uberuberuber

https://archive.ph/T3DAP

Was this a more economical approach than launching those missions on an expendable rocket, and just building brand new satellites?

The shuttle program launched 135 missions at a cost of $209 billion (2010 dollars).

Highly recommend this irreverent podcast by 2 engineers and former NASA contractors. They get out above their skies on some topics but the shuttle content is fun.

Episode 1: Why do Blake and Craig think the Space Shuttle was stupid? https://youtu.be/KRlD8SdFmaE

Episode 18: Challenger https://youtu.be/H98IGl7pSfQ

Critical care medic here. Adult CPR at least has some evidence in its favor on a population level, but only as a bridge to using electricity. CPR alone is merely slowing deaths arrival.

There is NO evidence to support any of the commonly used advanced cardiac life support drugs in terms of functioning brain leaving the hospital. Epinephrine (for arrest, not shock or anaphylaxis), atropine, lidocaine, amiodarone, procainamide, digitalis, etc. Its electricity or bust.

Just one of many reviews on this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129833/

His student Dani Daortiz is amazing to watch. https://youtu.be/5_KcQt0z-eE

The explanation of this 10 minute act using a non-gimmicked deck of cards is 3 hours long. https://www.vanishingincmagic.com/card-magic/dani-daortiz-fo...

Intuitive Surgical - Onsite in Sunnyvale, CA and Remote

Internet famous for doing surgery on a grape: https://youtu.be/0XdC1HUp-rU?t=72

'Intuitive has been built by the efforts of great people from different walks of life. Our outstanding team, with diverse backgrounds, life experiences, and ideas, has helped pioneer—and continues to be a leader in—the market for minimally invasive, robotic-assisted surgery. Our surgical and endoluminal systems serve a diverse and global community of healthcare professionals and their patients.'

Growing fast... https://careers.intuitive.com/us/en/c/information-technology...

The specific robot used was likely the da Vinci Xi. https://www.youtube.com/watch?v=_q-YQwFjIj0

Nice explanation of how a robotic sigmoid resection is performed: https://youtu.be/LpzxfMRlBVk

Firefly perfusion assessment time-stamp: https://youtu.be/LpzxfMRlBVk?t=1527

Disclosure- Intuitive employee with no specific knowledge about this case.

I believe so... however it is gold unlike most of the media pics showing a white Lexus.

A vehicle with a similar external sensor array has been parked in a lot near my workplace every weekday at lunch time for the past several weeks. Given the proximity to AC3 at Central and Wolfe, my coworkers and I had all assumed it was an Apple test of some kind.

Accords with the rumor mill surrounding Apple leasing a former Pepsi bottling plant down the street.

https://www.bizjournals.com/sanjose/news/2016/03/01/apple-le...

A giant leap backwards in information density.

The "in the news" section is just trending hashtag fluff.

"Easier Navigation" == More clicks to access the same content.

And best of all... no option in settings to opt out.

For 8 years, this man had the option to walk humanity back from the threat of hair-trigger, launch-on-warning nuclear armageddon. An armageddon that would either destroy humanity in a single day...or perhaps merely starve a few billion in the resulting nuclear winter. From these facts alone, I know everything I need to know about his, and all US presidents, commitment to the health of their citizens, and humanity at large.

More unethical than manufacturers of nuclear weapons components, missiles and drones?

Makes for a nice soundbite but I hope he doesn't actually believe this given Lockheed, Texas Instruments, General Dynamics, etc. are all a part of SV.

There are many great interviews by Scott Horton with Scheuer. http://scotthorton.org/tag/michael-scheuer/

On the AT up to a few weeks ago. A few hundred miles in a weekend hiker with one of these at a shelter let everyone recharge their devices and they were a modern Prometheus to us. If weight (33 oz + pot + utensil) were not such a crucial consideration to one's happiness when long distance hiking it would definitely be in my pack. It has worked very well for me when testing at home (boils 1 liter of water in ~4 minutes using a handful of wood fuel) and charges devices (subjectively) as fast as my wall outlet.

