domain:alakasa.substack.com?page=6?page=0?page=2?page=2
cjet79
3m ago
We managed to get to the victory screen this week. It came sooner than expected. We were sort of expecting to unlock some new secret technologies instead of the victory screen. We still have yet to do anything with promethean science packs.
I think in order to really do end game stuff I'm going to need to need to focus heavily on quality builds for a new ship. Or retrofit my existing massive ship. The sheer volume of asteroids in the outer system was overwhelming a blue belts ability to transport missiles. The flat front of the ship also had some vulnerability to asteroids clipping the sides.
But in order for the sheer quantity of stuff I'd want for quality builds, I'm gonna need to clear up more of the production on other planets.
Including plastic on Gleba, which is becoming a real limiter in getting enough quality red circuits. @No_one was brave in being the one to start our Gleba builds. But I think I need to make some of my own attempts, because I've seen the Gleba builds clogg up enough, and I have my own ideas about how to build a Gleba mega factory and it's different than his approach.
I think I want to build self contained mini factories. They take in the raw inputs, make their own necessary intermediate products and output final products. The benefit of this approach over sharing around intermediate products is that the intermediates tend to spoil the fastest of everything, and they tend to require the most in terms of bulk, so they fill up belts and then quickly spoil on those belts. The other benefit of this approach is I can just shut the whole mini factory down if there is enough end product on the logistics network. Rather than sending in a constant set of inputs that proceed to spoil and clogg up once the end storage or spoilage handlers are full.
MotteAnon12345
8m ago
Really? I could believe e.g. that some fundamentalist voters (a small minority) believe that the non-viable fetus is still a living creature and therefore deserves protection. I could also believe that Ken Paxton is an attack dog who will go after suffering mothers because it's in his political interest. But the median voter? If you brought a case of a late term miscarriage, would the median voter really insist doctors wait for weeks before offering medical care?
Admittedly, I don't have great evidence for my view. I haven't looked at voter surveys on this question for example (are there any?). I do have some evidence: the Tx legislature clarified the law in HB 3058. But what evidence do you have?
And if the median voter doesn't have such a hardline view, we're back to my original question. Why would the Texas Legislature impose such a blunt guideline instead of a more nuanced one?
iprayiam3
22m ago
No see this is the issue. If conservatives have been ‘pearl clutching’ about sexual morality for this long maybe it’s not performative… and further why are you surprised?
Your entire reaction (if not performative) thus rests on the conclusion that conservatives don’t earnestly find anything wrong with soliciting teenage prostitutes.
If you don’t find anything wrong with it, again- ok. But to assume anyone who does is pearl clutching is an extremely warped worldview
Folamh3
29m ago
A reference to https://youtube.com/watch?v=nCuf_O2xaw8&ab_channel=NT?
NewCharlesInCharge
33m ago
Bloodletting was ahead of its time?
Throwaway05
34m ago
PCPs have sick visits, you establish with a PCP and they'll schedule you urgently if something needs to be managed urgently, if you have an established relationship with a PCP they'll know how reliably you are and will do somethings over the phone. This is how it is supposed to work, Urgent Cares exist because people these days refuse to use the system how its designed (and it's because of incentives, I get it and have committed this crime also) but they aren't really designed for the care people ask of them.
Additionally, physician pay has decreased year after year for longer than the majority of the people in this forum have been alive. This has a number of important effects one of which is: most of the shit that annoys you most about doctors is not their fault, they are required to do it because they aren't in charge anymore (most people in most specialties are employed now and not in independent private practice).
-Can't do something simple over the phone has to be an appointment? It's because that doctor's employer requires it so they can bill.
-Appointment short and unrewarding? It's because that is how the employer wants appointments scheduled.
-Doctor pays mostly attention to the computer? It's because there is no admin time and if he wants to go home before 8pm he's gotta start charting in the room.
-Doctor asks you annoying repetitive questions? Someone has mandated they ask them in order to bill or satisfy regulatory requirements or some other annoying thing. Or some incompetent front desk staff person said you were a smoker or a drinker or are missing your appendix and it requires forms in triplicate to remove from your chart.
Doctors no longer work for themselves and are now required by law and by their employer to do things that annoy the hell out of patients and we hate it but its not our fault please dont blame us thank you.
Gaashk
35m ago
I think this happens anyway. If you need a complex surgery in New Mexico, they will send you to Phoenix or Texas, even if it’s fairly urgent.
