slow_titrator
TL2 Regular · Leicester, UK
Went up every six weeks instead of every four and had a much better time. One data point, offered as one data point.
Joined 29 August 2025 · last posted 20h
82 posts, newest first. Showing up to 150.
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Tracking intake honestly when appetite is absent Replied, post #116 · Nutrition & Training › Protein & intake · 27 Jul 2026 · 0 likes I read post #112 twice before replying, because I had assumed the opposite. The practical problem is that appetite suppression makes hitting a target genuinely hard,…
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Asking a follow-up: new topic or new reply? Replied, post #72 · Start Here › How to Ask · 26 Jul 2026 · 17 likes A photograph of a vial is rarely useful and a photograph of a document usually is. Redact the identifiers before you post either. The conclusion is tentative; the…
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eGFR fluctuation and the creatinine denominator problem — the long version Replied, post #37 · Clinical › Bloodwork · 25 Jul 2026 · 1 like This follows post #34 rather than contradicting it. Distinguishing three things in the egfr fluctuation discussion that keep getting used interchangeably: the…
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Why the Start Here categories exist, and what they are not for Replied, post #25 · Start Here › Welcome · 22 Jul 2026 · 3 likes Practical answer on Start, since the theoretical one is upthread: do the simplest check first, write down the result, and only then decide whether the complicated…
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Coming back to: Delayed gastric emptying and oral medication absorption: which drugs… Replied, post #52 · Practice › Interactions · 21 Jul 2026 · 0 likes Grateful for the specificity. Vague answers to this question are what sent me looking.
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Comparing documentation quality across the directory, tabulated Replied, post #11 · Sourcing › Vendor reports · 21 Jul 2026 · 0 likes Comparing your result to somebody else's on a different lot is not a comparison of suppliers. Lot is the unit and it should be in every report. Someone should write…
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Named, unnamed and unspecified impurities as regulatory categories — the long version Replied, post #89 · Analytics › Impurities & related substances · 18 Jul 2026 · 18 likes Freeze-drying itself does not generate impurities in any significant way. Handling before and after it does, which is why transit conditions belong in the discussion.…
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Follow-up: Prior authorisation: what the criteria usually require Replied, post #63 · Access › Insurance & coverage · 9 Jul 2026 · 13 likes Everything in post #60 holds. The case it does not cover is the one I have. Formulary changes happen on a published schedule, so a denial now may be answering criteria…
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Revisiting: What pooling buys you and what it destroys Replied, post #67 · Evidence › Meta-analyses · 25 Jun 2026 · 4 likes Study quality and weighting: some meta-analyses weight all studies equally; others weight by study size or study quality. The choice affects the result and should be…
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Spreadsheets: an appreciation — what changed since Replied, post #70 · Lounge › Off topic · 14 Jun 2026 · 8 likes The most useful thing anyone has posted about Spreadsheets in this category was a table of what had been measured and by whom. That is what I would want again.
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Comparing prices across jurisdictions without misleading yourself Replied, post #60 · Access › Pricing · 10 Jun 2026 · 12 likes Useful. I have added it to my own notes with the date on it.
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A reconstituted vial's beyond-use date and the reasoning behind common figures Replied, post #65 · Practice › Storage & stability · 6 Jun 2026 · 13 likes Light protection is easy and cheap. The original carton exists for a reason and a vial stored in it is protected without anybody having to think about it again. I have…
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A calculator that gives a right answer to the wrong question Replied, post #24 · Data & Tools › Calculators · 29 May 2026 · 0 likes Storage lookup: which conditions (temperature, time) are you considering storing in, and how much stability loss is expected? The calculator gives a rough estimate…
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An appeal that succeeded, with the letter structure — the long version Replied, post #22 · Access › Insurance & coverage · 28 May 2026 · 0 likes Reading rather than answering, but this is the post I would point somebody at.
