let me photograph it before it went to pathology (warning, gross):

https://www.flickr.com/photos/doctorow/54038418981/

They told me that the pathology would take 2-5 days. I reloaded the "test results" tab in the KP website religiously after 48 hours. Nothing was updated. After five days, I called the surgical department (I had been given a direct number to reach them in case of postsurgical infections, and made a careful note of it).

It turned out that the pathology report had been in hand for three days at that point, but it was "preliminary" pending some DNA testing. Still, it was enough that the surgeon referred me to an oncologist.

This was my third mistake: I should have called after 48 hours and asked whether the pathology report was in hand, and if not, whether they could check with pathology. However, I did something very right this time: I got a phone number to reach the specialist directly, rather than going through the Kaiser main number.

My oncologist appointment was very reassuring. The oncologist explained the kind of cancer I had ("follicular lymphoma"), the initial prognosis (very positive, though it was weird that it manifested on my rib, so far from a lymph node) and what needed to happen next (a CT/PET scan). He also walked me through the best, worst and medium-cases for treatment, based on different scan outcomes. This was really good, as it helped me think through how I would manage upcoming events – book tours, a book deadline, work travel, our family Christmas vacation plans – based on these possibilities.

The oncologist gave me a number for Kaiser Nuclear Medicine. I called them from the parking lot before leaving the Kaiser hospital and left a message for the scheduler to call me back. Then I drove home.

This was my fourth mistake. The Kaiser hospital in LA is the main hub for Kaiser Southern California, and the Nuclear Medicine department was right there. I could have walked over and made an appointment in person.

Instead, I left messages daily for the next five days, waited a weekend, then called up my oncologist's staff and asked them to intervene. I also called Kaiser Member Services and filed an "urgent grievance" (just what it sounds like) and followed up by filing a complaint with the California Patient Advocate:

https://www.dmhc.ca.gov/

In both the complaint and the grievance, I made sure to note that the outgoing message at Nuclear Medicine scheduling was giving out false information (it said, "Sorry, all lines are busy," even at 2am!). Again, I was really careful to say that the action I was hoping for was both a prompt appointment for me (my oncologist had been very insistent upon this) but also that this was a very broken system that would be letting down every patient, not me, and it should be fixed.

Within a couple hours, I had a call back from KP grievances department, and an hour after that, I had an appointment for my scan. Unfortunately, that was three weeks away (so much for my oncologist's "immediate" order).

I had the scan last week, on Hallowe'en. It was really cool. The gadget was awesome, and the rad-techs were really experienced and glad to geek out with me about the way the scanner and the radioactive glucose they infused in me interacted. They even let me take pictures of the scan visualizations:

https://www.flickr.com/search/?sort=date-taken-desc&safe_search=1&tags=fluorodeoxyglucose&user_id=37996580417%40N01&view_all=1

The radiology report was incredibly efficient. Within a matter of hours, I was poring over it. I had an appointment to see the doc on November 5, but I had been reading up on the scans and I was pretty sure the news was good ("No enlarged or FDG avid lymph nodes are noted within the neck, chest, abdomen, or pelvis. No findings of FDG avid splenic or bone marrow involvement").

There was just one area of concern: "Moderate FDG uptake associated with a round 1.3 cm left inguinal lymph node." The radiologist advised the oncologist to "consider correlation with tissue sampling."

Today was my oncology appointment. For entirely separate reasons, I was unable to travel to the hospital today: I wrenched my back over the weekend and yesterday morning, it was so bad that I couldn't even scratch my nose without triggering unbearable spams. After spending all day yesterday in the ER (after being lifted out of my house on a stretcher), getting MRIs and pain meds, I'm much better off, though still unable to get out of bed for more than a few minutes at a time.

So this morning at 8:30 sharp, I started calling the oncology department and appointment services to get that appointment changed over to a virtual visit. While I spent an hour trying various non-working phone numbers and unsuccessfully trying to get Kaiser appointment services to reach my oncologist, I tried to message him through the KP app. It turns out that because he is a visiting fellow and not staff, this wasn't possible.

