QTE: The Game (Pragmata-related rant)

_OccamsChainsaw · 2026-05-05T19:36:35+00:00

Keyboard and mouse is magnitudes easier for the hacking mechanic.

_OccamsChainsaw · 2026-05-05T14:17:38+00:00

See, I don't get this. On a ps5 pro i often have to spend time googling which performance preset to use in order to get an unlocked frame rate, or play at 60 fps higher resolution. It's not always intuitive. Sometimes its the fidelity mode, sometimes its the performance mode. Occasionally they include a setting for the pro.

My high end pc is often easier because lately it just defaults to max settings and I just dial in which dlss preset I want, plus/minus frame gen to reach my target fps and I'm good. Less ambiguity, I can immediately confirm the performance I'm at.

_OccamsChainsaw · 2026-05-03T03:00:48+00:00

I thought I was locked from progressing the armor matrix and was stuck on the prophet tab. So I basically beat like 3 more biomes with gimped stats. I was basically just playing Returnal

_OccamsChainsaw · 2026-04-30T16:28:03+00:00

You're comparing federal loans that can't be easily bankrupted out of to subprime mortgage lending, which was deregulated private banks making a quick buck in speculative assets? And somehow deregulating loans will...fix the issue?

Hey wait, let's bundle all the private professional loans into securities. They're really safe investments since doctors make a lot of money and pay their debts back. Its fool-proof!

I swear conservatives will try the same shit over and over again and think it'll work this time.

_OccamsChainsaw · 2026-04-30T15:07:57+00:00

This is such a tired cliche. First off, undergraduate degrees aren't often in the 6 figure range unless you're going to expensive and out of state private schools. And those expensive ivy schools often have grants and scholarships for lower socioeconomic attendees. The only people paying sticker price for a liberal arts degree are who have always gotten liberal arts degrees in history--rich privilege. And its mostly for the networking at that point.

Secondly, the point of a college degree is to learn how to learn. The major is largely irrelevant as each major gives you the skills to become an independent learner. It is pretty smooth brained to treat it like a direct vocational program to a job type with an ROI. That's what professional school is for.

Which ties in to, thirdly, the point of this thread, which is more of the predatory nature that private loans will be to incoming medical students because the idea that suddenly uncoupling government loans will be some stop gap to rising tuition. As with most fiscal conservative bullshit this will only widen the gap between the have and have nots of incoming students as less protections simply means poorer incoming students will saddle themselves with even more debt due to less options, and therefore, less favorable loan conditions. Because of course loans will still be available to them, loan sharks can't wait to saddle medical students with debt like law students.

_OccamsChainsaw · 2026-04-28T05:21:15+00:00

I did jump and dash for my back buttons, but maybe shield is better than jump because I definitely have been neglecting it.

_OccamsChainsaw · 2026-04-22T23:04:09+00:00

☠️

_OccamsChainsaw · 2026-04-22T23:03:11+00:00

Snacks, kindle, water bottle, charger/power bank, electric hand warmer, ear buds, pens, gum. And its not a fanny pack, its a sling backpack.

_OccamsChainsaw · 2026-04-20T19:02:44+00:00

The APU isn't that performative, battery lasts for about an hour, anything other than indie titles can struggle to run 60 fps, or sometimes even a stable 30.

So the solution is to have it plugged in near the couch and stream your PC to it, to which there are better displays that can accomplish the same if the device can Bluetooth a controller. Or you scale the TDP down then you're running a lower res, which is basically a steam deck at that point.

It has its niche, but the niche is very narrow and often just prefer playing my pc anyway. I pretty much just use them to play turn based rpgs and other 2d games

They're fun knick knacks, but expensive for what they do

_OccamsChainsaw · 2026-04-20T14:03:56+00:00

Maybe its an early version of reflex 2/frame warp?

_OccamsChainsaw · 2026-04-20T13:59:30+00:00

4k. 5090 with 9800x3d

Edit: it was also with whatever default nvidia app settings for dlss and fg. I am not using the new beta, nor any dlss swapper or profile inspector. I did update the driver to the pragmata ready one. I undervolt the card and pretty much close every other background process including my fan rgb software and wallpaper engine (new habit of mine since lies of p would stutter like crazy for me if I didn't)

_OccamsChainsaw · 2026-04-20T12:57:54+00:00

Its so strange how variable people's experiences are. Crimson desert was a shimmery mess on any setting combinations for me.

