Well, just Privateer for a non signing faction or nation then

First of all: As a healthcare professional but not your healthcare professional: What you describe has strong signs of a depressive phase and you should first and foremost seek professional help - don’t trust the internet on this and more importantly don’t start to self treat yourself in any way besides behaviour based measures.

Secondly: It can take ages. I’ve been there. Especially when your new job is similar to the old one it is quite difficult, as you “in theory” know what to do but in reality you still have to find your place in the new company. It will take time. But it will get better.

Literally what’s done. Most dogs are chipped these days

And law enforcement can absolutely find out.

And most cities in my country require the dogs to have a tag with a human readable number (both for tax and identification purposes) as well when they are out in public.

I would love to see a replacement that supports Anna’s Archive.

You could simply go to Austria and do that. Palatschinken is acceptable for any meal and delicious.

You are welcome - this is basically one of my specialities, even though my work focuses more on the prehospital fields.

Nope, no issues so far, but it’s new enough to already have received the new units directly.

The small Renault’s are actually more than decent EVs and can be compared to the Hyundai Inster.(With the later being the closest to a “high quality EV for everyone” I have seen. Fantastic car, small, comparable cheap, secure. They need to get a bit cheaper still,but we are getting closer)

If you are filthy rich the Porsches are decent, same goes for some of the BMW. The Nissan Arya is also okayish, so are Mercedes.

But yeah, Korea has the absolute king of the hill atm. I drive an EV6 (pre facelift). And honestly? It’s the most “fun” and “comfortable” car I ever had - and I used to have lots of expensive company cars in the past (Audi A4,A5,A6, BMW 5, Volvo), often with "lights and sirens " installed and drove Seat,Skoda,Hyundai, Volvo privately.

None of them were as fun. None of fhem were as versatile and comfortable. And funny enough I safe enormous amounts of money.

And all the downsides people worry about? So far I didn’t have any.

Charging? Absolutely no issue - beside the fact that my sparky is shit and I still don’t have a home box (but a 200 bucks mobile box off Amazon helps). Even with long distances it’s no issue - even in remote locations I had a chance to charge,often easier to find than petrol. And on regular trips it takes as much time to go to the toilet and get me a coffee. Which I would also do with petrol… So in fact I save a few minutes. Even under these circumstances I pay half compared to what I payed for petrol.

Battery issues? The car is used. So far: Zero degradation. We had it assessed by a professional company recently.

The only two issues it has: Preconditioning is somewhat random (which has been solved with the facelift) and the fact that the drivers profile is not based on the key sucks.

Yeah, the wireless charging is a no-go for me as well. I understand that it costs licensing and wastes energy. But the environmental impact of all the useless/lost cables is also a point,especially when you get your energy fully renewable/self produced. And in a lot of areas (airline lounges,etc.) it has become widely adopted/the norm.

They could easily have offered a “swap” battery that has a little less capacity but includes wireless charging - give people a fucking choice.

Yeah,but can we please leave Venice intact doing that? Without the tourists it’s a nice little city to be honest, and its inhabitants have suffered enough.

Maybe Marghera?

Sorry for the late reply.

Here are some leads - not all of these studies are truely “rockstars”, but they will lead you into the right direction if you follow their citations.

Myocardial Infarction: Searcy R, Patel R, Drossopoulos P, Arora S, Stouffer GA. Rural-urban disparity in survival and use of PCI in patients who develop STEMI while hospitalized for a non-cardiac condition. Curr Probl Cardiol. 2025 Mar;50(3):102979. doi: 10.1016/j.cpcardiol.2025.102979. Epub 2025 Jan 10. PMID: 39800089

Sasaki K, Koeda Y, Yoshizawa R, Ishikawa Y, Ishida M, Itoh T, Morino Y, Saitoh H, Onodera H, Nozaki T, Maegawa Y, Nishiyama O, Ozawa M, Osaki T, Nakamura A. Comparing In-Hospital Outcomes for Acute Myocardial Infarction Patients in High-Volume Hospitals Performing Primary Percutaneous Coronary Intervention vs. Regional General Hospitals. Circ J. 2023 Sep 25;87(10):1347-1355. doi: 10.1253/circj.CJ-23-0188. Epub 2023 Aug 10. PMID: 37558468.

