he'd be totally screwed, and probably unable to move (he'd absolutely be unable to stand).
The human body works best when exercised and used... use it or lose it. Ask any body-builder what happens when he stops lifting; his muscles will lose their strength-training-induced hypertrophy, and he'll get smaller. Zero gravity studies on returning astronauts have shown very rapid bone loss and strength loss... 14 years in orbit would render him unable to stand up... it would probably be a herculean effort to even lift his head. His bones might be so weak by that point that simple gravity could leave him with multiple fractures.
Think it can't happen? It happens all the time in elderly ladies with osteoporosis... and these are people who live in normal gravity (9.8m/s/s). I can't tell you the number of elderly patients I've had with rib fractures from a simple coughing fit... or spinal compression fractures from sitting down too hard in a chair.
14 years in zero g? He'd be weak as a kitten, and probably break half his bones simply from gravity.
But say the average install of SmoothWall is on a Pentium 100 machine, and it lasts for 3 years before being replaced because of failed capacitors in the power supply or a dead CMOS battery or a blown hard drive. All you've done is divert the machine from the landfill for three years.
Or you could replace the fan in that power supply to prevent its death... or replace the power supply entirely, or even the hard drive (if you're really cheap, ebay should provide plenty of old parts). Why replace the entire box for the failure of a single part?
The longer we can make a product's life cycle last, the longer people hold onto it, the less of a throwaway item a computer becomes. I'd love to see computers become more of a "durable good."
What it's really all about is making use of old hardware by running a specialized, task-specific, lightweight OS that doesn't require XP's resources. You understand what I'm talking about... linux in general is great for things like this.
Now, you'll never game on such a machine (one of the things that's driving bigger/faster computers), but you'll save it from an early death.. and the more times we can do that, the slower our landfills will overflow. It also might make people understand that they can do useful things with the computing power they already have, and that they don't need to buy company "X"'s marketing hype that they NEED a 3ghz computer to do websurfing and word-processing..
I'm not an environmentalist, but it makes sense to me.
Yes, you can hit OfficeMax, or Fry's, or Best Buy... and as you do, yet another computer goes into the landfill. Go ahead... purchase whatever black box you can buy the cheapest... but that's not what this article is about.
Also, I'll wager the uber-cheap router you just purchased doesn't have any IDS capability (like Snort), or a cacheing proxy, or eye-candy graphs, or remote management via SSH, or any of the other nifty features that smoothwall offers.
Yes, your hardware might not last... but the point is this: It still works. If you could keep it as a useful tool instead of turning it into a groundwater-polluting hazard, why wouldn't you?
I'm in the process of refurbishing all the computers in the physician's library at my hospital... all the old machines will be put to work doing something other than leaching toxins into the groundwater.
One will become a new firewall... one a fileserver... the possibilities are endless.
I don't know about you, but most of my colleagues just throw old computers away... I rescued 3 or 4 out of a colleague's garage a few months ago. Most physicians are NOT computer saavy, and might be open to assistance from a computer-saavy doc like yourself... just my observation.
Besides, there's the possibility of making "clean" electricity... there's almost no possibility of rendering lead/PCBs/mercury "clean."
turn them into smoothwalls for your friends and neighbors.
Seriously... I've recycled a bunch of old pentium-class machines that were headed for the landfill by setting up a "smoothie" and giving them away to ppl.
ulnar nerve problems can be a bit of a hobgoblin... the hand surgeons often wait as long as they can before operating on them because they sometimes don't get better after surgery (I'm thinking in particular of ulnar nerve transpositions for cubital tunnel).
Neuropathy can certainly be compressive (or diabetic, or drug-induced... there's a bunch of other possibilities). Are they sure that's why you have it? Hyperextending your elbow in your sleep is a bit odd... the most-common sleep posture is a flexor one. If you are sleeping on your back with your hands on your chest, that might do it (your elbows resting on the bed could compress the ulnar nerve... it's happened to me, in fact). YOu can find the ulnar nerve between the bony point of the elbow and that bony lump you can feel about an inch away towards the inside of your elbow). Good thing they're doing the nerve conduction study... that could be important in making the diagnosis.