I plan on winter hiking thru some areas with re-supply locations > 7 days apart and may use the biolite in place of my solar external battery (9.4 oz) since it will also serve for melting snow. I did not cook anything while on the AT (just soylent and mainstay bars) but I anticipate that warm meals will make winter hiking more enjoyable.

Having to negotiate some paperwork is a small price to pay for not dying of an infection. The ER is required by law to provide you with care, regardless of your ability to pay, or immigration status. They do not 'turn in' or 'report' people without ID/passport/green-card/etc. Depending on the nature of your illness, just taking an oral antibiotic is unlikely to be curative.

If you really want to just take an antibiotic, you could just rush order from here with no prescription needed. Fish antibiotics are the same as humans...just less quality control. http://www.fishmoxfishflex.com/index.php/fish-antibiotics.ht...

Amazon must have cracked down on their sale because they aren't available judging from the search results.

In the sturm und drang that has resulted from this tragedy, and the weeks to come of hand wringing about terrorists/crazyfolk/etc across the major news networks, I hope against hope that we can stow our reptilian brains for a brief while… In the 3 hours that have passed since the top comment was made, 205 people in the US have died from heart disease(1), an almost entirely preventable disease. This observation may be construed as heartless, insensitive to the victims, and "if it were your X then it would be different"… but I contend that each time we act like chimps and allow our attention to be drawn to the latest epidemiologically insignificant tragedy we lose as a species. A van distributing a year's supply of aspirin to the fleeing masses would have been more helpful than any ambulance..

(1) http://www.cdc.gov/nchs/fastats/lcod.htm

I'd like to again qualify my status as a non-expert with regards to the surgical aspects of trauma treatment and biochemistry. I have seen similar articles about the foam, and I must admit I am similarly skeptical. The ‘Golden Hour’ is one of those concepts in medicine that everyone praises (it originated @ Marylan’s Shock Trauma center if I recall), but it actually does not have an evidentiary basis.

There are 3 categories of trauma patient, people who will die no matter what you do (hole in the aorta), people who will live no matter what you do (fractured extremities), and people where the outcome may be influenced by treatment in the field. My non-evidence based opinion is that the people in this 3rd population who have the types of injuries that would benefit from this foam will be rather limited. The aorta, inferior vena cava, kidneys and parts of the duodenum, pancreas and rectum are all retroperitoneal. Thus, filling the peritoneal cavity with foam could put pressure on bleeding structures located in the retroperitoneal space, but I would be skeptical. So this foam is for people who have don’t have large hemorrhage of anything in retroperitoneal space and don’t have a fatal mesenteric, liver, or spleen injury, but do have an injury to one of these structures that is sufficiently bad to warrant the foam. The risk of exposing patients with liver and spleen lacerations that could have been managed non-operatively (again, not a surgeon by any stretch but I believe this is a growing trend) to an unnecessary laparotomy isn’t mentioned.

The target audience for this item is going to be armed forces medics with (in my opinion) highly variable clinical skills. Expecting these medics to accurately diagnosis these injuries under heavy stress and not sacrifice time that should be spent on proven therapies like blood administration, tourniquet placement, warm blankets, etc. seems unwise to me.

I am a former critical care medic, and lack the scientific training to judge the merits of their claims about mechanism of action, but if history is any guide regarding ‘miracle’ products it will not live up to the manufacturers claims.

The use cases I can think of and commentary:

-Hemostasis after non-emergent ear/nose/throat procedures. -Packing of the wound + local epinephrine administration is currently used. It costs nothing, is well understood, and doesn’t have the potential for embolization or immune system interaction weirdness.

-Hemostasis of an extremity wound AFTER a tourniquet has been applied. -After a tourniquet is properly placed, the arterial flow is halted. Trauma teams have learned from military and orthopedic surgeons that tourniquets are much safer than traditionally understood. Even an amputated limb has a warm ischemia team of 6 hours. The addition of a clotting agent would stop venous oozing, but wouldn’t affect hemodynamics of the patient. It might assist in the case of an inappropriately applied tourniquet.

