Recurrence Rate of Melanoma in Situ Excised With a 5-mm Excisional margin

 From jamanetwork.com.

 Here is the link.

Pistol malfunctions and how to clear them

 From American Handgunner.

 Very clear with pictures showing the procedures.

Here is the link.

 https://americanhandgunner.com/discover/malfunctions-you-are-going-to-have-them/

Age of Rage: America’s Anti-Free Speech Movement Forces Us Again To Choose Between Our Rights and Our Rage

 From Jonathan Turley.

 JT is on target.

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As the nation heads into the July 4th holiday, we have rarely been more divided as a people. Ironically, we are still debating the core values that define us, particularly the right to free speech. Indeed, “debate” hardly captures the rising anger and animosity from campuses to Congress. That is also nothing new.

While I have called this “an age of rage,” it is not our first. The United States was born in rage.

Roughly 250 years ago, a group calling itself the Sons of Liberty boarded three ships and dumped almost 100,000 pounds of English tea into the Boston harbor. The “Boston Tea Party” is still celebrated as an act of defiance that helped spark the American Revolution.

It was also an act of rage, a key moment that is the focus of my book out this week, “The Indispensable Right: Free Speech in an Age of Rage.”

As a nation, we have gone through almost cyclic periods of unhinged rage, including periods of what I call “state rage.” The first victim has always been free speech, including in our current age of rage. Indeed, this is arguably the most dangerous anti-free speech period in our history.

“The Indispensable Right“ is a reference to the description of Justice Louis Brandeis of core value in our nation. It is also a reference that captures our inherent conflict with free speech. Brandeis and his colleague Oliver Wendell Holmes are enshrined as civil libertarians who became the “great dissenters,” arguing for rights that remained unrealized for decades.

Yet, these two jurists would support some of the most abusive denials of free speech in our history. Holmes would supply the single most regrettable line of any opinion: that free speech protections do not allow citizens to shout fire in a crowded theater. That paraphrasing of his decision in Schenck v. United States continues to be used today as a rationalization for censorship and limits on free speech.

On free speech, Brandeis and Holmes were no heroes. Our true heroes are detailed in this book, a collection of true dissenters — anarchists, unionists, communists, feminists and others who risked everything to fight for their right to speak.

George Bernard Shaw once said “a reasonable man adjusts himself to the world. An unreasonable man expects the world to adjust itself to him. Therefore, all progress is made by unreasonable people.”

These are stories of wonderfully unreasonable people like Anita Whitney, a feminist who left a family of privilege to fight for social and political justice. The descendent of a family on the Mayflower and niece of Supreme Court Justice Cyrus W. Field, Whitney defied threats of the police that she would be arrested if she spoke in California in 1919 in Oakland.

With police standing around on stage, she refused to be silent and spoke against the lynchings of Blacks occurring around the country. Her abusive conviction would ultimately go before the court (with Brandeis and Holmes) and they would vote to uphold it.

Time and again, this country has abandoned our free speech values as political dissidents were met with state rage in the form of mass crackdowns and imprisonments. It is an unvarnished story of free speech in America and for better or worse, it is our story.

Yet, we have much to learn from this history as this pattern now repeats itself. The book explains why we are living in the most dangerous anti-free speech period in our history.

In the past, free speech has found natural allies in academia and the media. That has changed with a type of triumvirate — the government, corporations, and academia — in a powerful alliance against free speech values.

Ironically, while these groups refer to the unprecedented threat of “fake news” and “disinformation,” those were the very same rationales used first by the Crown and then the U.S. government to crack down on free speech in the early American republic.

The difference is the magnitude of the current censorship system from campuses to corporations to Congress. Law professors are even calling for changing the First Amendment as advancing an “excessively individualistic” view of free speech. The amendment would allow the government to curtail speech to achieve “equity” and protect “dignity.”

Others, including President Biden, have called for greater censorship while politicians and pundits denounce defenders of free speech as “Putin lovers” and “insurrectionist sympathizers.”

Despite watching the alarming rise of this anti-free speech movement and the rapid loss of protections in the West, there is still reason to be hopeful.

For those of us who believe that free speech is a human right, there is an inherent and inescapable optimism. We are wired for free speech as humans. We need to speak freely, to project part of ourselves into the world around us. It is essential to being fully human.

In the end, this alliance may reduce our appetite for free speech but we will never truly lose our taste for it. It is in our DNA. That is why this is not our first or our last age of rage. However, it is not the rage that defines us. It is free speech that defines us.

