I worked homeless outreach in a rural area. My job was to connect people to housing, assist with obtaining government benefits, and mental health services if necessary. They would spend the day at local hot spots, well trafficked convenience stores in the morning, well trafficked stores like the local grocery store for most of the rest of the day. A lot of them would hang out in the stores as long as possible to escape the heat/cold and many would also hit up strangers for money at these spots

They were often very hesitant or completely unwilling to share where they actually slept. Even though I worked for a nonprofit a lot of them saw me as a government employee and even the ones who didn’t still were very hesitant to trust me or any of my coworkers with that info. I’m pretty sure they were scared that I would call the cops or something. Some slept in wooded areas, some slept behind stores, some couch surfed, etc from the ones who did share and who I found (part of my job was being the point of contact for police and other emergency services who found people staying outside in dangerous weather and getting them emergency housing).

Even though it was probably like 2013 or so that I did this job the absolute cheapest room that would rent to the homeless was $700/mo. There were cheaper rooms around but they tended to require big deposits and would often refuse to rent to someone that didn’t already have a permanent address. I’m pretty sure that’s illegal but they would get around it usually by being vague and ghosting. “Oh so sorry someone else got the room”, stuff like that, and you’d see it was still available for 3 more months. I can’t even imagine what the rent is like now

Super depressing job. It’s very difficult to escape that cycle once you’re in it. It radicalized me a lot to work with people who were literally left on the street in a town with hundreds of vacant apartments. By our estimate there were maybe 20-40 homeless people in said town at any given point

You can also use komf alongside komga/kavita to just scrape metadata automatically upon import. A bit finnicky to get going (a tampermonkey script is required to give it accessible setting on the komga page) but works very well and even has a gui for identifying results and selecting the correct option if the auto scrape fails similar to jellyfin

For the actual reader part I just use komga as a server and read through Mihon (one of the tachiyomi forks) on my ereader mostly. occasionally I’ll use paperback on my iphone (although recently I’ve been trying Tachimanga, which is basically an iOS tachiyomi fork). Loads library, can sort by tag/library/date added, reads most things very well, can sync read status with the komga server (and/or manga updates or whatever), etc.

https://journals.sagepub.com/doi/10.1177/2167702620921341 - the bigger takeaway from this one is that trigger warnings reinforce trauma as a central part of the traumatized individuals identity but they did find some incidence of drawback/harm

https://journals.sagepub.com/doi/10.1177/21677026231186625 meta finding no benefit and actually can cause an anticipatory reaction making the person more engaged with the material

There are others, this is just what grabbed from 30 seconds on google scholar. Its been a bit since I’ve done more serious lit review and it’s not like I keep a directory of papers I’ve read

The issue is the culture surrounding trigger warnings. Let’s be real here, people looking for trigger warnings are generally (perhaps overwhelmingly) not looking for material to help with their exposure therapy. They are looking for a “warning” to help them screen material to avoid. The issue is that this creates an unrealistic expectation that is incompatible with the real world. You can avoid suicide, sexual assault, eating disorders, or whatever in your media (maybe) but real life won’t sanitize itself or warn you. You will encounter these topics, whether through the news, careless speech from friends, or even intrusive thoughts of your own. Research continues to show that avoidance of upsetting topics can worsen anxiety and ptsd symptoms

To your final point the idea of it helping to create a choice isn’t even as clear cut as you describe

https://journals.sagepub.com/doi/10.1177/21677026221097618 content warnings actually increase the likelihood someone will view problematic content. This point is further reinforced by similar findings in the meta linked above

So you have a system that ultimately makes creators feel like they’re doing something noble, that is likely at best useless and potentially harmful. Said system increases the likelihood that a person will view the problematic content but also enables the reality that a person will simply avoid the things that provoke their anxiety which again is more strongly established as harmful

https://www.sciencedirect.com/science/article/abs/pii/S0005796712001064 - ptsd worsens with avoidance

https://www.sciencedirect.com/science/article/abs/pii/S0962184904000290 - anxiety disorders do the same

There’s evidence that trigger warnings actually worsen anxiety and are counterproductive

The way to treat anxiety is to face the source of anxiety to try and change your relationship and reaction. The best way to do this is via controlled access that exposes one to the trigger gradually in a context that has no risk of harm (eg a media depiction, discussing the concept, building up to discussing the source of trauma that led to the phobic response if applicable)

Trigger warnings enable active avoidance. This sensitizes one to the aversive stimuli and makes the phobic response stronger. As a result when one encounters the stimulus (eg a friend, family, celebrity etc commits suicide, suffers an eating disorder, etc) your resilience to the trigger is now even lower and the response is more likely to be more significant than it was before.