-Hemostasis of an abdominal wound. - I guess they envisage pouring this material into the abdomen? That seems like the place most fraught with danger of embolization distally to the mesentery and the generation of immune system interaction weirdness beyond my knowledge base.

A kaolin-based product (Quickclot) was similarly marketed as a wonder drug for treating massive hemorrhage on the battlefield, and it has been less than wonderful in practice. There are youtube videos attesting to its efficacy on the femoral arteries of swine, however these videos ignore the effect wind has upon the powder in a combat setting, and the exothermic reaction that takes place to create the plug. The only way to stop a large hemorrhage is to use copious amounts of the material, resulting in severe burns in some case reports. Concern over embolization of the clotted material led them to create a gauze-bag version.

The company’s claims that holding pressure over the wound is not required runs counter to basic trauma care recommendations. The single best way to halt life-threatening hemorrhage in an extremity is a tourniquet, and the only thing that halts thorax hemorrhage is a surgeon’s finger. The inclusion of this gel in the treatment algorithm would need to be as a last resort, and must never distract from the basics of direct pressure and rapid transport to a surgeon.

I don't know if this qualifies as an ad hominem on my part, but the article comes across as written by the journalist in close coordination with the companies PR firm. The 'hook' inherent in the choice of headline combined with the lack of any discussion of the limitations of the product or previous failures with regards to ‘miracle’ hemorrhage agents cements this in my opinion.

I should have fleshed out that thought more fully. I agree it's a mouthful, but I was trying to convey that we no longer have to believe in such strange (bad) ideas because we have a new set of strange (better) ideas (connectomes and such) that actually have evidence underlying them. The way the course described Sakarnas was as 'bad non-physical spirits/objects/states' that were generated by the body, and that meditation would enable one to "release" them, and prevent their development in the future. Obviously the more evidence-based interpretation of meditation is that it in some way re-wires certain neural connections in a manner that seems to be generally positive.

I'm not in favor of change for the sake of change, but when better reasons are available to describe a phenomenon, I think we should adopt those reasons. Surviving for thousands of years is not a virtue when it comes to the validity of ancient texts or the actions of (historical?) individuals (Buddha, Jesus, Big-Mo, etc.).

It's obviously very hard to convey how much one advances in their practice in an objective manner without having an fMRI. The only real 'data point' I have in support of my experience was how radically my ability to watch my breath and maintain my posture changed after the course.

Before the course I was more or less haphazardly trying a breathing meditation where you count your breaths (say 5 or 10), and with a bead necklace I would count how many cycles of 10 I would manage in an hour. If my mind wandered during the 10 seconds then I would start again from 1. I averaged perhaps 20 successful cycles in an hour. I know this sounds, and probably is, atrocious. It was a sobering insight into how distracted I was by the rush of thoughts despite my own deliberate efforts at modulating those thoughts. Additionally, I would feel compelled to re-position my body every few minutes. The slightest pain or itch was enough to break my will and force me to readjust the pile of pillows I relied upon, again despite my own conscious desire to not move or scratch.

After the course, I can now sit comfortably on a simple Zafu cushion for an entire hour without losing awareness of my breath more than a handful of times, and certainly without having to move a muscle.

I don't expect my own anecdotes to convince anyone of the efficacy of these courses. I can only strongly encourage anyone interested to 'walk the path' by attending a formal course to give it a try. I have already signed up for another course to further my own practice.

I completed my first 10 day Vipassana course recently, and genuinely believe that a slightly modified version of the course should be an essential component of any person’s psychological maturation/development. The course I did was the ‘Goenka course’ (dhamma.org), and I would recommend it to anyone interested in learning more about meditation. It is free of charge to attend, and you can actually only donate to the organization if you complete the full 10 days.

