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User: The+Tyro

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  1. Whoa whoa whoa... on Ambulances to Get Virtual Doctors On Board · · Score: 2, Interesting

    And to be honest, physicians don't WANT paramedics bothering them at the emergency department for every incoming patient.

    I don't know what kind of ERs you deal with, but I'm usually very unhappy if a squad is inbound with a really sick patient and they DON'T call. That call gives me extremely valuable prep time, like calling for the difficult airway cart, getting my monster 8.5F subclavian trauma introducer ready, or opening a chest tube tray. If they just "roll in the door" with a pregnant-with-twins-and-seizing patient and they didn't call (and they weren't right around the corner), I guarantee we'd have a discussion/teaching session out in the ambulance bay.

    Otherwise, very little in your post to argue with.

  2. I don't know on Ambulances to Get Virtual Doctors On Board · · Score: 2, Insightful

    I used to be an EMS director... and I have reservations about putting certain things too far out in the resuscitation chain.

    That said, I agree with you; Early treatment is arguably better for many things... assuming that early treatment saves more lives than it costs.

    For instance, Thrombolytics for stroke. I find very few patients actually qualify for that particular intervention, either because they ignore their symptoms and miss the 3-hour window, or because they have contraindications. Despite the NINDS trial, I still have reservations. Maybe in the aggregate we do more good than harm, but in my personal sample size, I've seen a awfully high percentage of intracranial bleeds. This isn't something you could even consider moving out to the EMS world, if only because we don't have mobile CT yet.

    RSI is another example. Rapid Sequence Intubation with paralytics is practiced in very few EMS systems, if only because it's so very difficult to keep people trained to a sufficient standard where they can use it safely. Truth be told, even some physicians can't use it safely.

    The other issue becomes protocols and medical control (which is what this system appears to augment). Do your paramedics have sharp enough skills to be your remote H&P? I know more than a few physicians who'd have serious reservations about ordering a high-risk intervention based on somebody else's history and exam, particularly in this high-liability era. Remember... liability falls on the medical control or medical director physician. Even if the paramedic is just following protocols... who writes those protocols? It's usually the EMS director.

    Telemedicine is definitely here to stay; teleradiology has proven that. It just remains to be seen how far we feasibly take it.

    BTW, do you know Davak?

  3. Public Health on Arthur C. Clarke Reports From Sri Lanka · · Score: 1

    I have to disagree... anyone who stays in a disaster area like that will be at risk, tourist or native.

    Never underestimate what simple public health measures like garbage collection and sanitation do for you. Without working water treatment and sewage systems, the remaining residents will use whatever is handy. Ditches get turned into open sewers, and people drink whatever water they can find.

    You want to see a recipe for the rapid spread of disease? Try a nice warm environment, no potable water, and open sewers. Now add no power for refrigeration, and accumulated garbage with all the rodents/vermin that attracts. With the rodents come other animals to prey on them (like snakes... many of which were probably displaced by the rising water)...

    Bottom line: Most of that area should be evacuated of non-essential personnel. Let the DMAT and disaster-response types do what they do best.

  4. Good Grief on Arthur C. Clarke Reports From Sri Lanka · · Score: 5, Insightful

    All the recriminations now begin, even before the bodies are buried (or even counted). Bottom Line: This is an unprecedented natural disaster, and the same warning/response systems that existed in the pacific didn't really exist in that area of the world.

    This is something so far out of the realm of most peoples experience, that it's quite natural to assume some incredulity on their part. Do you pay attention to the wide-eyed guy on the street corner with the sign that says "The end is near?" I thought not... most people ignore him, just as you probably do.

    Just to add to the political fray, some reports have UN officials already complaining that the US and other western nations are being "stingy" with their aid packages... and even suggesting that those countries raise taxes on their citizens to pay for more aid (if you believe the Wash. Times).

    Maybe some of these folks should focus more on helping, rather than wasting their breath trying to find a scapegoat.

  5. It's called good will on Caveats In Reselling DSL Bandwidth To Neighbors? · · Score: 3, Insightful

    and it has value in the business world. Don't rule out giving away the access for free... you never know what you might get in return (and try not to expect too much... some people are leeches by nature).

    An example from my own experience. My "day job" is as an emergency physician... and that's what pays the bills. However, computers have been a life-long interest of mine, and I am fairly adept with them. It's a great hobby.