That said education on access to resources like 988 or other warm lines can lower suicide rates, maybe. Research is more mixed here because it’s difficult to prove causation

a virus perpetuates and replicates itself infecting other executables with its code, thus the name “virus”.

this is just shitty code that crashes hard. it’s not even particularly malicious, it doesn’t destroy anything

that’s not what a virus is

Bleed in my ass

those bass drum hertas tho

It hasn’t seen a release yet, code is here:

https://github.com/arjpar/WebShield-staging/tree/ldev

I’m not endorsing it, never heard of it before this post, but this was literally the second line of the readme

one of the most frustrating aspects of being a therapist in america in the past 10 years is the hand waving of the ethics involved in the financial renumeration of our relationship with those we serve

I would say a significant stressor for the overwhelming majority of the clients I have is financial woes. And because the system is backwards, those with high paying jobs well into their career tend to have the fancy PPO plans with no deductible where seeing me (or anyone) is only $10 despite the fact that they could much more easily afford a 5-10k deductible. Meanwhile the people who are making 20-50k a year on the other end of the spectrum almost always have those high deductible plans with sometimes massive deductibles and rarely have employer funded hsa.

I’m not an idiot, I run my own practice and I do the books for it. I can do the math to figure out how much take home pay someone has with those salaries. I can also conceptualize the cost of housing, food, phone, transportation, etc because I am also paying these things. So when I meet someone here and their appointments are $140 per meeting I am in a tough spot. I am asking them to take on a burden of $560 per month (assuming weekly sessions). That’s immense. And if the deductible is 5k, 7.5k, 10k, it will take ages to meet especially if they’re younger and not really making contact with many other medical providers.

I am contractually obligated to charge what your insurance pays me in these instances. If your insurance pays me $140 for the hour I have to charge you that until you hit the deductible. I could be dropped from the network if I modify this for you and get caught.

I can ask you to skip using your insurance and charge a lower out of pocket rate but this is complex. For one, many therapists can’t adjust their rate much lower. I have flexibility here because my practice is entirely telehealth so my overheads are much lower. But if you see them in an office? They are paying about 40-50% of that just in rent most places.

Additionally even with telehealth I have to be careful with adjusting rates. Insurance only pays me for specific timed and coded sessions. If you and I have a phone call for 25 minutes? Not covered. If you ask me to collaborate with your psychiatrist and I talk to them for 40 minutes? Not covered. The time I spend dealing with billing and this system, which works out to an average of 20-30 minutes per session? Not covered. So the 25% of my week doing billing shit and the overtime hours doing phone check ins, case collabs, etc. has to be covered by that.

This is why many therapists give fee schedules and charge you for all of these things. If you want paperwork from them it’s $1 a page, phone calls are $75/hr, etc. I can make it work without this because I’m not paying for office space but if I was I would need to do this to keep myself afloat.

This is also part of why many, many therapists simply don’t take insurance anymore. Just pay me the $140 directly. I can collect it via square or whatever and your billing is done. I no longer spend 5-10 hours a week on billing nonsense like fighting retracted payments, finding out why claims were denied, etc. You can submit receipts for out of network reimbursement and you deal with them.

I understand why my peers do what they do. But ethically it’s a mess. I signed up to help people and what I have become is a gigantic cash sink that puts a tremendous amount of pressure on the people I serve and is counterproductive to our work.

At the same time I deserve a fair salary for my work and this is the only way to get it. And if I protest the system by leaving it because it’s so broken then the end result is that there’s 1 less mental health provider who takes insurance. If I stop taking insurance altogether I alienate a ton of people with high need who can’t afford to pay out of pocket forever and/or don’t know how to navigate out of network reimbursement.

