life is but a rock tumbler for the soul
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Our daughter is the first US baby born from an automated IVF lab.
I wrote the first check into Conceivable, & eventually, they gave us our daughter. Watching the robots work felt like a moon landing. @sarahfrier captures the heartbreak, joy, life & death of this journey in @BW
A new robotic lab that makes human embryos using AI is now responsible for 19 babies. Is it better at IVF than humans are? bloomberg.com/news/features/…
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I BECAME A US CITIZEN TODAY 🇺🇸
This country isn't perfect. But, having lived elsewhere in the 🌎, I don't ever take it for granted that I can say what I want to say, as a woman I can do what I want to do, and I can love who I want to love. I am very proud to be an American.
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Speaking of loving whom I love, @CamillaFHermann waited patiently for me, in the cold rain, outside the building of the naturalization ceremony (since Covid, friends and family are no longer allowed in) and was the first person I saw as I emerged officially a citizen ❤️
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I was surprised by how emotional I felt. Looking around where the oath ceremony took place, there were ppl from everywhere. A beautiful reminder that this country is a place where so many hope to build a better life, like my mom who immigrated with 2 young kids a long time ago.
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AI in healthcare doesn’t really exist right now.
It should. It has the potential to meaningfully improve patient outcomes and provider shortages.
A 🧵on why AI companies don’t make it from my vantage point as a digital health investor. 1/
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@elonmusk’s multiplanetary ambitions require multigenerational thinking. But Mars will still be there while humans may not. Choosing not to have kids is the real quiet quitting.
Today I wrote for @PirateWires. Link below 👇
NEW TODAY: There’s no point of a multiplanetary future if there are no people left to populate it
The U.S. fertility rate sits at an anemic 1.79, far below the required level to replace our population. The global rate is not much better. This means we’re watching civilization compound into oblivion through the powerful force of exponential decline.
Even in countries with state-funded IVF programs, policy and technology have had little effect, because depopulation isn’t something you can fix with tax subsidies and robots. It stems from a fundamental devaluation of family life in post-industrial economies.
Once, having children was how you joined the world. Today — with help from parenthood’s total absence from narratives that celebrate professional ambition, romantic conquest, and lone-wolf heroism — it’s framed as opting out of it. Freedom is childlessness. Kids are a burden. DINK life (Double Income, No Kids) is not only accepted but vaunted like an achievement. In a culture addicted to self-optimization, the case against children practically writes itself.
Some people have deeply personal reasons not to have children. As for the rest of us, especially the self-proclaimed futurists who are resourced and capable? Wake up to the programming. Have kids now. Don’t wait for the perfect apartment with a nursery. Don’t wait until you can afford a night nurse, like I did, cutting into the window of opportunity to have another, and another. Don’t wait for your startup to exit, or to make partner, or to hit some phantom “ready” (readiness is just control, repackaged). Stop shitposting. Stop procrastinating. You need less money, space, and time than you think. Let it be messy. Let it be visible.
Choose this fundamentally creative act, a reason for living that breaks you open and remakes you. The future of humanity — whether on Earth, Mars, or beyond — depends on it.
(No pressure.)
(Link to the full piece is threaded.) 👇
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1/ @ACME’s invested in iconic D2C health companies like Curology, Pillpack, Brightside, & Tia. I ♥️ this space.
I take 1k+ mtgs/yr & invest in ~5 co.
Out of 955 emails,👇 are top reasons why I passed on D2C healthcare startups last year (🧵/18)
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Everyday I’m reminded that the most significant indicator of a company’s success is the founding team’s learning velocity.
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One of the most useful framework in my spiritual journey is @TheKenWilber’s:
Wake up — Seeing that there is a higher consciousness
Grow up — Maturing one’s views to be able to hold multiplicity of truths
Clean up — Healing and integrating any shadows (parts in ourselves, and therefore others, that are separated and unloved)
Show up — Expressing one’s full emanation in the world
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TL;DR I like full-stack digital health companies that own care delivery and can use AI/ML to augment what they do vs. AI/ML companies that try to sell to provider groups. Have not seen a company in the latter category be a breakout yet. 12/
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An in person conversation I had this week w a major Cerebral investor-
Me: So, how’s Cerebral doing?
🥸: Honestly, it’s a GREAT business.
Me: …
🥸: They’ve beaten projections every quarter.
Me: …
🥸: This stuff will blow over. Look at WeWork! They’re doing so well now.
Me: 🤯
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Excited to announce @ACME’s new $300m+ Fund IV and my becoming Partner alongside my dear friend & work wife @alexfayette.
Here are the things that I’m celebrating today 🧵:
businesswire.com/news/home/2…
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At some point, emptiness practice flips into liveliness practice. There’s nothing to defend anymore, nothing to empty. A thief entering into an already empty home. All sensations and phenomena are welcomed with open arms.