    As a side benefit, my hobby gives me something to trade... my nurses and ancillary personnel are forever bringing me broken/virus-ridden computers that I fix for them for nothing. (sometimes it's as simple as dropping in a knoppix CD and running a virus scan). You get unexpected bennies for doing such things... I've received cookies, gift certificates, other food, computer hardware, etc, etc... all for doing something that I enjoy anyway.

    This not only works for my staff, but also for business associates ( for instance, drug reps who I've helped out seem to bring me samples more often, which is very helpful for my indigent patients). I've set up networks and wireless hotspots for other physicians, and I'm also the unofficial IT go-to guy for them. Keeping the medical staff happy takes us back to "good will," and has a direct effect on my job security (if the CEO of the hospital decides to replace the ER group, which includes me, a hue-and-cry from the other physicians can save my job).

    It's all about making yourself valuable to other people... it creates "good will," which can pay off in all sorts of unexpected ways. Don't go into it expecting a big return, because people can often sense false altruism... but never underestimate what that good will can do.

  6. Re:the problem with Freenet on EFF Promotes Freenet-like System Tor · · Score: 2, Insightful

    Ryan,

    Thanks for the reasoned reply.

    I don't disagree that Freenet is a tool, but I'm not sure all factors are equal in judging tools. We could compare to Kazaa, which does trade legitmate files... but trades scads of pirated material. Kazaa may trade many pirated files, but the relative harm is far less. Copyright infringement isn't in the same ballpark as child molestation... the law recognizes this with the vast difference in their respective penalties. The amount of harm (and type of harm) with Kazaa can be argued either way... I don't find Freenet to be nearly as grey.

    Admitted, the Freenet choice is binary; install it and tolerate the content, or not. However, I don't find free speech as an issue to be so black-and-white (that'll bring on the flamewar). Like most things, one needs to apply the doctrine of competing harms.

    Everyone makes choices for themselves based on their own risk/benefit analysis. Cars and firearms inarguably cause thousands of spectacular deaths every year... yet if you really crunch the statistics, most guns are used to punch holes in pieces of paper, and most cars are tranportation devices rather than deathmobiles. My feeling is that the positive balance of content on Freenet is far less clear. If there's one legitimate persecuted speech document on Freenet, does that mean we tolerate 10000 pieces of child porn? That scale doesn't balance for me... but that's me, particularly when there are other ways to distribute that content without the baggage.

    I don't disagree with the existence of the tool... just one particular use of the tool. The choice being all-or-none, I couldn't justify a node for myself... I'm not saying those who set up those nodes are evil or amoral... just that their scales balance a little differently than mine.

  7. the problem with Freenet on EFF Promotes Freenet-like System Tor · · Score: 1, Interesting

    for me is not the speeds, or the difficulty in implementing it... it's the child porn.

    Sorry, but I just can't get past that. I hear all the posters and academics argue about "free speech means tolerating speech you don't like"... but free speech != exploitation of the innocent. Adult porn is one thing... you can at least make the argument that they're consenting adults just making a living... child porn is simply vile... it's sexual exploitation of someone too weak to fight, and mentally unable to understand and/or consent.

    I'm not attempting to play the "won't you think of the children?" card. I'm an EFF member, and a believer in free speech, but there's a bright line there for me. It's my job, literally, to take care of children who have been either physically abused, sexually abused, or both. Those kids are often brought straight to the ER, where Children's Services and I try to pick up the pieces. Maybe I'm too close to the issue, because it's simply visceral for me; I cannot stand the thought of aiding and abetting those kinds of acts, or encouraging the slime who get their jollies from that kind of thing.

    I'm a free speech supporter, but child porn on my computer? I just can't get there.

  8. Actually on Study Links Cell Phones to DNA Damage · · Score: 1

    I believe the association was between Testicular Cancer and radar guns.

    There were some court cases over this, with police officers suing radar gun manufacturers over their cancer cases (let's face it, if you lost a testicle(s) and thought it was somebody's fault, you might look for a scapegoat too). There was one study done (about ten years ago, if memory serves) where a cluster of Testicular Cancer cases was noted in State Troopers... the only common thread seemed to be that they all held their hand-held radar gun in their laps.

    I don't think the subsequent research ever panned out... so this may turn out to be an urban legend.

  9. thin on details on Study Links Cell Phones to DNA Damage · · Score: 5, Informative

    There's not nearly enough information here.

    I'd like to see them cone down the exact wavelengths that are purported to be problematic. It may be only a certain portion of that band that causes enough resonance in the DNA molecule to break the molecular bonds. The EM spectrum is large... and this could be a very wavelength-specific phenomenon.