2rafa
36m ago
There is no such thing as a private emergency department / A&E in the UK, there are a couple of hospitals like the Princess Grace and St John and Liz that have urgent care (mostly only from 9am to 7pm and not usually on holidays) but it’s only for ‘non life threatening’ stuff and if you rock up and it’s bad they’ll immediately call an ambulance to take you to an NHS A&E.
That said if you need inpatient treatment you can get out on the private wing of an NHS hospital as soon as you’re out of intensive care (if necessary) which is much nicer.
MotteAnon12345
36m ago
Page three of the opinion:
A physician who tells a patient, “Your life is threatened by a complication that has arisen during your pregnancy, and you may die, or there is a serious risk you will suffer substantial physical impairment unless an abortion is performed,” and in the same breath states “but the law won’t allow me to provide an abortion in these circumstances” is simply wrong in that legal assessment.
Similar wording shows up repeatedly.
2rafa
39m ago
That’s fine. Let’s double the number of physicians and surgical specialties, leading hospitals, top medical schools will all still have their own prestige and standards. But there will be enough doctors for everyone.
Folamh3
39m ago
The percentage of people who believe that... Shakespeare is mandatory reading off the top of their heads is also likely in a small minority
On the contrary: more than half of Americans still believe Shakespeare was "one of" the greatest playwrights of all time. That's not exactly the same question as "do you think Shakespeare should be taught in schools?" but I find it hard to imagine that only a small minority of Americans would answer "yes". Open to correction though, if you have a source.
faceh
47m ago
Yep, we discussed that a bit not long ago, so I can't say I'm donating entirely out of altruism.
I don't know if they filter out the microplastics from the blood somehow (probably not) or if they just get passed along to become the next guy's problem.
Throwaway05
50m ago
I mean you are always going to run into study design limitations. In this case most of the money in medicine wants NPs to look good so there isn't good funding for this. The VA (generally) has pretty much the worst healthcare in the country and the quality of care in the ED is also pretty much the worst in the hospital (because of how it gets misused). This is likely to flatten the curve a little bit - good doctors almost never work at the VA.
Psychiatry is a better example - psychiatric interviews and pharmacology are the most complicated in medicine. Mental health care NPs are terrible at both of these things, give people unnecessary medications and incorrect diagnoses and are legible experienced as lower quality by patients and staff with some regularity. In general hospital medicine nurses line up each other and that includes NPs but in most mental health care settings nurses will say they think the NPs are shit.
However the bad outcomes are mostly increased lifetime mortality and risk of side effects 20 years down the line when the patient is seeing someone else. This becomes effectively impossible to study so we don't.
Now you could argue that you don't really care about those problems and if its not obvious their is a skill difference in outcomes lets save money, who cares if people have the wrong medication or diagnosis. But that goes back to the ED stuff - you have a difference in mortality and morbidity, it may be small but most Americans value "the best possible" not "good enough."
Also, since this is why people normally bring it up - if you magically paid all doctors NPs salaries and didn't really change anything else......healthcare costs wouldn't go down at all in any substantive way.
Well conveniently I explained what happened with my primary care physician elsewhere in this thread.
i.e., he's been 99% useless to me compared to the time and money cost, so urgent care is simply the better option.
Ultimately if you say, go to your lawyer and ask for accounting help, they may charge you for it and try and help but they aren't an accountant.
Ackshully, as a practicing lawyer, I can say that that may very well be malpractice, and its for this exact reason I keep a number of trusted accountant and financial advisors in my rolodex to send clients to rather than even risk that issue.
MotteAnon12345
1hr ago
If NATO directly entered the war with large numbers of its own combat forces, it would defeat Russia's military and drive it out of Ukraine.
That was my assumption as well back in 2022. But then the Russia sanctions did nothing, Ukraine made some good advances and then got bogged down, and the West started running out of ammo. That last part is what got me. Because that's how the West won WWII against Germany (& Japan) and then the Cold War against Russia. We outproduced them until they couldn't afford it anymore.
Right now, the situation is reversed. It's Russia that enjoys a comfortable margin in artillery, tanks, and men. The West is giving Ukraine everything that isn't nailed down and it still isn't enough. Maybe the problem is a bloated inefficient military sector? Maybe the problem is political will? Maybe the problem is that we don't care enough about Ukraine? But those are all structural factors that are unlikely to change anytime soon. My current thinking is that the West can't challenge Russia in most of Europe and Russia can't challenge us in America proper. Africa is up for grabs and China will get the rest.
