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mostlysignssomeportents · 5 months

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Cigna’s nopeinator

I'm touring my new, nationally bestselling novel The Bezzle! Catch me THURSDAY (May 2) in WINNIPEG, then Calgary (May 3), Vancouver (May 4), Tartu, Estonia, and beyond!

Cigna – like all private health insurers – has two contradictory imperatives:

To keep its customers healthy; and

To make as much money for its shareholders as is possible.

Now, there's a hypothetical way to resolve these contradictions, a story much beloved by advocates of America's wasteful, cruel, inefficient private health industry: "If health is a "market," then a health insurer that fails to keep its customers healthy will lose those customers and thus make less for its shareholders." In this thought-experiment, Cigna will "find an equilibrium" between spending money to keep its customers healthy, thus retaining their business, and also "seeking efficiencies" to create a standard of care that's cost-effective.

But health care isn't a market. Most of us get our health-care through our employers, who offer small handful of options that nevertheless manage to be so complex in their particulars that they're impossible to directly compare, and somehow all end up not covering the things we need them for. Oh, and you can only change insurers once or twice per year, and doing so incurs savage switching costs, like losing access to your family doctor and specialists providers.

Cigna – like other health insurers – is "too big to care." It doesn't have to worry about losing your business, so it grows progressively less interested in even pretending to keep you healthy.

The most important way for an insurer to protect its profits at the expense of your health is to deny care that your doctor believes you need. Cigna has transformed itself into a care-denying assembly line.

Dr Debby Day is a Cigna whistleblower. Dr Day was a Cigna medical director, charged with reviewing denied cases, a job she held for 20 years. In 2022, she was forced out by Cigna. Writing for Propublica and The Capitol Forum, Patrick Rucker and David Armstrong tell her story, revealing the true "equilibrium" that Cigna has found:

https://www.propublica.org/article/cigna-medical-director-doctor-patient-preapproval-denials-insurance

Dr Day took her job seriously. Early in her career, she discovered a pattern of claims from doctors for an expensive therapy called intravenous immunoglobulin in cases where this made no medical sense. Dr Day reviewed the scientific literature on IVIG and developed a Cigna-wide policy for its use that saved the company millions of dollars.

This is how it's supposed to work: insurers (whether private or public) should permit all the medically necessary interventions and deny interventions that aren't supported by evidence, and they should determine the difference through internal reviewers who are treated as independent experts.

But as the competitive landscape for US healthcare dwindled – and as Cigna bought out more parts of its supply chain and merged with more of its major rivals – the company became uniquely focused on denying claims, irrespective of their medical merit.

In Dr Day's story, the turning point came when Cinga outsourced pre-approvals to registered nurses in the Philippines. Legally, a nurse can approve a claim, but only an MD can deny a claim. So Dr Day and her colleagues would have to sign off when a nurse deemed a procedure, therapy or drug to be medically unnecessary.

This is a complex determination to make, even under ideal circumstances, but Cigna's Filipino outsource partners were far from ideal. Dr Day found that nurses were "sloppy" – they'd confuse a mother with her newborn baby and deny care on that grounds, or confuse an injured hip with an injured neck and deny permission for an ultrasound. Dr Day reviewed a claim for a test that was denied because STI tests weren't "medically necessary" – but the patient's doctor had applied for a test to diagnose a toenail fungus, not an STI.

Even if the nurses' evaluations had been careful, Dr Day wanted to conduct her own, thorough investigation before overriding another doctor's judgment about the care that doctor's patient warranted. When a nurse recommended denying care "for a cancer patient or a sick baby," Dr Day would research medical guidelines, read studies and review the patient's record before signing off on the recommendation.

This was how the claims denial process is said to work, but it's not how it was supposed to work. Dr Day was markedly slower than her peers, who would "click and close" claims by pasting the nurses' own rationale for denying the claim into the relevant form, acting as a rubber-stamp rather than a skilled reviewer.

Dr Day knew she was slower than her peers. Cigna made sure of that, producing a "productivity dashboard" that scored doctors based on "handle time," which Cigna describes as the average time its doctors spend on different kinds of claims. But Dr Day and other Cigna sources say that this was a maximum, not an average – a way of disciplining doctors.

These were not long times. If a doctor asked Cigna not to discharge their patient from hospital care and a nurse denied that claim, the doctor reviewing that claim was supposed to spend not more than 4.5 minutes on their review. Other timelines were even more aggressive: many denials of prescription drugs were meant to be resolved in fewer than two minutes.

Cigna told Propublica and The Capitol Forum that its productivity scores weren't based on a simple calculation about whether its MD reviewers were hitting these brutal processing time targets, describing the scores as a proprietary mix of factors that reflected a nuanced view of care. But when Propublica and The Capitol Forum created a crude algorithm to generate scores by comparing a doctor's performance relative to the company's targets, they found the results fit very neatly into the actual scores that Cigna assigned to its docs:

The newsrooms’ formula accurately reproduced the scores of 87% of the Cigna doctors listed; the scores of all but one of the rest fell within 1 to 2 percentage points of the number generated by this formula. When asked about this formula, Cigna said it may be inaccurate but didn’t elaborate.