Heh... As for the drunks, I've thankfully got security guards to distract them. If they're big/bad enough, I assist my security guys by injecting them with the appropriate calming agent... up to and including neuromuscular paralytics... He who has the biggest pharmacy wins.
Yes, I'd love a wallhack in my ER... one that would allow me to keep track of the restless hordes in my waiting room without having to walk out there and endure the accusing "why-the-hell-aren't-you-working-faster?" stares from all the people with non-emergent complaints.
That and a nice area-of-effect weapon for when the obligatory miscellaneous drunk guy and his buddies decide to brawl in the department...
are not so much to protect the surgeon... they're to protect the patient.
They are most often worn during total joint replacements... if that artificial joint gets infected and colonized with bacteria (one of the most-feared complications of orthopedic surgery), it cannot be sterilized with antibiotics... it must be taken out in a second operation.
Orthopedic surgery redo's are a difficult surgical challenge, particularly in the setting of infection. The space suits are for the patients, not the surgeons.
but not unfamiliar...most surgeons these days get lap-scope training during their residency.
The current standard of care for many common surgeries is to do lap-scope unless you've got a compelling reason to do otherwise. Residents learn by imitation, and are trained by their attendings, so when their attendings are largely doing laparoscopic surgery, the residents will too.
As for longer instruments, it's all a matter of practice. The bronchoscope is an example that's more familiar to me... I use them during difficult intubations and to look for foreign bodies. Looking through the eyepiece while guiding the flexible tip with the control knob takes a bit of practice, and so do the the longer lap-scope instruments surgeons use.
I think hand-eye coordination is a critical skill for any surgeon to have (though judgement is probably even more critical)... anything that can sharpen it is for the good, IMHO.
but some of Napoleon's surgeons would have loved to have had access to a chainsaw.
Some of those surgeons singlehandedly did hundreds of amputations in a single day... and it wasn't exactly a gentle procedure. Four or five burly lads held you down, while the surgeon used a knife to quickly divide the soft tissues around the bone, and a bone saw to complete the amputation. A bit of cautery, and the next patient was brought forward...
Seems brutal by today's standards, but that's how lives were saved... a soldier with a gangrenous limb almost always died... a soldier with an amputation before infection could set in had a chance of survival. Remember that this was long before antibiotics were available.
Do a Google search for Jacques Lisfranc: to this day, some foot injuries are still named after him. Dominique-Jean Larrey is another name you might try.
I'm not running down plastic surgeons, I'm just telling you what they've told me. And for the record, there is nothing wrong with covering your butt, particularly in a litigation-prone field like plastics.
The reality is this: when a plastic surgeon takes care of an ER patient, it's often uncompensated, and the surgeon typically never sees that patient again after they are healed. Also, some of the antisocial types that end up needing that kind of surgical assistance can be quite litigious. If that patient comes back years down the line with some kind of legal action, the surgeon may not even remember them... so it's nice to have those pictures. No surgeon I've ever known puts them in his family album. Also, plastic surgeons are variable in their picture taking... the last case I testified in involved no pictures whatsoever.
As far as criminal courts, most plastic surgeons take pictures for their own records, not for criminal prosecution. In the case of domestic violence and sexual assault, the police take their own pictures for those... the surgeon's pictures can be challenged/thrown out in court if they're not dated, no chain of custody, no secure storage, etc.
As far as old records go, they are more of a help than a hindrance, even legally.
Finally, in the case of skin cancers, you rely on the pathology reports (or the intraoperative sections during a Mohs procedure) to tell you if the wound margins are clear... God help you if you rely on photographs for that.
screenshots are often taken and placed in the medical record... it's not only good documentation, it makes it harder for a disgruntled patient to come back later and sue, saying the appendix wasn't infected and the surgery wasn't necessary, etc; it's not only in the path report, it's right there in the chart in brilliant color.
Some surgeons, particularly plastic surgeons, are practically professional photographers... I've often had them come into the ER to sew faces of drunk drivers and bar-fight participants back together. The first thing they do is take a bunch of pictures. The reason why is pretty simple: A before/after picture comparison can be a real case-breaker for a plaintiff's attorney. Even with the most-expert plastic surgeon working on you, almost every wound scars to one degree or another... the before/after pics really put it into perspective for a jury.