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Common supplements people ask about, assessed one at a time — a second dataset Replied, post #104 · Practice › Interactions · 11 May 2026 · 21 likes Taking post #101 at face value and following it one step further. I would rather this thread reach "we do not know" about Common supplements than reach a confident…
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Second pass at: A pooled estimate that changed when one trial was added Replied, post #2 · Evidence › Meta-analyses · 8 May 2026 · 0 likes Search strategy determines what was found and is the part of the method least often scrutinised. A search restricted to one language or one database is a selection…
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Why the titration planner refuses to produce a schedule below a floor Replied, post #65 · Data & Tools › Calculators · 24 Apr 2026 · 33 likes The arithmetic in post #64 is right; the assumption feeding it is the part to check. Titration planning: a calculator that shows you the escalation schedule for…
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Prediction intervals and why they are more honest than confidence intervals Replied, post #25 · Evidence › Meta-analyses · 10 Apr 2026 · 0 likes A tighter confidence interval around a meaningless centre is worse than a wide interval around a meaningful one. Precision is not the objective. The general case is…
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What a certificate commits its issuer to — one year on Replied, post #37 · Analytics › COA interpretation · 24 Mar 2026 · 0 likes Peptide content and chromatographic purity are separate determinations and a certificate that reports only one has answered only one question. Content is the one that…
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Designing a personal experiment that could change your mind — one year on Replied, post #22 · Research Methods › N-of-1 designs · 18 Mar 2026 · 29 likes Duration should be set by how long an effect would take to appear rather than by patience. Stopping early is the commonest reason a personal experiment answers nothing.…
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Second pass at: The topic list is dense — is that deliberate? Replied, post #96 · Meta › Site feedback · 11 Mar 2026 · 6 likes Thank you — that answers what I came here to find out.
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A genuinely late dose: what the labelling says and what people do Replied, post #3 · Practice › Administration · 10 Mar 2026 · 0 likes The arithmetic in post #2 is right; the assumption feeding it is the part to check. Bleeding at the injection site: normal and usually minimal. A little blood at the…
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Peer-to-peer review: what actually happens on the call — one year on Replied, post #4 · Access › Insurance & coverage · 28 Feb 2026 · 11 likes A well-written denial is genuinely useful because it tells you exactly what to submit next. A vague one is the harder case. That has held every time I have looked,…
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Request: export my own posts — one year on Replied, post #52 · Meta › Feature requests · 27 Feb 2026 · 8 likes Feature request I expect to be refused, stated anyway: a private notes field on a topic, visible only to me. I keep those in a text file and the text file loses the…
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Preprint servers and what screening they do Replied, post #60 · Evidence › Preprints · 18 Feb 2026 · 13 likes Thank you for taking the time. That was more work than a reply usually is.
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Revisiting: Liver enzymes drifting down and what that usually means Replied, post #3 · Clinical › Bloodwork · 8 Feb 2026 · 0 likes Reporting rather than recommending, on Liver enzymes drifting. What happened is above. Whether it should have is a different question and not one I am qualified to…
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Revisiting: A page that has drifted out of date and needs a maintainer Replied, post #69 · Documentation › Wiki requests · 3 Feb 2026 · 15 likes Post #65 describes the usual case. This is about the unusual one. Say what would make the page wrong. A page whose failure conditions are stated is much easier to…
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Comparing my trajectory with the trial curves, carefully — a second dataset Replied, post #4 · Outcomes › Progress reports · 29 Jan 2026 · 0 likes The arithmetic in post #3 is right; the assumption feeding it is the part to check. The best progress reports here read as records rather than as arguments, and that…
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Run-in periods and the population they select Replied, post #55 · Evidence › Trials · 24 Jan 2026 · 22 likes On run-in periods, the part that usually goes wrong is that the question is asked as though it has one answer. It has a range, and the width of the range is the…
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Muscle cramps: the ordinary causes before the exotic ones Replied, post #89 · Practice › Side effects · 21 Jan 2026 · 0 likes Useful. I have added it to my own notes with the date on it.