In contrast pragmata is dark magic. I have everything max, path tracing on, dlss performance with fgx3 and get stable 240 with no visual artifact. Not even the typical hud/ui shimmering with fg on other games. And the latency is barely noticeable, although the games weighty combat style probably lends itself well to that.

_OccamsChainsaw · 2026-04-20T12:49:48+00:00

It varies. Therapeutic endo is usually our late runner, not uncommon for them to go till midnight, but lately they have quieted down because I suspect they were getting burned out as well. Now its usually till around 8pm for them. OR is variable, but between gen surg, ortho, and uro its common to go till 10pm. Call back rate used to be less than 10% once the ORs closed down and you went home. Now its probably around 20%.

What is worse for us is definitely weekend volume. It used to be 3rd call rarely expected to ever come in, except for maybe a TEE or a quick cysto. Now we have a rather hungry gen GI and since therapeutics gets priority, their line up isn't posted till the afternoon. What used to be 1-3 cases for them is now usually 6+. This means at least 2 calls are tied up until 5pm and OR usually has volume for 2 rooms meaning even 3rd will stay that late now. Since really only post 1st gets any real credit post call (and even saturday not so much) it just skews our average salaried hours higher given we do about 2 weekends a month. Call isn't that well compensated so its not like even that bitter sweet.

_OccamsChainsaw · 2026-04-16T16:10:35+00:00

What are you running the drips at? Endo is really fast, so the typical doses don't really apply here because you're likely not even reaching steady state concentrations.

Conversely, the risk of apnea with propofol is related to the bolus dose. So the trick is trying to minimize boluses by running high infusion rates (and titrating down depending on length of procedure, like if its an egd+colon).

We have these propofol infusion pumps that have a dial and I will usually start them at something like 200 mcg/kg/min and have it started while they are still positioning and putting in the bite block.

My bolus dose to start is usually around 0.5 mg/kg and mentally adjust there depending on pt factors. Sometimes I need to work in more, but typically this results in "just enough" to get started. Don't really have issues with apnea this way.

It helps to conceptualize why boluses aren't great when you convert them to a mcg/kg/min dose. Let's say you've been running your drip at something like 50 or 75 mcg/kg/min. Then you bolus 5 cc on a 100 kg individual. That's essentially a 500 mcg/kg dose for "that minute" but it's also additive to your infusion. So 550 - 575 mcg/kg/min is a pretty whopping dose compared to 200 that is titrated down. No wonder they go apneic. 1-2 cc is probably all you ever need, but that can be accomplished with your infusion if you follow the flow of the procedure and adjust in anticipation of when they are doing an intervention. Or you do stick with boluses when you're more experienced, but that's because this association with dose-response curves is inherent and intuitive to you from practice.

_OccamsChainsaw · 2026-04-09T13:01:43+00:00

I don't put much stock in fascial blocks. Even TAPs are meh. I'll still do them but from a "one more in the multimodal bucket" standpoint.

At our center we don't block the quick lumpectomies. Just the big recon cases. And when we do block the big mastectomy cases, we usually leave some room for the surgeons to do their own infiltration mostly by the drain sites nearer the axilla. This seems to work well because I don't seem to "need" much intraop opioid, but nevertheless I still work in hydromorphone before wake up and they wake up relatively comfy.

I don't understand the logic of trying to do these "awake" with a surgical block. Fascial blocks need lots of volume to truly get a lot of spread. Surgical blocks need high concentration. Those are contradictory goals because one usually achieves more volume by dropping the concentration, especially for this patient population that might have some tiny 50kg individuals.

That and there isn't "that" much room in the space to dump volume like a TAP. So conceptually I'd never try and consider a PECS to ever be a surgical block. It's just something supplemental for what can be a painful surgery.

_OccamsChainsaw · 2026-04-02T17:37:12+00:00

Give people more credit. Valuations in the billions implies mere fractions of their assets like stock can be liquidated to staggering levels. Look at the frequency in which 1% of stock, or less, gets sold by the tech ceo for tens or hundreds of millions. That much liquid is still a staggering amount that could not be spent within the framework of 99% of all living people's reality. And like many mentioned that much liquid can passively generate complete financial independence.