    For example, everyone knows that Ultraviolet radiation is harmful to humans... it causes sunburns, skin cancer, etc. However, clinical effects within the ultraviolet range of the EM spectrum (consisting of UVA, UVB, and UVC in order of increasing frequency) vary significantly. UVA will tan your skin, but isn't terribly harmful otherwise. UVB, and part of UVC will cause Ultraviolet Keratitis ("welder's eye" or "snow blindness"), and UVC is the worst for causing skin cancer (UVB causes cancer too, but UVC is worse).

    We frankly need much more information... particularly a bit more specifcity about what wavelengths of Cell phone radiation cause DNA damage. A shift of only 20-30 nanometers in the UV range can make a big difference in clinical effects... who knows where the sweet spot is in the cell band?

    I'm not throwing away my cellphone until I know more... a LOT more.

  10. Seconded... on Koolance Water Cooling Kit · · Score: 2, Informative

    and I'd add the following caveats.

    Looooong build time. I have one of the black models with the top-mounted fans, and it took the longest to build of ANY computer I've built. Like most of the geeks here, I build my own systems, and occasionally systems for colleagues/friends. Once you've built a few dozen systems, you can throw them together in record time... not the Koolance. The koolance literally took me most of the day to assemble, due to some unforseen mounting problems (see below).

    Not silent... in fact, it's downright obnoxious on the high-speed setting (though you don't notice it with your headphones on, playing a bit of HL2-Deathmatch). To be fair, however, the cooling performance is quite good... the GPU temps on my 6800GT hardly budge, even while 3D gaming on maximum settings.

    And while we're talking about cooling the GPU... they only recently came up with a decent waterblock for the Nvidia 6800 line of graphics cards. Prior to that new waterblock I just linked, you could cool the GPU with their combo chipset/video waterblock, but not the memory. Also note that their prior "video/chipset" waterblock would NOT fit the 6800's mounting holes... I had to gently enlarge the mounting holes in the graphic card by hand with a drill bit. If you think enlarging holes in a big-bucks graphics card like that isn't disconcerting, you're a richer man than I.

    So now they've made a custom waterblock for those graphics cards... I have NO idea if they've fixed the mounting holes/screws size mismatch yet.

  11. Re:Advertising on MPAA to Sue BitTorrent Tracker Servers · · Score: 1

    Yep... MTV has gone so far downhill that it's probably not worth saving. I remember when MTV first came on the air; today's Music Television bears little resemblance.

    Follow the money... and when they say "it's not the money"... it's always the money.

    BTW, Dan... haven't seen you for a while... how ya been?

  12. Servers on Half-Life 2 Deathmatch Confirmed · · Score: 2, Interesting

    Don't know what servers you picked, but I only had the problem you're describing with one of them... maybe your comp or connection need some tuning? Just a thought...

    Honestly, I had a blast playing it this morning... lots of action... people improvising with the gravity gun all over the place; there's nothing quite so cool as getting kills with a thrown filing cabinet. People were very good-humored about it too. Getting fragged with a filing cabinet is new/different/cool... without the humiliation of getting knifed in the original CS).

    Tip: get the RPG launcher and camp on the roof... you'll rack up some serious frags.

  13. Depends greatly on the IED on DIY Ordnance Disposal With An RC Truck · · Score: 2, Informative

    Many IEDs in Iraq are manufactured out of old artillery shells (the country is awash in them). They're readily available, have fusing apparatus already attached, and have a frangible metal shell that produces plenty of shrapnel. As a bonus, They're relatively safe to handle, and even rookie terrorists can drop one next to a roadway and run.

    Why bother with something volatile or percussion sensitive? Nitro? Picrates? You'd kill more of your buddies handling that stuff than you would kill intended targets.

    Plastic explosive is also used, but you typically can't set that off just by shooting it. Most plastic explosives are fairly insensitive to percussion, and require some sort of chaining, or booster explosive to set them off (like a blasting cap attached to some detonation cord, for instance).

    Burning is an idea, since most plastic explosives will burn... but you could do that by simply soaking it in diesel fuel and lighting it up (old dynamite is sometimes disposed of in this way)... you might not even need tracers.

    Conceptually, though, I like the way you think... far better to sit back at a safe distance and light it up with a rifle. The EOD guys do something similar to this with the .50 caliber Barrett rifles . An incendiary .50 caliber round will make short work of many IEDs and other ordnance.