Laparoscopic surgery is done with instruments, but they are not usually "remote controlled." You may be confusing this procedure with remote-controlled robotic surgery.
The procedure goes like this:
Patient is put under anesthesia, and the surgeon chooses his port sites based on the procedure to be performed (gallbladder, etc). Once the patient is out, their belly is insuflated with carbon dioxide (gives the surgeon more room to work). There is a camera involved, but the surgeon actually uses long instruments that fit through the trochars he placed through the 2 or 3 holes he made in the abdominal wall. The instruments are simply long... they are not remote controlled.
If you've got the choice, Lap-surgery is preferable to a conventional "open" case... the recovery time is much less. If you've ever had surgery, you know how much it hurts to have your abdomen opened... little things like coughing hurt for weeks. That said, some things require speed, exposure, room to work, and are safer if done open... your complicated aortic aneurysm repair is better done open.
BTW, the surgeon will usually reserve the right to convert the procedure to an "open" case... if you have a heavily calicified gallbladder (a so-called "porcelian gallbladder") he may have to cut you open just to get it out... only so much fits through those little trochars.
The fact that time card cheating took place before Bush took office proves what, exactly
For starters, it proves that it's an ongoing and long-standing problem, and there's little justification for special castigation of the current office holders; it's not like they invented the idea. I suspect the original poster was trying to score political points by conveniently excluding prior officials... it worked... and the original mods bought it.
My five minutes of RTFA allowed me to easily rebut the original poster's comment.. You may share a political bone with the original poster, but don't let your ideology blind you into encouraging weak trolls.
I love a good troll, and you probably do too... but you need to let the bad ones die the mod-death they deserve. For pity sake, the original poster brought up MP3s, starving people, etc... and conveniently ignored the actions of every other administration this country has ever had... far from true, and demonstrably false on a cursory perusal of the article.
and exactly how is this connected to the current administration? Perhaps reading the article would help you see through you anti-Bush myopia.
In interviews, five former Wal-Mart managers acknowledged erasing time to cut costs. Victor Mitchell said that as an assistant manager in Hazlehurst, Miss., in 1997, he frequently shaved time.
It would appear that this was going on long before the current administration came on the scene.
Also:
Mr. Pooters, a father of five who left the Air Force in 1997 for a career in retailing, talks with disgust about photocopied Toys "R" Us records that he said showed how his manager made it appear that he had clocked out much earlier than he had.
It appears the main protagonist of the NYT article entered retailing in 1997, where he noted this illegal practice. Maybe even before the current administration took office?
Additionally:
The Department of Labor recently reached two back-pay settlements with Kinko's photocopy centers, totaling $56,600, after finding that managers in Ithaca, N.Y., and Hyannis, Mass., had erased time for 13 employees.
It would appear the current administration is prosecuting these cases.
That wasn't even a very good troll... you're wasting everyone's time. C'mon moderators... don't reward weak trolls, make 'em earn it.
Buy, hey. "You can lead a horse to water, but you can't make him drink." No matter what I point out to you, I can't make you see the obvious. You have to choose for yourself. Keep your blinders on if that makes you happier. It's not my problem
Well said... very well said indeed, and absolutely applicable to you.
I've offered you an insider's perspective based on my lifetime professional experience and expertise as a prescriber... you, however, have elected to weight your few months programming software in a doctor's office more heavily. Do you realize you've built an ironclad, erroneous opinion based on little more than suspicion, superficial knowledge, condescension, and a cup full of drug-company pens on your computer desk?
My young man, I wish you the best, but you're barking up the wrong tree.
Drugs are not my thing, but I know of people who have been using recreationally their entire lives with few effects. I don't necessarily have a problem with people using recreational substances... but the ones who are smart and discrete about it are not the ones I see.
There are a couple of problems with people roasting their brains and killing themselves in search of a better buzz. One, it's a complete waste. Two, it's an ugly way to die. Three, it leaves behind a trail of sadness and tragedy. Four, I'm the one who has to break the bad news to their mother/father/children.
