I always wonder why they don't just move the clock 30 minutes in one direction and then NEVER DO IT AGAIN.
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If we compile statistics, we can look for the points where nobody has ever meaningfully recovered.
We do. This is where the guidance to stop resuscitation after 15 minutes without a rhythm comes in. Unless you're a child who drowned in cold fresh water, of course, or an adult who apparently died of hypothermia. The problem is that there are so very many different sets of facts, and people are far more resilient than you can imagine. And in the heat of the moment, we tend to opt to fight rather than to let go. Which is actually OK, I think.
For your example, ECMO can only be useful for acute lung failures including injury. It's useless in chronic cases where the lungs simply aren't going to improve.
Well, yes, ECMO is probably a bad example, because it's by definition an acute therapy that can't be continued more than a few days, at least at the current state of the art. Even there it's a bit questionable in the case of chronic disease exacerbated by acute cardiopulmonary collapse from a (presumably) reversible cause. But other therapies, like the simple $10K/day ICU bed, are much harder to argue against, unless you've given specific instructions. It reminds me a little of the old instructions for tuning a carburetor - turn the screw until the engine dies, then back up half a turn. Most of the really futile ICU cases I've seen didn't START as futile cases, but they sure ended that way.
Most other western countries have a bit less tendency to heroic medicine than the U.S.
I'm not actually all that impressed with medicine in "most other Western countries" as a touchstone for our own. Every country has its own social norms and conventions, all of which fold over into health care. We tend to value privacy, autonomy, personal space, personal choice, and hope for recovery more than most, and it costs us a lot of money.
I think the problem is that we don't know in advance when the "last days of life" are for anyone. Or at least we don't know if prospectively, and knowing it after the fact is kind of pointless in terms of limiting costs.
If there are treatments that are virtually never helpful, we need to stop using them. There aren't many interventions that actually fit that description, though, and even the most invasive of them - ECMO, for example (basically continuous heart-lung bypass) - have their place in restoring people to health in the right circumstances. Eventually the circumstances are such that death is inevitable, but recognizing that point is not something we know how to do with certainty. Even when we're pretty sure, communicating our own conviction is very hard. And where there is no certainty, there is the great likelihood of erring on the side of treatment.
Hospice care, which tends to be very inexpensive compared to attempts at cure, is helping because it gives people a viable alternative path. Most physicians with whom I deal (a very large number, as it turns out) are big fans of hospice care. Not because it's cheap, but because it helps make the case for avoiding further torture. It's not a bad way to reduce costs, though, and that's not irrelevant.
I'm a board-certified physician (among other things). There is no way that I would allow my colleagues to inflict the kind of death on me that they are forced to inflict on so many. Part of this is certainly that I know full well that we all exit this mortal coil toes-up, and there's no getting around it. Part of this is the personal reluctance to experience the diminished autonomy, indignity, pain,and hopelessness that comes with fanatically-treated terminal illness.
But a big part of it, I think, is just that I know that there are so, so many things that are worse than simply dying. Dying in agony, for one. Dying after having bankrupted my wife or my children. Dying after being reduced to a stinking thing in a bed long enough that only those who loved me most even want to be near me, and that only because they feel they must. Physicians see these things all the time, and we see the road that leads to them. We're not (that) stupid, and we would rather exit early on that road, not at its terminus.
As long as I have the capacity for joy I will strive to remain alive to experience that joy. When the capacity - or the joy - is gone for good, I have given quite strict instructions not only to my family but to some other clear-headed and insistent people who will do their best to ensure that I too will be gone without further "heroic" intervention.
The only problem that I have with the article is that it pretends that everyone should make the same decisions. Everyone has their own decisions to make, and without my knowledge and experience I might not make the same ones. I think as physicians we owe it to the people for whom we care to educate as well as we can and help them to understand why we might personally decide one way or another. But I will never tell them how they "ought" to decide - it's really their choice. Taking that choice away from a person leads too easily to very real outcomes that are much nastier than simply a life that ends later than it ought.
Good luck Rob. Don't be a stranger.
Not that I was all that fond of Sony anyway. Trying to rootkit my machine from a CD a few years ago didn't impress me, and the prices they charge have always been a little silly. With this action, Sony has now officially asked their lawyers to burn down decades of customer relationships. "Sony" and "Don't buy this" are now synonymous.
As far as two years of IP logs, good luck with getting anything useful out of that one. Then again, that wasn't the point. It was just another intimidation tactic to keep people from spreading the private keys. A little late, I think.
It's 2010 and I thought I'd delete all the old retarded stuff on here and say hi, I'm still alive, and I'm feeling much better now.
[My apologies for the lack of links: Google is your friend. The editor is being a bitch.]
If it reacts with acid, it's carbonate (such as calcium carbonate, CaCO2). The classic test for carbonates is to dump a 5% solution of HCl (hydrochloric acid, available as muriatic acid in any hardware store) onto the sample; if it bubbles, it's a carbonate. (I know one geologist who calls this test "barbaric.") You can also use common household vinegar.
