Amarok

Oh orthopods, they're a riot in the Uk. They won't have much use for a portable MRI. In trauma all they see is the bony bits where CT and XR are king, anything else is someone else's problem. A true ortho emergency is rare and patients can wait for surgery if neurovascular intact. They do have time guidelines to operate neck of femur fractures (still won't operate out of hours though). But an XR is often enough to proceed . A few caveats I can think of... For fulminant infection like necrotizing fasciitis: straight to OR, open and have a look at the tissues. Joint infections: stick a needle in and await results. Bone infections benefit from MRI but there's no change in management while stabilizing on antibiotics, plenty of time to arrange a scan.

Then we move on to elective surgery (planned). MRI with the best available resolution will increase diagnostic specificity and avoid unnecessary operations to labrum's, meniscus, etc. They don't need to be done in hospital and you can shop around.

At this point we're looking for problems to fit this solution, poor business model. Not surprisingly, limb only MRI machines haven't been successful.

My experience as well is that there's a relationship of trust between radiologist and surgeon that a trained algorithm cannot replace. Same reason why AI isn't a threat to sales people for high priced items.

I'm actually doing what we call a taster in neuroradiology and it's been fascinating. Strongly considering applying for residency next year!

I did my elective at the PET center in Turku, great team. They even let me play with the rat MRI for Alzheimer's. They had some cool projects under Marco Bucci at the time, I believe he just started at Karolinska.

It's used in specific emergencies: https://news.ycombinator.com/item?id=22340458

It has applications in emergencies[1].Speaking for the UK, every stroke center will want one. Dirt cheap as well. [1]https://news.ycombinator.com/item?id=22340458

Some devices are safe to scan at lower intensities and for less time, but it's the radiologist who check on that, so not my expertise.

For a change, I can contribute something to HN without being out of my depth:)

Background: I'm a doctor with 3 years experience in acute medicine. AMA

Clearing some MRI misconceptions: 1. It's indicated ASAP in specific emergencies and will change how we manage them. For acute ischaemic stroke, it detects patients within the recomended time window for thrombolysis. Simply, it shows the cellular swelling in the brain, gives an estimate of the onset and we decide the risk/benefits of dissolving the clot. Second use, for cauda equina syndrome. Again we're looking for acute CNS tissue damage, this time from spinal chord compression, and the change in management is emergency neurosurgery (good luck getting them out of bed without an MRI) For herpes encephalitis, MRI is debatable because you can start empiric treatment. But I've seen it done.

Another misconception for the first use scenario in stroke. The MRI sequences we're interested in only take 1-3min and CT doesn't help us. But in my experience the whole scan takes 2h to organize, so point of care MRI is a game changer. Every minute counts when you're saving brain tissue. And Lower definition with artifacts are acceptable because you're looking for gross changes in a critically unwell patient.

Bonus: A report from when I managed my first suspected stroke as a junior doctor.

"49yo lady day 1 post op for total knee replacement (elective admission). Commorbidities of hypertension, obesity and osteoarthritis. She was just started on apixaban and gabapentin as per protocol, when I was asked to see her for new onset upper limb bilateral tremor.

On examining her I found the symptoms had started 1h ago. She was presenting bilateral upper limb ataxia as well, reflexes were reduced on the left and there was numbness corresponding to C4 dermatome. At this point I was worried about acute stroke whithin the 4h window for thrombolysis. I discussed the case with the acute stroke consultant and examined the patient with him. We requested an MRI brain to assess for acute posterior circulation stroke, because he thought time of onset was unclear (as per WAKE-UP protocol). I acompanied the patient to neuroradiology services. The MRI sequences we were most interested was DWI and FLAIR which only took a few minutes. We quickly scanned through the images noting there were was no DWI-FlAir mismatched high intensity signal areas within the brain parenchyma. This allowed us to rule out acute ischaemic stroke.

6h later the symptoms subsided and I was satisfied they were due to an adverse reaction to gabapentin."

Given the short to long term treasury bond yield inversion in 2019, I'm preparing for a recession in 2021 by keeping 10% cash and clearing off all debt.

I also implemented a higher risk strategy when I rebalanced my portfolio at beginning of year: hedging a few healthcare stocks with predictions of around 6% returns, but could see a higher payoff if covid-19 hysteria sets in.

Skeptical of crypto performance during a recession, so rebalanced to 3%

Could you explain a bit more how you tag sections?

Demagoguery has a better track record than science at influencing people's actions.

For example, Dr Semmelweis who literally prooved hand washing saved lives. He was mocked and committed to an asylum by his colleagues, where he ironically died from infection after a beating.

You're comparing both systems using watthours of energy expended, so mentioning enthalpy of water vaporization is unnecessary and confusing.

I see an age where our orbital space is so full of waste we can no longer leave the planet

Also women have lower body temperature than men.

Paracetamol is even better and more commonly available

I was storing 500 euro bills under my bed during the 08 crisis. When I moved to the UK, Barclays was the only non shady place that accepted them.

azair.eu for Europe and Asia

Do we have accurate figures for the mortality demographics?

I believe opioid addiction is not well understood among general practitioners. Here in the UK, they accept as common sense that your patient won't get addicted if they're taking opioids for pain. Similarly for ADHD, when I was started on meds my psychiatrist reassured there was no risk of addiction because I had ADHD. In practice, whenever I spend more than 3 days without them I get terrible headaches.