I cannot tell you how many times I do a screening call with someone and they say “this sounds like what I need”, they tentatively schedule, and then once I run their insurance and give them the actual numbers of what treatment will cost they simply ghost. It is a system that actively deters people from seeking assistance because it is so cost prohibitive

And the insurance lobby has its fingers so deep into the framework of america that this will simply never be fixed. It will only be changed. Look at Kamala Harris’ proposed Medicare for all: it still allows private plans. That will be a movement in the right direction because it will end the idea of someone being “uninsured”, which is great, but it will also create a two lane system in which many practitioners will do whatever they can to avoid taking basic Medicare patients in favor of the commercial plans. Commercial plans, at least in my area, simply pay more. Significantly more. Like $80/hr vs $140/hr. And in the end I will have the same problems because the unnecessarily complex private insurance system will still exist and be very powerful. I will just have one more insurer to add to the web of complexity. But no politician will ever remove the private health insurance industry. To do so would alleviate so much spending waste, so many wasted administrative dollars and man hours, but it would also result in layoffs of hundreds of thousands, if not millions, of americans whose jobs rely on processing the complex bullshit of this system

Speed or mallrats depending on what kind of vibe you’re going for

edit: upon reflection I will change my Sandra bullock movie to “the net”. Terrible, but strong 90s vibes

your scenario is either worded incorrectly or very atypical (which is very possible, there are a lot of different insurance plans in the us

typically high deductible plans work in a way of “meet your deductible and then we cover x% after that”

eg I am a therapist, I bill your insurance $100 for an hour session. You have a $1000 deductible with 80% coinsurance.

Our first 10 sessions will cost you $100 out of pocket, which goes to me directly. I submit billing for these sessions but get no reimbursement from the insurer because you have already paid the full amount. However, my submission of billing indicates to the insurer that you paid $100 for a medical service on whatever date for whatever diagnosis.

After the $1000 deductible is met your insurance splits the bill with you 80/20. Now you pay me $20 per meeting and when I submit the billing the insurance (hopefully) pays the other $80 to give me the $100 per meeting I am owed.

This of course assumes no other medical spending goes on for the duration, otherwise you would hit your deductible faster. If you saw me 3x and then had a surgery that cost $5,000, you’d pay $700 for the surgery to settle your deductible plus an additional $860 (20% of the remaining $4300) and then sessions would be $20 under the 20% coinsurance.

You should also have an out of pocket max, this is kind of similar to a deductible but it is different. This is a tally of your total spending and once you hit it your coinsurance usually drops and you pay nothing.

Also important point is that deductibles reset every plan year. This should have been made abundantly clear to you but I still encounter many who do not know this

Additionally your insurance may have certain services covered that don’t cost you anything or where the deductible doesn’t apply (eg you’d only pay 20% even if it’s the first appointment of the year). Typically this is preventative care, things like physicals and vaccinations

That is the most typical. But like I said it there are many plans and variations. It’s possible you have a plan that prior to meeting the deductible you pay 50% of billing and then have a 0% coinsurance. This would be really great insurance.

It’s also possible that you have a benefits package from your employer that is basically paying 50% of your deductible in a roundabout way. this is far more commonly done by the employer funding an hsa/fsa account which would be a payment card that you use on medical spending and not the insurer. However, I have encountered plans where the hsa and insurance were rolled together and joint companies, where the hsa would pay all or part of billing prior to deductible on the patients behalf

Using the same examples above you’d pay me $50 until you met your deductible, then nothing once the deductible is met. If you had a $1000 deductible, saw me twice, then had the 5k surgery you’d pay me $100 and $900 for the surgery. If you have one of the situations where the employer is covering 50% of the deductible it would be the same but the surgery would be $400 because ultimately you’re only paying $500 of the $1000 deductible and your employer is covering the other half. This is not a situation I’ve ever encountered

Another important point is that deductible status is dependent on your providers doing timely billing and your insurance processing said billing in a timely manner as well. This does not always happen. As a result you may meet your deductible but my billing verification shows that is not the case. The examples I used above were clean and easy but it’s never that simple. Most people have a deductible around $2500 (and many 2-4x this) and see several different healthcare services.

I submit my billing at the end of each day but some places are sloppy and will take weeks to submit. This can lead to situations where you are charged money because I was under the impression you had a deductible but you should not have been. Eventually the insurer will pay me once things sort out. If I am good at record keeping (I am great at it for this reason) I will catch the double payment and send you a refund. This is why it is important for you to keep track of deductibles and medical spending. Not all offices are managed well. I’ve personally had money stolen from me (because this is literally fraud, to not refund the double payment) and I don’t believe it was ever intentional, just offices with shitty management. Let your providers know if you’ve met your deductible. I will always hold off on charging you if you tell me this, submit billing, and see what the insurance reimburses. If they reimburse me in full then you were right. If they don’t I send you a bill and if that is incorrect you need to call your insurance to complain

You should be able to track deductible and out of pocket spending on your insurances consumer portal (eg go to Aetna.com or whatever and click “for subscribers” and make an account, if you haven’t already). This should also give you an explanation of plan details.