As Dr Day slipped lower on the productivity chart, her bosses pressured her bring her score up (Day recorded her phone calls and saved her emails, and the reporters verified them). Among other things, Dr Day's boss made it clear that her annual bonus and stock options were contingent on her making quota.

Cigna denies all of this. They smeared Dr Day as a "disgruntled former employee" (as though that has any bearing on the truthfulness of her account), and declined to explain the discrepancies between Dr Day's accusations and Cigna's bland denials.

This isn't new for Cigna. Last year, Propublica and Capitol Forum revealed the existence of an algorithmic claims denial system that allowed its doctors to bulk-deny claims in as little as 1.2 seconds:

https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims

Cigna insisted that this was a mischaracterization, saying the system existed to speed up the approval of claims, despite the first-hand accounts of Cigna's own doctors and the doctors whose care recommendations were blocked by the system. One Cigna doctor used this system to "review" and deny 60,000 claims in one month.

Beyond serving as an indictment of the US for-profit health industry, and of Cigna's business practices, this is also a cautionary tale about the idea that critical AI applications can be resolved with "humans in the loop."

AI pitchmen claim that even unreliable AI can be fixed by adding a "human in the loop" that reviews the AI's judgments:

https://pluralistic.net/2024/04/23/maximal-plausibility/#reverse-centaurs

In this world, the AI is an assistant to the human. For example, a radiologist might have an AI double-check their assessments of chest X-rays, and revisit those X-rays where the AI's assessment didn't match their own. This robot-assisted-human configuration is called a "centaur."

In reality, "human in the loop" is almost always a reverse-centaur. If the hospital buys an AI, fires half its radiologists and orders the remainder to review the AI's superhuman assessments of chest X-rays, that's not an AI assisted radiologist, that's a radiologist-assisted AI. Accuracy goes down, but so do costs. That's the bet that AI investors are making.

Many AI applications turn out not to even be "AI" – they're just low-waged workers in an overseas call-center pretending to be an algorithm (some Indian techies joke that AI stands for "absent Indians"). That was the case with Amazon's Grab and Go stores where, supposedly, AI-enabled cameras counted up all the things you put in your shopping basket and automatically billed you for them. In reality, the cameras were connected to Indian call-centers where low-waged workers made those assessments:

https://pluralistic.net/2024/01/29/pay-no-attention/#to-the-little-man-behind-the-curtain

This Potemkin AI represents an intermediate step between outsourcing and AI. Over the past three decades, the growth of cheap telecommunications and logistics systems let corporations outsource customer service to low-waged offshore workers. The corporations used the excuse that these subcontractors were far from the firm and its customers to deny them any agency, giving them rigid scripts and procedures to follow.

This was a very usefully dysfunctional system. As a customer with a complaint, you would call the customer service line, wait for a long time on hold, spend an interminable time working through a proscribed claims-handling process with a rep who was prohibited from diverging from that process. That process nearly always ended with you being told that nothing could be done.

At that point, a large number of customers would have given up on getting a refund, exchange or credit. The money paid out to the few customers who were stubborn or angry enough to karen their way to a supervisor and get something out of the company amounted to pennies, relative to the sums the company reaped by ripping off the rest.

The Amazon Grab and Go workers were humans in robot suits, but these customer service reps were robots in human suits. The software told them what to say, and they said it, and all they were allowed to say was what appeared on their screens. They were reverse centaurs, serving as the human faces of the intransigent robots programmed by monopolists that were too big to care.

AI is the final stage of this progression: robots without the human suits. The AI turns its "human in the loop" into a "moral crumple zone," which Madeleine Clare Elish describes as "a component that bears the brunt of the moral and legal responsibilities when the overall system malfunctions":

https://estsjournal.org/index.php/ests/article/view/260

The Filipino nurses in the Cigna system are an avoidable expense. As Cigna's own dabbling in algorithmic claim-denial shows, they can be jettisoned in favor of a system that uses productivity dashboards and other bossware to push doctors to robosign hundreds or thousands of denials per day, on the pretense that these denials were "reviewed" by a licensed physician.

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/04/29/what-part-of-no/#dont-you-understand

#pluralistic #cigna #computer says no #bossware #moral crumple zones #medicare for all #m4a #whistleblowers #dr debby day #Madeleine Clare Elish #automation #ai #outsourcing #human in the loop #humans in the loop

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reasonsforhope · 1 year

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"The search has intensified for alternative energy-saving technologies for heating and cooling that don’t run on fossil fuels.

Now, by mimicking a desert-dwelling chameleon, Chinese scientists have developed a cheap energy-efficient, cost-effective coating on houses.

They say the new material could keep buildings cool in the summer or warm in the winter without using additional energy.

“Many desert creatures have specialized adaptations to allow them to survive in harsh environments with large daily temperature shifts,” said Dr. Fuqiang Wang, author on the paper describing the invention and researcher at the Harbin Institute of Technology. “For example, the Namaqua chameleon of southwestern Africa alters its color to regulate its body temperature as conditions change.”