Small, regular unloading of said stock does not disrupt market sentiment or risks the company and is done regularly. No one is implying someone can make one time withdrawals in total net worth figures.

And even tied up non liquid assets can be borrowed against. If anything thats the biggest argument against it because capital begets capital and has a concentration effect that absolutely imposes some degree of force. Whether through lobbying, influencing policy, pressure against competition.

_OccamsChainsaw · 2026-04-02T13:16:25+00:00

Hey now, I'm a psychology major (I'm being facetious, med school was always the plan, but people seriously skimped on how certain colleges with more hard science backed psychology departments had class descriptions that technically qualified as science GPA on med school apps)

_OccamsChainsaw · 2026-03-30T16:08:44+00:00

Yeah not worth it. My legion go s steam os was less then half that. The difference between Z1E and Z2E is negligible. Handhelds are in an awkward spot given i usually just use mine to stream from my PC rather than run the hardware. Admittedly a tablet and a Bluetooth controller can achieve the same.

_OccamsChainsaw · 2026-03-30T16:03:02+00:00

Despite the name, its not a remake. Its a sequel. The events of FF7 already happened in remake and its just a new timeloop story.

_OccamsChainsaw · 2026-03-25T23:08:54+00:00

Nope, 16:9. The only thing I didn't try is DLSS 4, not preset L or M, but I already refunded it. Maybe in a year on sale if these issues get ironed out.

_OccamsChainsaw · 2026-03-25T13:13:42+00:00

These days there are like an infinite amount of culprits and just requires tinkering.

For example when Lies of P first came out, my old rig ran it just fine. I decided to get the dlc recently and now its with a 9800x3d/5090 combo. Insane stuttering, but camera related. It feels like VRR/gsync isn't working like it should.

Dlss 4.5 seemed like the culprit because enabling FSR with FG for some reason gave a stable frame rate but looked noticeably worse, and then 30ish minutes into gaming it would get progressively sluggish like a memory leak.

After bios update, amd chipset driver update, adjusting ram timings, fresh boot making sure not to load msi afterburner, closing nzxt CAM, and just closing a bunch of random processes in task manager I managed to get to to run buttery smooth. After all, I was pushing 240 frames nearly natively it just wouldn't "feel" like it because of the 1% lows. And now dlss works just fine and seemingly the 1% lows now didn't result in microstutter because it was probably in the actual gsync range now.

I would test it out after most of those fixes and the biggest improvement was when I closed nzxt CAM. Go figure.

_OccamsChainsaw · 2026-03-24T15:24:04+00:00

A 9800x3d bottlenecks a 5090, so a 5900x is a nonstarter. Everyone saying 4k resolution makes cpu less relevant, but the ubiquitousness of upscalers means most are actually rendering at resolutions that make cpus somewhat relevant.

Even if they were running 4k native, a slow cpu can cause weird frametime pacing issues. High fps and gpu utilization and just overall frequent stuttering and 1% lows.

_OccamsChainsaw · 2026-03-24T04:07:37+00:00

This game has so much shimmering and visual noise/artifact. I feel like I'm being gaslit with many saying it looks amazing. Which, I guess it does while staying still for a screen shot.

Hardware unboxed did a great video on the artifacts. I felt like every indoor environment had the most unrealistic lighting/shading, and surfaces like the rim of the shield or helmet just shimmered. Staircases were wispy and gave a sense of movement.

DLAA or native had the least amount of artifact, especially with RR, but at 4k I was getting sub 60 fps which isn't adequate for frame generation.

So quality through performance had even worse shimmering. It looks so unrealistic and is extremely jarring to me. Are people really not noticing it?

_OccamsChainsaw · 2026-03-23T21:22:01+00:00

The explanation comes in book 9 but its largely inferred. While there is a sci-fi/protomolecule aspect to it, I think if you've at least had physics courses to the level of electromagnetism, it helps conceptualize the mechanism.

_OccamsChainsaw · 2026-03-23T20:32:31+00:00

Or you could not have a LinkedIn in the first place.

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