I eventually got through to the oncology department and had the appointment switched over. The oncology nurse told me that they've been trying for months to get KP to fix the bug where fellows can't be messaged by patients. So as soon as I got off the phone with her, I called member services and filed another grievance. Why bother, if I'd gotten what I needed? Same logic as before: if you have the stamina and skills to demand a fix to a broken system, you have a duty to use them.

I got off the phone with my oncologist about an hour ago. It went fine. I'm going to get a needle biopsy on that one suss node. If it comes back positive, I'll get a few very local, very low-powered radiation therapy interventions, whose worst side effect will be "a mild sunburn over a very small area." If it's negative, we're done, but I'll get quarterly CT/PET scans to be on the safe side.

Before I got off the phone, I made sure to get the name of the department where the needle biopsy would be performed and a phone number. The order for the biopsy just posted to my health record, and now I'm redialing the department to book in that appointment (I'm not waiting around for them to call me).

While I redial, a few more lessons from my experience. First, who do you tell? I told my wife and my parents, because I didn't want to go through a multi-week period of serious anxiety all on my own. Here, too, I made a mistake: I neglected to ask them not to tell anyone else. The word spread a little before I put a lid on things. I wanted to keep the circle of people who knew this was going on small, until I knew what was what. There's no point in worrying other people, of course, and my own worry wasn't going to be helped by having to repeat, "Well, it looks pretty good, but we won't know until I've had a scan/my appointment/etc."

Next, how to manage the process: this is a complex, multi-stage process. It began with a physician appointment, then a radiologist, then a pathology report, then surgery, then another pathology report, then an oncologist, then a scan, then another radiologist, and finally, the oncologist again.

That's a lot of path-dependent, interdepartmental stuff, with a lot of ways that things can fall off the rails (when my dad had cancer at my age, there was a big gap in care when one hospital lost a fax from another hospital department and my folks assumed that if they hadn't heard back, everything was fine).

So I have been making extensive use of a suspense file, where I record what I'm waiting for, who is supposed to provide it, and when it is due. Though I had several places where my care continuity crumbled some, there would have been far more if I hadn't done this:

https://pluralistic.net/2024/10/26/one-weird-trick/#todo

The title of this piece is "how to have cancer," but what it really boils down to is, "things I learned from my own cancer." As I've noted, I'm playing this one on the easiest setting: I have no symptoms, I speak and write English fluently, I am computer literate and reasonably capable of parsing medical/technical jargon. I have excellent insurance.

If any of these advantages hadn't been there, things would have been a lot harder. I'd have needed these lessons even more.

To recap them:

  • See a frontline care worker as soon as possible: don't wait for an appointment with a specific MD. Practically any health worker can prod a lump and refer you for further testing;

  • Get a direct phone number for every specialist you are referred to (add this to your phone book); call them immediately after the referral to get scheduled (better yet, walk over to their offices and schedule the appointment in person);

  • Get a timeframe as to when your results are due and when you can expect to get a follow-up; call the direct number as soon as the due-date comes (use calendar reminders for this);

  • If you can't get a call back, an appointment, or a test result in a reasonable amount of time (use a suspense file to track this), lodge a formal complaint with your insurer/facility, and consider filing with the state regulator;

  • Think hard about who you're going to tell, and when, and talk over your own wishes about who they can tell, and when.

As you might imagine, I've spent some time talking to my parents today as these welcome results have come in. My mother is (mostly) retired now, and she's doing a lot of volunteer work on end-of-life care. She recommends a book called Hope for the Best, Plan for the Rest: 7 Keys for Navigating a Life-Changing Diagnosis:

https://pagetwo.com/book/hope-for-the-best-plan-for-the-rest/

I haven't read it, but it looks like it's got excellent advice, especially for people who lack the self-advocacy capabilities and circumstances I'm privileged with. According to my mom, who uses it in workshops, there's a lot of emphasis on the role that families and friends can play in helping someone whose physical, mental and/or emotional health are compromised.

So, that's it. I've got cancer. No cancer is good. This cancer is better than most. I am almost certainly fine. Every medical professional I've dealt with, and all the administrative support staff at Kaiser, have been excellent. Even the doc who dropped the ball on my biopsy was really good to deal with – she was just clearly drowning in work. The problems I had are with the system, not the people. I'm profoundly grateful to all of them for the help they gave me, the interest and compassion they showed, and the clarity and respect they demonstrated in my dealings with them.

