mikecsh's comments

mikecsh | 2 months ago | on: Let's write a toy UI library

Do you not see the irony? If it's not your responsibility, why should it be the responsibility of the author of this tutorial?

People write tutorials on what they are interested in, what they have knowledge of, and what they want to share.

Accessibility is an important topic, to be sure, and is clearly of particularly high importance to you. Others might complain that they didn't include how to create a high performance table view, or embed an OpenGL view. I think most people, however, will take it as what it is - a well written, helpful contribution.

Your comment specifically asked if you were being harsh, and the consensus appears to be "yes". Perhaps if you worded things differently you might get a different response.

mikecsh | 2 years ago | on: Amazon PillPack – Your medication, sorted and delivered

Some medications are prescribed with this taken into account actually.

For example if a medication has sedating effects (such as some antidepressants) it may be advised to be taken before bed so this side effect is turned into something generally beneficial (more sleep) and less prevalent during waking hours).

Statins (cholesterol lowering medications) are usually prescribed at night time as this is when your cholesterol catabolism is most active.

Pain relief is often varied around sleep schedules

Insulin is scheduled around meals and sleep

Etc etc.

mikecsh | 2 years ago | on: Amazon PillPack – Your medication, sorted and delivered

UK pharmacists are able to to do blister packs but this is a hugely labour intensive endeavour. Specific quantities of each medication need to be dispensed, placed in the correct pocket, checked and double checked. Compared to dispensing a factory sealed box of $X units. As a manual process it does not scale to providing this service for more than a small percentage of patients where the benefit is greatest (memory impairment, etc).

Also in my experience pharmacists dislike having to do this laborious process.

mikecsh | 3 years ago | on: Swift Quit – Automatic App Quitting on Mac

Then use Cmd-H to hide it.

It's a different model to what you are used to and IMHO more flexible and powerful. If you try and keep operating in a manner learned on a different model you will inevitably be frustrated.

mikecsh | 4 years ago | on: The Dangers of Low Head Dams (2019)

Many of these structures have concrete channels downstream of the weir which means that the stopper/keeper/recirculating water is equally strong across the width of the river. It can also be extremely hard to swim with any sort of accuracy due to being constantly recirculated and not-very buoyant due to the entrained air.

There are other subtleties in 3D as well; some weirs form a downstream-pointing V when viewed from above the dam - these are generally considered safer as the currents will (generally) move you to the middle of the river and downstream where the water is more likely to be escapable - see [1].

Others can form an upstream-pointing V which has the opposite effect where the currents will move you towards the middle of the river but upstream back towards the stopper/keeper/hydraulic.

[1] https://assets.atlasobscura.com/media/W1siZiIsInVwbG9hZHMvcG...

mikecsh | 4 years ago | on: Anal oxygen administration may save lives

To clarify for you (again), my comment was regarding your unfounded derision of existing, proven, lifesaving technologies—I was not dismissing of the technique proposed in the article.

I don't think _"F### ventilators. They damage the patient's lungs, and laying tubes into the trachea requires traumatic surgery and carries significant secondary infection risk"_ is really offering an informed or balanced discussion of the risks and benefits of intubation and ventilation hence my initial reply.

On the contrary, this offers an emotive, highly negative, and uninformed opinion with no balance. We are in a time of a global pandemic with the general public now aware of intubation, ventilation, ECMO, CPAP, BiPAP, and other respiratory interventions. Many people and/or their families are having to face or consider these interventions. Your comment is potentially harmful.

Against to be clear, the medical profession is (spoiler alert) acutely aware of the risks and negatives of ventilation, including extended ventilation, ECMO, surgical and percutaneous traches, and every other intervention that is offered. These risks are discussed with patients and families who often lack the domain expertise, it therefore being part of the role of the doctor to explain to the best of their knowledge what options the patient has before them and likely outcomes of the different options. Ultimately (ideally) the patient makes a decision for themselves based on this information.

You can be sure that the nuanced and balanced discussion is a little more informative than "F### ventilators".

mikecsh | 4 years ago | on: Anal oxygen administration may save lives

Getting in a car is fraught with peril. Every time somebody gets in a vehicle they're dicing with death.

I think it's important to contextualise the risk. The risk of dying from an anaesthetic is about 1 in 100,000. Compare with risk of dying in a car accident in a given year for example.

And again, it comes down to risk:benefit. Anaesthetics are not given out willy-nilly. The reason for the anaesthetic is considered along with the patient's co-morbidities and personal physiological parameter where relevant. Based on this a reasonable estimate of the personalised risks for that patient for that operation can be given for the patient to choose if they wish to proceed or not.

mikecsh | 4 years ago | on: Anal oxygen administration may save lives

Angry much? Calm yourself down.