Stroke/Traumatic brain injury: Quantifying Improved Outcomes, Cost Savings, and Hospital Volume Changes From Optimized Emergency Stroke Transport. (2022). Stroke,53 (12), 3644–3651. https://doi.org/10.1161/strokeaha.122.039172

Tepas JJ 3rd, Pracht EE, Orban BL, Flint LM. High-volume trauma centers have better outcomes treating traumatic brain injury. J Trauma Acute Care Surg. 2013 Jan;74(1):143-7; discussion 147-8. doi: 10.1097/TA.0b013e3182788b5a. PMID: 23271089.

Saposnik G, Baibergenova A, O’Donnell M, Hill MD, Kapral MK, Hachinski V; Stroke Outcome Research Canada (SORCan) Working Group. Hospital volume and stroke outcome: does it matter? Neurology. 2007 Sep 11;69(11):1142-51. doi: 10.1212/01.wnl.0000268485.93349.58. Epub 2007 Jul 18. PMID: 17634420.

Tsai SHL, Goyal A, Alvi MA, Kerezoudis P, Yolcu YU, Wahood W, Habermann EB, Burns TC, Bydon M. Hospital volume-outcome relationship in severe traumatic brain injury: stratified analysis by level of trauma center. J Neurosurg. 2020 Mar 13;134(3):1303-1315. doi: 10.3171/2020.1.JNS192115. PMID: 32168482.

Trauma: Tang A, Chehab M, Ditillo M, Asmar S, Khurrum M, Douglas M, Bible L, Kulvatunyou N, Joseph B. Regionalization of trauma care by operative experience: Does the volume of emergent laparotomy matter? J Trauma Acute Care Surg. 2021 Jan 1;90(1):11-20. doi: 10.1097/TA.0000000000002911. PMID: 32925573.

Nathens AB, Jurkovich GJ, Maier RV, Grossman DC, MacKenzie EJ, Moore M, Rivara FP. Relationship between trauma center volume and outcomes. JAMA. 2001 Mar 7;285(9):1164-71. doi: 10.1001/jama.285.9.1164. PMID: 11231745.

Let me know if you need more info on a specific field.

Currently at a conference, but will do. Remind me in two days if I forget it.

Hello fellow Black Forestian! (Neustadt? It has 150 beds, doesn’t it? I hope you don’t mean Oberndorf,Stockach or Wolfach…In these cases I have a lot of bad news for you…but they don’t fit your description)

• Imaging: In cases like this, angiography is an imaging option to see which can be used (even though it’s much rarer these days).Germany is also pretty much alone with it’s common use of MRIs - these machines are expensive to run and are only that widespread because we use them far more than clinically indicated-this is why they are often outsourced to a radiology clinic(in Neustadt to a Freiburg one…their afterhour availability…is varying). Additionally even these machines often cannot perform all necessary imaging options (e.g. perfusion MRI for stroke)

• Blood means a blood bank. These cases need blood transfusions urgently. Currently none of the smaller Black Forest hospitals has more than a few emergency blood products. Everything else needs to be delivered - which is a problem if shit hits the fan

• Stroke is a nice example actually: We have a nice system of telestroke care,indeed. And medical development will kill it within the next few years. Because by now we have more and more evidence that thrombolysis (dissolves the blockage with a drug) has worse results than thrombectomy(removal of the cloth - in these cases with a catheter similar to a cardiac cath lab). And that even if it takes longer (lysis has a timeframe of 4.5 hours, cath can often be performed up to 24h after the incident) it shows better results. Even before that was it was a game of numbers as “bloody strokes” as in vascular damage strokes - the vessel is not blocked but ruptured- always couldn’t be treated in telestroke units as fhey required neurosurgical intervention and we knew from the beginning that the telestroke concept did them more damage than good,but as they were rarer it was acceptable. The cath-based thrombectomy has one major downside, though - it is an extremely advanced (both skill and equipment wise)and delicate process. In the black forest region only Freiburg Uniklinik, Villingen (rather recently) and Basel currently are able to do so.