Most importantly you should be able to call the office of the place (or billing dept if it’s a larger health network) doing the procedure to have their office manager check what you will be expected to pay for the procedure both at time of service and expected cost total. This takes only a minute but be forewarned it is essentially an estimate and not a guarantee. Billing can change last minute depending on how the procedure goes (eg added complexity allowing them to add another cpt code for something)

There’s a lot more to it than this unfortunately. Some plans have tiered deductibles, sometimes a staff member in a hospital isn’t personally enrolled and then are considered “out of network”, which is a whole other thing, sometimes you are still responsible for a certain services that the provider requires but the insurance refuses to pay. That last point especially: every time you establish with a medical office or get a procedure you sign something that says you are financially responsible for services not covered by insurance (I guarantee this, every time). So if you get bloodwork with like 30 tests and 2 aren’t covered even if you’ve met your out of pocket max and have the best insurance in the world you’re getting a bill (and potentially a hefty one, some blood tests are extremely expensive)

Sorry this is very long and complex but that is kind of how insurance is? To boil it down to a “eli5” 2-3 sentence explanation would either require your specific plan information in much more detail or to overgeneralize and potentially mislead you.

I mean like running their hypothetical control software/framework within a docker on a local server. Is that illogical? I do the same for the software that runs my ip cameras with my home server, instead of them needing to connect to some external server.

You’re ultimately right though, when it comes to docker I am at the proficiency level of “can deploy other people’s images” and not so much on the “have bothered to make my own”

You’re both wrong for speaking in absolutes. It could be pica but it’s impossible to fully assess such a situation based on a literal sentence description, you would need to know the context, frequency of behavior, occurrence with other items (eg is it solely soil). It could be soil eaten out of desperation to alleviate symptoms related to iron deficiency but again, impossible to know from a single sentence but a child eating soil would be grounds to evaluate for pica unless the child was specifically instructed or something (eg folk medicine)

brought to you by someone who spent 5 years doing neurodevelopmental evals of autism and intellectual disability in children, where pica came up a decent amount of the time (especially for the kids with ID)

It’s a perspective thing to a degree but it’s also your ability to avoid the crushing weight of reality.

Like approaching 40 I can appreciate that I finally have some money for the things I like, that I have more freedom and wisdom, that I still have the ability to start things, etc

But at the same time there’s the crushing reality. To get that money I trade time and if there’s one thing I miss about being young it’s the amount of free time I had. I just got a bass and I love playing it but I can only do like 20-30 minutes a day and have to skip many days because of life. When I was 16 or even 22 I could often practice drums or piano for hours per day. I could work less of course but that’s not usually an option for most people without changing jobs and also can lead to financial insecurity

Then the even less fun parts of recognizing your body just doesn’t work as effectively. The permanent neck injury I got from work when I was 25 that didn’t bother me as much then is significantly worse now despite physical therapy for years, cortisone, regular strength training, etc. what used to be a stiff neck is now genuine pain that impacts all the way to my shoulders. Knee injury from youth is similar. Then the just unfair bits like my vision deteriorating significantly. It’s not injury related, just lost the genetic lottery.

The cognitive decline as well. I’m still plenty sharp but I can recognize my math processing becoming slightly slower, tripping up my words more often, needing to read things more thoroughly than I did when I was 24 and in grad school, takes me longer to learn things like the bass, my reaction times in videogames are worse, etc. It’s nothing major of course, no family history of dementia thankfully, but it’s part of how the human body works. My job involves assessing people’s neurological state and somewhere in your mid to late 30s starts the slow decline. For some people this will just get to “pretty forgetful, senior moments” and then they die. For others not so lucky they get dementia and have a truly tragic end of days.

But at the same time I do think a sense of optimism is important. I just think it’s important to be rational and realistic about this. Radical acceptance helps here. I can’t get back youth or time lost or whatever, so no sense getting too distraught over it. This applies to youth as well, who may not deal with any of the above but often have their own problems that cloud the potential positives in their life. Anyone can lose their sense of joy and everyone has shit going on. Maybe for them it’s more existential dread, the crushing weight of finding direction, etc. The shift to optimism is that I remember despite the ugliness of reality there are still good times to be had, even if my neck hurts the whole time

A school district spends $180,000 (hyperbole, I don’t know actual numbers) of taxpayer money deploying this system between the actual hardware costs, maintenance costs to install the hardware, it costs to implement it into their network, and probably an ongoing contact with this dummy’s company. Maybe only for support but with the way things are now I’m sure they built this app to phone home to their servers (introducing a huge potential security risk over simply running it locally on the schools existing network infrastructure in a docker or something), calling it “cloud based”, and charging the district 1k/month to run the devices the district now owns and should be able to operate without the company. The company then talks about how they’ll back up records and safeguard data so you don’t have to worry about that (that it dept you pay is pointless!)