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Pharmacy supply in the UK and the questions you will be asked Replied, post #15 · Regional › UK & Ireland · 20 Jan 2026 · 29 likes The number people quote for pharmacy supply is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly…
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A partial dose because the pen emptied mid-injection Replied, post #84 · Practice › Administration · 10 Jan 2026 · 0 likes Post #83 answers the question as asked. The question underneath it is different. The single most common technique error described here is drawing to the wrong…
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A partial dose because the pen emptied mid-injection Replied, post #67 · Practice › Administration · 9 Jan 2026 · 13 likes Where I part company with post #65, and it is a narrow parting. The failure mode on partial dose because the pen is boring rather than dramatic. It is almost always the…
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Aggregates and why a purity assay may miss them entirely Replied, post #20 · Analytics › Impurities & related substances · 21 Dec 2025 · 11 likes Answering the question post #16 raises rather than the one it answers. A definition problem is doing most of the work in this aggregates discussion. Once the term is…
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Pen mechanics when the cartridge is nearly empty — does this still hold? Replied, post #32 · Devices › Pens & autoinjectors · 21 Dec 2025 · 0 likes Confirming post #30 from a second method, which matters more than confirming it from a second person. Nothing here is medical advice, and pen technique is the single…
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The decimal-point error, and the habit that catches it Replied, post #62 · Practice › Reconstitution · 16 Dec 2025 · 7 likes Decimal-point error is one of those subjects where the general answer and the answer for a specific case diverge, and the thread will go in circles until someone says…
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Revisiting: Aggregates and why a purity assay may miss them entirely Replied, post #47 · Analytics › Impurities & related substances · 23 Nov 2025 · 10 likes Taking post #44 at face value and following it one step further. Aggregates sits at the boundary between what this community can usefully discuss and what it cannot,…
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[2026 update] What steady state means for the decision to escalate Replied, post #124 · Practice › Dosing & titration · 17 Nov 2025 · 7 likes There is no published evidence about slower escalation because nobody studied it. That means the trials support not going faster and are silent on going slower, which…
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Temperature loggers worth the money — the long version Replied, post #65 · Devices › Cold chain · 29 Oct 2025 · 19 likes Narrowing post #63, because the general version has more than one answer. Adding the boring version of Temperature loggers worth the money, because the interesting…
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New subcategory: rationale and scope Replied, post #86 · Meta › Announcements · 22 Oct 2025 · 6 likes Everything in post #84 holds. The case it does not cover is the one I have. Last note on this: announcements here get more replies than most topics and almost all of…
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A parcel that arrived warm: a decision process, not a verdict Replied, post #94 · Practice › Storage & stability · 20 Oct 2025 · 2 likes Worth separating two things that post #92 runs together. Temperature excursions in transit are common and are not all equal. A few hours warm is a different event from…
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New subcategory: rationale and scope Replied, post #65 · Meta › Announcements · 19 Oct 2025 · 0 likes Where I would push back on the new subcategory consensus is the confidence, not the direction. The direction looks right. The confidence is borrowed.
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A preprint whose numbers changed substantially at publication Replied, post #85 · Evidence › Preprints · 9 Oct 2025 · 6 likes Everything in post #81 holds. The case it does not cover is the one I have. Always label it as a preprint in any discussion. A preprint is not a published trial and it…
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[2026 update] Storing lyophilised material long term: what governs the shelf life Replied, post #7 · Practice › Storage & stability · 2 Oct 2025 · 0 likes Where I part company with post #4, and it is a narrow parting. Visible particulate is a strong signal in the other direction: it is a reason to stop and ask rather than…
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Citing a preprint in a maintained document: our rule and its reasoning — does this still… Replied, post #16 · Evidence › Preprints · 26 Sep 2025 · 2 likes Say it is a preprint in the first line rather than the last. Everything downstream depends on that status and readers arriving from search will not scroll for it.
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Citing a preprint in a maintained document: our rule and its reasoning — does this still… Replied, post #5 · Evidence › Preprints · 25 Sep 2025 · 10 likes Post #4 describes the usual case. This is about the unusual one. What changes between preprint and publication: authors respond to reviewer comments, re-analyse data,…
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Detection wavelength and why 214 nm and 280 nm disagree Replied, post #43 · Analytics › HPLC & UHPLC · 5 Sep 2025 · 27 likes I would keep detection wavelength and the decision it usually gets used for separate in this thread. They are related and they are not the same question, and merging…
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Checking someone else's arithmetic: a worked example thread Replied, post #64 · Practice › Reconstitution · 5 Jul 2025 · 15 likes Sensible. I would want the same detail before I acted on it either.
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Coming back to: When "no data" is the complete and final answer Replied, post #21 · Compounds › Other compounds · 22 Jun 2025 · 2 likes I had read the opposite somewhere and cannot now find where, which tells me something.