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Even now it’s probably still easier to raise money as a crypto project than a women’s health company
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The bar is so shockingly low for VCs that being able to regulate my nervous system and not show up reactive is a massive differentiator in founders' eyes. Wild
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At the hospital to start my annual cancer check process. What a visceral reminder of why I invest in healthcare. We all deserve the wealth that is our health.
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I've been spending lots of time in digital health and consumer social this year and always get, "??? they're so different." They're not. To me it's ultimately about improving the wellbeing of humans. Healthcare improves the hardware and social improves the software. You need both
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Hurdle #1: The fragmented nature of US healthcare = pockets of data that company has to painfully get agreements to centralize to even train models. This means interfacing w/ bureaucracies like health systems & unis = months/years of startup burn. 3/
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Hot take: Cerebral will be a bigger scandal than Theranos when it’s all said and done.
Yes, Theranos is a sensational con man story. But patient impact is much more serious in mental health mis-treatment vs. getting another blood lab bc 1st one was funky.
Cerebral started off prescribing antidepressants, then it found there was more profit in Adderall. Here's the story about how the startup focused on growth, sometimes at the expense of clinical quality. w @khadeeja_safdar and @anfuller
wsj.com/articles/cerebral-ad…
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I heard someone say this today. I'm not Christian but I find the sentiment beautiful and true: “You should live your Christian values out in the world, because you may be the only Bible someone gets to read.”
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This is assuming employer direct-contracting stay as a model. The company that will likely win is the one that wins national contracts w payors, who can then offer robust mental health packages as part of their plans to their employer clients without creating a separate budget.
Every mental health startup will inevitably pivot to B2B to lower churn.
And due to the crowded market, savvy employers will drive down prices, which will in turn reduce pay for therapists.
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OK cool thing about my dear friend and my spouse working together...
I get to see firsthand @chrissyfarr absolutely crush it for @CamillaFHermann @OathCare. I've never seen an investor add so much value on recruiting in such a short period of time holy moly.
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Demand for mental healthcare in this country is the highest it's ever been yet commercial insurers keep cutting down their reimbursable rates so supply keeps going down. The US healthcare system is so screwed. We all lose (except those making $$$).
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Hurdle #2: Even once the data needed is acquired, the data itself may be of poor quality and require serious cleaning. Bad data >> bad models = game over. 4/
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Hurdle #4: Getting adoption in the system is brutal unless you’re also delivering care vertically. The latter is also brutal; you’re essentially building your own provider group and care delivery infrastructure. 7/
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Bae slaying. @CamillaFHermann
Great story by @dodgeblake on how @chrissyfarr started as a user on @OathCare and then 🚀 led their $6m Seed.
So proud of this team! @mddstephens @DrTed_Oath @Nursejudysf + more 💪🏼
businessinsider.com/oath-car…
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“I’m looking at a lot of sperm these days.” A sentence I never thought I would utter in my life 😬 @deenashakir @AlyssaJoyJaffee @lesliejz @chrissyfarr
Join us as we chat about fertility right now! nitter.app/i/spaces/1nAJEYnEkBkJL
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One of the things I most appreciate about living in SF is how it’s shattered my inherited East Coast illusion that fancy colleges and degrees matter at all.
The smartest, most capable people I know don’t have them. Some do. There is no correlation.
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Women of NYC, Phoenix, LA, & SF...
Drop everything you're doing rn & sign up @ asktia.com to be your permanent medical home.
I just went in for my annual Well Woman exam. It's the best healthcare I've gotten in my entire life as a woman. A 🧵on why it's so unique:
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Hurdle #5: Documenting and demonstrating superior clinical outcomes that will win over risk averse providers. If you don’t own your own care delivery stack, you have to convince provider groups to use your application. 8/
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There are very, very few healthcare companies that are utilizing AI. And when they say AI, it’s actually just ML.
AI in healthcare doesn’t really exist right now. (It should, and we can go down a rabbit hole another day of why it doesn’t).
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Hurdle #6: The providers are clinically convinced; but who’s paying? Very few reimbursed by insurance. So either patient pays or providers with already thin margins pay for it. Harder to convince if your value prop is cost savings vs. adding rev. 9/
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Side note: I’m writing as I wait for my annual post-cancer check up at a 🏥. Walking into a hospital is a universally vulnerable experience for most humans. Participating in #JPM22 convos while also viscerally going through patient experience reminds me of what’s important here.
