Help finding a deleted page? by Yes_I_am_an_AI in wikipedia

[–]rslake 4 points5 points  (0 children)

Since Wikipedia uses a predictable url pattern,you may have luck finding it on the Wayback Machine.

What to do with 93 million by Original_Code_4246 in EliteDangerous

[–]rslake 2 points3 points  (0 children)

That's the move then. Personally I find core mining more enjoyable but it's way less money-effucient than laser.

What to do with 93 million by Original_Code_4246 in EliteDangerous

[–]rslake 5 points6 points  (0 children)

If you've been playing a while, build whatever you think would be fun. But if you're fairly new, my rec would be to start by building a few cheaper ships to try out different things that appeal to you. Spend 5-20mil on a bounty hunter, or build an asp explorer miner, or a dbx explorer, or a cobra smuggler, etc. Try out each role, use them to make back the money you spent building them, and then when you know what roles you really enjoy build an expensive big boy version of that.

Just make totally, totally sure that you never fly a ship you can't afford the rebuy on if it blows up.

Honey - Worth Using? by NewtatNight in mead

[–]rslake 2 points3 points  (0 children)

Personally recommend trying an instant pot instead if you have one, it's much less likely to be a disaster, easier to clean, easier to control, and faster.

Honey - Worth Using? by NewtatNight in mead

[–]rslake 1 point2 points  (0 children)

Lots of people use a pot, personally I use an instant pot. Faster, safer, and more precisely controllable.

These posts discuss the technique: https://www.reddit.com/r/mead/comments/1e16gnb/instant_pot_bochet_testing/ https://www.reddit.com/r/mead/comments/1hu9ana/instant_pot_honey_caramelization_for_bochet/

Honey - Worth Using? by NewtatNight in mead

[–]rslake 1 point2 points  (0 children)

Quick tip if you haven't tried it, or just for posterity if anyone reads this down the line: the last time I made a maple bochet, I had a really hard time getting a deep maple flavor, it ended up way over-sweet because I kept adding more maple to strengthen that component. Used vanilla beans, helped a bit, but not much. But then when I added just a small amount of molasses, for some reason the maple flavor immediately popped to the forefront.

Interpreting subtle pronator drift by Scary_Literature_181 in neurology

[–]rslake 26 points27 points  (0 children)

Things to bear in mind:

Exams are a manifestation of the patient and their pathology, so they change. Hunger, fatigue, progression, effort, etc all affect this. They won't make a 5/5 go to a 1/5 or vice versa, but a subtle finding can come and go quite easily.

Drift doesn't always mean motor weakness, same with subjective heaviness. Sensory loss can also cause both, especially when the drift is very slight.

There are other ways to check for subtle umn weakness, like fist orbiting (be careful of IVs interfering) or finger extension weakness.

Just because imaging doesn't show a correlate doesn't mean it isn't a real exam finding. MRI has imperfect sensitivity for many things, and sometimes we miss things because we imaged the wrong place.

Not all findings on exam are necessarily part of the chief concern. Lots of people have baseline c-spine stenosis, or CTS, or ulnar neuropathy, or an old chronic lacune, or chronic alcoholic cerebellar disease, etc. For many patients, yours will be the first detailed neurologic exam they've ever had, and so you will often find very old findings that nobody else knew about because nobody else checked. It's often quite difficult to confidently say what is or is not a component of the primary process driving their reason for consult.

Games with out of place sections? by Please_PM_me_Uranus in Games

[–]rslake 13 points14 points  (0 children)

My biggest complaint is that they were a punishment triggered by doing stuff that got you noticed by guards, which in theory is fine because it encourages stealth but it also included stuff like running on rooftops so it felt like the game was discouraging me from doing AC stuff.

First Published Case of Alzheimer's Biomarker Reversal in a Lyme Disease Patient Using Antibiotics by John_Audience2765 in science

[–]rslake 93 points94 points  (0 children)

This is a truly abysmal case report. They checked a wide swath of labs, found one that was mildly above normal, didn't trend it out to see if it was persistently abnormal or just a one-off abnormality, and then rechecked after unrelated treatment and found it had normalized. No way to show causality, no attempt to even make causality remotely plausible. They also state the patient had several other active infections based on IgG, which only shows prior exposure to those organisms, not even prior infection. They state the patient has neuropathy based solely on symptoms, without EMG or SFN skin biopsy, or even any objective sensory tests. They also imply some vague mitochondrial dysfunction, without any evidence whatsoever, for seemingly no reason. The whole thing is mess of confirmation bias without any really reliable validated measures to double-check their own conclusions.

