Comment Re:This (Score 1) 87
miegakure comes to mind.
From TFA:
That technology from Epson when applied to game, users do not put on those wearable display for hours and hours every single day, they only put them on when they play games.
On the other hand, nurses working in the hospitals may end up wearing the glasses which projects infrared lights many hours each days.
My question being --- Would prolonged exposure to infrared light poses any danger on the eyes of the wearer ?
Unlikely. IR light has a longer wavelength and thus less energy than normal "visible" light, this is why we can't see in the infrared - the photons are not energetic enough to cause a conformal change in one of the double bonds in rhodopsin. This also partial explains why we can't see in the UV spectrum. The only variable will be the intensity of the light potentially causing thermal damage, but I doubt this would be that powerful enough for that. In addition, starting IVs is not the only thing nurses do....I'd guestimate that it is only about 5% of their daily work load on the general med-surg floors (where most patients have an IV already) and probably no more than 10-15% of the ED RNs.
Now here's the rub....is robotic surgery any better, or offer benefit above, laparoscopic surgery?
Ultimately it will be since the entire purpose of inserting the robot in the process is to provide finer control and filter out accidental motions that could cause mistakes and complications with traditional, hands-on-the ends-of-sticks laparoscopy.
You would think that that might be the case. An engineer would think that way...I know I did when I was an engineer.
However, you are wrong. You don't understand how surgery is performed. For starters, this is more biology class than chemistry or physics....this is not a photoelectric cell where light above X wavelength will fail to excite the atom out its orbital to produce a current. This is 2 kg of fertilizer (plus or minus 200 g) will produce more robust flowers then 1 kg will. You are dealing with inherently unstable organisms that are extremely fault tolerant because the have to exist in a fault filled world.
The "finer control" is useless (I've seen older surgeons with a horrible tremor perform the most masterful procedures). We're not dividing cell layers, we're dividing tissue planes which usually start to tease apart with gentle traction. We rarely measure things out, and exacting measurements are never used (at least in abdominal surgery which is the vast majority of robotic cases are, cardiac cases usually use blanks to measure the fit of valves and neurosurgeons and ophthalmologists who arguably require the finest motor control do well without a robot and will likely never use one anyway). Say I find a tumor in the colon. I am required to resect back 5 cm on either side...but I will get equally good results at 6 cm, or 7cm. Hell, as long and I leave some of the colon, the patient will do well. A lot of what I do is dictated by where I see the problem....in many cases I have to remove the problem area, plus an extra margin. This is not a 2x4 where it has to fit in precisely, this is a piece of tissue with potentially unseen disease that requires an adequate margin of resection and a good blood supply to heal. In addition, I think you underrate the level of precision a bare surgeon's hands have, and overrate the about of tolerance the human body has.
Most complications are acts of omission not commission. Meaning, you did something without knowing it (using the electrocautery too long or not realizing that it was too close to another structure resulting in transfer of thermal injury). This type of problem will not - can not - be overcome with the robot. Other causes of complications include equipment malfunction or mis-use (such as a stapler failing), and ultimately poor surgical judgement. So basically, a robot adds nothing to reducing the complication rate, and rather adds a new level of complexity to the problem. Is that an improvement?
I spent two years looking into ways to use the precision of the robot to improve general surgery. Came up blank. We designed a few new attachments for it....but they mostly mimicked things that already existed for open surgery, or were needed to overcome some constraint imposed by the robot.
Right now it's use is limited by the number of approved procedures and the pack of wolves salivating at the prospect for waves of lawsuits against the manufacturer and operators. This limits the amount of data being produced to evaluate its effectiveness.
The only real future applications will be for tele-surgery, which with global travel being what it is, still hasn't reached any level of significance other than: "Hey we can do this!"
When I was in medical school (decades ago), we had a lecture by one of the pioneers of endoscopic gall bladder surgery (cut some 1-2cm slits and use long-handled tools and a tiny camera to cut/remove/etc) which I well knew was already preferable to the "open procedure" that slashed the patient open (classic surgical proverb: you can never have too much exposure) so you could have the working space to reach in and do it with your big mitts)
I was a big fan, but as a student of both philosophy and the history of science I had to ask how he justified performing the procedure *before* (until) he got the complication down to the level of the standard open incision. He was outraged (as were my classmates) and tersely stated that he had gotten consent (not knowing that I'd done a thesis on the inadequacies and inherent ludicracy[sic] of getting "informed consent", especially based on information from the surgeon who wishes to do the procedure).
