I’ve mostly found that smart alerts just overreact to everything and result in alarm fatigue but one of the better features EPIC implemented was actually letting clinicians (like nurses and doctors) rate the alerts and comment on why or why not the alert was helpful so we can actually help train the algorithm even for facility-specific policies.

So for instance one thing I rated that actually turned out really well was we were getting suicide watch alerts on pretty much all our patients and told we needed to get a suicide sitter order because their CSSRS scores were high (depression screening “quiz”). I work in inpatient psychiatry. Not only are half my patients suicidal but a) I already know and b) our environment is specifically designed to manage what would be moderate-high suicide risk on other units by making most of the implements restricted or completely unavailable. So I rated that alert poorly every time I saw it (which was every time I opened each patient’s chart for the first time that shift then every 4 hours after; it was infuriating) and specified that that particular warning needed to not show for our specific unit. After the next update I never saw it again!

So AI and other “smart” clinical tools can work, but they need frequent and high quality input from the people actually using them (and the quality is important, most of my coworkers didn’t even know the feature existed, let alone that they would need to coherently comment a reason for their input to be actionable).

No plan survives first contact with the enemy.

Like Enron, LOL.

deleted by creator

deleted by creator

War. Coal mine. Oil rig. None of which should even exist IMO, but that’s a different debate. I’ll respect somebody wanting that lifestyle even if idgi at all but there’s a buuuunch of people out there wanting a partner to do all the trad shit while they do fuckall trad shit. And the modern stuff they’re doing is always all the worst and least fun. They’re exactly the kind of people that would die of a diet-related illness despite never having looked at a spice rack.

I’m glad to hear that but how much alcohol? If you’re maintaining a constant blood alcohol level and get the shakes when you try to quit you should go to the hospital/ER and have them help you withdraw because those shakes can eventually turn into full blown seizures.

Ty! Sometimes it’s nice to give you guys tips because my patients usually just start swearing at me at the suggestion that they may have caused at least some of their own problems.

Yeah Xanax is literally the worst thing possible for this, especially as a frequent thing. It’ll significantly worsen your sleep quality in the long run. (Hi I’m a psych nurse and I meet a lot of people stuck in insomnia hell because they’ve been slapping a Xanax bandaid on it for a few years while it just continued to devolve and now they’re basically psychotic because they never actually fixed the root issue.

I’m also hearing a lot from you about medications and next to nothing about any lifestyle changes. No medication will ever actually fix this kind of problem. Medications just give you a leg up on fixing yourself.

First of all what stimulants do you use, especially caffeine and nicotine? (I would also hope you already know to avoid meth and cocaine and not take stimulant ADHD meds at bedtime.) Are you avoiding them in the last 6 hours before bed? A lot of people (especially with ADHD) will say stimulants calm them down but what they’re actually feeling is a change from their baseline restless anxious awake to a focused, productive awake. The second one feels more settled, and can actually help you fall asleep briefly if the specific problem is difficulty holding still long enough to sleep, but it’s going to completely fuck up your circadian rhythm in the long run.

Speaking of circadian rhythms, are you trying to keep your body in a steady daily routine? This includes a consistent bedtime, but your mealtimes and daily physical activity are part of your circadian rhythms too. There’s a lot of different schools of thought on how to time meals and exercise to best support sleep, but the general consensus is just don’t do either right before bed. I would also recommend adding a structured “wind-down” period to your nightly routine that takes 15-30 minutes where you do one of like three basic things:

• something mind-numbingly boring

• something you’ve always found soothing/comforting

• Journaling about the day to give your brain a head start on the memory processing it’s about to do.

It’s also very helpful to create full sensory environments that you use to trigger pavlovian responses. You know how pavlov’s dog drools when the bell rings because it’s used to food showing up when the bell rings? The biggest difference between you and a dog is that you get to decide what you want to be trained to do. The downside to this is that it can take a while to train these responses into your body, so be patient and don’t just give up after like a week. So you’ll want to create at least two full and distinct sensory environments. The specifics don’t matter as much as creating a consistent routine for yourself, but here’s some examples of things I’ve tried or seen people try:

Alert

• Sight: Curtains open / sunlight / full spectrum white light is the input that aligns most closely with most people’s existing natural rhythm.
• Sound: Music, white noise of people talking in the background.
• Smell: Essential oils are actually really good for training pavlovian responses in yourself because of how powerful scent memory is. A lot of people like to incorporate citrus-y smells for alertness, but personally I actually really enjoy just keeping my used coffee grounds from the morning in a cup on my desk. That also brings us to the next one…
• Taste: Coffee has a pretty distinct taste that most people associate with alertness, and you can get a similar taste from chicory root and/or decaf coffee, but one real cup right after waking up shouldn’t mess you up too bad. Chewing gum is also an option, however.
• Touch: The big one for me doing classes from home during COVID was still getting up and putting on “outside clothes” even if I was just sitting at the computer at home.

Rest

• Sight: usually red-yellow spectrum light, and much lower brightness around bedtime. You can turn on a red-shift filter for most electronic devices these days, and LED bulbs also often come in a yellow-orange incandescent style color (and a lot of hobby/makeup lights have multiple color settings for this reason as well, white for when you’re working, orange/yellow for resting/relaxing.
• Sound: some people listen to soothing music, I conditioned myself to fall asleep to the sound of a raging thunderstorm because I sleep during the day and work at night, and the thunderstorm sounds easily block out daytime noises.
• Smell: Lots of options here too for essential oils or other scented products. You could also use a specific lotion or wash your sheets in a specific scented detergent. A lot of people say they find lavender scents to be particularly soothing, but again, the exact sensory trigger isn’t important as much as you picking one to use consistently.
• Taste: Herbal tea is my biggest recommendation here, but you could also go with a small snack/sweet as part of your nightly routine.
• Touch: We already covered wearing different clothes, but some additional options include a weighted blanket or one of those compression sleep pods (I just got one to try out recently and like it so far!)

