NICE guidelines.
"Evidence on the specific eGFR equations or ethnicity adjustments seen by the committee was not from UK studies so may not be applicable to UK black, Asian and minority ethnic groups. None of the studies included children and young people. The committee was also concerned about the value of P30 as a measure of accuracy (P30 is the probability that the measured value is within 30% of the true value), the broad range of P30 values found across equations and the relative value or accuracy of ethnicity adjustments to eGFR equations in different ethnic groups. The committee agreed that adding an ethnicity adjustment to eGFR equations for different ethnicities may not be valid or accurate...."
My creatinine levels are high because my body mass - including muscle mass - is well above average. On the basic kidney tests my GP did, my numbers indicated kidney disease. Doing a Cystatin C test showed very clearly that my numbers were firmly in the normal range.
The page does go on to point out the muscle mass issue:
> The committee highlighted the 2008 recommendation, which states that caution should be used when interpreting eGFR and in adults with extremes of muscle mass and on those who consume protein supplements (this was added to recommendation 1.1.1).
Further down they do mention Cystatin C, and seem to have basically decided that a risk of false positives is acceptable because of a lower risk of false negatives. That part is interesting, and it may well be the right decision at a population level.
But if your muscle mass is sufficiently above average, the regular kidney tests done will flag up possible kidney disease every single damn time you do one, and my experience is that UK doctors are totally oblivious to the fact that this is not necessarily cause for concern for a given patient and will often just assume a problem and it will be up to the patient to educate them.
EDIT: What's worse, actually, is the number of times I've had doctors or nurses try to help me to "game" this test by telling me to e.g. drink more before the test next time, seemingly oblivious that irrespective of precision, making changes to conditions that also invalidates it as a way to track changes in eGFR is not helpful.
I'm not sure what point you're trying to make here. Have I missed somewhere in the discussion where eGFR equation adjustment based on ethnicity has been discussed?
Creatinine is the standard marker used for eGFR. It is also a byproduct of muscle metabolism. People who regularly lift weights or have lifestyles that otherwise result in a higher-than-normal muscularity will almost universally have higher creatinine levels than those who don't, assuming similar baseline kidney function. It's also problematic for people with extremely low muscle mass, for the opposite reason.
It's one of the reasons enhanced bodybuilders can get bit with failing kidney function - they know that their eGFR is going to look worse and worse based on creatinine formulas so they ignore it, when the elevated blood pressure from all the dbol they're popping is killing their kidneys.
Cystatin C is the better option for people with too much (or too little) muscle for creatinine to be accurate.
It's yet another way, but not the only way. We have for a long time seen things like Silvercloud - which is the cheaper version of a talking therapy where the patient mostly keeps a structured diary and one qualified therapist is required to review many more patients compared to a real-time conversation therapy model.
If it can be set to private then it can be set to public again. I don't use any of those platforms but I would always assume that all my usage might end up being published one day.
Careful, when you ramp the hyperbole up to this point you are essentially just lying.
A decade ago you could quickly check the blue mark and know that the account most likely belonged to the person it was labelled for. The people who had a mark when they shoudn't have were by far the minority, and mistakes were the exception.
In 2026 a blue checkmark actually means the account is far more likely to be fake, more likely to be lying and more likely to be engagement trolling. There's no guarantee it even belongs to a human person. The platform gives the account holder money if they can convince you to click spam links!
It's not even close to having the same value now as it did then.
> A decade ago you could quickly check the blue mark and know that the account most likely belonged to the person it was labelled for.
They routinely removed blue checkmarks of people that had naughty opinions. The account was known to belong to the actual person. This was no mistake, it was just the good boy badge being removed for vibes.
My point is not that Twitter now under its retarded billionaire king is better. It is not.
It was shit then, it is shit now. The world would be objectively a better place if Twitter had never existed.
The turd just smells different under Musk. You happened to enjoy the old smell.
> They routinely removed blue checkmarks of people that had naughty opinions
This is actually you doing it again, lying-via-hyperbole. This didn't happen routinely (it was high profile enough to get news stories the few times it did) and it was pretty specifically white supremacist groups.
> You happened to enjoy the old smell.
If you approach conversation with a little more honesty yourself you might not just fall into the assumption other people are partisan.
That's what you are doing. I am pretty left-leaning myself, if you look at my post history.
Twitter was a notorious toxic dump long before Musk acquired it. Nothing in what I described was a lie.
The blue checkmark was supposed to be something that meant "account is verified, person is who they say they are". It was weaponized by the platform itself to mean "this person has no naughty opinions". Now I ask, was this an improvement?
Now it is actually more straightforward. "Blue checkmark means person gives money to Twitter on a monthly basis". It is still a toxic dump, it just smells different.
This sounds like I need to host my PDS. Easy for me with no public profile but if I was someone famous wouldn't that mean I needed enterprise class hosting?
You don't need to host your own PDS for any of this to work. It works the same way regardless of who hosts your PDS.
I think what may be confusing you is that Bluesky (the company) acts in two different roles. There's hosting (PDS) and there's an app (bsky.app). You can think of these conceptually as two different services or companies.
Yes, when you sign up on Bluesky, you do get "Bluesky hosting" (PDS). But hosting doesn't know anything about apps. It's more like a Git repo under the hood.
Different apps (Bluesky app is one of them) can then aggregate data from your hosting (wherever it is) and show different projections of it.
Finally, no, if you're famous, you don't need enterprise hosting. Hosting a PDS can be extremely cheap (like $1/mo maybe)? PDS doesn't get traffic spikes on viral content because it's amortized by the app (which serves from its DB).
The west was enjoying the peace dividend while Russians were dealing with the collapse of the USSR so the answer to your question depends on who you ask.
This is a somewhat useful filter for actual consumers but here we are also looking at large scale fraud. The article mentions opponents using rotating IP addresses and high volumes of refund requests to try to overwhelm counter-fraud measures.
https://www.nice.org.uk/guidance/ng203/chapter/rationale-and...
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