Pictured: A Namaqua Chameleon

...Many systems, such as cooling paints or colored steel tiles, are only designed to keep buildings either cool or warm, and can’t switch between modes.

Inspired by the Namaqua chameleon, Dr. Wang and his colleagues wanted to create a color-shifting coating that adapts as outside temperatures fluctuate...

When heated to 68 degrees Fahrenheit, the surface began to change from dark to light grey. Once it reached 86F, the light-colored film reflected up to 93% of solar radiation.

“Even when heated above 175 degrees Fahrenheit for an entire day, the material showed no signs of damage,” reported Dr. Wang.

The team then tested it alongside three conventional coatings—regular white paint, a passive radiative cooling paint, and blue steel tiles in outdoor tests on doghouse-sized buildings throughout all four seasons...

In summer, the new coating was significantly cooler than the white paint and steel tiles, according to the findings published in the journal Nano Letters.

“During spring and fall, the new coating was the only system that could adapt to the widely fluctuating temperature changes, switching from heating to cooling throughout the day,” Dr. Wang added.

The researchers say that the color-changing system could save a “considerable” amount of energy for regions that experience multiple seasons, while still being inexpensive and easy to manufacture."

-via Good News Network, September 21, 2023

#chameleon #extreme heat #climate adaptation #architecture #green architecture #saving energy #climate crisis #global warming #sustainability #solarpunk #good news #hope #biomimicry #air conditioning

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planesawesome · 1 month

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What is the reason for modern aircraft not using swept back wings like the F-14 Tomcat?

The main reason modern aircraft do not use swept-back wings like the F-14 is due to the advancements in aerodynamics and materials science. Swept-back wings were initially developed to delay the onset of shock waves and reduce drag at transonic and supersonic speeds.

While this design was effective for the F-14, it came with trade-offs, particularly in terms of complexity and weight. The variable-sweep mechanism added significant weight and maintenance requirements, which are less desirable in today's cost-conscious and efficiency-driven aviation industry.

Also, modern aircraft benefit from advanced computational fluid dynamics (CFD) and wind tunnel testing, allowing engineers to optimize wing shapes for specific performance criteria without relying on variable-sweep designs. This has led to the development of more efficient fixed-wing designs that can achieve similar or even superior performance across a broader range of speeds. For example, the F-22 Raptor and F-35 Lightning II utilize fixed-wing designs with advanced aerodynamics and stealth capabilities, making them highly effective in modern combat scenarios.

Modern fighter jets are designed to be multi-role platforms, capable of performing a wide range of missions from air superiority to ground attack. This versatility demands a design that can perform well in various flight regimes, from low-speed, high-angle-of-attack maneuvers to high-speed intercepts. Fixed-wing designs, coupled with advanced flight control systems, provide the necessary performance and flexibility without the added complexity of variable-sweep wings.

The emphasis on stealth technology in modern military aviation has influenced wing design. Swept-back wings, while beneficial for high-speed flight, can create larger radar cross-sections, making the aircraft more detectable. Modern stealth aircraft are designed with smooth, continuous surfaces and internal weapon bays to minimize raddar signatures, which is more easily achieved with fixed-wing designs.

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askoverlordvox · 13 days

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VoxTek™ Employment Contract

I, @helluvahotelfan , invoke the infernal powers of Hell to complete the following contract between myself and the Overlord, Vox. Hereafter, "the employee" will refer to Jenn, "the employer" will refer to VoxTek™, "the Overlord" will refer to Vox, and "the contract" will refer to this agreement, signed and sealed by a handshake.

Payment: to complete this contract, the employee signs over possession of their soul to the Overlord. For as long as the soul remains in the Overlord's possession, the terms and conditions of this contract are considered valid. Additionally, the Overlord cannot kill or willfully maim or harm the employee while this contract is in effect.

Terms: The employer will provide housing(1), a competitive(2) salary, the latest(3) model of Hellphone, insurance (4), two weeks of paid training, 30 vacation days per year (5), 30 days of sick leave per year (6), a free upgrade to replace or enhance a body part(7), a 200 year(8) retirement plan, and 24/7 protection from reasonable(9) threats. The employee will fulfill the job description provided below to the best of their ability.

Conditions: This contract remains in effect provided both the employee and the Overlord wish to continue adhering to the terms. At any time, either party may request breaking the contract. The request must be accepted by the Overlord. The Overlord reserves the right to change the job assigned to the employee in the event of subpar performance.

Job Title: Junior Data Collector

Department: Research & Development

Job Scope: Junior Data Collectors follow instructions from Senior Data Collectors and report to Project Leads all data obtained throughout marketing, testing, and further analysis. Data Collectors observe tests, trends, and other indicated measurements at the direction of Project Leads and record data as instructed by Project Leads. Data Collectors are expected to report accurate figures. Data Collectors may, on occasion, be asked to participate directly in Projects but never to the extent Hazard Pay would be required. Any injuries incurred as a result of Data Collection are to be reported immediately to the Project Lead.