Anyway like I said, these can take a while to train your body to do, so pick things that will be easy for you to do, set up your space to make it as easy as possible to keep doing them, and keep at it. The most important thing is consistency and routine.

lmk when AI can wipe your grandmas ass because right now they barely trust the robots to save my CNA’s back by just doing the lifting part. If an AI can actually do your job properly I can almost guarantee it wasn’t a real job to begin with. And yes, that includes artists; if an AI can match the quality of your art, you had problems way before all of this.

I would start by observing the places around you that serve food. Stop by 30 minutes to an hour before close and see when and where they typically throw things out and what condition the food is still in.

It is an excellent show of how giving away a huge amount of it has no functional effect on their life and literally just lowers their high score.

deleted by creator

Could you imagine if someone made a search engine that just filtered mainstream shows by tvtropes tags? AND does the dog die’s content warning database???

Maybe try some fanfiction though. There’s a LOT of fanfiction written to create an ending for a series that never got one. The media will be different (although fanART is a thing too). Even if you’re worried about writing quality (hey, we were all 12 year old aspiring writers at one point) you can find some absolutely gripping stories. Force Over Distance completely fixed Stargate Universe for me. It was also super gay and had a bunch of University level math that may have been complete horseshit for all my dumb ass would know, but other than that was almost disturbingly faithful to the source material.

Those were kinda upsides for me personally but the cool thing about fanfiction is that you do whatever you want over there we’re all just gonna mind our business in-LOL no there’s bitch fights over on tumblr every other fucking hour over shit that’s either completely dumb or wildly terrifying and most of those fights are about which popular media characters are legally/physically able to and/or should hold hands.

Anyway I’m extremely picky (even with smut), but sorting by kudos and only reading the first two or three for a smaller Fandom (more for a bigger one obvs) has never done me dirty when I want a particularly engaging read. This isn’t to dig on other styles or skill levels of writing; there’s many different reasons and ways to write, and many ways that people get better at writing over time. But also I get that feeling of just wanting to smash your way through a 20 book series. The dopamine high is exquisite.

I suspect they do but don’t know for sure. The reasons I would think they do are because they use a lot of other linguistic concepts almost eerily similarly to the point that when you account for the sensory difference there’s not many differences left. I’ve also seen some fascinating clinical examples (some of them actually from discussing the patients’ speech sign? qualities with the interpreter since that’s part of my assessment).

One of the coolest things I ever saw was a patient who signed ASL as a first language and couldn’t write well. So where a hearing person might sound a word out even just silently feeling your lips move, they were fingerspelling off to the side to “feel out” how the words were spelled! It might seem really dumb of me but it really blew my mind to think about at the time.

I forget where I read about this one, but deaf schizophrenics tend to visually hallucinate disembodied signing hands or moving lips, instead of hallucinating auditory voices.

In another case I saw the patient had a lot of weird, wide jerky arm movements that could be really alarming to an unexpecting passerby. We knew the patient was deaf and signed, but we also weren’t certain it was ASL (long story). The interpreter then told us that whether or not the patient was typically able to speak ASL, they were not doing so at that time. I don’t recall if or how they would have checked for any of the other sign languages). But it turned out when they cleared up that they did in fact speak ASL, which means that was sign-salad! Word-salad is a classic symptom of psychosis and is exactly what it sounds like- seemingly random words and syllables just all mashed in together. AND IT HAPPENS IN SIGN LANGUAGE TOO BECAUSE IT’S ALSO A LANGUAGE AND THAT’S FASCINATING!

Also I suspect it would either manifest as shakiness in the hands or something else entirely that isn’t intuitive from a hearing perspective. For instance I found out that to show double letters in fingerspelling you slide, you don’t bounce. I wouldn’t have thought of it that way but it makes sense now that I know I guess.

Anyway I really should go to sleep I work tonight!

The library of congress no doubt envies Archive of Our Own’s tag system. Say what you will about fanfiction but they have filters for literally all of this and more. I know it’s probably not what you’re looking for, but man if it was!

Stop explaining shit. Show them a fucking picture. They’re artists more than engineers, they’re visual/spatial people. Find a picture online of what you want. Once you’ve gotten a really good, absolutely chefs’ kiss prefect cut, take a picture each of all four sides and the top, then start showing barbers those instead.

Source: am psych RN and have lots of experience with ppl who are actually abusing drugs.

Yeah you’re thinking about this waaaaaaaay too hard. PDMP is basically just a record that’s open to interpretation. One script from one doctor for 10 of an opiate looks fine and makes sense, especially if you also report the medical history of having had a surgery that year.

What they’re looking for for signs of abuse is things like:

• lots of different doctors (shopping around)
• one doctor but in obscene quantities or doses (pill mill, also the patient will need to be tapered, depending on the drug cold turkey could kill them).
• a drug that is different than the one they found on testing, so for instance you have a script for Adderall but there’s no Adderall in your pee but there is oxy. That means you probably sold it or traded it for the oxy.

TLDR; Ten pills once is chump change.

Oh yeah the decision of whether to practically strip naked in the Walmart bathroom is a hard one, especially considering the higher likelihood that someone is attempting to covertly film me. You can also attempt to shift one side of the crotch to the side enough, but then you’re risking getting piss all over your clothes if you don’t do it well enough.

deleted by creator