I'm also very grateful to my wife, my parents, and my boss at EFF, all of whom got the news early and demonstrated patience, love, and support that helped in my own dark hours over the past couple of months.

I hope you're well. But you know, everyone gets something, eventually. When you find yourself mired in a broken system full of good people, work the system – for yourself and for the people who come behind you. Take records. Make calls.

Look after yourself.

Hey look at this (permalink)


A Wayback Machine banner.

This day in history (permalink)

#20yrsago Brands aren’t worth as much as we thought https://web.archive.org/web/20041107050607/https://www.wired.com/wired/archive/12.11/brands_pr.html

#15yrsago EU kills 3-strikes proposal (yay!) but all is not well (eek!) https://www.laquadrature.net/en/2009/11/05/Europe-only-goes-half-way-in-protecting-internet-rights/

#15yrsago The Secret Science Alliance and the Copycat Crook: inspirational kids’ science comic https://memex.craphound.com/2009/11/05/the-secret-science-alliance-and-the-copycat-crook-inspirational-kids-science-comic/

#10yrsago EFF leadership change: Cindy Cohn to head organization https://www.eff.org/press/releases/cindy-cohn-become-effs-new-executive-director-2015

#10yrsago 1980 D&D ad asserts that RPGs are woman-friendly https://twitter.com/JonBolds/status/518044059240124417

#10yrsago Chip-and-PIN cards let nearby fraudsters steal $1M at a time https://www.wired.com/2014/11/chip-n-pin-foreign-currency-vulnerability/

#5yrsago After decades of corporate theft, Spinal Tap is finally getting paid by Universal https://variety.com/2019/biz/news/spinal-tap-universal-music-settle-copyright-dispute-1203393300/

#5yrsago Jeannette Ng was right: John W Campbell was a fascist https://locusmag.com/2019/11/cory-doctorow-jeannette-ng-was-right-john-w-campbell-was-a-fascist/

#5yrsago “Christian” hospital charges its own nurse $900,000 for her premature baby https://www.propublica.org/article/how-one-employer-stuck-a-new-mom-with-a-bill-for-her-premature-baby

#5yrsago When the company that made your prosthetic feet won’t repair them https://memex.craphound.com/2019/11/05/when-the-company-that-made-your-prosthetic-feet-wont-repair-them/

#5yrsago The Porch of Doom: a Halloween haunt that sends visitors to a billionaires’ Mars where they are expected to do all the dirty work https://www.youtube.com/watch?v=KpfVhfty_4I

#5yrsago The inspiring story of how Cloudflare defeated a patent troll and broke the patent-trolling business-model https://blog.cloudflare.com/the-project-jengo-saga-how-cloudflare-stood-up-to-a-patent-troll-and-won/

#5yrsago Lynda Barry’s “Making Comics” is one of the best, most practical books ever written about creativity https://memex.craphound.com/2019/11/05/lynda-barrys-making-comics-is-one-of-the-best-most-practical-books-ever-written-about-creativity/

#1yrago A link-clump demands a linkdump https://pluralistic.net/2023/11/05/variegated/#nein

Upcoming appearances (permalink)

A photo of me onstage, giving a speech, holding a mic.


A screenshot of me at my desk, doing a livecast.

Recent appearances (permalink)


A grid of my books with Will Stahle covers..

Latest books (permalink)


A cardboard book box with the Macmillan logo.

Upcoming books (permalink)

  • Picks and Shovels: a sequel to "Red Team Blues," about the heroic era of the PC, Tor Books, February 2025

  • Unauthorized Bread: a middle-grades graphic novel adapted from my novella about refugees, toasters and DRM, FirstSecond, 2025


Colophon (permalink)

Today's top sources:

Currently writing:

  • Enshittification: a nonfiction book about platform decay for Farrar, Straus, Giroux. Today's progress: 758 words (77013 words total).