Hours: Mandated work hours are 1000-1600, Monday-Thursday unless Project Leads get approved for a different work cycle.

(1) Housing starts at one bedroom, one bathroom, kitchen and washer/dryer included 550 square foot apartment. Housing can be upgraded through promotion or by registering dependents with Human Resources. (2) Competitive rates based on job title and relative cost-of-living analysis for Pride ring standards. Salary will always be 400% of current housing cost. (3) Latest model refers to latest model to pass all safety checks and either is commercially available or in phase 4 of production. (4) Insurance covers health, vision, and dental plans, as well as maternity/paternity leave, Family Medical Leave Allocation, and associated costs. (5) Unused vacation days roll over but will not exceed 75 days. Vacation days accrued past 75 days will either be paid out to the employee in a lump sum, signed over to another employee, or forfeit. Decision must be made within 1 month of employment anniversary date. (6) Unused sick leave rolls over but will not exceed 60 days. Illness or injury requiring more than 60 days to recover but at no fault of the employer will be deducted from vacation days. Illness or injury incurred during the execution of job duties will not be charged to the employee. (7) Available upgrades subject to change depending on demand. Specific upgrade offered: replacement of one eye with a VokTek™ High Definition digital recorder. Any data or information recorded by an upgrade becomes property of the employer with employee consent. (8) 200 year retirement plan based on projected life expectancy increase following the cessation of Exterminations. In the event Exterminations resume, this requirement will be lowered to 50 years. (9) Reasonable threats are those not provoked by the employee, provided the employee remains within designated areas when directed by senior personnel. Ex: leaving the approved VoxTek™ Extermination Bunker during an Extermination or insulting an Overlord/Sin/Ars Goetia are examples where the employer is no longer liable for the employee's protection.

Signed and confirmed via handshake with the Overlord,

Jenn

It took me a moment to find it, I apologize; you wouldn't believe how many copies I have in my office. Of course I have a digitized copy but Hell runs on old school methodologies, so having a hard copy is still required.

Now, @zayne1, you can make your determinations.

#ask overlord vox #vox has eyes everywhere #ask blog #sinner jenn #((this took entirely too long and it's way too concise to be a proper contract))#((but there's a reason I didn't become any type of lawyer and it's because their shit's too fucking wordy))#((also fuck now I wanna work for Vox give me those fucking hours bro))

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thoughtportal · 6 months

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At least one in five people who have had COVID-19 will develop what is known as “long COVID,” characterized by signs, symptoms, and conditions that continue or well after a COVID-19 infection. According to officials, Detroit has the second highest rate of long COVID in the nation, with over 25% of adults who had COVID-19 reporting long-term symptoms.

In response, a new no-cost mobile health unit is working to provide metro Detroiters with screening for the condition, intending to gather research on long COVID’s effects and bridge the gap to healthcare access in marginalized communities.

On Friday, March 15, declared Long COVID Awareness Day, Michigan Speaker of the House Joe Tate, Michigan Rep. Tyrone Carter, health experts, and community members gathered for an event highlighting the first-of-its-kind CT chest screening program.

The unit was created about a year ago through a partnership between Moderna, Team Wellness Center, People.Health, and other local community organizations.

“Some of our locations service some of the most vulnerable communities in the whole state,” Dani Hourani, Director of Team Wellness Center, said. “It’s very important for us that we are able to bring them resources that they otherwise would not have.”

So far, the screenings have not only helped the impact of long COVID but also been able to detect non-COVID-related illnesses including cancer. Plus, the team has connected patients with further care and testing when needed.

“Whether you’re in Detroit or rural areas, bringing healthcare access directly to the community and partnering with organizations that have that trust with community members is critical,” Tate said at the Friday event. “We still have more work to do to make sure that we lessen the impact of COVID on this community.”

Anyone over 18 who has had COVID-19 and is still experiencing difficulty breathing or other symptoms is encouraged to get scanned. People can fill out a form at People.Health to schedule an appointment.

#metro times #detroit #michigan #COVID #long COVID

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blueteller · 1 year

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Kim Rok Soo, and "Foresight"

You know, something occurred to me recently...

We all know that on Earth 2, the "lie" Cale told about being able to see the future was half-true, in a way. He'd seen a version of the future, in a different world. While the kid with "Lie Detection" power could tell that this was a lie – as in, "Foresight" wasn't actually an Ability – it was still true to some extent.

But you know, I started thinking... while it might have been a "lie" from Cale... it was actually NOT a lie for Kim Rok Soo. ...The other one. The 20-year-old KRS from Earth 2.

Think about it. By arriving via Sealed God's test, Cale possessed that KRS's body – but that wasn't all he did. He actually shared memories with him. It might be an aspect of "Record", or it might have been a side effect of a god placing two versions of the same person in one body. Either way, that KRS actually inherited those memories for good. The full 15 years of the other timeline, and all the knowledge that comes with it.

Thus, KRS actually became a prophet.

