I work in disaster planning - so if you want a really good disaster to happen then give me a call.
To be more serious:
I write disaster response plans mostly for the medical field, e.g. hospitals, nursing homes. That starts with ordinary fires and flooding, but also includes things like “IT outtakes”(which kill far more people than fire each year), “supply line collaps”, etc.
We also train staff, mostly management, and conduct full scale exercises. Additionally I write medical intelligence and evacuation reports. These are basically “plans” for aid workers, expats. that go to risky places: “Oh, I broke my leg in bumfuck nowhere South Sudan! What now? Is there a hospital? Which one do I go to? Which one has actual doctors? Is there a chance that a medical evacuation plane can reach me?”
Originally I am a critical care paramedic and I am currently studying towards (another) master degree in healthcare management. Before I founded my current company I worked as a consultant for various healthcare related firms, before that as an ambulance service director.
But mass casualty situations always were “my thing” and the multi-stakeholder approach I take during planning talking to basically all roles in a hospital, from the higher ups to the guy in charge of waste disposal, is something I enjoy immensely.
I had one with my countrys version of the “Van”. Then ubiquity had a zero day exploit become public knowledge back then and someone renamed the SSID “NotThePolice”. Didn’t do anything else. Just that.
Yeah, you’re of course right, after a 12h shift people should go outside in the dark rainy night instead of enjoying themselves for an hour in front of a PC and first and god forbid they live in a region without much nature.
I mostly buy parts for my woodworking shop at home from Ali. A benchdog is a benchdog and they are absolutely the same to what you get at Amazon,etc. And they are literally 1/3 of the price here even if you add shipping and customs. So if one is truely shit I couldn’t care less.
So far I had no bad experiences really - one shipment was missing a 2 bucks piece but I can live with that. Some things actually surprised me as the quality I got was better than expected.
Electronic wise I bought a Qotom mini PC from them years ago (directly from the Qotom shop) which still works as my UTM.
You are absolutely right in terms of most paradoxical reactions - and interestingly they even change during a patient’s life. (Everyone working with mental health patients has a good story about a nana on a -pam going totally apeshit, throwing with faeces and definitely not getting any sedation from it).
Nyquil and Nodoz are actually quite common for paradoxical reactions,as are all Benzodiazepines. And there are patients who absolutely do react sensitive to medication. I am a good example for it myself: I am a fairly bulky guy but need minimal dosages for hypnotics like propofol - an amount I would consider barely sufficient for a 50kg nan knocks me out. Give me a Benzo on the other hand and I talk to you when others are already not breathing anymore.
SSRI are a bit different here, though. While I am absolutely sure, that classical paradoxical reactions exist they are extraordinarily rare, simply based on the mechanism of action the SSRI use. A true paradoxical reaction would mean that ones serotonin mechanisms react vastly differently - while this does occur it’s extraordinarily rare, most common in already extraordinarily sick patients and would have led to other problems beforehand. There is overwhelming evidence that almost all cases reported are caused by the (almost physiological) initial paradoxical effect, insufficient plasma levels or insufficient adaptation times.
Again, there are patients who still will react strangely to SSRIs (and I am absolutely not a fan of them, I think they are an easy way out for a lot of providers but the cost/risk ratio does not really recommend them). And a lot of patients don’t have a good experience with them. But that is not a paradoxical reaction but simply the difference between patients mental reaction to it. Which should be evaluated after proper dosage levels are achieved.
Why I am so particular about that topic? First off we see a lot of patients self therapy with SSRIs lately - changing their dosages, stopping them without any slow reduction,etc. That kills people. And from a broader stance we do see a lot of “self declared reactions” in patients. And that is a huge problem and a huge cost increase for the whole system.
(Buckle up fellas, grandpa is talking about the war again)
To stay with SSRIs: If someone has a proper paradoxical reaction to them we can no longer safely use Triptans against migraine, SNRIs, tricyclic antidepressants, MAOIs, amphetamines, pethidine, tramadol and heaps of other drugs as paradoxical reactions have been linked to Serotonin syndrome. I recently had someone report a penicillin allergy. 10% of all patients report it. Less than 1% of those have it. We couldn’t properly interview the patient so we had to use alternative antibiotics. They are more expensive, often less powerful, often reserve-Antibiotics we try to avoid giving directly, have more side effects (in this case they led to the patient needing dialysis for quite some time. This is achieved by putting two finger sized catheters in your vessels. Not pleasant and definitely risky. (This is how I met her, we transferred her to a hospital being able to do that)
Wanna know what happened in reality with the penicillin? The patient took a course of it and suffered from diarrhoea for two days. That’s a common side effect from the penicillin killing your gut flora. She told her GP and he explained it to her. When she moved she told her new GP about her “bad Penicillin allergy”. Which led to this clusterfuck. There is a good chance the whole shebang she suffered from (Sepsis, Amputation, Dialysis, etc.) could have been avoided as the infection was highly sensitive to… penicillin…
Hope that anecdote explains why I am so critical about this topic. It’s absolutely okay and necessary to recognise different drug tolerances (even more so as they are not considering gender, ethnicity,etc. most of the time) - but please do so openly with a healthcare provider and don’t self diagnose.
Paradoxical reactions to SSRIs are quite common and simply mean that the required levels are not yet reached - either by too low of a dose or by (much more common) not taking them long enough. SSRIs take 14-21d of taking the right dosage to properly work.
And please: Do not fiddle around with SSRI dosages and administration: This can absolutely kill or fuck someone up permanently.
Came here to write that. Central Park didn’t need to be copied because a lot of European cities had that decades to centuries before.
Tiergarten Berlin, Schlossgarten Stuttgart, Praterinsel Vienna, Planten un Blomen Hamburg, Maschsee/Eilenriede in Hannover, Züriberg Zürich, just to name a few in the Germanophone world.
It’s possibly harder to find a large city who hasn’t some equivalent than find one with it - and most without one lost it after WW2 and American city planning.
Amazon is only slightly better than AliExpress here, lots of bullshit recently, but at least they are faster. But if you look closer you often find the same stuff from AliExpress for more than three times the price there. So far I only had one or two issues with AliExpress, but as a rule I tend to not buy anything that goes on my body or food, has batteries in it or is worth more than 20 (very rarely more than 100 due to my countries custom rules) bucks with the exception of microelectronic components.
Etsy has been good for me if you look for actual local sellers or digital products - Only once has an issue there,that was clearly dropshipped. But most of the stuff I buy there is a digital download from some obscure graphic artist anyway. Nowadays I more and more tend to use Fiverr for that and get properly made to order graphics anyway.
Yeah, thankfully in central Europe our “bumfuck nowhere” still means that some infrastructure is reachable within 120min usually - and as long as the weather permits we throw dozens of helicopters at it.
Personally I am far more afraid of other scenarios therefore.