Three months after deployment it turns out the sensors can be tripped by many things not related to vaping, maybe increases in heat, mouthwash breath, etc. the false positives are due to a hardware flaw and cannot be fixed with a patch. Feel free to upgrade to sensor version 2.0, now with improved accuracy! (read: the problem still exists but isn’t as bad). Only another 40k to buy the new hardware, rip out the old hardware (which is now worthless), install the new stuff, and configure the software for everything (again, maintenance and IT costs)

9 months after deployment the company is doing poorly because their product is stupid and only a few idiots actually bought it (way to go idiot). There’s concerns because they sent a new Eula that outlines data sharing policies. They are potentially finding ways to harvest the data they agreed to safely store to try and create a new revenue stream to right their sinking ship. District counsel says fighting the Eula change will be expensive and there’s not much precedent for it, plus they state they will anonymize data before sharing so it’s not a ferpa violation, technically. It feels scummy but you can’t do anything about it. You also don’t really trust them to only sell anonymized data but you can’t prove they aren’t crossing that line so whatever, I guess

15 months after deployment they get hacked because they’ve run out of vc cash, never could get an actual profit stream going (turns out they’re spending 750,000/yr on salaries for 5 people and they’re all kitted out with sick work computers for what is basically coding a web app, but I digress). security of their servers was one of the budgetary constraints they chose to make to right the ship (but had to keep the $1800 office chairs and the 15-20k/mo rent loft they use as an office in a hcol area). The contract says this may happen and they’re not responsible unless there’s gross negligence on their part, which you can’t prove, and that they do some bare minimum reactionary shit after the fact to mitigate damage. So they’re legally blameless and now you get to notify your community their children’s data was leaked to god knows who, whoops

22 months after the fact they go out of business officially. You get a form email about the company’s journey and the difficult decision they had to make to stop fucking around on a dumb project that sucks because no dumbass vc will give them fun bucks anymore to keep playing tech bro billionaire. All the sensors stop working because they require a connection to the servers, which they shut off immediately without a sunset period. You’re reminded every day when you log in to the schools admin panel and get 350 “sensor not connected” error messages and your students bitch about the “sensor not connected: server not available” error pop up showing up on their classroom console. It takes IT a few days to remove their shit from the network and that costs you even more money in wasting your IT staff time when they should be fixing the broken computers in the computer lab or whatever.

Now your school has a bunch of weird boxes on the wall. Sometimes people ask you about them and you go “oh those don’t do anything” and remember that they cost taxpayers in your community tens, if not hundreds, of thousands of dollars and wasted hundreds of hours of your supports staffs time that they could’ve been using to improve the school

But then you scroll on instagram and see there’s this new thing that will detect when kids are bullying each other. You just have to put a camera in each classroom. It’s okay, it won’t record. It will just use the power of AI and machine learning. You’re sold right there and the cycle starts again

There’s a theory that says this is the case (I can’t remember the name) but if it was accurate it’s probably been thoroughly destroyed by the modern diet which is laden with foods that push reward cravings (like excessive carbohydrates)

I mean the internet has become a piecemeal existence where you’re expected to add on things like it’s McDonald’s so I guess this is just the next step in the trend

I miss 1997 when the internet and all the information on it was free (save purchasing a computer and the monthly fee for an isp, if you want to be pedantic I guess)

lmao really? so you’re still a non subscribing pleb that gets the “please support our cause and subscribe” stuff but you literally only no longer get targeted ads? Shameless

am I reading this right that you would pay and still get advertisements, just not targeted ones?

Also nontraditional warfare that has technically been seen but not really (at least in an officially acknowledged way, maybe something like stuxnet?) like offensive cyber warfare. If things truly came to trading blows russia does have very talented cyber espionage folks and the us has shown many times that it has pretty shocking vulnerabilities on many critical points of cyber infrastructure. these probably haven’t been attacked because it would be a literal act of war to go after the power grid, weapons systems, water delivery systems, etc but if the gloves come off then you better believe these systems start getting attacked by state sponsored actors who will never come anywhere near american land