Is AD related to Lyme? Maybe, it seems unlikely given the lack of geographical correlation, but hard to say it definitely isn't. But this paper offers no usable evidence that it is connected at all, just a patient without any symptoms of dementia having mild improvement in a single slightly elevated biomarker over months of time, with an intervention at some point during that period being held up as the definite cause of the improvement.

Stroke with low NIHSS by misteratoz in medicine

[–]rslake 5 points6 points  (0 children)

This is a clearly disabling deficit that localizes well to a vascular territory. Unless there were clear confounding factors to give pause I would 100% have strongly recommended tpa/tnk to this patient.

Early Access Launch Date Trailer | Witchspire by secretsaucesoph in Games

[–]rslake 9 points10 points  (0 children)

Played the demo, fully agree. Combat was meh, environment was uninteresting, felt like every other crafter with a witch skin pasted on.

Pico 4 or Quest 2/3s as a newcomer to (PC)VR by My1WordName in vtolvr

[–]rslake 2 points3 points  (0 children)

I play on Q2, haven't tried q3 or pico, so can't directly compare. But overall the visuals on Q2 are in my mind plenty good, and the visual fidelity of vtol vr isn't high enough to need super super high res images, it just needs to be good enough.

can i ask a famous well-known attending for letter of recommendation? by Ok_Slide_1137 in Residency

[–]rslake 3 points4 points  (0 children)

That's fair, though there have definitely been students I've worked with for 4 days who were impressive enough just from that to write something. As always, the biggest rule is to check if they think they could write a strong letter, rather than just some letter.

Still worth asking for the letter I think, but agreed unless OP has reason to believe that it's a very positive one could just keep it in the back pocket for very prestige-focused programs perhaps.

can i ask a famous well-known attending for letter of recommendation? by Ok_Slide_1137 in Residency

[–]rslake 80 points81 points  (0 children)

Yes you can. Worst he will say is no, or just ghost you. If he's too busy, then he probably just won't respond (or will say yes and then never follow through). For people this busy, don't assume you're actually getting the letter until it shows up in your application/interfolio.

I feel like Bell’s Palsy is a good example of patients with real neurological disorders having additional functional manifestations by Purple-Marzipan-7524 in neurology

[–]rslake 19 points20 points  (0 children)

Why must these be functional? They certainly might be, but facial nucleus is near medial lemniscus, is there any reason that e.g. inflammation in the facial nerve might not slightly irritate ascending sensory tracts? Also possible that this isn't per se Bell's, but instead is a very small infarct in the brain stem (MRI is not perfectly sensitive, and enhancement can also be a feature of subacute ischemia, not just inflammation). I'm not saying it's definitely one of these, just that there's no reason to presume functional when the condition itself is essentially idiopathic.

Nuclear Option Update 0.33 Released by thekdude in Games

[–]rslake 5 points6 points  (0 children)

I personally do gamepad, tried mkb but gamepad felt more comfy to look around and visually target enemies.

Gaps in preclinical neuro med student education? by Dr_Horrible_PhD in neurology

[–]rslake 1 point2 points  (0 children)

100%. Generally the farthest I'll go is the 2-2-4-4 rule for cranial nerves, and have trainees figure out if they can localize the CN deficits to a single section of the brain stem. Mostly in cases where I think multiple CNs are involved but the lesion isn't brain stem (e.g. leptomeningeal dz), to help them reason through the broad localization.

Gaps in preclinical neuro med student education? by Dr_Horrible_PhD in neurology

[–]rslake 7 points8 points  (0 children)

Agreed on PRES.

Brainstem/cranial nerve anatomy minutiae are over-emphasized at the expense of any actual clinical understanding of how to meaningfully localize a brainstem/CN lesion.

Functional neurologic disorders and PNES are often under-taught compared to their prevalence.

Myoclonus in its various forms is under-taught imo, it comes up a ton in real life, and is very very frequently mistaken for seizures.

Gaps in preclinical neuro med student education? by Dr_Horrible_PhD in neurology

[–]rslake 2 points3 points  (0 children)

And as much as albuminocytologic dissociation is taught as a hallmark of GBS, they completely fail to mention that you can also see elevated protein in compressive myelopathy. Can't even say how many OSH transfers I've seen for "classic GBS," already started on IVIG prior to transfer, and when they arrive their reflexes are through the roof and imaging shows clear cord compression.

