iiinova — where your digital self keeps evolving

Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 16/07/2026

... it recovered, bounced over to a nearby deck chair, then flew off into the trees.

Bird chilling on a deck chair before flying off.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 16/07/2026

... but with a quiet cardboard box and a bit of time...

Less covered cardboard box, containing one spooked bird.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 16/07/2026

Took off the frame and found this little bird with its wing pinned. Juvenile Starling?

A juvenile looking bird with its left wing caught in the metal frame of the fireplace grate.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 16/07/2026

Intermittent fluttering audible from the fireplace. Cat taking an interest. Moved some furniture to find what looked like feather fluff on the adjacent tile.

Grey underfeather fluffs on black tile next to the fireplace. Uh-oh.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 15/07/2026

Our home air filtration arsenal is doing a pretty good job of keeping up as the outdoor particle count rises, but the VOC levels are still up.

Graph of PM2.5 concentration indoors (Awair, blue) and outdoors (yellow) today.

VOC levels today, inside and outside. Note the units are different.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 15/07/2026

A reminder that air filtration doesn't need to be fancy or expensive. #onstorm The clean air delivery rate (CADR) of a box fan filter or full Corsi-Rosenthal box is kinda impressive. cleanaircrew.org/box-fan-filt...

Single-filter single-box-fan DIY air cleaner design.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 15/07/2026

Armwaving AI generated estimates of what to expect inside if the outdoor PM2.5 level is 300mcg/m3. I don't consider our house "clean room" grade, but if we're hovering around 15-20 right now, I guess our investment in air filtration is paying off.

ChatGPT estimates of the kind of indoor PM2.5 levels to expect under various household conditions when the outdoor level is around 300mcg/m3.

Windows open / very leaky home: 240–300+ µg/m³

Closed, leaky home without filtration: 180–250 µg/m³

Average closed home without filtration: 165–180 µg/m³

Tighter home with good HVAC filtration: 90–150 µg/m³

Properly sized HEPA purifier: 50–120 µg/m³

Well-sealed clean room with strong HEPA: potentially <50 µg/m³

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 15/07/2026

Here. I zoomed in on the indoor curve for you.

Isolated the PM2.5 curve for my indoor air quality monitoring. The screamingly high levels outside are affecting the inside, but our filtration is doing what it can to keep up.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 15/07/2026

Here's our current PM2.5 data starting at 6am this morning. Even with fairly aggressive filtration of our indoor air, you can see the outside conditions (yellow) are starting to pull up the (blue) indoor curve. #onstorm #smoke

Currently the PM2.5 inside is at 17mcg/m3, but outside it's more like 300mcg/m3 and climbing.

15 is the Canadian indoor residential average (non-smoking households). The Indoor Air Hygiene Institute recommends it stay below 12 with no spikes above 35.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 15/07/2026

Currently the worst air quality in the world. The. World.

IQAir air quality rankings. Sorry, Ontario, but higher and redder is worse, worse, worse.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 15/07/2026

I went inside for an hour and I swear it was darker outside when I came back out. Looking north on King, Uptown Waterloo. #DLWS #onwx #onstorm #smoke #nofilter

Orange haze settling on King St. in Waterloo, Ontario. July 15th, 2026 #nofilter

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 14/03/2026

Hmm. (I drive an EV, so I had to look it up)

Gasbuddy graph of average Canadian (blue line) and Ontario (red line) gasoline prices in Canadian cents per litre, with abrupt increase starting at the beginning of March.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 10/11/2025

"Despite decades of extensive documentation exposing the Israeli State’s systematic use of torture, these grave violations have been persistently disregarded, fostering a culture of impunity that enables repeated and flagrant breaches of... fundamental human rights." www.bmj.com/content/391/...

In the BMJ: "Opinion: Torture and health worker complicity in Israeli detention sites." Follow link for full text.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 21/10/2025

"The 30 key EM:POWER Recommendations below are distilled from the corresponding sections of the report." caep.ca/key-recommen...