I find it interesting that people in this thread have replied as if I'm some kind of Office-of-Drug-Control-Policy magpie, when I'm simply offering a valuable bit of clinical correlation about the downside of ecstasy use. Part of informed consent is "informed," and you can't make rational, adult decisions without all the facts. Ecstasy isn't all sweetness and light; there are real, legitimate concerns about its immediate and long-term effects.
I don't necessarily have an anti-drug agenda (I do have an anti-stupid-drug-use bias). I just want people to understand the risks and benefits... that's the legal and ethical standard in my practice.
FYI, the origin of the title "Doctor" is the Latin "Docer" meaning "teacher;" I simply consider that part-and-parcel of what I do.
Histologically, there is little doubt that MDMA can be harmful to serotonergic neurons, and that Prozac can block the neurotoxic effects of ecstasy, even when given hours afterward (this is in animal studies... it's still ethically frowned upon to carve up live human brains). The reports about prozac blocking ecstasy's clinical effects are all over the neutral--->negative spectrum.
There is one study from 1993 where the researcher studied/asked eight ecstasy users their subjective opinions of E on prozac... they felt there was no difference. However, the sample size was small, and there is substantial anecdotal evidence from other users that Prozac substantially inhibits the "roll" from ecstasy.
What is totally lacking, however, is any evidence that prozac increases ecstasy's subjective or histological effects.
And there is NO substantial proof the harm to the neurons is permanent.
I guess it depends on your definition of "substantial." There's certainly a growing body of evidence regarding MDMA... almost none of it good.
Slashdot Mirror
he'd be totally screwed, and probably unable to move (he'd absolutely be unable to stand).
The human body works best when exercised and used... use it or lose it. Ask any body-builder what happens when he stops lifting; his muscles will lose their strength-training-induced hypertrophy, and he'll get smaller. Zero gravity studies on returning astronauts have shown very rapid bone loss and strength loss... 14 years in orbit would render him unable to stand up... it would probably be a herculean effort to even lift his head. His bones might be so weak by that point that simple gravity could leave him with multiple fractures.
Think it can't happen? It happens all the time in elderly ladies with osteoporosis... and these are people who live in normal gravity (9.8m/s/s). I can't tell you the number of elderly patients I've had with rib fractures from a simple coughing fit... or spinal compression fractures from sitting down too hard in a chair.
14 years in zero g? He'd be weak as a kitten, and probably break half his bones simply from gravity.
I want max headroom
Well, *I* never found him that attractive... but if stuttering does it for you...
it's a delaying tactic... but it's a worthy one.
But say the average install of SmoothWall is on a Pentium 100 machine, and it lasts for 3 years before being replaced because of failed capacitors in the power supply or a dead CMOS battery or a blown hard drive. All you've done is divert the machine from the landfill for three years.
Or you could replace the fan in that power supply to prevent its death... or replace the power supply entirely, or even the hard drive (if you're really cheap, ebay should provide plenty of old parts). Why replace the entire box for the failure of a single part?
The longer we can make a product's life cycle last, the longer people hold onto it, the less of a throwaway item a computer becomes. I'd love to see computers become more of a "durable good."
What it's really all about is making use of old hardware by running a specialized, task-specific, lightweight OS that doesn't require XP's resources. You understand what I'm talking about... linux in general is great for things like this.
Now, you'll never game on such a machine (one of the things that's driving bigger/faster computers), but you'll save it from an early death.. and the more times we can do that, the slower our landfills will overflow. It also might make people understand that they can do useful things with the computing power they already have, and that they don't need to buy company "X"'s marketing hype that they NEED a 3ghz computer to do websurfing and word-processing..
I'm not an environmentalist, but it makes sense to me.
Yes, you can hit OfficeMax, or Fry's, or Best Buy... and as you do, yet another computer goes into the landfill. Go ahead... purchase whatever black box you can buy the cheapest... but that's not what this article is about.
Also, I'll wager the uber-cheap router you just purchased doesn't have any IDS capability (like Snort), or a cacheing proxy, or eye-candy graphs, or remote management via SSH, or any of the other nifty features that smoothwall offers.
Yes, your hardware might not last... but the point is this: It still works. If you could keep it as a useful tool instead of turning it into a groundwater-polluting hazard, why wouldn't you?
