Cat Hicks

@grimalkina

Author of The Psychology of Software Teams: she/her 🏳️‍🌈 Catharsis: Host at:

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Cat Hicks@grimalkina· 23d

The handout from this skill is very long, but it includes a mini lit review, the DOIs of sources, search terms, evidence red flags (e.g., retrospective studies, lack of long-term data as in the case of this particular regime, it's new). Also proposing scenarios to look into

Scenario 2: A side effect escalates and needs intervention

What the evidence says about likelihood: Grade ≥3 events occurred in roughly 30–45% across real-world and perioperative data (higher in the newest before-surgery trial). Skin grade 3–4 ~13%; high-grade blood sugar ~5.7%; neuropathy tends to build cumulatively over cycles.
Early signs to catch: Rash spreading/worsening rather than settling; numbness or weakness that's new or progressing; blood sugar creeping up on labs; persistent new diarrhea or fatigue (possible immune-related effect from pembrolizumab).
How early action changes outcomes: Caught early, these are typically managed with a dose hold, dose reduction, topical/systemic steroids, or supportive care — often letting treatment continue. Catching drift early is the whole point of watching.
What monitoring catches it: Lab trends + your logged observations of the specific changes above.

The perioperative evidence is essentially one trial, four months old, with overall-survival data still maturing and a higher grade ≥3 rate (71.3%) than the metastatic setting (55.9%). Treat published averages as provisional for his exact regimen.

Cat Hicks@grimalkina· 23d

Now, it's going to create a lit review using things like my Pubmed connector. It will even tell me what search terms it uses so I can go use them, because that's also something I wanted in my harness. You will notice links and flags -- all from my skill instructions

Comparative-safety network meta-analysis. Xie et al. (Ther Adv Med Oncol, 2025): 11 RCTs, 7,586 patients; EV+P had higher overall side-effect rates but lower grade ≥3 rates than platinum chemo. DOI ⚠️ Abstract only.
Real-world checks (do the trial numbers hold up in ordinary practice?): Mayo Clinic, 183 patients, grade ≥3 30.6% DOI; Austrian registry, 203 patients, grade ≥3 38.4%, immune-related events 19.2% DOI. Both female-led, both "consistent with trials, manageable." ⚠️ Retrospective; abstracts only.

From the FDA: The label carries a boxed warning for severe and fatal skin reactions (SJS/TEN), which occur predominantly during the first cycle but can come later; in the MIBC combination trials, skin reactions occurred in 65% (all grades), grade 3–4 in 13%. Additional warnings: high blood sugar, lung inflammation (pneumonitis/ILD), peripheral neuropathy, eye disorders, infusion-site extravasation, and fetal harm. The FDA approved this perioperative regimen for cisplatin-ineligible MIBC on Nov 21, 2025. Sources: FDA approval notice, DailyMed label.
What I couldn't pin down: a precise perioperative-setting incidence figure for pneumonitis/ILD specifically (it's a named warning and monitored risk, but I didn't retrieve a clean number for his exact regimen), and I didn't access any full texts.

Cat Hicks@grimalkina· 23d

I won't show you all the demographic back and forth, but I'll show you just how easy it is to make an AI-administered survey good, even with the stupid AI tone ("honest" lol), you can dramatically improve LLM output with a good harness Here are inventory instructions: github.com/DrCatHicks/i...

1. The regimen and setting — this one matters most.
Is this EV on its own, or EV plus pembrolizumab (often written "EV+P")? Pembrolizumab is an immunotherapy that adds a whole separate category of possible reactions, so knowing this reshapes the search. And roughly what setting — advanced/metastatic, or something else you were told?
2. Where they are in the course.
When did treatment start, and which cycle are they on now (or how many infusions so far)? Some of the most serious reactions cluster in the early cycles; others (like nerve symptoms) build up cumulatively over time. Timing changes what's most likely right now.
3. Baseline health that maps onto EV's specific known risks. Any of these that apply:

Blood sugar — any diabetes, pre-diabetes, or higher body weight? (EV can push blood sugar dangerously high, and this risk is concentrated in certain people.)
Nerves — any numbness, tingling, or weakness before starting treatment, from any cause?
Skin — any pre-existing skin conditions, or a history of bad drug rashes?