The 30 key EM:POWER Recommendations are distilled from the corresponding sections of the full report. See website for full text.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 21/10/2025

"CAEP commissioned the EM:POWER Task Force to probe the system and its many stakeholders, identify underlying problems and propose a framework for system redesign. Their work took over two years and forms the basis of this report." caep.ca/executive-su...

EM: POWER roadmap infographic for tackling emergency department overcrowding.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 08/10/2025

CASCADES Canada has fantastic patient and prescriber educational materials on their site. cascadescanada.ca/action-areas... The main site has lots of other good ideas that support the healthcare community in transitioning towards high-quality, low-carbon, climate resilient care. 🧵 I'm

Sustainable Inhaler Alternatives chart from CASCADES Canada, graded by environmental impact.

Note the up-front caveat that switching inhalers should never be forced, especially in situations where doing so could affect level of symptom control and frequency of exacerbations.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 08/10/2025

"There is new evidence in children 12 years of age and adults that PRN budesonide/formoterol decreases exacerbations in comparison to PRN SABA, with different levels of evidence in those with very mild versus mild asthma." 🧵

Controller Therapy

ICS/LABA
Advair MDI
fluticasone/salmeterol
125/25; 250/25 mcg

Zenhale MDI
mometasone/formoterol
100/5; 250/5 mcg

Consider substituting:

≥ 6 years old:
Advair Diskus
fluticasone/salmeterol
100/50;250/50; 500/50 mcg

≥ 12 years old:
Symbicort Turbuhaler
budesonide/formoterol
100/6; 200/6 mcg

≥ 18 years old:
Breo Ellipta
fluticasone furoate/vilanterol
100/25; 200/25 mcg

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 08/10/2025

"Metered-dose inhalers (MDIs) are a significant contributor to health care’s climate emissions. They contain high levels of hydrofluorocarbons that, when released into the atmosphere, act as potent greenhouse gases." 🧵

Controller Therapy

ICS
Qvar MDI
beclomethasone
50; 100 mcg

Flovent MDI
fluticasone propionate
50; 125; 250 mcg

Alvesco MDI
ciclesonide 100; 200 mcg

Consider substituting:

≥ 6 years old:
Flovent Diskus
fluticasone propionate
100; 250; 500 mcg

≥ 6 years old:
Pulmicort Turbuhaler
budesonide
100; 200; 400 mcg

≥ 12 years old:
Arnuity Ellipta
fluticasone furoate 100; 200 mcg

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 08/10/2025

"Dry powder and soft mist inhalers (DPI and SMIs) do not contain propellants and have a substantially smaller carbon impact." 🧵

Reliever Therapy

SABA
Ventolin or Teva-Salbutamol MDI
salbutamol 100 mcg

Consider substituting:

≥ 6 years old:
Bricanyl Turbuhaler terbutaline 0.5 mg

≥ 6 years old:
Ventolin Diskus salbutamol 200mcg

≥ 12 years old with Asthma:
Symbicort Turbuhaler
budesonide/formoterol
100/6; 200/6 mcg doses

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 22/09/2025

Here's Ontario's plot. Anticipate schools to drive respiratory transmission rates higher. There's still a fair amount of entero/rhinovirus (12.1% positivity) and a hint of parainfluenza (1.2%) so it isn't "all COVID" out there, but 9.0% for SARS-CoV-2 makes it worth considering if symptomatic.

Plot of SARS-CoV-2 percent positivity in Ontario compared to the number of tests performed per week.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 22/09/2025

I don't think "highlight" is the word I'd have chosen. health-infobase.canada.ca/respiratory-...

Highlights for the week ending September 13, 2025 (week 37)

SARS-CoV-2 (COVID-19) - 9.6% - percentage of tests positive

Upward trend.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 24/07/2025

Complete loss of Starlink connectivity confirmed in Cambridge, Ontario - part of what sounds like a global outage pattern.

Screenshot of Starlink app showing disconnection a service outage in my area (Cambridge, ON).