  • A Little Brother short story about DIY insulin PLANNING

  • Picks and Shovels, a Martin Hench noir thriller about the heroic era of the PC. FORTHCOMING TOR BOOKS FEB 2025

Latest podcast: Spill, part four (a Little Brother story) https://craphound.com/littlebrother/2024/10/28/spill-part-four-a-little-brother-story/

This work – excluding any serialized fiction – is licensed under a Creative Commons Attribution 4.0 license. That means you can use it any way you like, including commercially, provided that you attribute it to me, Cory Doctorow, and include a link to pluralistic.net.

https://creativecommons.org/licenses/by/4.0/

Quotations and images are not included in this license; they are included either under a limitation or exception to copyright, or on the basis of a separate license. Please exercise caution.

How to get Pluralistic:

Blog (no ads, tracking, or data-collection):

Pluralistic.net

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https://pluralistic.net/plura-list

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https://mamot.fr/@pluralistic

Medium (no ads, paywalled):

https://doctorow.medium.com/

Twitter (mass-scale, unrestricted, third-party surveillance and advertising):

https://twitter.com/doctorow

Tumblr (mass-scale, unrestricted, third-party surveillance and advertising):

https://mostlysignssomeportents.tumblr.com/tagged/pluralistic

"When life gives you SARS, you make sarsaparilla" -Joey "Accordion Guy" DeVilla

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cjheinz
23 hours ago
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Direct call-to-action: if you can improve crappy systems due to knowledge, time, etc., please do so.
Lexington, KY; Naples, FL
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If we sow hate, we will reap division by Kimberly Kennedy
Monday November 4th, 2024 at 8:18 PM

Forward Kentucky
1 Comment
If we sow hate, we will reap division

Whatever the outcome of the 2024 presidential election, there is one thing we can all agree upon:

America is deeply divided, and that’s not good for our (capital D) Democracy.

Nastiness, vilification, and “otherism” have become normalized. Violent rhetoric has adults and children afraid that people will take up arms to “take our country back.” What hope do we have at unity?

We all bear personal responsibility for this, starting by recognizing our own personal biases; I know I have them. What have you said about Democrats? about Trump or his followers? about immigrants, politicians, transgender or “woke” persons?

How did we get here—and is there anything we can do to heal the divide?

The Trump Effect

Meanness, disdain, contempt. Trump’s hate-filled torrents sound like schoolyard bullying — what we teach our kids not to do (and for Christians, are decidedly UN-Christian).

More important, they’re usually LIES. Hundreds of fact checks have concluded that Trump’s postulations about the threats posed by transgender persons, immigrants, journalists, poll workers, etc. are false. Thus the fear is frankly irrational.

The Gingrich Effect

When Newt Gingrich became the GOP Speaker of the House in 1995, he literally wrote the playbook for today’s partisan “Just Say No” politics. “He conceived of governing as war,” wrote Jennifer Senior of the New York Times, and used his tactics to effectuate “the annihilation of bipartisan comity.” His playbook includes positive words to use about compatriots and pejorative words for the opposition (like many in the cartoon); interestingly, it includes the word “liberal” (as in “freedom of thought”) in the derogatory column.

Most striking, however, is Gingrich’s pronouncement against compromise with Democrats. Why does this matter? Because refusing to compromise signals that the opposition is your adversary, and that ideology is corrosive to democracy.

The Parent Effect

Our children see and hear what we believe, in our homes, at our dinner table, in print media on our countertops, on our televisions and broadcasting from our radios. If they consume “otherism,” they naturalize it. This is unwitting propaganda (I know, I am guilty too) that their developing brains don’t have the ability to differentiate. Are you willing to share (I try to) the other side’s opinion?

The Consequences

We’ve seen them: Divided neighborhoods. Personal attacks at City Council and School Board meetings. Facebook friends being “unfriended.” Family members not speaking to each other. People using hostile language they would not have formerly used. And so on.

More worrisome is that our children are being indoctrinated to continue this legacy.

Our kids of all ages are afraid. They come to us in tears, afraid of the election and its aftermath, of the violence they believe will come. They urge us to travel to places like Canada; how ironic: the country whose motto is Be Kind.

The Imperative

We have to stop trying to convince, coerce, bully, and legislate everyone in the country into thinking alike, because it is never ever going to happen, and it is perpetuating the rift that is destroying our Democracy. Instead, let’s stop the word war and take steps to restore democracy:

The principle of equality of rights (political, social, and economic), and fair and equal treatment and opportunity.