Cat Hicks@grimalkina· 23d

An example of me working the problem is in the informed-patient skill I wrote. I will continue with this very serious example, and give you a different user you might not believe in, someone pretty skilled with evidence. I wrote this query the way *I* would write it, into *my* evidence harness

Cat Hicks@grimalkina· 23d

astronaut gun meme that says "wait all data is socially constructed"/"always has been"

Cat Hicks@grimalkina· 23d

Here is google with AI stripped out of the query. It is, obviously, still doing a lot of text processing and scaffolding behind the scenes, and it also makes this link. But this is what it feels like to just see a sea of links while panicking about your loved one. You tell me: is this better?

Enfortumab vedotin-ejfv plus pembrolizumab (EV-pembro) has “totally shifted the field” in locally advanced and metastatic urothelial carcinoma care, according to Jonathan Rosenberg, MD, the Enno W. Ercklentz, Jr. Chair and chief of the Genitourinary Oncology Service at Memorial Sloan Kettering Cancer Center in New York City. However, the groundbreaking treatment is associated with specific toxicities, especially in the early stages of treatment, a period during which Dr. Rosenberg recommends that oncologists carefully assess patients.

The most common early toxicity is skin rash, which is typically not very serious. “It can be associated with itching, or a diffuse macular rash,” Dr. Rosenburg said, adding that a small percentage of patients may get blistering, or sometimes intertriginous rashes. If needed, topical and oral steroids can be helpful treatments, he said. “I generally recommend consultation with a dermatologist for early rashes that occur in the first treatment cycle,” he added. The rashes are often easily managed, although patients with severe toxicities may need a dose reduction of EV-pembro or discontinuation of enfortumab.

Cat Hicks@grimalkina· 23d

Let's use a chemo example. Now, this is opening up browser version of claude that is stripped of all my harness -- and my harness is GOOD, forces lots of literature review checking and explicit source, so you're seeing the worst version. There are issues - you don't know what it's "read" really

The reassuring context: most skin reactions on this drug are mild — itching, dryness, a maculopapular (flat-and-bumpy) rash — and manageable. The problem is that a minority progress to something dangerous, and the early hours matter, because the main treatment is stopping the drug promptly.
Here's how to tell the difference. These are the red flags that mean get emergency care now (ER, or call the oncology team's urgent line immediately):

Blistering or peeling skin, or skin that looks like it's sloughing or coming off
Skin that is painful to the touch (not just itchy)
Sores, erosions, or blisters in the mouth, on the lips, in the eyes, or on the genitals — mucous membrane involvement is one of the most important warning signs
Red, painful, or crusting eyes
Fever occurring together with the rash
A rash that is spreading quickly or covering large areas of the body
Facial swelling along with the rash

Any one of those, especially blistering/peeling or mouth-and-eye involvement with fever, is a "go now" situation. SJS and TEN can escalate fast and are life-threatening, and the people treating this person need to see it early.

If the reaction is milder right now — itching, dryness, a rash that isn't blistering, no mouth/eye sores, no fever — it still warrants calling the oncology team today rather than waiting until the next scheduled visit. They may want to see it, treat it, or hold a dose. Reactions that start mild can change, so it's worth flagging even if it doesn't yet meet the emergency bar above.
A couple of practical things that help: taking clear photos of the rash as it develops (so the team can see progression), noting when it started relative to the last infusion, and noting whether there's any mouth soreness, eye irritation, or fever, since those are the details the oncology team will ask about first.
Would it help if I put together a short, printable summary of these warning signs to keep on hand or share with the person you're caring for?
This is a sensitive medical situation, and I'm working from general drug-safety information rather than seeing the actual reaction — the oncology team's guidance about this specific person always takes priority, and when in doubt about anything blistering, painful, or involving the eyes or mouth, erring toward the ER is the safe call.

sources shown in the claude thinking trace

Cat Hicks@grimalkina· 23d

you tell me which seems to be doing the best job with tossing up elements of the information space

Cat Hicks@grimalkina· 23d

I put the exact same stupid but very human query into both

I'm in Seattle and we're struggling with the coffee which tends to be kind of too dark for my stomach and I miss coffee like verve coffee in San Francisco, what coffee should I go look for?