A 2024 Mid-Priced Automobile Sells for the Same $300 Price Paid for a Model T Ford in 1924

From George Reisman.

An interesting perspective about inflation.

It really does, if you can pay for it in Gold dollars. Based on the present price of gold bullion, of approximately $2,000 per ounce, a twenty-dollar US gold coin, which contains not quite an ounce of gold, sells for just about $2,000. Put together 15 of these $20 gold coins and you have 300 gold dollars, which represents $30,000 paper dollars, which is the price of a new mid-range automobile.

Who says prices have gone up? The truth is that the price of our paper money has plunged. When we had a gold standard, the price of a paper dollar was a gold dollar. Today, the price of a paper dollar is just one gold cent. So it takes correspondingly more of this cheap money to buy anything.

Here’s how to stop this process. Just repeal whatever laws are in the way of merchants accepting gold and silver coins at their actual market bullion value, not their face value. Consider, for example, that the price of silver is now about $24 per ounce. An old pre-1964 dime contains .0715 ounces of silver, a quarter contains 2.5 times as much, and a half dollar contains 5 times as much. (A silver dollar contains more than 10 times as much.) The silver content of a dime, times its current price per ounce, gives it a market value on the order of $1.70, which means, for example, that a $10 meal in a fast-food restaurant costs less than 60 cents in silver coin.

If precious-metal coins could be used at their market value, Gresham’s so-called “Law” that “bad money drives out good money,” would be totally reversed. Good money, i.e., gold and silver, would drive out bad money, i.e., irredeemable paper money. People would see every day, when they went shopping, that prices were rising only in paper money, not in the precious-metal money (or paper money redeemable on demand in precious metal). They would turn against the paper, unless and until they could have confidence that it could easily be redeemed for precious metal.

Mohs surgery in the treatment of melanoma

 From the Journal of the American Academy of Dermatology.

Here is the link.

Here is the abstract.

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Mohs Micrographic Surgery (MMS) for treatment of melanoma offers several advantages over wide local excision (WLE), including complete histologic margin evaluation, same-day resection and closure, and sparing of healthy tissue in critical anatomic sites. Recently, a large volume of clinical data demonstrating efficacy in MMS treatment of melanoma was published, leading to emerging patient safety considerations of incurred treatment costs, risk of tumor upstaging, and failure of care coordination for sentinel lymph node biopsy (SLNB). MMS offers a safe, effective, and value-based treatment for both melanoma in situ (MIS) and invasive melanoma (IM), particularly with immunohistochemistry use on frozen sections. Compared to wide local excision, MMS treatment demonstrates similar or improved outcomes for local tumor recurrence, melanoma-specific survival, and overall survival at long-term follow-up. Tumor upstaging risk is low, and if present, alteration to clinical management is minimal. Discussion of SLNB for eligible head and neck IM cases should be done prior to MMS. Though challenging, successful multidisciplinary coordination of SLNB with MMS has been demonstrated. Herein, we provide a detailed clinical review of evidence for MMS treatment of cutaneous melanoma and offer recommendations to address current controversies surrounding the evolving paradigm of surgical management for both MIS and invasive melanoma (IM).

Association of physical activity pattern and risk of Parkinson’s disease

 Here is a link to the paper: https://www.nature.com/articles/s41746-024-01135-3

 Here is the abstract.

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Increasing evidence suggests an association between exercise duration and Parkinson’s disease. However, no high-quality prospective evidence exists confirming whether differences exist between the two modes of exercise, weekend warrior and equal distribution of exercise duration, and Parkinson’s risk. Hence, this study aimed to explore the association between different exercise patterns and Parkinson’s risk using exercise data from the UK Biobank. The study analyzed data from 89,400 UK Biobank participants without Parkinson’s disease. Exercise data were collected using the Axivity AX3 wrist-worn triaxial accelerometer. Participants were categorized into three groups: inactive, regularly active, and engaged in the weekend warrior (WW) pattern. The relationship between these exercise patterns and Parkinson’s risk was assessed using a multifactorial Cox model. During a mean follow-up of 12.32 years, 329 individuals developed Parkinson’s disease. In a multifactorial Cox model, using the World Health Organization–recommended threshold of 150 min of moderate-to-vigorous physical activity per week, both the active WW group [hazard ratio (HR) = 0.58; 95% confidence interval (CI) = 0.43–0.78; P < 0.001] and the active regular group (HR = 0.44; 95% CI = 0.34–0.57; P < 0.001) exhibited a lower risk of developing Parkinson’s disease compared with the inactive group. Further, no statistically significant difference was observed between the active WW and the active regular groups (HR = 0.77; 95% CI = 0.56–1.05; P = 0.099). In conclusion, in this cohort study, both the WW exercise pattern and an equal distribution of exercise hours were equally effective in reducing Parkinson’s risk.