  14. Variation on that theme on DIY Ordnance Disposal With An RC Truck · · Score: 1

    A number of troops in the Iraq AOR have taken distinct advantage of the very phenomenon you describe.

    Some troops figured out that the terrorists were using circuit boards taken out of locally sold radio-controlled cars to detonate their IEDs. The troops began equiping the lead vehicles in their convoys with transmitters that continually broadcast on these frequencies.

    There's a link here with some details.

    The terrorists are also using cell-phones, FRS radios, and HAM gear to set these things off... those pictures were taken in Fallujah from the terrorists' IED workshops.

    Sometimes broadcasting on the bomb-detonating frequencies isn't a bad thing, particularly if you've already found a suspect device, or are already at a safe distance. Pity the unfortunate souls who radio for help when the suspect device is right at their feet...

  15. True enough on Medical Care Gets Outsourced Too · · Score: 1

    Emergency care is available for all. I ought to know... I provide that kind of care.

    People frequently come to the ER as a convenience ("I didn't want to wait to see my family doctor," or "I couldn't sleep," or my favorite "I wanted a second opinion"). ER care is abused, and people often will NOT do what's needed, and bounce back to me for the same problem I've already treated. I saw a girl a few weeks ago who bounced back to me 3X for her pelvic inflammatory disease (Gonorrhea and Chlamydia, if you must know), all because she didn't take her antibiotics... she finally admitted it when I confronted her on the last visit... she ended up being admitted to the hospital. I see all kinds of people bounce back because they won't stop drinking/smoking, or won't follow my instructions. It's frustrating to spend time teaching patients, only to have them ignore you and come back even sicker. Don't laugh... you're paying for them.

    There are many people who won't do the right thing for themselves no matter how much you try to help them. Single payer has no cure for human stubborness and denial.

  16. that might work... on Anatomy of a LAN Party? · · Score: 1

    I believe this is known as the Bernhard Goetz maneuver (he was the famous "subway vigilante"): declare yourself bankrupt when you get successfully sued by one of your attackers. At least, that was his status when last I heard... I don't know if anyone's really heard much from that guy in a few years.

    Unfortunately for Bernie, bankruptcy doesn't always nullify legal judgements against you... so the admonition about future earnings may still apply.

    This is all part of state law, of course, so your situation can be very different from state to state; you'd be well-advised to consult a local attorney for this kind of thing.

  17. Re: Ummm... on No Secret Ballot for Military Personnel? · · Score: 5, Interesting

    On the off chance that you really don't know, I'll try to offer some context.

    Much of the ill will regarding clinton came from his history. He stated that he "loathed the military", and subsequently dodged the draft. Despite this, he still managed to get himself elected commander in chief... that really rankled the older vietnam-era guys that were still around... some of them couldn't say Clinton's name without spitting. They resented very much having to salute and take orders from him (the younger guys resented Clinton for the same reasons, but it was really palpable among the older guys).

    Clinton's sexual indiscretions were also a huge liability. Military members can be prosecuted under the UCMJ for adultery alone; sexual indiscretions with a subordinate (ie. Miss Lewinsky) are even worse. Many active duty members felt that Clinton, as commander in chief, should be held to the same standard. It's a pretty terrible example to set when the commander gets off for something that would earn a lowly Sergeant a court-martial...

    Note: we haven't even started talking about his politics.

    Anyway, that'll get you started... I'm sure some others in this forum can add some additional thoughts.

  18. you could buy a gun safe on Neither Rain, Nor Snow, Nor Dark of Night... · · Score: 2, Interesting

    Larger, roomier, and probably more readily available than a proper heavy floor safe (I think they sell them at Walmart). Plus, you can bolt most of them down, and many come with fire-resistant liners.

    Add a waterproof container and lock your safe, and you can probably evacuate with impunity.

    Side note: a friend of mine was researching buying just such an item a few years back, and had literature from a bunch of companies. The funniest brochure had a series of pictures of safes involved in various disasters... they were all the same: big pile of ashes/rubble/timbers, with the scorched-but-otherwise-intact safe sticking up out of the rubble.

    IIRC, the same phenomenon was noted in Nagasaki after the atomic bomb was dropped... the four Mosler vaults of the Teikoku bank were found still standing in the middle of the ruins, contents intact.

  19. Ummm... on No Secret Ballot for Military Personnel? · · Score: 5, Interesting

    That wouldn't put a huge dent in the military, which tends to vote republican 80+ percent of the time (I saw a statistic at one time that showed military officers voted republican 8 to 1 over democrat... Here's an article about the Duke Study ).