Verve's whole thing is bright, clean, light-to-medium roasts — the opposite of Seattle's old-guard dark-roast reputation (the Starbucks/Vivace lineage that probably explains the too-dark, too-harsh cups you've been getting). The good news is Seattle has a strong light-roast scene now; you just have to look past the classic names. Here's what to seek out.

a google search results page with a top link to a list of "where to find excellent coffee in San Francisco" (also lots of button clutter)

Cat Hicks@grimalkina· 25d

🧐

Cat Hicks@grimalkina· Jun 30

Two of my favorite beings This has been a wild month, between big joys like my book coming out, but also crisis as we needed to triage and respond to health challenges for me (thankfully I am stabilized and we hope 🤞 ok now but healing from a period of pretty immense pain) and hard family news.

A photo of an atmospheric grey morning on a rocky beach where a small woman crouches to take a photo of a white dog. Waves and rocks are in the frame

Cat Hicks@grimalkina· Jun 26

This is why I wrote "in California" in the next reply! Here's the wall in an exam room I was in recently

Two signs say no cell phones and no audio or video recording without express permission

Cat Hicks@grimalkina· Jun 23

hello, last year an academic engineering reviewer said my developer open science project on identity threat and belonging was "too much psychology for a software audience" and now my ebook is a #1 seller in COMPUTERS POST ARMY RISE

a screenshot of the kobo ebook platform shows the psychology of software teams (preorder) is at the top of the list of "bestsellers" in "computers ebooks"

Cat Hicks@grimalkina· Jun 23

well in nyt they say "many previous studies" find it a "reliable proxy for narcissism" and link this journals.sagepub.com/doi/abs/10.1... which says this

Ham et al. (2018) and Ham, Lang, Seybert, and Wang (2017) employed an alternative
unobtrusive measure of CEO narcissism by measuring the size and contents of a CEO’s signature in SEC filings (2 of 42 articles). Their rationale posits that a larger signature represents
the grandiose nature of a narcissist. To validate the measure, Ham et al. used student samples
in a laboratory setting. While the main advantage of the measure is that it captures a behavior
under the direct control of the CEO (i.e., his or her signature), the measure may not fully
capture narcissism’s multifaceted nature. Ham et al. also provided external validation by correlating the measure with employee ratings of CEO narcissism, as obtained by O’Reilly et al.
(2014). As this is a newer measure, it has seen limited use to date.

Cat Hicks@grimalkina· Jun 23

what on EAAAAAAARTTTTTTHHHHHHHHHHHHH

Narcissism. In the interest of maximizing data availability and minimizing social desirability and self-deception biases, we measured CEO narcissism unobtrusively (Chatterjee and Hambrick, 2007, Grijalva et al., 2020). Consistent with prior research on CEO narcissism (e.g., Cragun et al., 2020, Ham et al., 2017, Ham et al., 2018, O’Reilly et al., 2014), we collected four unobtrusive indicators of CEO narcissism and created a composite index: (1) the prominence of the CEO’s photograph in the company’s annual report; (2) the CEO’s signature size; (3) the CEO’s cash compensation divided by that of the second-highest paid executive in the firm; and (4) the CEO’s non-cash compensation divided by that of the second-highest-paid executive in the firm (Chatterjee and Hambrick, 2007, Ham et al., 2017). These formative indicators reflect CEOs’ tendencies to be portrayed as special and superior—both in centering their images and identities in company communications and in displaying entitlement to pay themselves more than others (e.g., Oesterle et al., 2016, Rijsenbilt and Commandeur, 2013). Of the 318 CEOs, 259 CEOs had available data for all four indicators. To ensure the most accurate representation of where each CEO fell in the population, we standardized each narcissism indicator using all available data.2 Our results were consistent in magnitude and direction when we standardized the data after removing CEOs with missing data from the sample.