It was a sincere question, one that I felt could not answer to my own satisfaction (his answer didn't help; he'd simply been looking to "the medical advance" and had never been trained in genuine ethics), but despite that, I feel that he had done the right thing, and that tens of millions have greatly benefited since.
I think you answered your own question right there. The benefits of the procedure outweighed the risks. Informed consent, even for risky surgery, is still valid....so long as you properly inform the patient of the risks and benefits of the procedure. The patient gets to make their own decision. I consent patients for emergent (crash) procedures on a frequent basis. They are so sick that they may not survive the operation; however, without one they will certainly die. Most choose to take the risk. (Some decide that enough is enough and wish to be made comfortable, which is a valid option)
Now you can always argue that the patient, not being a physician, will never truly understand the risks, but that's the imperfect world we live in. OTOH, if this physician did not go through all of the risks, then that's another story.
Though not all would-be 'medical advances' end so salubriously, the sad fact is, we don't know any better way -- and I'd wager that we'll have workable fusion generators long before we have a better usable method for making medical advances. "First, do no harm" was a simplistic principle suited to the era before Christ when a doctor was as/more likely to do harm as/than good. (Note that the Hippocratic Oath forbids surgery outright)
We are now skilled enough that some of our advances seem "too good to deny to all comers" without full data -- but where are we to get that data, except by trial (and error). We are not yet advanced enough that MOST of our attempts at medical advance are so beneficial, nor are we advanced enough to have a much better alternative to "try it and see".
Now here's the rub....is robotic surgery any better, or offer benefit above, laparoscopic surgery? I will say with a decent amount of authority, there are very few procedures that have any advantage done robotically (namely those deep in the pelvis) - but note, they can still be done laparoscopicallyor even open. But there are very inherent risks....the robot removes all haptics from the surgeons hands (versus being mildly reduced in laparoscopic procedures). The first exercise you ever do with a robot is rip a piece of suture apart....you never get to feel how much tension is on it - so you "learn" what the limits look like, as opposed to feel like. There are other things inherent to the robot that also make it more difficult such as clutching (think of how you lift your mouse to move it back to the center of the mouse pad when you try to scroll a long distance) and the lack of knowledge of where your instruments are pointing.
To a lot of surgeons out there, robotic surgery is a solution looking for a problem. The worst part is....the uninformed public things that "robotic surgery" must be better. It is not. It is mostly a marketing tool. A robot will not make a poor surgeon better, it just gives them an excuse to hide behind....
Disclaimer: I am a surgeon. I have used the robot (but not been certified in it is use), and I refuse to become certified A) because it offers no benefit in my elective cases B) it is contraindicated in my emergent cases (the majority) and C) as I stated, I do not believe in the benefits.
Couldn't something like this be practiced on animals first? If you want to stay in good w/ the ASPCA, become a vet for a while (seriously). Secondly, are there cases (extreme obesity?) where endoscopic or laproscopic procedures have a particular advantage, such that the possibly greater risks of the new procedure are outweighed by the known risks of a standard procedure for such cases?
The certification process, as I understand it, requires you to perform surgery using animals for the initial certification, later, you perform several surgeries on people while being proctored.
There are several surgeries that are much easier, and less morbid when done laparoscopically, but they can still be done open. There is no surgery that is done currently that must be done laparoscopicallyor via a robot - all can be done openly - and open is the fall back when you encounter problems laparoscopicallyor via robot.
For those who have not seen it, this link shows a video that (on my quick perusal) adequately shows a simple procedure done with the robot.
having to clone red cells
Red cells have no nucleus, how do you "clone" them?
Grow them from stem cells, perhaps.
One could grow them from stem cells, induced pluripotent stem cells, normocytes, or a myriad of other cells. You see, mature RBCs do not have nuclei, but normoblasts or less mature RBCs do....when they mature they eject their nuclei. Anything less mature than a regular RBC is fair game.
Would something like this be accepted by groups like Jehovah's Witness' that do not accept blood transfusions?
