If you only wanted to become basically proficient at reading it (not writing it, or reading at speed), Arabic script isn't that hard to learn, is it? A couple of weekends, perhaps. And going to a Latin alphabet makes your country much more accessible for others who use Latin script (and correspondingly more difficult for those who use Arabic script, but I believe that was Ataturk's point). Written Chinese takes ages to learn well, so presumably there's a real advantage on the learner's end to switching.
Warrantless wiretapping of international communications that is not admissible in court is a far smaller threat to our civil liberties than warrantless 24/7 tracking of all movement that is admissible in court.
Depends on the state, and whether or not the gun is loaded. Even in states that are generally pro-gun, and have shall-issue laws regarding concealed carry, the open-carry laws have occasionally been ruled to be essentially meaningless - if you put the gun in a hip holster, you're hiding the barrel, and if you're hiding any part, you're doing concealed carry...
Don't use the phone in Illinois or Massachusetts; all parties must agree to recording, with no exception for being in public. And don't speed at all if you follow the cop; they can pace you from in front as well as behind, and slow down to pull you over and give you a ticket. (Happened to a friend in NJ.)
Funnily enough, cops have no actual duty to prevent crime, only to investigate it after the fact. 99 times out of 100, when I see a police car in the area around my neighborhood it's running a speed trap, not patrolling the neighborhood.
Funny, the last time the cops pulled my wife over (for not having a seatbelt on as she turned off our home street) and she realized that she didn't have our current insurance card, I tried to come by and offer it to them. They didn't know the law (it makes it quite clear that the driver is NOT required to have the proof of insurance on their person, only to be insured, and that the police are required to make some attempt to verify the insured status if feasible), and told me that I would be arrested if I didn't vacate the scene immediately "for interfering with police business". And that it would be her fault if they shot me on a suburban street at 5:00 on Saturday afternoon. If that's not making up the law as you go, what is? Mind you, I'm 35, flabby, white, and drive a very boring, very new car. Any cop who thinks I'm a threat when I step out of a car with both hands visible and an insurance card in my hand waving hello is in need of a return to the academy.
Well, FWIW, if you're going all day, that may be why you're only seeing older nurses. Try night. Many places, you have to work your way up to to get day shift.
You can always move to a less-desirable area. I'm in a small city (metro ~300k) in the southeast, in a university hospital setting, and we have plenty of nurses in their 20s and 30s.
I agree that "personal responsibility", while an important value in real life, isn't the way to structure a complicated system. I just wanted to make a point that the government - because of its role as regulator - will tend to be too cautious in approving potentially dangerous new methods while ignoring the risks of existing methods. I'll give you the short version of sugammadex:
When performing most surgeries - abdominal procedures, most broken bones, lots of ear/nose/throat procedures - the standard procedure is to place a breathing tube through the vocal cords; i.e., past the last possible obstruction. This guarantees a clear path to the lungs regardless of how the patient is positioned. To do this, we both induce anesthesia (give an agent to make someone unconscious) and, in nearly all cases, give a paralytic drug to make the process easier and less traumatic to the patient's mouth. There are two main choices: succinylcholine and rocuronium. Rocuronium is basically free of side effects, but once you give it, it will be at least half an hour before the paralysis can be reversed - and the reversal agent is neostigmine, which pharmacologically antagonizes the paralytic agent but contributes to nausea and vomiting. Succinylcholine (suxamethonium in the UK) chemically consists of two acetylcholine molecules joined back to back, and so it is metabolized by acetylcholinesterase (though somewhat slower than the natural ligand). It works by stimulating the receptors until they fatigue. Its great advantage is that it is very quick to act, and that it wears off after (usually) five to ten minutes. The downsides are that it can act as a trigger for malignant hyperthermia, that it reliably produces an increase in serum potassium (which could trigger ventricular fibrillation), and that some people have altered metabolism producing hours or even days of paralysis from a single dose.