I'm in the process of refurbishing all the computers in the physician's library at my hospital... all the old machines will be put to work doing something other than leaching toxins into the groundwater.
One will become a new firewall... one a fileserver... the possibilities are endless.
I don't know about you, but most of my colleagues just throw old computers away... I rescued 3 or 4 out of a colleague's garage a few months ago. Most physicians are NOT computer saavy, and might be open to assistance from a computer-saavy doc like yourself... just my observation.
Besides, there's the possibility of making "clean" electricity... there's almost no possibility of rendering lead/PCBs/mercury "clean."
turn them into smoothwalls for your friends and neighbors.
Seriously... I've recycled a bunch of old pentium-class machines that were headed for the landfill by setting up a "smoothie" and giving them away to ppl.
Doing my part to stamp out worms and viruses.
ulnar nerve problems can be a bit of a hobgoblin... the hand surgeons often wait as long as they can before operating on them because they sometimes don't get better after surgery (I'm thinking in particular of ulnar nerve transpositions for cubital tunnel).
Neuropathy can certainly be compressive (or diabetic, or drug-induced... there's a bunch of other possibilities). Are they sure that's why you have it? Hyperextending your elbow in your sleep is a bit odd... the most-common sleep posture is a flexor one. If you are sleeping on your back with your hands on your chest, that might do it (your elbows resting on the bed could compress the ulnar nerve... it's happened to me, in fact). YOu can find the ulnar nerve between the bony point of the elbow and that bony lump you can feel about an inch away towards the inside of your elbow). Good thing they're doing the nerve conduction study... that could be important in making the diagnosis.
Heh... As for the drunks, I've thankfully got security guards to distract them. If they're big/bad enough, I assist my security guys by injecting them with the appropriate calming agent... up to and including neuromuscular paralytics... He who has the biggest pharmacy wins.
LTNS, wowbagger... how ya been?
Yes, I'd love a wallhack in my ER... one that would allow me to keep track of the restless hordes in my waiting room without having to walk out there and endure the accusing "why-the-hell-aren't-you-working-faster?" stares from all the people with non-emergent complaints.
That and a nice area-of-effect weapon for when the obligatory miscellaneous drunk guy and his buddies decide to brawl in the department...
so we have an orthopedic surgeon on slashdot as well (I presume by the spelling that you're British?) ... it's good to meet you.
I see you've already met Davak... he's an internist. I'm an ER doc myself.
I'll be sure to call you for my next arthroscopy.
are not so much to protect the surgeon... they're to protect the patient.
They are most often worn during total joint replacements... if that artificial joint gets infected and colonized with bacteria (one of the most-feared complications of orthopedic surgery), it cannot be sterilized with antibiotics... it must be taken out in a second operation.
Orthopedic surgery redo's are a difficult surgical challenge, particularly in the setting of infection. The space suits are for the patients, not the surgeons.
but not unfamiliar...most surgeons these days get lap-scope training during their residency.
The current standard of care for many common surgeries is to do lap-scope unless you've got a compelling reason to do otherwise. Residents learn by imitation, and are trained by their attendings, so when their attendings are largely doing laparoscopic surgery, the residents will too.
As for longer instruments, it's all a matter of practice. The bronchoscope is an example that's more familiar to me... I use them during difficult intubations and to look for foreign bodies. Looking through the eyepiece while guiding the flexible tip with the control knob takes a bit of practice, and so do the the longer lap-scope instruments surgeons use.
I think hand-eye coordination is a critical skill for any surgeon to have (though judgement is probably even more critical)... anything that can sharpen it is for the good, IMHO.
but some of Napoleon's surgeons would have loved to have had access to a chainsaw.
Some of those surgeons singlehandedly did hundreds of amputations in a single day... and it wasn't exactly a gentle procedure. Four or five burly lads held you down, while the surgeon used a knife to quickly divide the soft tissues around the bone, and a bone saw to complete the amputation. A bit of cautery, and the next patient was brought forward...
Seems brutal by today's standards, but that's how lives were saved... a soldier with a gangrenous limb almost always died... a soldier with an amputation before infection could set in had a chance of survival. Remember that this was long before antibiotics were available.