    I'd have to say from my own experience (former military officer talking here) that the percentage is probably higher than they think. I can count on one hand the number of real liberal democrats I encountered during all my years in the military.

    Bush is respected by almost all the current and former US military personnel I know, in distinct contrast to Bill Clinton. When I was in the service, many officers and enlisted so despised Clinton that they refused to display any certificates, awards, decorations, citations, etc with his signature on them. Despite the prohibition on using "contemptuous words" against the commander-in-chief and elected officials, most guys were (privately) very frank about how they felt... The level of enmity was really remarkable.

  20. I hope they win on JibJab Sues for Fair Use of Right to Parody · · Score: 2, Interesting

    but it's for purely selfish reasons... I want them to keep making those little cartoons. I've gotten some real gut-busting laughs out of those guys. I watched the latest one over and over... Also, if you can find it, watch the old hip-hop one they did with Bush, Clinton, Gore, etc (I think it was called "Capitol Ill") that one was also an unqualified riot (Sorry... I googled, but couldn't find a link)

    It'd be a shame to have those guys muzzled; particularly when they do such nice work (there are a lot of terrible flash cartoons out there).

  21. Re:Well... on Living Without a Pulse · · Score: 1

    Ya done good, kid. Be proud.

    Oh, I'm not ashamed of my efforts at all... it was just one of those surreal moments; reminded me of Roddy Piper's final scene in "They Live" (Old B-movie reference, I know).

    Never a dull moment.

  22. Sorry on Living Without a Pulse · · Score: 1

    Your initial post sounded like naked greed, rather than a reasoned position... I wish you'd expounded a bit more initially; you'd have saved me having to apologize for my scourging.

    Let me throw out a few thoughts... consider them, even if you do not agree.

    Payments would drive up the cost of organ donation. What's to prevent it from becoming a bidding game, where the poor and underinsured can no longer compete? Medical necessity should rule all, yet injecting profit may turn it into a financial decision. Putting a value on life is a slippery business in the best of circumstances... I frankly don't feel sufficiently wise to make that kind of decision.

    I'm very leery of injecting financial incentives into the organ donation process. My fear is that offering such incentives will lead to gaming the system for profit, to the detriment and death of patients. Almost no physician who's been in practice very long will argue this point: unscrupulous people will do unspeakable things for a pittance, even to their own kin.

    So far in my career, I more than once have witnessed family members stall/delay ending a relative's suffering, just so they could make it to the first of the month and collect that next check. I've seen people stab/shoot siblings for a pair of tennis shoes. Injecting payments to the families may tempt many families to not seek aggressive treatment, at precisely the time they should be their critically-ill relative's greatest advocate. When you're waving thousands of dollars under a family's nose, it's not difficult to imagine someone forging an amendment to the ill relative's living will. Those critically-ill and brain-injured patients are absolutely helpless; I'm terrified of the prospect of offering their families a cash payment to part them out.

    What dollar amounts are we talking here? 10k for a kidney? 25k for a liver? I've seen people tortured and killed for far, far less.

  23. Well... on Living Without a Pulse · · Score: 1

    he had tried to kill himself by getting drunk and laying in front of a train (and he succeeded... not too many people survive having an enormous chunk of their torso literally torn off).

    I suppose he was angry because he thought I was going to save him... Well, he needn't have worried; his suicidal efforts/injuries absolutely crushed any skills I might have had to save him... it's a miracle he even survived the 1/4-mile ambulance ride.

  24. You're right. You're absolutely right on Living Without a Pulse · · Score: 1

    Boy, you must live for stories like this

    Actually I do... but not for the reason you might be thinking. (I hit the karma cap years ago, and get mod points all the time that I don't use).

    I can't tell you how much I've learned from reading this forum... I love it. I've picked up some excellent info, websites, references, and technical pearls that it would have taken me years to discover on my own. The least I can do is contribute to the discussion, especially when it addresses something in which I am sufficiently expert to (hopefully) offer some useful comment.

  25. Funny you should say that on Living Without a Pulse · · Score: 1

    I've had dead/near dead people do some pretty freaky things, including one guy who flipped me off moments before he finished bleeding to death.

    I'm pretty sure that carries quite a bit of cosmic weight... a "F*** you" from a dying man...

    Yep... If reincarnation's real, on the basis of that episode alone I'm probably coming back in my next life as a dung beetle.