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 28/06/2025

I've never had an issue with either hearing my patients or being heard by them through masks, even in a noisy emergency dept. In the rare instance when they are hearing impaired and lip-reading dependent, I just use Google Live Transcribe with the font size cranked up. My mask stays on.

This program is closed captioned for the hearing impaired

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 31/05/2025

Playing with long exposure at Niagara Falls.

Long exposure image of the water going over Niagara Falls, which smooths out the water for an interesting effect.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 17/05/2025

The front yard duck now comes with bonus front yard ducklings.

Duck nest in our front yard, now containing freshly hatched (still wet) ducklings. Only a matter of time before they make the march to the nearby pond.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 09/05/2025

'𝙒𝙝𝙚𝙣 𝙀𝙫𝙚𝙧𝙮 𝙎𝙚𝙘𝙤𝙣𝙙 𝘾𝙤𝙪𝙣𝙩𝙨' This Ontario-wide campaign aims to educate the public about 9-1-1 abuse. Please remember 𝟵-𝟭-𝟭 𝗶𝘀 𝗳𝗼𝗿 𝗲𝗺𝗲𝗿𝗴𝗲𝗻𝗰𝗶𝗲𝘀 𝗼𝗻𝗹𝘆. Let's keep the lines clear so help is available for us all when we need it. Pass it on, and learn more at: wheneverysecondcounts.ca

CLEAR THE LINE

9-1-1 is for life-threatening emergencies.

Non-emergency calls to 9-1-1 can delay someone from getting help in a real emergency. Keep 9-1-1 lines open for all of us when we need urgent help.

wheneverysecondcounts.ca

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 05/05/2025

5% of 43.1million? Less than 2.2million. (it would be 2 million without projecting for population growth) How does a cap at 5% not represent a reduction in both absolute numbers and relative proportion compared to today? What would this meme have you believe?

Mark Carney just announced that he will cap the number of foreign students and foreign workers in Canada at 5% of the population.

For context, that's two million people, which is the amount we already have right now.

HE'S NOT REDUCING THE NUMBERS AT ALL

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 05/05/2025

Is that number accurate? This image is from a StatsCan report noting 2.4mil work or study permit holders at the beginning of 2024. There are more recent StatsCan numbers that estimate 2.6mil foreign work or study permit holders in the country right now-ish. www150.statcan.gc.ca/t1/tbl1/en/t...

The total number of NPRs living in Canada increased for the ninth quarter in a row to reach a record high of 2,793,594 on April 1, 2024. Of these NPRs, 2,430,282 were permit holders (work or study) and their family members and 363,312 were asylum claimants, protected persons and related groups (with or without work or study permits).

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 05/05/2025

Estimates of the current proportion of the Canadian population made up of international students and temporary foreign workers in 2025 is 7.2-7.3%. With a population of 41.5 million, that comes out to just over 3 million in absolute numbers.

The government is set to follow the 2025–2027 immigration levels plan announced in October 2023, which proposes to cap the combined population share of international students and temporary foreign workers at under 5% by 2027. As of now, this group makes up 7.3% of Canada's total population of 41.5 million.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 05/05/2025

Here's another politiki-meme that floated past me. It prompted me me to do a little poking around. Sounds awful at first, right? Politicians? Lying? You're joking. But, hang on a sec... 🧵

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 04/05/2025

New deployment for old camera hardware: DUCK CAM This momma duck built a nest in our yard. Now we can peek in on her and her eggs without my kids scaring the quack outta her each time.

Serene looking duck hen continues her long sit on her nest full of eggs.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 02/05/2025

Robin Cam 2025 is go. Some noobs have already made an appearance!

Robin nest. They return to the same spot every year, so we pointed a camera at it. You can see one chick, but I think there's another one in there, as well as an unhatched egg.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 02/05/2025

Exceptionally disturbing. This isn't a "transparency initiative" as much as a weapon. It's an attack on any body that brings friction to the injection of partisan talking points - including alternative facts and outright falsehoods - into the domestic infosphere.