In comes sugammadex, a large molecule that chemically binds to rocuronium and related molecules in the bloodstream and prevents them from paralyzing muscles. It means that we can give rocuronium, allow it to paralyze a patient, and quickly and safely produce a complete reversal if we aren't able to intubate the patient, without waiting for the drug to be metabolized. We can leave patients deeply paralyzed until the end of a procedure, making the surgeon's job easier (in open abdominal surgery, for example, the paralysis is necessary to be able to close the abdominal wall) while still being able to reverse the paralysis almost instantly. And we don't have to worry about the possibility that the patient will metabolize the drug too slowly.
The FDA's concern was about allergic reactions. This is a classic problem of bureaucracies; there is much less danger in saying no than in saying yes, just as nobody ever got fired for buying IBM. But by saying no rather than yes, they are ignoring the real danger that the current succinylcholine-vs-rocuronium choice poses to patients - one that is much less easily handled than an allergic reaction (or even frank anaphylaxis - it's not as though the drug would be self-administered in remote settings; it's made to be given in an OR or ER to a patient whose blood pressure, respiratory rate, oxygen saturation, pulse rate, and EKG are all being monitored). So we should be cautious about having the government do things, because it's inherently less flexible than private organizations (The Joint Commission being one example) that can easily serve most of the same role. Let the government regulate things that really must be regulated, but be careful what you loose them upon, because they rarely stop where you want them to.
Anesthesiologists had the same problem. They worked at different hospitals, with different equipment, and that caused mistakes. They standardized equipment, mistakes went down, fatalities went down, insurance premiums went down.
This shows that government can work.
The Anesthesia Patient Safety Foundation has nothing whatsoever to do with government. Never did. You do need there to be an outside body that keeps looking for the big picture, and maybe the FDA is the right place to do that - but maybe it's not. The FDA, after all, has too much incentive as a regulator to be overly cautious - witness the story of sugammadex, which would have basically retired succinylcholine and neostigmine from clinical practice. In expressing concern over potential hypersensitivity, the FDA completely neglected the possibility that the status quo might be more dangerous.
Don't be an LPN. Preferably, don't be an associate's degree RN. Get a BSN, it's more work but it'll get you hired and it will open the doors to administration when you get tired of actual nursing.
I've seen enteral tubes in the NICU that had Luer ends, and while it's not a BP cuff, our surgical tourniquets connect via Luer. There's some funny stuff out there, if you look. For example, here is a jejunostomy tube with a Luer connector.
Pilots and nuclear plant operators are trained for it
Nuclear plant operators work at the same plant every day. Pilots on long journeys don't go to sleep in a 747 and wake up in an unknown vehicle that probably is an A300, but then again might be a 767. Effectively communicating an entire patient history is difficult - really difficult. You never really know what details you get that will turn out to be important. It's not surprising that we haven't gotten it down perfectly.
You're going to put your thumb on the end of a tube that has a patient's blood at the other end? Not exactly good sterile technique.
The best solution is probably to continue to use the existing Luer system for intravenous sets and alter the sets used for epidurals and feeding. Of course, you'll have to come up with a solution for arterial lines (can't use those to inject drugs, but they are currently manufactured just like IV lines and rely on proper labeling) and air systems.
Well, PISS and DISS (yes, those are the real acronyms) involve large equipment that isn't considered a disposable. Luer systems are almost all disposable equipment.
It's almost certainly worth the cost, but the cost is real.
I strongly suspect that they meant to talk about an inflatable tourniquet, rather than a BP cuff. The inflatable tourniquets in my hospital do, in fact, have Luer connectors. Of course, we only use them in the OR, and it's pretty easy to distinguish an IV from a cuff...
I am an anesthesiologist, so I deal with every single one of those tubes. YMMV.
Anesthesiology as a specialty has made vastly greater steps in safety than any other field of medicine. Part of that is that so much of our job depends on machines; we can design machine systems so that they fail gracefully and safely. Standardized fittings have been part of that safety system, so that tubing made by company A works on company B's machines. The connectors for breathing tubes are all the same.