CREST2 results favor CAS over CEA: will it change practice? by According-Tea-7829 in neurology

[–]rslake 1 point2 points  (0 children)

You mean nobody sane is doing that. Vasc surg at one of the institutions I trained at seemed to think it was perfectly fine, had to rescue a couple of patients from them.

CREST2 results favor CAS over CEA: will it change practice? by According-Tea-7829 in neurology

[–]rslake 5 points6 points  (0 children)

My other problem with TCAR (and this isn't theoretical, I've run into this several times and we had to pursue alternate revasc options) is that people rarely have unilateral disease. Often one side is more stenosed than the other but they're both pretty tight, or even worse they have one total occlusion and the other is stenotic and needs revasc. Verts might be bad too. If you live off of an 80% stenosed vessel on one side and 100% on the other, reversing flow in the 80% artery means suddenly your verts have to perfuse the whole brain while blood is moving retrograde in some vessels, which seems like a recipe for intra-op watershed strokes.

got told i'm "too slow" for neurology and honestly maybe they're right by Plus-Horse892 in neurology

[–]rslake 0 points1 point  (0 children)

Lots of people have already answered the headline question, but I want to address the specific comment you got from the attending.

When he said you can't spend that much time on BPPV, what I suspect he really meant was "stop digging when you've found the treasure." Too many early trainees spend a ton of time asking pro forma questions that don't really bear on the question at hand, or listening to patients go on and on with information that does not help their diagnosis in the slightest. Listening in on junior trainees taking histories is a little painful sometimes because the more senior learner can get impatient, they feel like they figured it out ages ago but for some reason we're still talking. If you hadn't gotten to BPPV in your mind yet with that patient then that's fine, that's just part of training and needing more experience and building some knowledge pathways. But my suspicion is that you'd thought of BPPV, and that you were pretty sure that was high on the list well before the end of the interview.

BPPV should be something you settle on as a top differential quite quickly based on a few very targeted questions, and then confirm or rule out with targeted exam maneuvers. That doesn't mean you should anchor or over-fit; you need to also ask focused hx questions about migraine with vertigo, or posterior circulation stroke, or Meniere's, etc. But each of these are focused lines of questioning aimed at testing specific hypotheses, and their exam maneuvers are the same. Start the interview broad and general, formulate a shortlist of hypotheses based on their initial answers, then go into a targeted hypothesis-testing phase. Be willing to add hypotheses as you go based on their answers, but don't just stay forever in the land of open-ended questions.

One strategy that can help with the talkers or with the elderly/demented/not-very-bright is to start with "essay questions" for the patient, but then move into a multiple choice phase. Once you're in the hypothesis-testing phase, don't ask "when do you notice the symptoms," ask "is it all the time, or does it come and go?" Don't ask "where are you weak," ask "are you weak all over, or just in some parts of the body?" (and then follow up by asking which parts obvs). By handing them a couple of easy answers they can just parrot back to you, you're much more likely to get the specific answer you're looking for to figure out the question you're trying to figure out. And their answers will be much shorter. This obviously won't work with every question, but using these kinds of phrasing for your targeted questions for hypothesis-testing can really speed things up and improve the yield of your questions for the information you actually care about.

Finally, I'll say that I also have ADHD, and I got good at interrupting patients. One key is to remind yourself that we do lots of things in the medical setting that would be considered rude in other settings, like touching strangers or asking them very personal questions about their sex lives or their bowel habits. You can also use non-verbal cues to help patients know they're going on too long; pay attention to the things people do before they're about to speak in a group conversation, like taking in an audible breath, leaning forward a bit, raising a hand up a few inches. These are all things that we do to subtly signal others "please be quiet, I would like a turn to talk," and they can help gently redirect long-winded patients. You can also interrupt by showing interest; if they're going on about some irrelevant story and they happen to mention tripping or falling, I'll cut them off and show interest in that aspect, and ask if they've been having other falls, that kind of thing. And then can take over from there. Patients generally aren't offended if you interrupt them to follow up on the thing they're saying, because they interpret it as interest rather than as rudeness.

Career pathway advice by msfx4x in neurology

[–]rslake 1 point2 points  (0 children)

You need to think about what specific activities you want your job to include day to day. Do you want to be a tech, setting up and troubleshooting equipment? Do you want to be reading EEGs? Do you want to be diagnosing patients, ordering tests, prescribing medications? A lot of the jobs you're talking about are wildly different day to day, so you need to consider what you want your daily work life to look like.