Clearly if anal oxygen proves to be safer and as effective then it will be adopted. No one is disputing that.

My comment was regarding your expletive laden derision of devices which save hundreds of thousands of lives.

And you seem to have missed the point. I did. It say hospital acquired infections are not prevalent or problematic. My point was that every decision in medicine s based on risk and benefit. If you need ECMO you will almost certainly die without it. If you have ECMO there is a compratively small risk of infection that may kill you.

And yes thanks, I did read the article. I’m also a doctor and have spent many months working in ITU, anaesthesia, and operating theatres, and managing acutely unwell COVID-19 patients.

Let us all be glad you’re not making any treatment decisions.

mikecsh | 4 years ago | on: Anal oxygen administration may save lives

What a bizarre comment. Every patient who goes under general anaesthesia for surgery (life saving or otherwise) is ventilated and usually without issue.

“Laying tubes into the trachea” I presume refers to tracheostomy.

Let’s be realistic here - if you are requiring a tracheostomy and ventilator, or ECMO the you are severely unwell. A blood transfusion, or small risk of infection is the least of your worries at that point.

As with everything in medicine there is a risk:benefit ratio. If you need ECMO you literally cannot oxygenate your own blood even with a ventilator. No ECMO = you die.

mikecsh | 4 years ago | on: Wake Turbulence from a Paper Airplane (2020) [video]

> Heavier, slower aircraft make stronger turbulence

Is it the weight of aircraft that contributes to the wake turbulence or the physical size? Presumably these usually correlate pretty well but just asking for clarity…

mikecsh | 4 years ago | on: Using a Pager in the 21st Century

Ah yes - sorry, I read that too quickly. The answer to that (at least limited to my experience of pagers in many UK hospitals) is that they don't carry any sensitive data at all.

There are a lot of other issues with them though. There are few companies supplying them so they are actually very expensive. Consequently in our publicly funded health service they are not replaced often and many are in a poor state with batteries held in by tape etc.

The main issues from perspective as a user is the synchronous model of communication that they enforce. Unless something is an emergency, it's an unnecessarily disruptive workflow.

There are usually a limited number of phones on a ward, which are usually very busy lines. Using pagers for routine communication means:

1. Physically move myself to a location with a phone 2. Wait for phone to be free 3. Call a number to send the bleep 4. Wait for a response (bearing in mind the recipient needs to be free, move to a phone, wait for that phone to be free, and call back) 5. Guard the phone from others using it until I receive the call 6. Hope that no one else calls the phone in the meantime

Bearing in mind that everyone is always busy in hospital this is a huge source of frustration and wasted time, hence the move towards secure messaging apps for these scenarios. Unfortunately these are mostly being built as silos rather than interoperable communication networks.

As mentioned above, for actually alerting a group of people to an emergency when you need an immediate response, pagers are still hard to beat.

mikecsh | 4 years ago | on: Using a Pager in the 21st Century

In my experience (UK) there is no personal information transmitted. There are two main types of bleeps:

1. Sending the number of a telephone extension you want the recipient of the bleep to call. For example, if I need a cardiology opinion, I will bleep the cardiologist with a telephone extension and wait for them to (hopefully) call back while I am still but he phone and before it is called by anyone else. This data is not sensitive. These are the types of bleeps which are being replaced slowly by asynchronous communication via apps

2. Emergency bleeps which are designed to alert a specific group of people on the arrest team to respond to an emergency. These usually work quite differently. Instead of 1:1 they are 1:many and usually carry a different alert tone, followed by a (generally poor quality) audio alert of the operator saying something like "paediatric cardiac arrest inbound to ED, ETA, 5 minutes". Again these carry no sensitive data.

mikecsh | 4 years ago | on: Using a Pager in the 21st Century

>> I'd wonder why

I'm a doctor, and whilst I despise carrying a pager it does have some benefits over more modern alternatives in some scenarios.

Mobile (cell) reception in hospitals is generally very poor and wifi connectivity is also generally poor. Trying to rely on either of those to deliver critical communication (e.g. bleeps to the crash team to respond to a cardiac arrest) is more unreliable than the hospital blasting a simple radio signal that any pagers within a few mile radius will always receive and decode appropriately.

For less critical communications (e.g. where you might bleep someone to contact them to a refer a patient to their specialty) there is a (slow) move towards messaging apps or email. These solutions do not yet have the immediacy and reliability of a simple pager for critical applications.

page 1