One of the strengths of democracy is that all are welcome to the table. Greatness comes from recognizing and incorporating the ideas and contributions of all people, not just a chosen few. Compromise is a compilation of the best of both sides and is greater than the sum of its parts because of the goodwill it generates.

Three Solutions:

  • Call upon state and federal legislators to make laws that uphold — not restrict — democratic ideals, starting with Diversity, Equity, and Inclusion programs.
  • Take someone of the opposite political persuasion out for coffee. Talk. Find common ground. Talk about ways to heal our divide.
  • The easiest solution IS as simple as it sounds, and the lesson we teach our children:

Be KIND.

&&&

--30--

Tip Jars
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cjheinz
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Yes! True dis!
Lexington, KY; Naples, FL
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The Powerful Density of Hypertextual Writing by Jason Kottke
Monday November 4th, 2024 at 8:17 PM

kottke.org
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The NY Times has had a difficult time covering the 2024 election in a clear, responsible manner. But I wanted to highlight this short opinion piece from the paper’s editorial board, which I’m reproducing here in its entirety:

You already know Donald Trump. He is unfit to lead. Watch him. Listen to those who know him best. He tried to subvert an election and remains a threat to democracy. He helped overturn Roe, with terrible consequences. Mr. Trump’s corruption and lawlessness go beyond elections: It’s his whole ethos. He lies without limit. If he’s re-elected, the G.O.P. won’t restrain him. Mr. Trump will use the government to go after opponents. He will pursue a cruel policy of mass deportations. He will wreak havoc on the poor, the middle class and employers. Another Trump term will damage the climate, shatter alliances and strengthen autocrats. Americans should demand better. Vote.

What makes this piece so effective is its plain language and its information density. This density is a real strength of hypertext that is often overlooked and taken for granted. Only 110 words in that paragraph but it contains 27 links to other NYT opinion pieces published over the last several months that expand on each linked statement or argument. If you were inclined to follow these links, you could spend hours reading about how unfit Trump is for office.

A simple list of headlines would have done the same basic job, but by presenting it this way, the Times editorial board is simultaneously able to deliver a strong opinion; each of those links is like a fist pounding on the desk for emphasis. Lies, threat, corruption, cruel, autocrats — bam! bam! bam! bam! bam! Here! Are! The! Fucking! Receipts!

How the links are deployed is an integral part of how the piece is read; it’s a style of writing that is native to the web, pioneered by sites like Suck in the mid-90s. It looks so simple, but IMO, this is top-notch, subtle information design.

Tags: design · Donald Trump · journalism · NY Times · politics · writing · WWW

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cjheinz
1 day ago
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Yes! Blogging w hyperlinks is the way to go!
Lexington, KY; Naples, FL
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Crows hold grudges. “When a murder of crows singles out a person... by Jason Kottke
Friday November 1st, 2024 at 1:30 PM

kottke.org
2 Comments
Crows hold grudges. “When a murder of crows singles out a person as dangerous, its wrath can be alarming, and can be passed along beyond an individual crow’s life span of up to a dozen or so years, creating multigenerational grudges.”

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cjheinz
5 days ago
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Corvids rule.
Lexington, KY; Naples, FL
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1 public comment
tante
3 days ago
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"When a murder of crows singles out a person as dangerous, its wrath can be alarming, and can be passed along beyond an individual crow’s life span of up to a dozen or so years, creating multigenerational grudges"

Same TBH
Berlin/Germany

Collection of 2000+ Free Science Images from the NIH by Jason Kottke
Thursday October 31st, 2024 at 4:18 PM

kottke.org
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screenshot of the NIH scientific images site that shows thumbnails of the images in categories like viruses, anatomy, and proteins

From the NIH, a collection of 2,000+ public domain science and medical art visuals (molecules, plants, viruses, proteins, brushes for repeating items like DNA, fungi, equipment…). High-resolution, free to use — scientists on social media seem pretty pumped about this.

scientific image

scientific image

scientific image

See also PhyloPic, a collection of 10,000 “free silhouette images of animals, plants, and other life forms, available for reuse under Creative Commons licenses”. (via @waldo.net)

Tags: art · science

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cjheinz
6 days ago
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Sharing a nice share ...
Lexington, KY; Naples, FL
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