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A report I filed that turned out to be wrong, and the correction Replied, post #116 · Sourcing › Vendor reports · 22 Jun 2025 · 0 likes Reports of ordinary results are more valuable than reports of remarkable ones, precisely because only the remarkable ones get posted elsewhere. Take the reasoning and…
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Which panel is worth repeating and which is worth ignoring Replied, post #34 · Clinical › Bloodwork · 8 Jun 2025 · 7 likes Time of day: some biomarkers vary across the day. Cortisol in the morning differs from cortisol in the evening. Comparing results from different times of day is…
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Sequence verification for an obscure compound: how it is done Replied, post #53 · Compounds › Other compounds · 4 Jun 2025 · 30 likes What I would want before treating sequence verification as settled: the method, the sample, and whether anyone tried to find the opposite result. Two of the three are…
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Reading an MS report that only gives you a single number Replied, post #75 · Analytics › Mass spectrometry · 10 May 2025 · 15 likes I read post #73 twice before replying, because I had assumed the opposite. Positional isomers and epimers are mass-identical. Any argument that a mass result rules them…
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Storing a pen in use versus a pen unopened Replied, post #8 · Devices › Pens & autoinjectors · 16 Apr 2025 · 0 likes Adding a note of thanks rather than an opinion. I did not know most of that.
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When to suspect the method rather than the sample Replied, post #114 · Analytics › Method validation · 13 Apr 2025 · 2 likes Validation is compound-specific and matrix-specific. A method validated for one peptide is a starting point for another and not a validated method for it. Someone will…
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Journal club: SURMOUNT-1, read without the press release Replied, post #94 · Evidence › Journal club · 10 Apr 2025 · 1 like That matches what I have seen, for whatever a single anecdote is worth.
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A 5 mg vial and a 0.25 mg dose: the arithmetic in full — the long version Replied, post #68 · Practice › Reconstitution · 1 Apr 2025 · 0 likes Arithmetic step by step: a 5 mg vial with 2 mL of diluent gives (5 mg) / (2 mL) = 2.5 mg/mL. On a U-100 syringe at that concentration, 100 units = 1 mL = 2.5 mg, so…
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Review: a draft on reconstitution arithmetic, with objections Replied, post #77 · Documentation › Doc review · 27 Mar 2025 · 15 likes Post #76 is the version of this I will quote in future. One addition. Reviewing your own nomination is fine and is not sufficient. Somebody else has to read it for the…
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Why cagrilintide alone is discussed so much less than in combination Replied, post #22 · Compounds › Cagrilintide & amylin analogues · 24 Mar 2025 · 30 likes Adding the measurement that post #21 says would settle it. Cagrilintide molecular characteristics: it is a synthetic amylin analogue, substituted to prevent the…
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Adjudicated events and why the definition matters — the long version Replied, post #62 · Evidence › Trials · 24 Mar 2025 · 20 likes Answering the Adjudicated events question as asked, then the question I think is meant. As asked: yes, with the qualification below. As meant: it depends on how the…
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Coverage for the indication versus for the drug — a second dataset Replied, post #35 · Access › Insurance & coverage · 22 Mar 2025 · 2 likes Where I part company with post #33, and it is a narrow parting. Adding the boring version of Coverage, because the interesting version keeps getting posted and the…
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Biased agonism: a real phenomenon, an over-used explanation Replied, post #124 · Pharmacology › Receptor biology · 18 Mar 2025 · 0 likes Species differences in receptor pharmacology are substantial in this family, which is one reason rodent data has translated unevenly.
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Adducts: sodium, potassium, and the peak you did not expect Replied, post #35 · Analytics › Mass spectrometry · 15 Mar 2025 · 12 likes I would put moderate confidence on the mainstream reading of adducts and no more. That is not scepticism for its own sake; it is where the sourcing actually stops.
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Revisiting: German, French and Dutch differences, compared Replied, post #3 · Regional › European Union · 13 Mar 2025 · 9 likes What I can speak to on German is narrow, so I will keep it narrow rather than generalising from it. Beyond that boundary I do not know.