• A myocardial infarction is another very good example. The state-of-the-art treatment for an MI is a catheter intervention. Period. Anything else is not even remotely as good. We also know, that interventionists need a certain quantity of interventions to do so reliably,fast and with a good quality. This already makes it hard to impossible for a small hospital to provide good outcomes. Even medium sized hospitals like Tuttlingen(450 beds )fail to provide these, especially in urgent cases. There is already an abundance (fucking Waldshut has one but does not provide urgent care 24/7)of cath labs in Germany - which by a “euros needed to treat” perspective is a total waste of money but as cath interventions are a good way to make money for a hospital it is acceptable for some reason. Most other countries in the world cannot afford this luxury (and we can’t either, tbh) Anyway. In your case the MI wouldn’t even be transported to the small hospital right now. The ambulance service does a 12 lead. If this confirms a STEMI (MI with urgent cath lab need-the most urgent one) it will be transported to a cathlab right away(currently Villingen,Krozingen, Freiburg Uni and Josefshaus, Freudenstadt, Singen, Basel,sometimes Waldshut, sadly Lörrach). And no, we don’t measure outcomes just for the cases which arrive at the hospital alive - all major studies factor in transport times and even then the results are absolutely staggering in favour of a concentration of facilities. (And even if we would follow international standards and remove the Cath labs from Waldshut, Lörrach and Tuttlingen the patients would benefit). There is only one very small subgroup of patients this doesn’t apply to: Patients who either already have an cardiac arrest at the time the ambulance arrives or within the first 10min of treatment and in theory could be catheterised with ongoing CPR - but these are rare, even then have a horrible outcome and the evidence even in an urban setting simply is inconclusive.

Don’t get me wrong, I do agree with you on some points:

• Our secretary of health is…a dimwit. As a Bavarian reingeschmeckter here I really really feel ashamed. We didn’t want him and then he became a secretary of health here. (And I’ve met him personally. The only good thing I can say about him: He is not as bad as Karl Lauterbach or Jens Spahn)

• The uni hospital fucked up,yes. But at the moment of “shit hit the fan” the patients survivability would have been better in a uni hospital - even considering the driving distance. (Hungary has an excellent ambulance system that surpasses ours in some areas)

And don’t get me wrong: The way we “concentrate” hospitals in Germany is a scam. We actually simply close hospitals without extending the amount of beds and capabilities in the centres. Which then of course leads to overcrowding, etc. From a healthcare economist’s perspective you would need to build up 1.2 beds in a centre per bed closed as people normally would need to stay a bit longer there due to various reasons. Only then it works properly. There is also the option to retain some beds in a step down approach, with primary and urgent care being delivered in the centre and the patient later being transferred to the “smaller” facility but treatment is still being controlled by the centre, as well as using the smaller facility as an urgent care clinic, e.g. in partnership with external medical offices. As it is done in the UK,Australia, Hungary (sic!), Italy,Australia, etc. But for the later we would need a centralised healthcare management and not a rag rug of different providers.

Oh damn. Here we go again.

We have a mountain of evidence, that small hospitals are providing far worse outcomes, even if you factor in transport times to larger facilities. They don’t have the equipment(from blood, to imaging, interventional radiology, etc.), the qualification(you won’t find a interdisciplinary surgical team like you find in a larger centre)and the experience(you need to have a certain case load to keep your skills up) to handle cases with higher severity.

Of course people feel like the “good old hospital” close by would “save their life”, but the times where a small surgeon saves a life are long gone. (And realistically they fucked up more than enough cases back then as well. We have started to gather evidence about that since the 50ies).

In that case multiple people fucked up. There is zero evidence that the uterus rupture wouldn’t have happened if she was an inpatient - or that she would have survived if she was an inpatient in that small hospital.

Which hype? Matrix as a protocol is used for a decade now, especially by various big governments (French, Luxembourg and German governmental messenger, various German states, German and Polish armed forces, German healthcare messenger, various smaller projects in Latin America), is bridgeable (I currently have it bridged to Whatsapp and Signal amongst others) but I really don’t see a hype - on the contrary I only see people predicting me the immediate apocalypse of Matrix for 5 years now, currently due to matrix.org (one of a hundred instances) introducing a premium account model for the most cost intensive (heavily media sharing)users. (See below for that).