The Ukraine war has proven NATO to be a paper tiger.
anon_
1hr ago
Instead of allowing (as engineers, bankers and lawyers do) a big gradation of physicians, all of whom can call themselves the prestige title doctor but who vary widely in terms of competence, pay and reputation in the profession, doctors have focused on limiting entry, reserving their title for themselves and therefore turning away many decent candidates.
This will lead to the same problem -- just in different terms.
The issue isn't the title -- it's the nature of the jobs. Bringing them all under the umbrella of "physician" just moves the status problem to intra-physician jockeying.
Throwaway05
1hr ago
In order to learn the U.S. standard of care you must learn with a U.S. level of resources and training. Much of Europe can meet that standard but the third world cannot. This is magnified by the fact that the U.S. population is more challenging due to obesity and other factors.
Putting aside that general point, with surgery in specific we are talking about modern surgical modalities - I don't know how many da Vinci's are in the entire continent on Africa but I doubt it's more than a handful.
anon_
1hr ago
But this isn't a lie -- Gaetz really did pay for sex on Venmo & PayPal. There are receipts.
"My opponent is going to lie so therefore the black-letter truth doesn't matter" is a take.
Corvos
1hr ago
And I don’t think ambulances will take you to a private hospital, though I might be wrong.
bonsaii
1hr ago
This may be true for some very common surgeries, but you still need the surgeons on staff to be trained in less common situations/surgeries as well. Otherwise, you have scenarios where you need a surgery but turns out the surgeon on shift has done that particular surgery once in his life and has to wing it.
bonsaii
1hr ago
But who would pay for necessary infrastructure and surgical supplies. Where are the patients going to get the MRI and CT scans necessary for pre-operative planning? The places that already have resources for those things have their own surgeons to train.
My dad's theory of gifts has long been that the best gifts are something you'd want, but would never buy for yourself because you wouldn't spend the money. To this I would add things that the recipient wouldn't think of or know about, though this always has more danger of the recipient not actually liking it. There's a long theory of "buying experiences" but I generally try to avoid it unless I can personally take them there and know their schedule well enough to know they can go with me, I hate the gift card as a concept ever since I worked retail for a couple years and realized how few giftcards are ever actually used.
I broadly agree with both your dad's and your theory. The general issue with personalized gift-giving, is that often you end up muddling into subjects in which the gift-reciever is more knowledgable and idyosincratic than yourself: For example, I have a friend who really likes romantic novels, and I don't know much about them, should I gift her a critically acclaimed one? A silly, but popular one? Am I going to end up gifting something that she has already read?
My own advice, that doesn't overlap with what you've already said, would be:
- Look for things on the edges of the area of overlap of your interests: You might not be able to figure out which are the best rugby jersey to gift your rugby-obsessed cousin, but you might be able to find him a great rugby-related book.
- Rather than "gift experiences", gift consumables: Even if they're willing and able to buy it, a coffee-head will always appreciate a good bag of coffee.
- Contary to the neuroticism of my first paragraph, an obvious gift is often a good gift, most people aren't thinking too deeply about this: A lion plushie for your friend's newborn named Lionel is likely to stand out, the bar for thoughtfulness is that low.
phailyoor
1hr ago
Alot of the better students in my high school went to do nursing because it's easy money and has pathways to move up such as NP. Also anecdotally I've gotten good diagnosis and treatment from NP for stuff I couldn't figure out myself.
In fact doctors are the midwits saddling themselves with debt and a late start all in pursuit of prestige as seen by the PMC for a job that's not as lucrative as it looks.
EdgeCityRed
1hr ago
His family here in Florida have tens of millions of dollars. This grift would seem...unnecessary.
Sounds like a design problem.
Sounds like a design problem.
Sounds like a design problem. I'm not blaming them, definitely not individual doctors.
But doctors are theoretically in the best suited to raise the issue and demand or impart adjustments. Seems like there's a large... incentive problem, who profits from keeping things as they are, and why don't they suffer consequences for failure?
Another Eliezer Yudkowsky tweet that lives rent free in my head on top of the other one is his almost certainly correct argument that completely removing all regulations currently effecting the healthcare industry would create immediate improvements compared to the status quo. (can't find the actual tweet at the moment)
So, hope that Trump takes a chainsaw to the healthcare regs?
He also has interesting ideas on addressing the status quo
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