Do a Google search for Jacques Lisfranc: to this day, some foot injuries are still named after him. Dominique-Jean Larrey is another name you might try.
I'm not running down plastic surgeons, I'm just telling you what they've told me. And for the record, there is nothing wrong with covering your butt, particularly in a litigation-prone field like plastics.
The reality is this: when a plastic surgeon takes care of an ER patient, it's often uncompensated, and the surgeon typically never sees that patient again after they are healed. Also, some of the antisocial types that end up needing that kind of surgical assistance can be quite litigious. If that patient comes back years down the line with some kind of legal action, the surgeon may not even remember them... so it's nice to have those pictures. No surgeon I've ever known puts them in his family album. Also, plastic surgeons are variable in their picture taking... the last case I testified in involved no pictures whatsoever.
As far as criminal courts, most plastic surgeons take pictures for their own records, not for criminal prosecution. In the case of domestic violence and sexual assault, the police take their own pictures for those... the surgeon's pictures can be challenged/thrown out in court if they're not dated, no chain of custody, no secure storage, etc.
As far as old records go, they are more of a help than a hindrance, even legally.
Finally, in the case of skin cancers, you rely on the pathology reports (or the intraoperative sections during a Mohs procedure) to tell you if the wound margins are clear... God help you if you rely on photographs for that.
I didn't mean to nit-pick you there... you were on the right track.
Your surgeons play FPS games with you? Mine are too busy to play games.
Now, I do have some of my ancillary staff that indulge in a bit of counterstrike...
Do a google search for "Alan Zarkin."
He's an OB/GYN from New York who actually carved his initials into a woman's abdomen with a scalpel after doing her C-section.
I wish I'd been on the disciplinary board for that one... I'd have had his license for breakfast.
screenshots are often taken and placed in the medical record... it's not only good documentation, it makes it harder for a disgruntled patient to come back later and sue, saying the appendix wasn't infected and the surgery wasn't necessary, etc; it's not only in the path report, it's right there in the chart in brilliant color.
Some surgeons, particularly plastic surgeons, are practically professional photographers... I've often had them come into the ER to sew faces of drunk drivers and bar-fight participants back together. The first thing they do is take a bunch of pictures. The reason why is pretty simple: A before/after picture comparison can be a real case-breaker for a plaintiff's attorney. Even with the most-expert plastic surgeon working on you, almost every wound scars to one degree or another... the before/after pics really put it into perspective for a jury.
A picture is truly worth a thousand words.
IAAD, and here's the deal:
Laparoscopic surgery is done with instruments, but they are not usually "remote controlled." You may be confusing this procedure with remote-controlled robotic surgery.
The procedure goes like this:
Patient is put under anesthesia, and the surgeon chooses his port sites based on the procedure to be performed (gallbladder, etc). Once the patient is out, their belly is insuflated with carbon dioxide (gives the surgeon more room to work). There is a camera involved, but the surgeon actually uses long instruments that fit through the trochars he placed through the 2 or 3 holes he made in the abdominal wall. The instruments are simply long... they are not remote controlled.
If you've got the choice, Lap-surgery is preferable to a conventional "open" case... the recovery time is much less. If you've ever had surgery, you know how much it hurts to have your abdomen opened... little things like coughing hurt for weeks. That said, some things require speed, exposure, room to work, and are safer if done open... your complicated aortic aneurysm repair is better done open.
BTW, the surgeon will usually reserve the right to convert the procedure to an "open" case... if you have a heavily calicified gallbladder (a so-called "porcelian gallbladder") he may have to cut you open just to get it out... only so much fits through those little trochars.
Just FYI
The fact that time card cheating took place before Bush took office proves what, exactly
For starters, it proves that it's an ongoing and long-standing problem, and there's little justification for special castigation of the current office holders; it's not like they invented the idea. I suspect the original poster was trying to score political points by conveniently excluding prior officials... it worked... and the original mods bought it.
My five minutes of RTFA allowed me to easily rebut the original poster's comment.. You may share a political bone with the original poster, but don't let your ideology blind you into encouraging weak trolls.