The problem with the Luer system (which is the connector in the article, although they never named it) is that it's so damned useful. A single connector means that you use another kind of equipment in a pinch. It means that when I dose an epidural, I don't have to hunt down a special epidural needle and syringe. When the cuff on a breathing tube needs to be adjusted, I can use a plain old syringe. I can even use those plain old syringes to fashion an emergency oxygenation kit to keep someone alive when they quit breathing and we can't get a breathing tube in place. (If you're interested, and in a hospital, take a 3 mL syringe. Remove the plunger. Stick a 7.0 ETT connector into the back of the syringe. Perform needle cricothyrotomy with the largest IV catheter you can get, attach the syringe to the catheter, stick an Ambu bag on the ETT connector, crank up the O2 flow, and start squeezing. And get a surgeon working on the formal trach right away, because you might oxygenate with this but you sure won't clear any CO2.)
You obviously know far more than I do about this, but I would ask: for someone who makes $50 in income, would she be better off getting rooked for an unrecognized writeoff of $50, or paying you your minimum fee?;) I don't do my taxes (anymore), a CPA does. And in the years I ran a for-profit enterprise (tutoring), well, it didn't matter - my wife was paying tuition and the Lifetime Learning Credit reduced our taxes due to zero. And it was a cash business.
On a more serious note: in the case at hand, it appears that she would definitely fail the IRS business-vs-hobby distinction - she's running a blog for kicks, the money she gets from it is just help in offsetting expenses. In that particular case - when it is definitely a hobby - wouldn't it belong on schedule A? And so not itemizing deductions would matter then. (That way my thought process in the parent comment.)
Yes, but in return you got an LLC, which can have certain tax and liability advantages. She's getting nothing in return. Hobby that makes money != business.
Oh, I know why the teachers want a cartel. Virtually every rational actor would love to be part of a cartel, if we'd let them. I'm just not sure why it is that we should give them one.
If it were my choice, I'd make unionization and strikes by government employees illegal; we already have extensive civil service protections. One price of taking a government job and getting those protections should be that you don't get to leave every other citizen unable to get their services.
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If you only wanted to become basically proficient at reading it (not writing it, or reading at speed), Arabic script isn't that hard to learn, is it? A couple of weekends, perhaps. And going to a Latin alphabet makes your country much more accessible for others who use Latin script (and correspondingly more difficult for those who use Arabic script, but I believe that was Ataturk's point). Written Chinese takes ages to learn well, so presumably there's a real advantage on the learner's end to switching.
Too bad they enforce laws that don't exist.
When law enforcement loses the confidence of middle-aged suburban Republican white male professionals, you know they've gone over the edge.
Our cops are famously corrupt. Civilian complaints... lead to trouble. And they're ignored.
Warrantless wiretapping of international communications that is not admissible in court is a far smaller threat to our civil liberties than warrantless 24/7 tracking of all movement that is admissible in court.
Depends on the state, and whether or not the gun is loaded. Even in states that are generally pro-gun, and have shall-issue laws regarding concealed carry, the open-carry laws have occasionally been ruled to be essentially meaningless - if you put the gun in a hip holster, you're hiding the barrel, and if you're hiding any part, you're doing concealed carry...
Don't use the phone in Illinois or Massachusetts; all parties must agree to recording, with no exception for being in public. And don't speed at all if you follow the cop; they can pace you from in front as well as behind, and slow down to pull you over and give you a ticket. (Happened to a friend in NJ.)
Funnily enough, cops have no actual duty to prevent crime, only to investigate it after the fact. 99 times out of 100, when I see a police car in the area around my neighborhood it's running a speed trap, not patrolling the neighborhood.
Funny, the last time the cops pulled my wife over (for not having a seatbelt on as she turned off our home street) and she realized that she didn't have our current insurance card, I tried to come by and offer it to them. They didn't know the law (it makes it quite clear that the driver is NOT required to have the proof of insurance on their person, only to be insured, and that the police are required to make some attempt to verify the insured status if feasible), and told me that I would be arrested if I didn't vacate the scene immediately "for interfering with police business". And that it would be her fault if they shot me on a suburban street at 5:00 on Saturday afternoon. If that's not making up the law as you go, what is? Mind you, I'm 35, flabby, white, and drive a very boring, very new car. Any cop who thinks I'm a threat when I step out of a car with both hands visible and an insurance card in my hand waving hello is in need of a return to the academy.