Overdramatic blog post,sorry. I can’t stand the whole “fremmium” crybabies that then literally recommend the next freemium or “non transparent funding model” service… And don’t understand the fundamental difference between the Protocol and one of its implementations.

Matrix as a protocol is solid and is used far beyond the Matrix messenger. (e.g. the French and German governmental messenger, the German healthcare messenger,various armies,etc.) With a lot of commits coming from there - but not enough funding,that is definitely an issue.

The current issue with Freemium is solely limited to the matrix.org instance. There are hundreds of federated instances out there that aren’t Freemium and won’t have the need to go that way as they are funded differently.(e.g. the Lemmy Instance I am currently writing from, feddit - we are financed through other means) As they are federated it doesn’t matter - and honestly, I personally tend to see this as a good thing - it will lead users away from matrix.org towards other instances, making the whole network more reliable and decentralized.

There are two other issues that are relevant, though: The way the foundation is run is not ideal, definitely - there are and were issues and I am not happy with some management decisions, but at least they are getting somewhat better recently (government board). The whole protocol does not evolve as fast as it should be and this is an issue,especially as a it also affects bug fixing. As an executive for a (much smaller) company myself I see management issues and infighting due to lack of leadership within the foundation and I am not happy with that. The second issue is Element as a company that does things companies do - focus on making money. This in theory would be a good thing if Element would send enough money AND effort upstream to seriously bring the whole project forward. For a long time this seemed to be the case,but licensing issues and the “stale” development off Element X(Matrix 2.0) has me questioning that as well - but recent changes show us hope in that regard. We also need to carefully reconsider if element is keeping too much"closed" source code for monetized features and what influence VC really has. In conclusion: We need better leadership for Matrix,more transparency and more funding.

The good news is: It doesn’t mattter too much - if the current foundation fucks up and goes belly up it is not the end of Matrix - the protocol is decentralized enough and the licencing of the core components permissive enough for another (better?) foundation to start over. There are dozends of clients available and we have alternative servers available by now.

The funding part nevertheless is my major pet peeve here. All around Europe governments try to get rid of US tech - and use Matrix protocol based products. But they hardly if ever fund that. If Germany, France, Poland and Luxembourg (the big users) would give 5€ per year for each client they implement all issues with funding would be gone, Matrix 2.0 would be available in a few months, VC could be pushed out of elements AND they could mandate more transparency.

The issue with funding is relevant for all NGOs and especially in tech. Running servers costs a fuckton of money.

Signal has a respectable amount of backers but is a centralized protocol and when Trump does something shady moneywise their infrastructure,money and possibly even people will be gone within 24 hours.

Threema has a more sustainable business model but Switzerland is,well, difficult, in terms of privacy and intelligence services overreach, especially towards traffic pointing to foreign servers or hosts.

Revolt is a centralized service with no federation,limited selfhosting capabilities,with unclear funding(we are waiting for a financial transparency report for ages now).

Polyproto is still not quite there feature wise and funding, etc. is unclear.

Delta Chat is indeed an option but has massive technical limitations.

That leaves XMPP as the sole big competition if you want non-centralised, non-US based, privacy friendly, messaging.

And Switzerlands records in terms of privacy sadly is far worse than most people think - even with the last attack being repelled.

Matrix (preferably on a non-matrix.org instance) currently is the preferable non US and privacy friendly way.

Now make it 60! That’s the only number that counts! One per second!

(And yes, that’s doable,done that,but won’t do it again…it wasn’t pretty,it wasn’t fun)

Yeah, a friend of mine literally told them “I’d rather let you fire me than end up in El Salvador”.

They didn’t fire him. The US client was infuriated, but now they meet in Canada or London.

Don’t get the Kobo,it works only mediocre with Calibre Web and other “web based” “personal librarys” - and Kobo is forcing Kepub down users throat more and more. Kobo only looks good if you come from the hellhole that Kindle has become,tbh.

I would highly recommend looking into Pocketbook and especially Onyx if your goal is a more “free” approach.