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The username reference doesn't match 16 characters as claimed

This article is 2 years old and rather misleading. The battery electric vehicle itself is much less efficient than both the fuel cell electric and conventional vehicles. This is because of the weight of the batteries that need to be transported. If you also take into account the energy used to produce the vehicles, in particular, the batteries, the BEV becomes the least efficient of the 3. It also doesn't account for on site hydrogen production and PEM or Alkaline technologies, which reduce the losses in transport, production and compression for an 86% efficiency.

This is just plain desinformación, hydrogen has an efficiency of 70%, which means a loss of 30%, and yes this figure is improving by "throwing money at it"

Perhaps lithium battery manufacture is improving rapidly because we're investing more on it.

And your video has one huge logical fallacy "assuming energy comes only from Green and renewable sources" If that's the case then hydrogen is the most environmentally friendly choice even with the loss of energy, which is also improving.

anedoctally, my dandruff cleared up after I switched from cold showers to lukewarm

Ideally the future is nuclear fission transitioning to fusion, with hydrogen fuel cell vehicles.

Lithium battery production and recycling is still very damaging to the environment, even if it stopped relying on coal for energy[1][2].

Hydrogen vehicles also have a longer lifespan and range compared to electric vehicles, while needing less time to refuel[3]. Now if only we invested as much in hydrogen harvesting technology as we are investing in lithium batteries.

[1]https://amp.theguardian.com/sustainable-business/2017/aug/24...

[2]https://www.weforum.org/agenda/2017/11/battery-batteries-ele...

[3]https://www.sciencedirect.com/topics/engineering/hydrogen-fu...

I don't understand why the successful implantation of the embryo is amazing.

Many women take immunossupressants while pregnant, and many undergo IVF to give birth, some of which to allogeneic embryos (egg donations). This last one doesn't seem to affect significantly implantation, with the main concern being a higher risk of pregnancy hypertension[1]. I expect conceiving with an allogeneic uterus would be similar, since in both the genetic differences between embryo and uterus are comparable.

Succeeding in combining the two is just a matter of probability, which I don't think is that low. Especially if you consider that the uterus had to come from a compatible donor, so the number of HLA mismatches will be lower.

1. http://www.ncbi.nlm.nih.gov/pubmed/20543201

During pregnancy the mother was on a triple immunosuppressant regimen: azathioprine, tacrolimus, and prednisolone (corticosteroid). The first is a Pregnancy Class D drug (some reports of human birth defects), and the two are class C (birth defects only in animal studies)

A study on azathioprine use in early pregnancy found an increased risk of congenital malformations which wasn't statistically significant (from 4.7% to 6.2%) , and an association with preterm birth and low-weight[1]. But a later meta-analysis concluded only the increased risk of preterm birth was significant for this class of drugs[2]

It's mentioned in the article that the mother developed pre-eclampsia (simply put, hypertension during pregnancy, which can lead to eclampsia, with seizures and coma). This should also be a concern for the other women in the study[3]: Firstly, immunosuppressants might increase pre-eclampsia, since the risk is about double in women with a kidney transplant (22%). Also, the age of the donated uterus should be considered: the risk increases seven-fold for pregnancies after 50, though it hasn't been shown the problem is in the uterus itself. Finally, the risk is higher for IVF conception.

Given this accumulation of risk, I'm curious how the other pregnancies carry on.To understand what's at risk, being born preterm is associated with increased morbidity and mortality, as well as lower achievement in general. Some papers point towards epigenetic changes (DNA methylation) as the etiology.

1. http://www.ncbi.nlm.nih.gov/pubmed/19343728

2. http://www.ncbi.nlm.nih.gov/pubmed/22434610

3. http://press.thelancet.com/wombtransplant.pdf (original paper)

>shorter hours were assumed to be a natural consequence of increased productivity

Another possibility is that progress will increase the amount of people that are unemployed or unneeded to support society, as the others continue to work the same hours. Not that far-fetched, if you consider our current work-culture.

If this happens, there would be rising social unrest at first, but I believe we'd reach a tipping point and a decrease in population would eventually correct the offset. Of course human reproduction can't be explained away by simple supply and demand, but the fact is, birth-rates are lowering in developed nations.

While these may just be suppositions, I think it's interesting to try and predict how progress will shape our population growth.

This premise reminds me of the plot of a movie, I think it was The Cube. From what I remember, it dealt with how bureaucracy could be used to perpetuate evil, without those involved thinking that what they're doing is wrong.

Once the machinery is in place, inertia makes it very hard to stop: the cogs don't need to worry about the bigger picture, they can just keep on turning.

http://www.imdb.com/title/tt0123755/

Caffeine appeared when plants started producing it, however it must have evolved from a similar molecule. I guess it makes more sense to talk about evolution of larger molecules like proteins, but the title isn't completely wrong.

Public health services are sub-par, if you want the best standard of care you'll need to go private. Ironically, government workers qualify for a special health insurance, which allows them to use most private hospitals.

Also, part of your salary goes into paying social welfare, and the employer pays some of it as well (about 11% from the employee and 22% from the employer). No idea how that compares to the US.

One of the reasons I switched from windows to debian was not having to deal with windows-style updates: you can have the computer running and don't need to reboot after updating. I wonder if someone already thought of applying the same principle to consoles.