It must be incredibly interesting from an outsider's perspective. The older KRS was someone who eventually developed at least 2 time-related powers: Record, which allows him to remember the past flawlessly... and Instant, which allows him to transcend the limits of time. That means, the other KRS would eventually have at least 3 time-related powers. (And it's completely possible that there could be more, as the author had been teasing us with the possibility since forever.)

Now, as far as the Koreans of Earth 2 know, KRS was some 20-year-old punk who suddenly developed a bunch of super powerful abilities on top of "Foresight".... and then suddenly "lost them", for some reason. Since it's a trend in TCF that people never actually question our protagonist, and make up a bunch of quite-crazy-yet-quite-accurate theories about him instead... I'm pretty sure they're going to assume that KRS "sacrificed" those powers for the sake of changing the future. As in, that KRS was able to access those abilities because he saw himself having them in the future. Which, again, is not quite true, but not completely a lie either.

By changing the "future" of Earth 2, Cale actually did make KRS sacrifice the potential of eventually transmigrating as Cale Henituse and getting those Ancient Powers in another dimension. ...Meaning, it wouldn't be completely false. It would put "yet another" time-related Ability on KRS's tab: the ability to use your own "future powers", at the cost of losing them forever by abusing the ability. ....Again, which is not exactly what happened, but it's not totally wrong either.

Basically: by the whole misadventure of "getting possessed by yourself from another dimension", KRS got more "time-related abilities" on his tab – both as an actual thing, since the "future" memories were real, and also in the perception of other people.

In other words... KRS is constantly involved in time shenanigans, no matter what dimension, lol

#tcf #lcf #trash of the count's family #lout of the count’s family #cale henituse #cale #tcf cale #kim rok soo #earth 2 kim rok soo #tcf theory #tcf analysis #character analysis #tcf meta

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probablyasocialecologist · 1 year

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The bifacial solar cell, developed at the US Department of Energy’s National Renewable Energy Laboratory (NREL), harvests reflected sunlight hitting the back of the device, offering an unconventional route to producing higher energy yields for less space and cost. Typical advances to solar cell efficiency rates centre on iterative improvements to the side facing the Sun. This new approach could boost the energy harvesting capabilities of solar panels beyond their theoretical limit. “This perovskite cell can operate very effectively from either side,” said Kai Zhu, a scientist at the Chemistry and Nanoscience Center at NREL who led the research. Current solar cell technologies, which use silicon as the semiconductor material, have an efficiency rate of around 26 per cent – higher than the 23 per cent achieved in lab tests by the front side of the new panel. The back side of the panel, however, achieves an efficiency of about 91-93 per cent of the front, which offers up to 20 per cent more power overall when harvesting reflected sunlight.

#solar energy #solar power #renewable energy

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smallnico · 2 months

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when you made the comic about wyll saying that thing about orin i liked that the him inside his thought bubble didnt have the post-transformation horns and eye. a thoughtful little touch, it made me contemplate the ghost of his character arc (sorry if this is rude to the developers its just how i feel.) i also thought the comic was good overall. thanks ⭐️⭐️⭐️⭐️⭐️

AUH NO THANK YOU <333

yeah i'm so glad people noticed and enjoyed that detail!! i love wyll so dearly and i also (with love to larian for everything they Did do) think he suffered a bit from the last-ish minute changes they made to his character. they were necessary changes, and they made him who he is today, but he didn't get as much thorough and layered development as some of the other companions did. he and karlach are both in this camp lmao, and i believe for the same reason. they didn't become who they are until pretty late in the development process, unlike someone like astarion, who's been himself since very early on.

all this to say, i love wyll and i am determined to explore what is there as best as i can, and i fucking love taking little details and pulling them out. wyll is a confident person who outwardly states that 'self-doubt' is one of the most dangerous monsters a person could fight, and he tends to double down on his confident persona every time something happens to rattle that confidence. moments like the tiefling party illustrate this for me very clearly -- if you wander around with him in the emerald grove post-devilification, a lot of key npcs will say to the effect of "wyll, what in the fuck happened to you", or react with fear and uncertainty. they're willing to accept it given any amount of time and thought, but there's not nothing to his worry that people see him as a monster, and of course, he's already been through the trauma of that same snap judgement by his father, so. he puts on a brave face and keeps his distance from the people he fears he makes uncomfortable, because what else are you going to do? enforce your own uncertain presence in front of regular, good people who are just... trying to live their lives? having a good time at a party? they don't want to be scared. you've been working your whole life to try and keep people like them safe so they don't have to feel scared or unsafe. you are getting in the way. this isn't for you. you aren't welcome here. it does no good to argue that point when you could just keep your chin up and leave.