99.99% of all carbonates on the Earth are sedimentary. Usually, they form in shallow to medium depth water when microscopic critters with calcium shells die by the kazillions and fall to the ocean floor, where they pile into layers that give us things like limestone. There is one exception, however: Oldoinyo Lengai is a volcano in Tanzania that produces carbonate lava (the only carbonate-producing volcano in the world -- all the rest produce silicates, products based on SiO2). Someday I would like to see a sample of this igneous carbonate, because while silicates are really really important in geology, they're also really really common, and thus really really boring.
A relatively inexpensive bulk chemical analysis could tell you the exact composition of your samples, and you would probably find a pretty high iron content, which accounts for the trigger on your metal detector. My educated guess is the mineral siderite, FeCO3. It is common both in hydrothermal veins and in sedimentary formations.
Sinkholes can form when subterrainian water flows dissolve minerals (such as carbonates), forming a cave that later collapses. When this happens, you get a crater. And yes, you can get a pretty big one, depending on how deep the cave is.
So yes, it's a probably a sinkhole.
Are the "Jury of your peers" seriously that gullible that they feel they have to institute massive punitive damages on an individual?
Next stupid question?
i find the gameplay to be excellent, but the game itself is unstable.
i run it on a dual-head hp desktop with a 1.86ghz processor, 3g of ram, and an nvidia geforce 9400 gt. i'm using windows 7 pro, fully patched, with dx11 and the steam version of the game installed. it's not a great machine, but it certainly should be adequate to play this game in single-player mode.
it's not. it often crashes during game in initialization, and randomly in the middle of the game, and it doesn't seem to matter if it's in dx9 or dx11. when i am in windowed mode and minimize, the entire machine lugs. when i maximize the window again, it doesn't redraw the screen or respond to keyboard input. my only option was to kill the process, losing the game state. even when not minimized, the load on the machine seems quite high.
i'm very disappointed with the stability.
not better than microsoft. microsoft has merely made a well-announced, long-planned strategic decision to stop supporting XP on new products. this isn't a surprise, and anyone who complains about it needs to stop living in 2001.
- You pretty much can't get processing in your own business name if you're up-front about what you do, in the United States.
- You can't get processing in Europe, either, unless you're actually in the EU. Opening a shell corporation won't help, and even then, it's also impossible.
- You might be able to get "high risk" processing outside of the United States, out of somewhere like Vietnam or the Philippines. If you do, you can expect games with your money.
- You can expect to have your bank hold on to your funds a minimum of three months. This is not something like a 5% rolling reserve. It is, instead, a 100% rolling reserve.
- You can expect your contract to say that when you end your contract (even at the end of term in the normal course of business), your processor can hold onto 100% of your money for an additional year, starting as soon as you give your required six months notice.
- You can expect your contract to say that you surrender your domain name to your processor in perpetuity.
- You can expect to pay as much as 25% of revenue for this "service."
- You can expect to find it impossible to open even a normal checking account into which to deposit your funds, because no bank in the universe will want to deal with you, simply because you run an adult business.
- About the only semi-reputable (caveat emptor) business that will do billing for adult websites is CCBill. You can expect to pay CCBill at LEAST 10% of your revenue, and if you want to take Visa, you have to pony up another $750 non-refundable startup fee, and a $500 annual fee, on top. Approximately 40% of adult transactions are Visa, so not accepting Visa isn't a viable option for most businesses.
- CCB's software absolutely sucks. It is bloated, slow, doesn't give good control over affiliates and their production, and doesn't produce usable reports. And, I have never once given an email address to CCBill (yes, I use unique addresses for such transactions) that didn't get sold to a spammer. This includes addresses I gave to them in a business relationship, not just buying a website subscription.
- Verified by Visa and MasterCard SecureCode, which are supposed to eliminate chargebacks, are not available to adult entertainment sites. No explanation has ever been given about why this is so, but if you run porn, you can't use these "enhanced security" services.
- CCBill supports only subscription-based services. They don't support physical good sales. Want to sell DVDs, t-shirts, photographic prints, USB keychains, or other goods along with your site subscriptions? Too bad.
- No well-known payment service aside from CCBill allows porn. This includes PayPal, Google Checkout, Moneybookers, and the rest. Want to sell legal second-hand DVDs on eBay? Good luck figuring out how to get paid. I have a warehouse full of stuff I basically can't sell because I can't get paid.
One of the reasons problems are so rampant in credit card processing in adult entertainment is that the cartels have made it nearly impossible to get legitimate processing, and so businesses that want to take credit cards have to resort to quasi-legal tactics to be able to run them. It becomes a self-fulfilling prophecy.
One of the things I looked into was the possibility of creating, essentially, a pornographer's bank. The bank would adhere to customary American banking law, but would explicitly accept legal adult entertainment business. The question we could never get an answer to was whether or not Visa and MC would allow such a bank to back merchant accounts and issue credit cards. You can't get an answer to that question unless you already are a bank. Nobody is willing to risk the several million dollars it takes to buy or start a bank without an answer to that question, and no existing bank is willing fly such a balloon for you. Catch-22.
If you pick your jobs right, you could make as much as $3/hr on Mechanical Turk. I know because at one point it was the only income I had.
Texas has had this since 1984. What's the story here?