That would be a good question. Having worked at a hospital that took over as the regional "bloodless center", I witnessed a wide variety of behaviors from JWs. Some were not very "orthodox" and would take blood, others only after consultation with their elder, others steadfastly refused. Apparently there is a lot of variation amongst individual "churches", but INAJW..
I'll tell you, a "bloodless" liver transplant is not for the faint of heart. I've been involved with a few transplants that required > 100 units of packed red cells. Doing these with none.....that stressed our skills to the max. And before you think that liver transplants can and therefore should be done bloodless...not all of bloodless ones survived. This would be a nice breakthrough.
It's interesting that this is still a cellular based concept, having to clone red cells and somehow transferring the hemerythrin. The linked article did not specify much detail.
Codons are sets of three letters. Every creature has its own unique codon table - every three letters (GATC) make up one codon, so there are 64 possibilities.
Almost. Every species has its own take on tRNA codong, but there is a lot of similarity up to the Kingdom level
But the fun thing is that many codons actually code for the same amino acid, but take different times to complete the process. Either because some molecular rotation is taking place or just because it's a time delay to allow folding to complete elsewhere. Then sometimes the sequence is used in reverse order (creating a back-to-front version of whatever is made) and sometimes even the sequence of letters is read with an offset of one or two letters, so essentially one group of letters can code for six different chains of amino acids.
Uh, no...not molecular rotation or time delay....this is actually more of a planned overlap. Pretty neat how nature planned this one. And as for mRNA being converted to a protein using tRNA (tranlation), it is strict one-way encoding (5' to 3' IIRC). dsDNA (but not ssDNA) (transscription) may be read in either direction, but mRNA not so (is is very much like ssDNA)
Sorry, I made the mistake of reading what it said, not what it meant.
That's ok, you'll just evolve to do better next time.
Of course, a hospital *ambience* is what's important?! And you get pretty damn close. Most complications are known ahead, in which case a home birth is ill advised.
No. If I must spell it out: the ambiance of home births do not equate to the success of a hospital based birth.
There are plenty of "known complications" that can predict the need for C-section:pre-eclampsia, hypertension, previous (high risk) fetus, HIV infection of the mother, sexually transmitted infections, previous classical Caesarean section, previous uterine rupture, prior problems with the the perineum, bicornuate uterus, to name a few.
The problem lies in the unexpected indications (same reference): prolonged labour or a failure to progress (dystocia), fetal distress, cord prolapse, uterine rupture, hypertension or tachycardia after amniotic rupture, placenta praevia, placental abruption or placenta accreta, breech or transverse presentation, failed labor induction, large baby weighing >4000g (macrosomia), umbilical cord abnormalities (vasa previa, multilobate including bilobate and succenturiate-lobed placentas, velamentous insertion), meconium in the amniotic fluid, fetal acidosis (including lactic acidosis), amniotic fluid embolism, and my personal favorite the wonderfully morbid splenic artery rupture, to name a few. Not to mention the risk to the baby once delivered including aspiration, respiratory distress (including apnea), bronchopulmonary dysplasia, persistent pulmonary hypertension of the newborn, cardiac abnormalities not seen on screening ultrasounds, necrotizing enterocolitis, sepsis, and cardiac arrest, to name a few more.
Most of the midwives/doula/witchdoctors have little to no training in these conditions. They literally "do not know what they do not know". As a result there is often a significant and life-threatening delay in transfer to a medical center where someone who is versed in all aspects of child birth (the Ob-Gyn), gets to bail the mother and fetus out. Wanna roll the dice with your kid? Go for it, you have every right - most women and fetuses will survive...but for those who have complications, I repeat: Caveat Emptor.
As for me and my wife? I'm not going too risk it, and I personally have the skill, knowledge, experience and license to perform c-sections (albeit emergent ones)....
Home birth is quite safe in all but high-risk cases, and we know which ones those are.
Several Ob-Gyns I know are fond of noting:
You can't expect 21st century outcomes with 18th century ambiance.
Caveat Emptor.
Police and London Ambulance Service attended and took the 23-year-old man to hospital where he remains in a stable condition. The victim had been shopping and was on his way home when he was hit with a brick. He was then stabbed and robbed. A copy of Grand Theft Auto, a watch and mobile phone were stolen during the robbery. The motive for the attack is unclear at this stage.
I believe the motive was for a high score.
BLISS is ignorance.