of course, that's sad as hell, are you fucking kidding me? wyll deserves better than that, but he won't accept better because he's not the type to ask for grace or patience from others, and he's from a background where he's not confident he will receive it -- his father's grace is one thing, but think for a second about how he talks about ulder ravengard's personal history as well: ravengard sr. is the son of a tradesman serving a role meant for patriars. i don't doubt that all that comes with its own baggage and passed-down high standards. as soon as ravengard sr. let his guard down, you know a flock of upper-class baldurians was just waiting to tear him apart for it, because you see them do the same thing to gortash even though he's literally mind-controlling several of them. i don't doubt that ulder ravengard instilled in wyll a driving need to not only be better than other men, surer than other men, more dependable, reliable, with more sterling integrity than other men at all costs, remember the words of balduran, memorize the values of the city, love baldur's gate more than other men, be ready to face them and prove these things to them at all times because they are always testing you. it's hard to have the most demanded of you at all times, and it can create the kind of man wyll is: a man who sees self-doubt and hesitation as a monster, worse than a mind flayer or a devil. and he knows from experience (again, from ulder ravengard himself) that flagging for a second, not being able to explain yourself sufficiently to the people around you, is enough to get you cast out and shunned forever.

but it's not possible for a human being to live like that. they're impossible standards for a reason. wyll has a flawless facade of confidence, but he's not immune to self-doubt and angst under the surface, and this comes out when you play as him or investigate some of the details he drops in a regular tav/durge playthrough, and his devil transformation really does shake his confidence. look:

all of a sudden he's using 'i guess' and 'maybe' and 'could' and 'i might', more uncertain language, to say nothing of what he's actually saying. he's been put in a position where he thinks people will never see the wyll underneath again unless he asks it of them, something he has been conditioned to never expect people to do -- if you have to ask, you're not projecting a solid enough image of confidence and skill and good leadership. then there's the sheer body horror and dysmorphia of minding your own business and one day your boss physically transforms you into a monster forever. wyll is trying so hard at any given moment to not let it bother him, but it so clearly does, and it would bother anyone -- but wyll ravengard is supposed to be better than anyone, better than a normal man. he lives inside stories of heroes and hyperbolic idioms, Things One Says about Heroes, because he's never been allowed to be a normal man. he had to sneak out of the house to play hopscotch with lower city kids. to me that says everything. he has been taught to lead an idealized existence free of doubt, but that just means he's gotten very good at hiding his doubts and anxieties, his inconsistencies, his human error. he has so much trouble facing the fact that he also experiences internal conflict, just like anyone.

he spares karlach because she's an innocent, because it's the right thing to do, but he struggles with making that decision because he knows it's going to hurt him, and he refuses for a long time to admit that to himself, much less anyone else, because it makes him feel lesser. it makes him feel like the worst person on the planet to admit that he was afraid for his own life, essentially staring down the barrel of a gun to say no to mizora when faced with an innocent in need of protection, even though he wouldn't dream of even making a good person mildly uncomfortable for two minutes while they get used to the way he looks.

part of my vision for wyll's development is just, him getting a little bolder with the things he says, because we all know he says some out of pocket shit for no reason, and part of why that is so funny to me is because he says those things with all the confidence of a train barrelling forward, because of course he does, he's wyll ravengard, he has to be everything to everyone, he can't do something as human as cringe or twitch an eye and go 'ah. nope, that's not what i meant' when he blurts out something thoughtless, or something that sounded better in his head. i like the idea of turning into a monster being the thing that eventually makes him more comfortable with being human. part of letting your guard down around your friends is saying stuff you think they'd get a kick out of even if it doesn't fit the perfect image of the hero you're trying to be, or saying something that comes out wrong and letting yourself cringe when it wasn't received the way you wanted it to be. letting yourself let go of the idealized version of yourself and trusting your friends enough to know that they won't think less of you for it, because they still know you would rather die than let an innocent person get hurt, even if you do feel scared for yourself in the process.

tl;dr yeah i like to depict wyll slightly awkward and nervous. let the man be a human being and vulnerable for god's sakes he's been through enough. i love him

#loquor #the askbox #anon #bg3 wyll #wyll ravengard #bg3 analysis

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ngdrb · 2 months

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Positives about Joe Biden and Negatives about Donald Trump

Positives about Joe Biden

Over the years, Joe Biden has demonstrated an evolution on key issues. Notably, on criminal justice, he has moved far from his much-criticized "tough-on-crime" position of the 1990s. His proposed policies aim to reduce incarceration, address disparities in the justice system, and rehabilitate released prisoners .

Accomplishments: Throughout his extensive political career, Joe Biden has dedicated himself to serving the American people. As a U.S. Senator and Vice President alongside Barack Obama, he has been involved in various initiatives and policies aimed at fighting for Americans .

Leadership and Resilience: Despite facing challenges and uncertainties, President Biden has demonstrated resilience and leadership. His administration has achieved significant milestones, such as the passage of the infrastructure bill, which had been a longstanding goal for previous administrations.

Public Perception: Joe Biden's favorability ratings have been relatively positive, with a net favorability rating of +9 points in recent high-quality live interview polls. His favorability rating is above his unfavorable rating in almost all polls, reflecting a generally positive public perception .

Health and Vigor: Despite facing health challenges, including testing positive for COVID-19, President Biden has shown vigor and determination in fulfilling his duties as the head of state.

Likability and Personal Conduct: According to a Pew Research Center study, voters are more likely to view Joe Biden as warm and likeable compared to Donald Trump. A larger percentage of voters give Biden warm ratings, with about one-in-three voters expressing intensely positive feelings about him .