Cat Hicks@grimalkina· Jun 22

*Jumanji drumbeats in the distance* Psychology of Software Teams is ALMOST HERE www.drcathicks.com#book

A screenshot of the Amazon listing for the Psychology of Software Teams shows it as a "top new release" in software project management

Cat Hicks@grimalkina· Jun 18

He fall on him face

Cat Hicks@grimalkina· Jun 18

Very cute tbh

A very tiny newt guy rests on a wet muddy stone

Cat Hicks@grimalkina· Jun 14

When you're hanging out with tech friends in San Francisco and you need to interpret the headlines for them and talk about the differences between observational causal inference and designed experiments and the math pitfalls of each and all you have for paper is a verve bag

A brown paper bag with hand drawn silly graph sketches on it showing multiple relationships between individuals and approaches to statistically analyzing them

Cat Hicks@grimalkina· May 17

the social identity theory psychologist in me jumped OUT when I saw this in my headphones Espresso started Magic moment

Two survey items that ask How much do you align your identity to your job? and Do you feel comfortable being your authentic self at work? with five likert-style answer choices

Cat Hicks@grimalkina· May 17

they highlight some national diffs like this that I'm really curious about

Learning Pressure shown in percentages, South Korea and Mainland China say improving technical skills is the most challenging job aspect at higher percentages than United States and United Kingdom

Cat Hicks@grimalkina· May 17

Coming for you, Toronto!! Looking forward to giving my CTO Craft con keynote which is about measurement AFTER you've messed up: improving how carefully you work towards evidence, stopping the ad hoc metrics chaos, and repairing your organization's ability to learn from itself

A photo shows two stacks of stickers in little mesh bags, one with Cat's book cover that says developers deserve science and one with a hand drawn illustration of little brains in jars that says developers are more than brains in jars

Cat Hicks@grimalkina· May 14

god dammit now I feel like I have to learn to understand this commit hook stuff

a screenshot of Cat's github repo for the learning-opportunities skill which now has 1.4k stars

Cat Hicks@grimalkina· May 9

Out of laptop sticker room? There will also be bookmarks!

A pile of bookmarks that say The Psychology of Software Teams on one side, and Developers Deserve Science on the other side, with an illustration of mountains and ridge plots

Cat Hicks@grimalkina· May 9

Perhaps you have thought to yourself, *I'm* on board the Psychology of Software Teams train, but how can I identify fellow POST fans in the wild?? Well if you find me at a 2026 conference or book reading you can get a TINY PROPAGANDA STICKER

A sticker shows a tiny book cover of the Psychology of Software Teams on a terracotta background, and white text reads Developers Deserve Science

A sticker shows a black and white hand drawn illustration of brains in jars on a terracotta background with white text that reads Developers are more than brains in jars

Cat Hicks@grimalkina· May 4

I was really pleased with the xwing harness referential I did while still making this a non-costume/fashion version! I knew I didn't want to wear a whole vest (it is warm in San Diego in July)

A picture of Cat taking a selfie in a mirror that shows the side of an orange flightsuit style jumpsuit with a white stripe on the side and a white ankle tie. Her hair is in princess leia-style buns

A picture of Cat standing against a fence holding an xwing helmet wearing orange flightsuit style jumpsuit with white stripes on the sleeve

Cat Hicks@grimalkina· May 3

Here's just a section from the entry on her doctoral advisor 🤷‍♀️

An extremely long ass description of the career and research of Steinberger where his spouse is not mentioned

Cat Hicks@grimalkina· Apr 19

it became their term for "anything about humans" somehow

a screenshot from google scholar shows 112,000 results for developer personality traits

Cat Hicks@grimalkina· Apr 19

Perfect rec as I am already a fan enough to put a quote from it at the top of one of the pieces of writing I did that meant the most to me! :) osf.io/preprints/ps...

A screenshot of a paper reads: A Cumulative Culture Theory for Developer Problem-Solving by Catherine Hicks, Developer Success Lab and Ana Hevesi, Uploop. Underneath their names, a quote reads “If, however, one avoids the linear, progressive, Time’s- (killing)-arrow mode of the Techno-Heroic, and redefines technology and science as primarily cultural carrier bag rather than weapon of domination...”- Ursula Le Guin, The Carrier Bag Theory of Fiction

Cat Hicks@grimalkina· Apr 18

uh oh I am hearing there are even feminist studies of Bell Labs re: the telephone www.jstor.org/stable/j.ctt...