Well, FWIW, if you're going all day, that may be why you're only seeing older nurses. Try night. Many places, you have to work your way up to to get day shift.
You can always move to a less-desirable area. I'm in a small city (metro ~300k) in the southeast, in a university hospital setting, and we have plenty of nurses in their 20s and 30s.
I agree that "personal responsibility", while an important value in real life, isn't the way to structure a complicated system. I just wanted to make a point that the government - because of its role as regulator - will tend to be too cautious in approving potentially dangerous new methods while ignoring the risks of existing methods. I'll give you the short version of sugammadex:
When performing most surgeries - abdominal procedures, most broken bones, lots of ear/nose/throat procedures - the standard procedure is to place a breathing tube through the vocal cords; i.e., past the last possible obstruction. This guarantees a clear path to the lungs regardless of how the patient is positioned. To do this, we both induce anesthesia (give an agent to make someone unconscious) and, in nearly all cases, give a paralytic drug to make the process easier and less traumatic to the patient's mouth. There are two main choices: succinylcholine and rocuronium. Rocuronium is basically free of side effects, but once you give it, it will be at least half an hour before the paralysis can be reversed - and the reversal agent is neostigmine, which pharmacologically antagonizes the paralytic agent but contributes to nausea and vomiting. Succinylcholine (suxamethonium in the UK) chemically consists of two acetylcholine molecules joined back to back, and so it is metabolized by acetylcholinesterase (though somewhat slower than the natural ligand). It works by stimulating the receptors until they fatigue. Its great advantage is that it is very quick to act, and that it wears off after (usually) five to ten minutes. The downsides are that it can act as a trigger for malignant hyperthermia, that it reliably produces an increase in serum potassium (which could trigger ventricular fibrillation), and that some people have altered metabolism producing hours or even days of paralysis from a single dose.
In comes sugammadex, a large molecule that chemically binds to rocuronium and related molecules in the bloodstream and prevents them from paralyzing muscles. It means that we can give rocuronium, allow it to paralyze a patient, and quickly and safely produce a complete reversal if we aren't able to intubate the patient, without waiting for the drug to be metabolized. We can leave patients deeply paralyzed until the end of a procedure, making the surgeon's job easier (in open abdominal surgery, for example, the paralysis is necessary to be able to close the abdominal wall) while still being able to reverse the paralysis almost instantly. And we don't have to worry about the possibility that the patient will metabolize the drug too slowly.
The FDA's concern was about allergic reactions. This is a classic problem of bureaucracies; there is much less danger in saying no than in saying yes, just as nobody ever got fired for buying IBM. But by saying no rather than yes, they are ignoring the real danger that the current succinylcholine-vs-rocuronium choice poses to patients - one that is much less easily handled than an allergic reaction (or even frank anaphylaxis - it's not as though the drug would be self-administered in remote settings; it's made to be given in an OR or ER to a patient whose blood pressure, respiratory rate, oxygen saturation, pulse rate, and EKG are all being monitored). So we should be cautious about having the government do things, because it's inherently less flexible than private organizations (The Joint Commission being one example) that can easily serve most of the same role. Let the government regulate things that really must be regulated, but be careful what you loose them upon, because they rarely stop where you want them to.
Anesthesiologists had the same problem. They worked at different hospitals, with different equipment, and that caused mistakes. They standardized equipment, mistakes went down, fatalities went down, insurance premiums went down.
This shows that government can work.
The Anesthesia Patient Safety Foundation has nothing whatsoever to do with government. Never did. You do need there to be an outside body that keeps looking for the big picture, and maybe the FDA is the right place to do that - but maybe it's not. The FDA, after all, has too much incentive as a regulator to be overly cautious - witness the story of sugammadex, which would have basically retired succinylcholine and neostigmine from clinical practice. In expressing concern over potential hypersensitivity, the FDA completely neglected the possibility that the status quo might be more dangerous.
Don't be an LPN. Preferably, don't be an associate's degree RN. Get a BSN, it's more work but it'll get you hired and it will open the doors to administration when you get tired of actual nursing.
If you're reopening sternotomies at the bedside, sterility is the least of your problems.
