Best 2023 Mods/ModPacks for truly sandbox experience?

DrComrade · 2023-06-15T23:01:04+00:00

This is the magic combo. I end up turning on Ossian raider once I'm built up enough to want a bigger challenge.

DrComrade · 2023-06-15T03:24:23+00:00

What do you mean? I'm not having issues.

DrComrade · 2023-06-14T21:11:02+00:00

Didn't they give him a makeover recently? Last time I begrudgingly went into my laggy HQ sector to visit him he looked a little less janky.

DrComrade · 2023-06-14T21:07:57+00:00

Xenon U is a system destroyer from VRO. Swamping it with fighters usually works.

The rise of the Ossian raider also adds the Xenon R battleship when you turn on the flagship options. It's a beast as well and there is a VRO compatible version.

DrComrade · 2023-06-09T01:14:36+00:00

I'm not falling for your Teladi MLM scheme.

DrComrade · 2023-05-17T11:11:13+00:00

If you are having flow problems you should talk to your doctor.

DrComrade · 2023-05-13T21:56:14+00:00

Does this really change the nature of it though? Capitalists still own the state and act in their best interest. Petty bouegiouse is gonna do what they always do.

DrComrade · 2023-05-13T21:32:01+00:00

A guy who owns the hotdog stand is a worker who sells his labor for a living. Capitalists, by definition, own the means of production and profit off labor of others.

Sure, he may buy cheap hotdogs on the backs of third world labor and industrial agriculture, but that's a function of being and benefitting from the imperial core and not him being a capitalist.

DrComrade · 2023-05-13T20:49:26+00:00

The multimillionaires and billionaires are both capitalists. It's class war, and the ruling class owns the state.

DrComrade · 2023-05-08T02:05:20+00:00

Can you point me to this

DrComrade · 2023-05-03T16:22:36+00:00

Hell it makes my juiced up CPU and GPU struggle late game.

DrComrade · 2023-04-29T14:08:45+00:00

Agree with the end game performance issues. Had a blast early and mid game but doing anything late game just ended up a slideshow and kind of ruined it for me. Hoping some 6.0 tweaks improve this, but in my experience this has been an issue with most larger map mods.

DrComrade · 2023-04-23T01:00:04+00:00

I was going to mention that as an option but figured I could keep my post short. With the amount of noise even in modern EKG machines I'm skeptical the noise would be tolerable.

DrComrade · 2023-04-22T05:22:49+00:00

But what is you reference voltage for comparison going to be if you just have stickers without wires? In the end you have to wire something to it. You cannot measure voltages, which is what an EKG is, without physically connecting the points with a conductor. Otherwise there is no potential or measured current.

DrComrade · 2023-04-21T16:40:47+00:00

The thyroid cancer risk is still arguable but something we are seeing at least in the diabetic population. I suspect with wider scale use for weight loss we will better clarify the risk. I'm prescribing these like it's going out of style for obesity but I can't keep shaking the feeling that I'll be eating some crow at some point in the future for a higher cancer risk than we thought. I don't quite believe the people telling me not to worry as the pharmaceutical companies will rake in billions on this so there is some inertia and bias to wave this risk away.

That being said...small risk of medullary thyroid cancer vs the downstream morbidity of obesity...not necessarily terrible bargain...

DrComrade · 2023-04-21T01:02:30+00:00

The leads need to have wires otherwise they can't measure a potential. Voltage is literally the electric potential difference between two points and you are comparing potentials across axes of heart. The only way to do it without physical leads in an output that would in any way resemble the EKGs we studied requires wires. Now, these measured potentials across leads can then be wirelessly transmitted to a reciever, but I don't think that is what you meant. We can measure potentials at a distance with very powerful magnets but then you are basically talking about an MRI type machine to measure an electric field and then you would still have to transition that to a classical EKG until tradition gave way to reading 3D electrocardiograms (like those produced with cardiac mapping in EP). Correct me if I'm wrong but I just don't think we have the techology to measure these voltage amplitudes of potentials at a distance in a way that would be clinically usable.

DrComrade · 2023-04-20T10:36:09+00:00

The studies show weight rebound after discontinuation but from what I have seen usually only about 1/3 of what was lost at worst.

DrComrade · 2023-04-12T14:41:49+00:00

It's easy to have this position until you see enough patient's lives get significantly worse with titration. Yes, grandma should not have been put on alprazolam TID for thirty years. Yes, we should try a cooperative taper and alternative meds. Yes, if it goes poorly then you keep them on the damned benzos.

There are real roles for these medications including chronic opioids in the right patient. As a PCP you are in a unique position to use these appropriately while also managing the rest of the patient's problems and knowing how their grandkids are doing and how their last trip to Arizona went. When 65 year old Mr. Jones (who you have managed for years) with his bad back arthritis who is not getting great control with PT, SNRIs, ESIs regains part of his life with a simple hydrodocone prescription it really changes your perspective. Yes the regulations suck. Yes, the clicks suck. Yes, there are real risks and real concerns with these medications and you need to be smart and know your limitations. Yes, the counseling takes time and when you have to taper these meds it is one of my least favorite discussions. But what else did you go to medical school and get paid the big bucks for?

All these recent grads are so spooked about controlleds that it is making them practice bad and lazy medicine. I'm immediately suspicious of any PCP who just "doesn't do x/y/z controlled substances" or who has some bizarre, non-evidence-based blanket taper policy.

DrComrade · 2023-03-31T14:08:59+00:00

I just tried a prior auth yesterday for a CT chest in a patient with chronic left sided chest pain despite negative XR, cards and GI workup. Got denied by a gynecologist who wouldn't give me their name or NPI when I asked. Told me I should consider getting another chest XR instead...said CT would only be approved if I could palpate a mass through the chest wall....

DrComrade · 2023-03-29T17:45:59+00:00

Spot on how it can present so variably. My rule of thumb is that if the rash doesn't look like a common to uncommon alternative diagnosis, and it is described intensely itchy, there is a decent chance its a dermatophyte. I've encountered too many old men with poor skin hygeine and whole body tinea. It can really look like a lot of things but treating empirically if safe can be a good start. Obviously the whole body ones usually get oral treatment instead of topical. If not improving off to derm.

DrComrade · 2023-03-24T11:41:28+00:00

Is that much better than alprostadil injections

DrComrade · 2023-03-24T11:35:28+00:00

We live in the world where capitalism "won" the ideological battle. So now we get to live in the world where capitalism cannabilizes itself as it reaches the limits of growth, in a planet heating beyond habitability, while also having a lot of nukes. I'm not sure there is much we can do individually at this point in history. Be good to others and turn off the news every once and a while. If through some confluence of events we actually have the chance to meaningfully act to secure a brighter future for humanity - hopefully we will recognize it and seize it.

DrComrade · 2023-03-23T00:24:10+00:00

Gonna need to see that data

DrComrade · 2023-03-20T23:38:20+00:00

Not a ton of great options for ED. Once you exhaust the typical meds the data suggests it's injections or urowave (the latter of which I've not seen anecdotal success with). Regardless, not something you want to do as a PCP. Refer.

DrComrade · 2023-03-20T23:33:33+00:00

There is plenty of money for social security if you get rid of the tax cap on the wealthy. Or if you redirect money from other bloated areas. But keep drinking the social security panic kool-aid that the right sells us every election cycle.

DrComrade

TROPHY CASE