I love a good troll, and you probably do too... but you need to let the bad ones die the mod-death they deserve. For pity sake, the original poster brought up MP3s, starving people, etc... and conveniently ignored the actions of every other administration this country has ever had... far from true, and demonstrably false on a cursory perusal of the article.
Don't defend the original post... let it die.
and exactly how is this connected to the current administration? Perhaps reading the article would help you see through you anti-Bush myopia.
In interviews, five former Wal-Mart managers acknowledged erasing time to cut costs. Victor Mitchell said that as an assistant manager in Hazlehurst, Miss., in 1997, he frequently shaved time.
It would appear that this was going on long before the current administration came on the scene.
Also:
Mr. Pooters, a father of five who left the Air Force in 1997 for a career in retailing, talks with disgust about photocopied Toys "R" Us records that he said showed how his manager made it appear that he had clocked out much earlier than he had.
It appears the main protagonist of the NYT article entered retailing in 1997, where he noted this illegal practice. Maybe even before the current administration took office?
Additionally:
The Department of Labor recently reached two back-pay settlements with Kinko's photocopy centers, totaling $56,600, after finding that managers in Ithaca, N.Y., and Hyannis, Mass., had erased time for 13 employees.
It would appear the current administration is prosecuting these cases.
That wasn't even a very good troll... you're wasting everyone's time. C'mon moderators... don't reward weak trolls, make 'em earn it.
then drops down to its coldest temperature at the mesopause
Heh. For a second there I thought that said "Menopause"... many of my older female coworkers with hot flashes would disagree.
Sorry... it's early yet.
Buy, hey. "You can lead a horse to water, but you can't make him drink." No matter what I point out to you, I can't make you see the obvious. You have to choose for yourself. Keep your blinders on if that makes you happier. It's not my problem
Well said... very well said indeed, and absolutely applicable to you.
I've offered you an insider's perspective based on my lifetime professional experience and expertise as a prescriber... you, however, have elected to weight your few months programming software in a doctor's office more heavily. Do you realize you've built an ironclad, erroneous opinion based on little more than suspicion, superficial knowledge, condescension, and a cup full of drug-company pens on your computer desk?
My young man, I wish you the best, but you're barking up the wrong tree.
Believe what you will.
I do try to be worth reading, and I appreciate your comments.
Drugs are not my thing, but I know of people who have been using recreationally their entire lives with few effects. I don't necessarily have a problem with people using recreational substances... but the ones who are smart and discrete about it are not the ones I see.
There are a couple of problems with people roasting their brains and killing themselves in search of a better buzz. One, it's a complete waste. Two, it's an ugly way to die. Three, it leaves behind a trail of sadness and tragedy. Four, I'm the one who has to break the bad news to their mother/father/children.
I find it interesting that people in this thread have replied as if I'm some kind of Office-of-Drug-Control-Policy magpie, when I'm simply offering a valuable bit of clinical correlation about the downside of ecstasy use. Part of informed consent is "informed," and you can't make rational, adult decisions without all the facts. Ecstasy isn't all sweetness and light; there are real, legitimate concerns about its immediate and long-term effects.
I don't necessarily have an anti-drug agenda (I do have an anti-stupid-drug-use bias). I just want people to understand the risks and benefits... that's the legal and ethical standard in my practice.
FYI, the origin of the title "Doctor" is the Latin "Docer" meaning "teacher;" I simply consider that part-and-parcel of what I do.
It is the opposite... Trust me on this one.
Histologically, there is little doubt that MDMA can be harmful to serotonergic neurons, and that Prozac can block the neurotoxic effects of ecstasy, even when given hours afterward (this is in animal studies... it's still ethically frowned upon to carve up live human brains). The reports about prozac blocking ecstasy's clinical effects are all over the neutral--->negative spectrum.
There is one study from 1993 where the researcher studied/asked eight ecstasy users their subjective opinions of E on prozac... they felt there was no difference. However, the sample size was small, and there is substantial anecdotal evidence from other users that Prozac substantially inhibits the "roll" from ecstasy.
What is totally lacking, however, is any evidence that prozac increases ecstasy's subjective or histological effects.
And there is NO substantial proof the harm to the neurons is permanent.
I guess it depends on your definition of "substantial." There's certainly a growing body of evidence regarding MDMA... almost none of it good.