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Sounds great, doesn’t it?

 The most trustworthy statistical studies to evaluate treatment efficacy are prospective, double-blind, and randomized. Participants are assigned to the treatment and placebo groups randomly and then tracked over time. This study is prospective. However, the treatment (exercise) group is not chosen randomly. Existing active and inactive groups were used. This is a fundamental flaw because there can be an association between a tendency to exercise and a predisposition to develop Parkinson’s disease.

 The study does not justify the conclusion that an inactive person can reduce his/her Parkinson’s risk by becoming active.

Unintended Deformation of Stents During Bifurcation PC

 From Cardiology.

This suggests about a 4% chance of an undetected complication that materially increases the risk of a serious cardiac event.

Here is the link.

Why is Biden still the likely Democrat candidate?

I wonder - - - 

 Assumptions

    Biden is not running the Government.

    One or more people (the Bosses) other than Biden have control of the Government.

    The Bosses' primary concern is their retention of power.

    The Bosses retain power if Biden is the Democrat candidate and he wins.

    The Bosses lose power if Biden is the Democrat candidate and he loses.

    A Biden alternative is likely to exercise considerable power if he/she wins.

    The Bosses are likely to lose considerable power if a Biden alternative wins.

    The Bosses lose power if a Biden alternative loses.

Implications

    The only scenario in which the Bosses are likely to retain their current power is if Biden is the Democrat candidate and he wins.

    The Bosses are likely to support Biden until the bitter end.

Victor Davis Hanson provides insights about the Left

 VDH is on target.

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The Left Knows Leftism Doesn’t Work

Do not expect the radical left to survey the wreckage of socialism and communism in history and accept that statism impoverishes people and erodes their freedoms. There will never be admissions by our elite that progressivism exists mainly for the acquisition of power by the utopian and virtue-signaling few, who ensure that they are never subject to the baleful implementation of their ideological agendas on the rest of us.

Still, leftists look around at what they have done to America in the last four years and implicitly know that the plan did not work, the people detested it, or both.

How do we know this? By a variety of barometers.

None of the major Biden “achievements”—10 million illegal aliens across a nonexistent border, key components of the cost of living 25-30 percent higher than in 2020, wars and chaos abroad, DEI racial and tribal obsessions, wars on fossil fuels—poll at even 40-45 percent. Biden’s own approval ratings, as the nominal architect of the most left-wing agenda since the Roosevelt administration, hover between 36 and 34 percent.

But most importantly, the left is not running on its record of the last three-and-a-half years but instead studiously ignoring it, at least temporarily through November. Suddenly, we aren’t hearing so much about cancelling pipelines and freezing federal oil leases, or so much demonization of the “greedy” oil companies. Instead, Biden is further draining the strategic petroleum reserve and begging OPEC in general and the no-longer-demonized Saudi Arabia in particular to pump oil as fast as possible.

We were lied to for nearly four years that the border was “secure,” as 10 million foreign nationals flooded across. Then we were told Biden was helpless to stop the deluge since he had no legal right to enforce federal immigration law through executive orders—a ridiculous excuse that even he would soon drop. Despite their eagerness for new constituencies, no one on the left dares to openly praise the influx of the last four years, much less demand more illegal immigration.

Instead, as November looms, Biden is suddenly reinstating the very Trump executive orders that once, despite deep state and court obstruction, finally closed the border—and which Biden himself had originally overturned. Note that Biden is now partnering with the Mexican government—which terribly fears another Trump presidency endangering Mexico’s annual $60 billion in remittances from mostly illegal aliens in the United States—to curb some of the illegal immigration before the November election.

The administration’s pandering at election time is a de facto admission that its agendas did not work, permanently alienated the people they hurt, and are now being forgotten or reversed—albeit temporarily—to retain power at all costs.

Few on the left praise the disastrous COVID lockdown, the canonization of Dr. Fauci, the mask and social-distancing craze, and the gospel that endless boosters were necessary to protect Americans. Even the left, although again quietly, assumes that the lockdowns did more damage than the virus, that Dr. Fauci repeatedly lied when he swore he did not subsidize gain-of-function viral research at the Chinese top-security virology lab at Wuhan, and that the virus came not from the lab but from a wandering pangolin or errant bat.