Accomplishments: President Biden has outperformed Trump on various fronts, including inequality, green spending, and crime. His third year in office was marked by an economy that remained resilient despite challenges like inflation and surging borrowing costs.

Personal Qualities: Despite a decline in public impressions of Biden's personal qualities, he is still perceived as able to manage government effectively. Additionally, a significant percentage of voters believe that Biden cares about the needs of ordinary people.

In summary: Joe Biden's presidency has been considered highly positive due to several key factors. His administration managed to implement significant legislation aimed at economic recovery, infrastructure development, and climate change mitigation. Biden also re-established international alliances and restored a sense of stability and decorum to the presidency. His efforts in addressing the COVID-19 pandemic, including successful vaccination campaigns, were pivotal in saving lives and reviving the economy.

Negatives about Donald Trump

Donald Trump's presidency has been marked by various controversies and criticisms, as evidenced by a range of factors and public opinion.

Worker Safety and Health: The Trump administration has been criticized for disregarding negative impacts on worker safety and health, such as proposing rules that could endanger young workers and patients.

Handling of Race Relations: Trump received negative marks for his handling of race relations, with a majority of adults expressing concerns about his approach and the divisions along racial, ethnic, and partisan lines.

COVID-19 Response: Trump's legacy has been defined by the controversial handling of the COVID-19 pandemic, with widespread criticism of his administration's response to the crisis.

Controversial Statements and Actions: Throughout his political career, Trump has been associated with a series of controversial statements and actions, including derogatory remarks about immigrants and divisive rhetoric.

Erosion of Democratic Institutions: Trump has been criticized for questioning the legitimacy of democratic institutions, including the free press, federal judiciary, and the electoral process, leading to concerns about the erosion of democratic norms.

Tax and Financial Practices: Trump's financial practices, including tax-related issues and potential conflicts of interest, have been the subject of scrutiny and criticism.

Policy Priorities: Critics argue that Trump's policy priorities have favored corporations and the wealthiest few at the expense of other segments of the population.

Public Perception: Public opinion reflects stronger negative views on the potential downsides of a Trump presidency, with concerns about his personality traits, views on immigration, and the economy.

In summary, Donald Trump's presidency has been marked by a range of controversies and criticisms, including concerns about worker safety, race relations, the COVID-19 response, controversial statements, erosion of democratic institutions, financial practices, policy priorities, and public perception. These factors have contributed to a complex and divisive public perception of his presidency.

#politics #donald trump #joe biden #potus #scotus #heritage foundation #trump #democracy #democrats #republicans #please vote #vote blue #get out the vote #vote biden #vote democrat #vote blue to save democracy

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karliahs · 3 months

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The average public library is not only a provider of the latest Anne Enright or Julia Donaldson: it is now an informal citizens advice bureau, a business development centre, a community centre and a mental health provider. It is an unofficial Sure Start centre, a homelessness shelter, a literacy and foreign language-learning centre, a calm space where tutors can help struggling kids, an asylum support provider, a citizenship and driving theory test centre, and a place to sit still all day and stare at the wall, if that is what you need to do, without anyone expecting you to buy anything. [...] The trouble comes when libraries – and the underpaid, overstretched people who work in them – start to become sole providers for all these things: when years of cost-cutting mean that the state has effectively reneged on all but the most unavoidable of its responsibilities to the troubled, the poor, the educationally challenged, the lonely, the physically unwell, the lost or the homeless. “We risk becoming a social care safety net,” said Nick Poole, the outgoing CEO of the library association Cilip, and “our staff are not clinical staff”.

#i try not to library post on here but god.#this article #captured so much of my experience working in public libraries #the chaos the joy the dissonance the grief #this specific thing that makes me feel complicated things when i see posts celebrating everything libraries are to people #bc yes! yes!#but also the feeling this article describes so well #where you are aware every second of the death spiral of social care and community support in this country #and how needed and how inadequate the library is. as this last tiny bastion of community care #part of the reason i stopped working in the nhs was bc of that constant overwhelmed hopelessness #the awareness of all the systems we use to care for each dwindling more and more every year #man #i don't know #i loved this article a lot #kind of want to send it to everyone who has ever told me my job must be so peaceful

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monocodoll · 10 months

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Drug Dealing(MonocoDoll's Vile Ventures) Mod Report(Weed Edibles, Marijuana License, Felony Consequences, Smuggling, Cocaine/Meth Rackets, Heat System, Steroids, Doctor Appointments, Lean, Possibility of PMA in MDMA, House Arrest, and small update to Adderall) Part 2

Doctor Appointments

Doctor Appointments are used to get prescribed medication such as Adderall, Xanax, PainKillers, Cold Medicine, and Estrogen blockers. Your sim is limited to one doctor visit a day.

To Visit a Doctor, your sim will need to go to the Hospital Rabbithole. Costing 100 Simoleans

After selecting the option, your sim will go into the Hospital for around an hour and a half. If the doctor finds that your sim needs any medication, they will provide it to your sim.

[Being Prescribed Adderall]

-Adderall is Prescribed to Sims with the Absent Minded Trait.