I've seen enteral tubes in the NICU that had Luer ends, and while it's not a BP cuff, our surgical tourniquets connect via Luer. There's some funny stuff out there, if you look. For example, here is a jejunostomy tube with a Luer connector.
Pilots and nuclear plant operators are trained for it
Nuclear plant operators work at the same plant every day. Pilots on long journeys don't go to sleep in a 747 and wake up in an unknown vehicle that probably is an A300, but then again might be a 767. Effectively communicating an entire patient history is difficult - really difficult. You never really know what details you get that will turn out to be important. It's not surprising that we haven't gotten it down perfectly.
You're going to put your thumb on the end of a tube that has a patient's blood at the other end? Not exactly good sterile technique.
The best solution is probably to continue to use the existing Luer system for intravenous sets and alter the sets used for epidurals and feeding. Of course, you'll have to come up with a solution for arterial lines (can't use those to inject drugs, but they are currently manufactured just like IV lines and rely on proper labeling) and air systems.
gas couplings
Well, PISS and DISS (yes, those are the real acronyms) involve large equipment that isn't considered a disposable. Luer systems are almost all disposable equipment.
It's almost certainly worth the cost, but the cost is real.
I strongly suspect that they meant to talk about an inflatable tourniquet, rather than a BP cuff. The inflatable tourniquets in my hospital do, in fact, have Luer connectors. Of course, we only use them in the OR, and it's pretty easy to distinguish an IV from a cuff...
I am an anesthesiologist, so I deal with every single one of those tubes. YMMV.
Anesthesiology as a specialty has made vastly greater steps in safety than any other field of medicine. Part of that is that so much of our job depends on machines; we can design machine systems so that they fail gracefully and safely. Standardized fittings have been part of that safety system, so that tubing made by company A works on company B's machines. The connectors for breathing tubes are all the same.
The problem with the Luer system (which is the connector in the article, although they never named it) is that it's so damned useful. A single connector means that you use another kind of equipment in a pinch. It means that when I dose an epidural, I don't have to hunt down a special epidural needle and syringe. When the cuff on a breathing tube needs to be adjusted, I can use a plain old syringe. I can even use those plain old syringes to fashion an emergency oxygenation kit to keep someone alive when they quit breathing and we can't get a breathing tube in place. (If you're interested, and in a hospital, take a 3 mL syringe. Remove the plunger. Stick a 7.0 ETT connector into the back of the syringe. Perform needle cricothyrotomy with the largest IV catheter you can get, attach the syringe to the catheter, stick an Ambu bag on the ETT connector, crank up the O2 flow, and start squeezing. And get a surgeon working on the formal trach right away, because you might oxygenate with this but you sure won't clear any CO2.)
That said, it's the right thing to do.
You obviously know far more than I do about this, but I would ask: for someone who makes $50 in income, would she be better off getting rooked for an unrecognized writeoff of $50, or paying you your minimum fee? ;) I don't do my taxes (anymore), a CPA does. And in the years I ran a for-profit enterprise (tutoring), well, it didn't matter - my wife was paying tuition and the Lifetime Learning Credit reduced our taxes due to zero. And it was a cash business.
On a more serious note: in the case at hand, it appears that she would definitely fail the IRS business-vs-hobby distinction - she's running a blog for kicks, the money she gets from it is just help in offsetting expenses. In that particular case - when it is definitely a hobby - wouldn't it belong on schedule A? And so not itemizing deductions would matter then. (That way my thought process in the parent comment.)
Until the IRS goes back and retroactively declares it a hobby and assesses penalties and interest on the whole amount.
She might not itemize deductions. I had numerous years in which itemizing would have been less than the standard deduction.
Well, if she was trying to write off business expenses, it would be a different story. There's no indication that she is.
Yes, but in return you got an LLC, which can have certain tax and liability advantages. She's getting nothing in return. Hobby that makes money != business.
Oh, I know why the teachers want a cartel. Virtually every rational actor would love to be part of a cartel, if we'd let them. I'm just not sure why it is that we should give them one.
If it were my choice, I'd make unionization and strikes by government employees illegal; we already have extensive civil service protections. One price of taking a government job and getting those protections should be that you don't get to leave every other citizen unable to get their services.