Biden and his supporters are no longer blaming or firing the police but rather trying (albeit quietly) to get more law-enforcement officers to serve—given the predictable crime wave that followed the George Floyd riots.

Ditto for all the left-wing hysterias of the last eight years. No one any longer claims that Christopher Steele’s dossier was factual. No one insists that Hunter Biden’s laptop was likely “Russian disinformation”, or that “Anonymous” was a courageous “top-ranking” administration official. All these hysterias, it is tacitly admitted, were cooked-up left-wing canards to emasculate the Trump candidacy and presidency.

Outside of politics, leftists are quiet as their failed bromides are being undone. The idea of the FBI partnering with social media to suppress politically-dangerous news is something the left is not eager to repeat.

The same recognition is beginning to apply to the lawfare waged against Donald Trump. Jack Smith’s crusade to get Trump is undermined by prosecutorial misbehavior concerning the evidence seized at Mar-a-Lago and by the asymmetrical treatment by another special counsel accorded Biden in comparison with Trump. Smith’s efforts to speed up the trial before the election only made his persecution more politically transparent.

Fani Willis’s outrageous behavior will likely delay indefinitely her weaponized indictments. The James and Bragg convictions will likely be overturned and were intended mostly to embarrass Trump, bankrupt him, and harm his presidential campaign.

All of the left’s once-grandiose ideas of packing the Supreme Court, ending the filibuster, admitting two new states to win four more liberal senators, and destroying the Electoral College have little public support and will go nowhere. Corporations like Disney, Target, and Anheuser-Busch have all begun backtracking on their money-losing, market-share-eroding woke/DEI agendas.

Universities are terrified that their endowment income is either static or in decline, given a rising drop-off in public and alumni giving. They know their race-based, non-meritocratic admissions and hiring are increasingly destroying their brand names. To accommodate their new non-meritocratic student bodies, they have variously inflated their grades to the point of parody, watered down work requirements, or introduced gut courses—and as a result, they are quickly losing their once-coveted prestige. Some campuses are already reinstating the SAT and ACT requirements that were thrown out in 2020-21 in the hysteria that followed the death of George Floyd. Harvard and Stanford aren’t boasting that the erasure of the SAT created a more competitive student body and raised standards to new levels.

The twin ideas of foreign-funded Middle-Eastern-studies centers and of admitting tens of thousands of affluent, full-tuition-paying Middle-Eastern students led to institutionalized anti-Semitism on campus and eliminationist rhetoric right out the old Klan playbook. The appeasement by university presidencies only whets the appetites of those who unlawfully occupy, vandalize, deface, and disrupt. Their pro-terrorist chants and emblems are bleeding the universities of billions of dollars in lost donations.

In short, the policies that the left has given us over the last years—hyperinflation, spiking staple and gas prices, racial and tribal chauvinism, dangerous streets, an emasculated and politicized military, and wars abroad—did not work, and are now being masked to retain power, put on hold, or even reversed.

The reasons for the failure are ancient, given that socialism and progressivism are contrary to human nature.

Borders are essential to national sovereignty and confidence and delineate the unique values, traditions, and customs of a people, without which they revert to mere tribes without social commonalities and political cohesion. No society can pick and choose which national laws are enforced and which ignored—and still remain a nation of laws.

People obey laws because, in a cost-benefit analysis, they fear the consequences of lawbreaking. Otherwise, the laws of the wild prevail and the strongest dictate to the weaker. Citizens must be discouraged, not encouraged, from favoring their own tribe and race, tribalism being the oldest of human biases. Money is not a construct but represents the real value of capital and labor and cannot be printed into national wealth. Abroad, most nations are illiberal and their aggressiveness is deterred only through guarantees that they will lose more than they will gain through war.

We sometimes forget all that unpleasant human baggage, due to irrelevant distractions, or the utopianism that is the handmaiden of affluence and leisure. Often, the opulence and freedom arising from free-market economies and limited constitutional government create so much prosperity and liberty that its beneficiaries believe such good fortune to be their natural and commonplace birthright and so begin destroying the very system that blessed them.

But if Biden and his handlers have taught us anything, human nature cannot be fooled, and the current four-year experiment will have to end before it ends us—and soon.

Bill Maher provides perspective on recent protests

 Bill Maher at his best.

Wake up kids.

Here is the link.