The course is almost entirely rational and in the spirit of honest scientific inquiry. The rules seem arbitrary and silly but they are very helpful in quieting your mind, and enabling you to focus entirely on the practice at hand. It took me until Day 3 to let myself relax and enjoy the absence of tweets, posts and text notifications rather than feel anxiety about being disconnected. Assuming one is there for 240 hours, I only have an issue with ~5 of those hours being a bit ‘woo-woo’ as The Amazing Randi would say. I think of Goenka (the videos used in the evening lectures are available on youtube) as a kindly grandparent who just wants the best for you but occasionally tangents into bullshit. Despite his continual admonishments to only believe what is rational, he seems to genuinely believe the magical stories surrounding the Buddha, and it was distracting to have to segue from ‘this is a genuine insight into how the mind generates its own suffering’ to ‘oh wait he is talking BS’. If one replaces some of his more magical terms that are almost Freudian (ie Sakarnas) with 'Maladaptive neuronal connections' they actually make sense.

The sheer number of hours one is able to practice in this setting really accelerates the development of concentration/mindfulness. I think of the ~110 hours spent meditating during the course as equivalent to 220 days worth of 30minutes/day practice, and feel like I have ‘time traveled’ past 60% of a year of training. Happy to answer specific questions if anyone is considering attending a course.

Daniel Ellsberg discusses this in a great talk at the Nuclear Age Peace Foundation. The US didn't think Khrushchev was insane enough to delegate control over the weapons (which we did and still do), but he in fact had. He revoked delegation at some point after Kennedy's speech if I recall correctly.

http://www.youtube.com/watch?v=wk1-2qtWph0

While the doctor's office may have been the proximate agent asking him to 'lie', the true culprit is the incomprehensible, self-contradictory system that elected and unelected bureaucrats in the US have cobbled together over the decades. If the doctor doesn't maintain that privacy paperwork (which as rms noted the police can view at will anyway), they will not receive reimbursement from CMS. There are likely other statutory issues with HIPAA that I'm unfamiliar with. It's difficult to fault them for not wasting their limited time/money resisting the paperwork requirements when it would only detract from patient care resources.

If he were actually In Extremis, the physician/nurse/EMS would treat him under implied consent. Technically a patient of sound mind can refuse care but in practice someone who looks like rms (beard discrimination) ranting about his privacy would rather quickly be hit with a B52 (50mg Benadryl, 5mg Haldol, 2mg Ativan). Emergency providers are in a bit of a quandary as they must choose between the possibility of missing a subdural hematoma on a patient refusing care and facing a wrongful death lawsuit, and facing a lawsuit for unlawful imprisonment and assault.

Most definitely. If the patient's presentation suggests hypoglycemia, it isn't uncommon for a medic to test the glucose level with their machine and administer oral glucose (D50 IV if obtunded) without even getting to a detailed physical that would reveal the implanted pump/monitor. If an amp of D50 failed to raise the blood sugar, then we'd start hunting for other causes like exogenous insulin overdose.

ror.y.h.and

I have a deck with ~40,000 facts for the USMLE Step 1 & 2 licensing boards that I use daily just for fun. My goal is to have flashcards that cover an entire medical school curriculum.

Here's the spreadsheet that I am making the flashcards from...it is primarily medical facts but lots of assorted knowledge as well.

http://dl.dropbox.com/u/21526819/Master%20Memorize%20List.xl...

I'm just postulating. I am a cubicle monkey in medical publishing nowadays and use support staff for tasks that don't require a higher level of expertise, thereby freeing up my time to produce more value.

I understand the importance of learning to do things for oneself within an organization, but at a certain point doesn't it become wasteful to have someone making $50/hr fetching packages when it could easily be done by a lower wage earner, thereby ensuring that the "brain power" (in this context...not denigrating intelligence based upon career path) can focus on what they're getting paid for?

I'll second the first commenter.

A NPO just needs to reinvest profits towards whatever its mission is...

I work for a non-profit medical association, and there is every bit as much of a concern about turning a profit on our products, its just where the profits end up that is different.

Heck, we're even getting xmas bonuses. 5% Base salary + $1,000.

I work for a medical association that publishes a top-100 journal (I work on different products, not the journal), and we have ~20 full time staff members internally working on it. Actual delivery of web content is handled by an outside vendor with their own staff. Tack on the declining $ available from advertising, plus ever more onerous pharma restrictions and there is no way that the content could be delivered for free.