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What I always forget and have to constantly remind myself (and really the heart of my spiritual practice) is that stories are most powerful when I remember that they are just that — stories. Then I can create while still maintain liberation
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Hot take on man’s downfall from Eden: Knowledge from the apple is the addition of prefrontal cortex in sapiens. Emergence of Intellect marks a division from Presence and Wholeness enabled by the conceptual mind, whose powerful ability to tell stories is the very fountain that generates creation AND illusion.
Which, without skillful means, shrouds the primordial and pristine nature of being, of unconditional non-dual love, itself. In Christianity, we get to the truth through grace and forgiveness. In Buddhism, we get to the truth through seeing the nature of reality itself. Different journeys, same destination.
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Best part of my day was getting to see these two IRL @deenashakir @AlyssaJoyJaffee at #RHSummit22.
Missing @chrissyfarr @lesliejz. One day all 5 of us will actually be in the same selfie and it will be a Captain Planet / Avengers moment (pick ur generational metaphor).
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Realizing that a thriving relationship is less about dividing household operations “equally” & more trading off of who’s the more resilient one at a given moment & thus can take on more.
In my experience, “equal” has been the ideal but in practice can be static & unrealistic.
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My life is complete. I have done what I am meant to do this world. (@PadmaLakshmi 👋).
World’s best egg sandwich👇
Crispy whites, gooey yolk, melty cheese, bite from green onion, spice from chili oil, nutty whole wheat bread.
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Hurdle #3: Deciding which application can get venture funding. TAMs for most AI applications in healthcare (not including pharma in this thread) are small bc they provide ancillary services / tooling (e.g. diagnosis assist, workflow automation). 5/
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Thank you @Rock_Health for this incredible honor 🙏 And what a joy to be alongside my favorite humans @deenashakir @AlyssaJoyJaffee
Congrats to our Top 50: Supporters—the leaders fueling and funding digital health initiatives. @AlyssaJoyJaffee, @aikeho, @deenashakir, @SolomeTibebu, @Liam406, and @RicardoRJohnson!
#Top50inDigitalHealth #10YearsofTop50
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You know why good journalism is dying? It’s morphed into PR.
@chrissyfarr told me how frustrating it was as a reporter to get non-answers from experts when they really are the ones w ground level truth. So now I try to do my small part to say the real thing vs my PR talking pts
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I can’t get this Jewish x Asian menu that I dreamed up out of my head. Time to make it? 🧵 of dishes:
1. Matzoh ball soup with ginger scallion sauce and chili oil.
2. Chopped liver rice balls onigiri 🍙
3. Nigiri sushi rice with smoked salmon & everything bagel seasoning 🍣
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Trying out @Levels in a group experiment with @rypan @timjschwartz @bermster.
What should we know going into it?
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Hurdle #7: Onboarding, training providers and admins. Does it work seamlessly with their current workflows? Little frictions add up to minimum adoption in the actual field unless it’s something so important that there is a top-down mandate. 10/
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Had such an energizing and beautiful conversation with @JakeOrthwein today.
One of the threads we touched on: That awakening isn't a "laddering up" of more and more light absence of dark. Awakening is an expansion and inclusion of both more light and more dark. 🧵
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The best gift we can give our future kids is teaching them how to regulate their nervous system.
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We spend so much time running away from the unbearable tenderness of being human even though it is what gives us the most meaning and joy in this short life.
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Reality check: The tech people who moved to Texas are wealthy enough that they’re not affected by policies.
Worried about abortion? They have money to travel across states to get the best care. Worried about school shootings? They send their kids to private schools w security.
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In the Mahamudra and Dzogchen traditions there are specific markers for awakening / enlightenment. If what is scientific is what is repeatable, they have created a repeatable framework and maps for awakening and concrete ways to check!
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This makes my stomach churn. It is wild how they're endangering patients' health for the sake of growth.
forbes.com/sites/katiejennin…
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The #girlmance I have with @lesliejz is 🔥☄️. 📸 here of us celebrating @chrissyfarr back in 2021. This is what a gourmet hug looks like.
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Life is like that week in high school where you have to take care of an egg, except the egg is me
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Emptiness… it’s an unfortunate term. It doesn’t mean things go away or that they have no substance. A good synonym for emptiness is “mere construction.” — Dan Brown, recorded in Cloudless Mind, volume 1
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I’m actively trying to break out my learned helplessness, even when my small actions likely futile.
I moved mtgs to call senators on HR8.
Knowing it’s futile but training myself to act & not numb so when the right opp arises for impact, I’ll have the muscle memory to do it.
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Ok in movie / TV scenes where the👮♂️puts the person getting arrested into the back of the police car, they never show seatbelt being put on the handcuffed person. Does that happen in real life??
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My mom moved to an entirely new continent with 2 young kids as a single parent with nothing and started from scratch. People can do anything if they put their minds to it.