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Research-use-only status: what it means legally and practically — a second dataset Replied, post #108 · Compounds › Other compounds · 7 Mar 2025 · 27 likes Thymosin alpha-1 has a regulatory history in several jurisdictions and a real clinical literature, which puts it in a different evidential category from most of its…
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Research-use-only status: what it means legally and practically — a second dataset Replied, post #98 · Compounds › Other compounds · 24 Feb 2025 · 0 likes Where I part company with post #94, and it is a narrow parting. Reading a supplier's product description as a marketing document: that is exactly what it is. The…
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[2026 update] Journal club: SURPASS-2 and the semaglutide 1 mg comparator Replied, post #137 · Evidence › Journal club · 23 Feb 2025 · 29 likes SELECT (N Engl J Med 2023): Semaglutide cardiovascular outcomes without diabetes. The first outcome trial in people without diabetes, which decoupled the cardiovascular…
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Triple agonism: additive, synergistic, or neither? Replied, post #18 · Compounds › Retatrutide · 13 Feb 2025 · 0 likes Offering a way to settle triple agonism rather than another opinion about it. Two measurements, taken the same way, a fortnight apart. If the difference is within the…
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Research-use-only labelling: what it means and what it does not — the long version Replied, post #81 · Sourcing › Regulatory · 9 Feb 2025 · 17 likes Careful with the language on Research-use-only labelling. "Not detected" and "not present" are different findings and the first is a statement about the method.
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Why quantitation is the hard part, not detection Replied, post #4 · Analytics › Home & field testing · 19 Jan 2025 · 16 likes A request rather than an answer: could whoever has the primary source for quantitation post it? I have seen the claim three times this month and each version had lost a…
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[2026 update] New subcategory: rationale and scope Replied, post #94 · Meta › Announcements · 26 Dec 2024 · 7 likes Answering the question post #90 raises rather than the one it answers. New subcategory is one of those subjects where the general answer and the answer for a specific…
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Coming back to: Recording a dissent on a document rather than suppressing it Replied, post #11 · Documentation › Doc review · 3 Dec 2024 · 0 likes I had written a reply contradicting post #9 and deleted it. Here is what survived. Ask what the page would look like if it were wrong. A document with no stated failure…
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Training through a dose escalation week Replied, post #5 · Nutrition & Training › Resistance training · 20 Nov 2024 · 12 likes On post #3 — agreed on the reasoning, with one qualification. Volume: the number of sets per muscle group per week that supports muscle maintenance is roughly 12 to 18…
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Choosing which test to pay for, given a fixed budget — does this still hold? Replied, post #32 · Sourcing › Independent verification · 15 Nov 2024 · 0 likes Cross-checking one lot with two services independently is the cleanest test available and is rarely done because it costs twice as much.
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Reading a preclinical wound-healing model and its relevance to a human tendon Replied, post #37 · Compounds › Repair & healing peptides · 12 Nov 2024 · 4 likes Coming back to post #33, because the follow-up matters more than the original answer. Nothing in this subcategory is medical advice and several members here are…
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People with a low starting BMI: where the evidence stops Replied, post #14 · Clinical › Special populations · 10 Nov 2024 · 6 likes Nothing in this subcategory is medical advice and the questions asked here are precisely the ones that need an individual assessment. If that reads as pedantic, it is,…
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Follow-up: Tirzepatide's shorter half-life and its one practical consequence Replied, post #8 · Compounds › Tirzepatide · 24 Oct 2024 · 26 likes Nothing to add on the substance. Thank you for taking the question at face value.
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Follow-up: Where the four-week escalation interval comes from, and what it is not Replied, post #84 · Practice › Dosing & titration · 16 Oct 2024 · 10 likes Post #83 is right about the mechanism and I think understates the practical bit. Concentration and dose get conflated constantly in this subcategory. Changing how much…
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Follow-up: Where the four-week escalation interval comes from, and what it is not Replied, post #67 · Practice › Dosing & titration · 20 Sep 2024 · 1 like I had written a reply contradicting post #65 and deleted it. Here is what survived. If someone has run four-week escalation interval properly I would rather read that…
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SURPASS-2 and the comparator dose question that will not go away Replied, post #8 · Compounds › Tirzepatide · 31 Aug 2024 · 4 likes I think the SURPASS-2 question is answerable and has not been answered, which is a more optimistic position than most of this thread.
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Oral contraceptives and delayed emptying: what the data shows Replied, post #70 · Practice › Interactions · 19 Jul 2024 · 30 likes I had written a reply contradicting post #68 and deleted it. Here is what survived. A pharmacist can answer most questions in this subcategory in a few minutes with…
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Cold packs, phase-change material, and what survives ten days Replied, post #89 · Sourcing › Logistics · 10 Jul 2024 · 3 likes The thing about cold packs that took me longest to accept is that a plausible mechanism is not evidence of an effect. It is a reason to look, not a result.