-Athletic sims have the chance of being misdiagnosed and therefore may be prescribed Adderall. By Default 10% chance

[Being Prescribed Xanax]

-Sims with either Stressed, Feeling Anxious, Scared, Strained, Feeling Out Of Sorts, Impending Episode, Delusional, Terrified, Fear, or Upset moodlet will be prescribed Xanax.

-Sims with the Unstable trait will also be prescribed Xanax.

[Being Prescribed PainKillers]

-Sims with either Bad Landing, PwnedByBull, Lost The Brawl, Ouch My Face, Hurt Hand, Mosquito Bite High, Mosquito Bite Mid, Mosquito Bite Low, Cat Scratch, Shredded dignity, Saddle Sore, Forcibly Dismounted, Kicked, Bitten, Hurt Foot, or Tooth ache will be prescribed Pain Killers.

[Being Prescribed Cold Medicine]

-Sims with either the Germy, Pestilence Plague, or Sick and Tired Moodlet will be prescribed Cold Medicine.

[Being Prescribed Estrogen Blockers]

-Sims with an Enzyme level of 60 or above and have not yet received permanent liver damage. Will be prescribed Estrogen Blockers.

[Being Prescribed Nothing]

If the doctor finds no issues with your sim. The sim will be prescribed nothing and be sent on their way.

Lean

I had also mentioned Lean on a previous report. However, they were not fully developed at the time. I decided to go back and work on implementing Lean into the game.

[Effects While Under the influence]

Lean will temporarily remove Sleepy, Tired, Exhausted, BuzzCrashed, OrganicKonaLiftBuzz, OrganicSlappicnoBuzz, an OrganicMidnightMudBuss. As well as provide a small boost to your fun. However, Lean will make Sims feel Dazed.

[Withdrawals]

While the sim craves Lean, they will gain the Feeling Anxious, Stressed, and Strained moodlet. They will also take a 1/5 hit to their energy and a 2/5 hit to their fun meter.

[Overdosing]

If your sim consumes too much of the drug, they have a chance at overdosing. It can be either fatal or non fatal. If fatal sim will die. If non fatal the sim will pass out.

Possibility of PMA in MDMA

Anytime your sim purchases Normal Quality MDMA from a Drug Dealer NPC. There is a 10% that the MDMA Baggy or MDMA Pill Bottle may contain PMA. Purchasing High Quality MDMA however, is excluded from this possibility.

If your MDMA has PMA inside, when your sim goes to consume some of the MDMA, the sim will consume PMA instead. Which will result in the effects of MDMA to take longer to take effect.

To check whether your MDMA has PMA inside, you can now purchase Stay Safe Test Kits at the grocery store. Once you have these in your inventory. You can select any MDMA Baggy or MDMA Pill bottle and check whether PMA is inside. Selecting the option will inform you how much PMA is inside. The kits have up to 5 uses.

House Arrest

I also decided to go back and implement a house arrest feature. Now if your sim is arrested and have less than $2500 worth of Illegal product, they will be sentenced to House Arrest for a day.

They will have a total of three hours to get to their home. Otherwise they will be arrested if they are not home by the time the moodlet expires.

Once they are home, they must stay in their home lot for the duration of the house arrest. Stepping out of their home will immediately notify law enforcement and therefore your sim will be arrested. And they won't be getting House arrest if they are arrested due to a breach in their house arrest sentence.

Small Adderall Update

I decided to go back to Adderall and have it have an additional function. On top of what was previously mentioned on reports about Adderall. Adderall now temporarily replaces the Absent Minded Trait with the Perceptive Trait. Once the effects of Adderall wear off. The sim will regain their Absent Minded Trait. If the sim does not have the Absent Minded Trait, then one random trait will be temporarily replaced with Perceptive.

And that is all I have to report on for this month. We went over Weed Edibles, Marijuana License, Felony Consequences. Smuggling, Cocaine/Meth Rackets, Heat System, Steroids, Doctor Appointments, Lean, Possibility of PMA in MDMA, House Arrest, and the small update to Adderall.

I was honestly all over the place this month. A significant amount of progress was made this month. For next month, I'm not too sure what to work on. At the moment, the only major things left are the animations and reactions of the sims that you smoke around. And some minor features to work on next would be to make Lean Craftable, make the overdoses chances tunable, Be able to cut Cocaine Baggies into lesser quality via Baby laxatives, Correcting Spelling errors, Making Images for the moodlets, Make the LSD Sheets into more of a Simlish style, and a Shroom harvestable (I honestly forgot about them when I initionally made all the other drug plants).

Additionally, I also decided on a name for this mod. I have been calling it The Drug Mod for quite a while now. However, during this month I decided on a name. I'll call it MonocoDoll's Vile Ventures. Another nice little detail I want to add to the release for this mod is to have a cover art for the mod upon release. I commissioned my friend. Which is the same individual who made my OC. So I am looking forward to their upcoming sketches.

Now I am going to go back to being a ghost. However, I want to thank everyone again who has been patient.

#ts3 modding

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