Targeting the “censorship industrial complex”

Both GEC and R/FIMI, its pared-down successor office, focused on tracking and countering foreign disinformation efforts from Russia, China, and Iran, among others, but GEC was frequently accused—and was even sued—by conservative critics who claimed that it enabled censorship of conservative Americans’ views. A judge threw out one of those claims against GEC in 2022 (while finding that other parts of the Biden administration did exert undue pressure on tech platforms).

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 02/05/2025

Meme in my feed points at Reuters reports of a Japan-Qatar deal on LNG (true) but claims the Canadian govt has refused similarly lucrative LNG export deals with Japan (not true). Alberta just made such a deal, and there are apparently more on the way. www.canadianenergycentre.ca/reliable-jap...

Canada is now Japan’s second-largest supplier of propane, according to World Bank data, where uses include automobiles, electric power generation and petrochemical feedstock.

“The long history of reliability in the supply of propane from Canada serves as the basis for the high expectation for Canadian LNG to Japan,” said IEEJ chair Tatsuya Terazawa.

“We see LNG from strategic partners like Canada as important to our energy security and our country’s efforts to significantly reduce our dependence on coal as well as to provide dispatchable power to deal with the intermittency of renewable power.”

During a recent trade mission to Japan, leaders from Canadian organizations Energy for a Secure Future and the First Nations LNG Alliance signed a memorandum of understanding with IEEJ to advance energy trade.

“There is a real commitment between the three organizations to work together to support Canadian LNG projects being successfully built and getting our product to markets in Asia that need energy security and low-emission energy options,” said Shannon Joseph, chair of Energy for a Secure Future.

“It is an extremely positive thing.”

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 29/04/2025

Wait. Is @macleans.bsky.social not doing their live-colouring coverage of the federal election this year?!?

Graphic from Maclean's "Live-colouring the 2021 Canadian election results."

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 04/04/2025

“Fucking Dr. Google bullshit. They want medical treatment, but they don’t want medical advice.” "Stop looking at your goddamned phone!"

Noah Wylie as Dr. "Robby" Rabinovich on The Pitt exclaiming "Fucking Dr. Google bullshit" when confronted with a antivaccine denialist parent.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 02/04/2025

100.1 JackFM outta Rhinelander, Wisconsin, the Ice Fishing Capital of the World! en.m.wikipedia.org/wiki/WRHN

Coverage map for WRHN 100.1 FM in Rhinelander, WI (2023 radio-locator.xom)

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 01/04/2025

I want a Cory Booker / Tom Morello collab asap.

ChatGPT/AI generated image purportedly showing Tom Morello and Cory Booker if they were jamming out.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 01/04/2025

Not an April Fool's Day post. Absolutely no way this hospital renaming will lead to any degree of confusion. No chance. Nope. #watreg #waterloo #kitchener

Waterloo Regional Health Network (WRHN, aka "wren") announces the new official names for hospitals in Waterloo Region. Grand River Hospital (KW Campus) will now be known at WRHN Midtown. St. Mary's General Hospital is now WRHN Queen Blvd, and Grand River Hospital (Freeport Campus) is now WRHN Chicopee.

Note they couldn't use street names for the (former) Grand River Hospital sites because the Midtown and Chicopee sites are both on King Street in Kitchener.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 29/03/2025

Agreed, and the wren flew right past me as well. I tried converting it to B&W. Meh.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 29/03/2025

Who knows. Maybe it'll grow on me. Maybe. The sad thing is that Grand River Hospital updated their visual identity style guide a few years ago, and absolutely f**king nailed it.

Grand River Hospital and St. Mary's General Hospital contemporary logos and logotype.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 29/03/2025

I'm underwhelmed by the visual branding for the new merged hospital system: Waterloo Regional Health Network. I'm guessing the logo is an attempt to smash the GRH lotus into a dove that's... brown? The logotype looks like it was set in MS Word. #watreg #waterloo #kitchener

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