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I’ve lived my whole life, ever since a toddler, w chronic pain. My knees periodically would hurt, like they’re in a lobster cracker.
No prior doc took initiative to look into it. Until today @Ask_Tia. My doc listened & ordered labs for what I suspect is juv rheumatoid arthritis
Women of NYC, Phoenix, LA, & SF...
Drop everything you're doing rn & sign up @ asktia.com to be your permanent medical home.
I just went in for my annual Well Woman exam. It's the best healthcare I've gotten in my entire life as a woman. A 🧵on why it's so unique:
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I am a 1st gen immigrant. My mom moved here as a single parent w 2 young kids. Mom worked at my grandma’s hair salon during the day & took college classes at night. She kept a pillow & blanket in the car to nap in btw her shifts & classes.
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1/ Hot take: The employer direct contract model in healthcare will eventually be less relevant as payors move to offer benefits that were previously fragmented as part of their plans.
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Over time, the methodologies below have been the most impactful. Each have a lot of crossover impact in other categories (eg Dzogchen really applies to all) but for simplicity:
Wake up — Mahamudra and Dzogchen
Grow up — @ConsciousLG with @DianaChapman
Clean up — Psychedelic therapy, IFS, Hoffman program
Show up — Relationship yoga with @CamillaFHermann, deep friendships (eg @sashachapin), life unfolding!
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Our household lives & breathes digital health. I invest in dh cos. My founder4life @CamillaFHermann is building one at @OathCare.
Helping parents w their most life-changing experience = constant topic in our home for yrs. Excited to be part of this journey now w @chrissyfarr.
Here's my personal take on @OathCare from the perspective of being a user desperate for support while pregnant during the pandemic - and later as an investor. medium.com/omers-ventures/in…
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One of the greatest joys of being meat-sacks on this rock hurtling through the abyss of space is sitting out in the sun with the person you love on a nice day
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This 👇 why payors can’t implement value based care yet. @wah__yan is 💯 right here. Infrastructure that will enable vbc is an area I’d love to invest in.
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There is no me without my mom. She’s my hero. It doesn’t matter how often I think about this, it always brings tears to my eyes. I feel them now as I write this.
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So many of my male friends have asked if there could be a @Ask_Tia for men.
The US healthcare system is so bad that even the population that most benefits from its default care design is not getting adequate care.
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Access is not enough in this brave new world of digital health; Brightside's commitment to quality sets it apart from everyone else.
Proud to announce our co-leading @withbrightside's Series B. We led the Series A just a year before. Why? 🧵
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I'm moderating a panel on D2C vs. B2B biz models in health 3:30PM @HLTHEVENT Garden Stage. Feat @glassruss at @Headspace, @robinberzinmd at @parsley_health, @sidviswanathan at @truepill_rx, & Sarah Jones Simmer at @joinfoundhealth.
Aiming w this great crew for substance > fluff
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“I'm convinced, I've seen enough, it's time to step back and hand over the keys to Hollywood to @Chloe_Domont. It's her world now, I am just another analyst who wants to help her succeed.” @firstshowing on FAIR PLAY @sundancefest
cc @leopoldhughes
Sundance 2023: Chloe Domont's 'Fair Play' is an Extraordinary Thriller onfs.net/3kBUk2p
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Someone pls report how much the founders and early investors have each sold and gained in secondaries while employees, providers, and patients hold the short end of the stick…
Cerebral, which raised $300 million at a $4.8 billion valuation this month led by SoftBank, changed the status of more than 200 employees, mostly therapists, from salaried to hourly workers in August and made their health insurance contingent on quotas. forbes.com/sites/katiejennin…
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My favorite person @agbreiten in the sea of JPM suits. I aspire to this level of no effs given ❤️
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Digital applied to mental health…
Pro: Enables greater access in a time of unprecedented need.
Con: Without a relentless commitment to patient outcomes & wellbeing, companies stray & become pill mills to grow revenue. << This is where board governance in startups is critical.
When Covid hit, the fed gov’t relaxed a rule preventing doctors from prescribing controlled substances like Adderall without an in-person visit. Silicon Valley saw an opportunity: diagnosing ADHD online. 🧵
wsj.com/articles/startups-ma…
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Doctors who listen seem like a given but it is not for women. @Ask_Tia is the best healthcare I have ever received in my life. I am a happy patient of their SF clinic.
Trying out @Ask_Tia today! I had such a bad experience seeing a doctor at Kaiser that Tia made sense for me to check out. Women just want doctors to care and listen to them genuinely ya know 💁🏻♀️ We deserve better healthcare!!
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Happy #InternationalWomensDay 👯♀️
This tweet has since been deleted but it gave me a good laugh and a good reminder how much left there is to do 🤦🏻♀️
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