Going To Sleep Is Free, But

NYT: Google Gets Ready to Rumble With Microsoft

• Categories: Software, Technology
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If you're long GOOG (or even if you just like Gmail), read this in the New York Times.

Swapping 3G SIM Card Into Activated iPhone Fails

• Categories: Technology
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Having settled on giving my wife the iPhone I wanted to see if I could insert her 3G SIM into the already activated iPhone so that her cellular number wouldn't change. No joy. I saw a brief message about it being the wrong SIM (even though the SIM cards appear identical on the outside). The device worked, but I had no cellular signal strength indicator or carrier name.

What I've done instead is set her original number to forward calls to her iPhone number when it's off.

iPhone + New User = Fascinating

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I did buy an iPhone even though I said I wouldn't (buy this first one). The line at our local ATT store was about 20 people long when I checked at 5:45 p.m. Friday on the way home from work so I waited and snagged a 4GB iPhone. It is as insanely great as the commercials make it out to be. Fast, responsive, intuitive, solid, revolutionary...all those things.

I think the real power of the iPhone is in how easily people who are not tech savvy can interact with it. If Apple is going to sell as many iPhones as they think they're going to sell it will have to be to people who are not gadget freaks. By that measure this device hit the bulls eye.

I gave the iPhone to my wife, showed her how to turn if on, and asked her to perform certain actions without telling her how. She made a call in less than 15 seconds (to me, I'm happy to say) and soon thereafter figured out how to use the contact list to call her sister. She next used Safari to go to her favorite site for weather radar images (what is it with women and weather radar?) and bookmarked it. She took my picture and added it to my card in the contacts. She then SMS's her sister, who chatted right back and she got to see that iChat-like conversation log. Next, out to the garden to take pictures of her flowers.

Every cell phone she has ever owned before this one has had these abilities (contact list, SMS, web browser, built-in camera) and they went unused in every case. Only recently did she start to watch John Stewart's Daily Show and local weather reports in Cingular Video on her V3xx. Not until she got an iPhone did she actually enjoy using all those features and even did so without prompting from me throughout the day.

Tomorrow I'm going to give it to my nine year old son and watch him interact with it. In the mean time I want to thank and congratulate Steve Jobs and everyone at Apple for this breakthrough product.

I didn't make the Google Health Advisory Council :-(

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Well, I've checked my old e-mails to be sure I didn't miss something important. I didn't make the cut for the Google Health Advisory Council. (sigh)

Why I'm Not Buying The (First) iPhone

• Categories: Computers, Software, Technology
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With only three weeks to go until the release of the iPhone the frenzy is peaking. What features will it have? What is the twelfth icon? Will it have a SIM tray? Where will be the best place to buy one? I decided to today that I don't care. Let me explain why I won't be buying Apple's iPhone.

I've learned not to buy the first of anything Apple puts out. Though I love the company and have been buying their computers and other devices since the beginning, I think that (especially recently) there's good reason to be patient and let other people help Apple work out the kinks.

I ordered the MacBook on the day it was announced....and had the heat-sink problem. I ordered the 24" iMac the day it was announced...and had it up and die on day four of owning it. There are other examples of released hardware that was flawed initially but improved with each revision that, thankfully, I didn't experience myself. The bottom line is that being first has a price and that it's worth giving Apple a chance to learn from the initial release and improve the hardware with subsequent revisions. That doesn't mean waiting for the next model. Apple revises hardware between new releases, too.

The second reason for waiting is that the device you really wanted is usually the second one in the model line, not the first. But you compromise, tell yourself it's still worth getting the first one, but it's not. Because as soon as the second version comes it, you decide you should have waited. That's what happened to me with the Newton. I bought each new model as it came out (and still have a 2100).

What do I expect in the second version of the iPhone that I think makes it worth waiting for? Better-than-EDGE speed, for one thing. A camera that's better than 2 megapixels for another. GPS for a third. And many fewer problems.

Today, I put down my own good money for a Nokia N95. Five megapixel camera, built-in GPS, and a mature OS that has lots and lots of third-party apps. With iSync and the release of Nokia Media Transport yesterday (nice write-up here), adding contacts, calendars, iTunes music, photos, and videos just got a lot simpler.

Acoustic Respiratory Monitoring: What Is It?

• Categories: Anesthesia practice, Technology
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An intriguing press release last week from Masimo (known for their motion artifact-resistant pulse oximeters) begins as follows:



The release then refers to "an adhesive bioacoustic sensor applied to the patient's neck and connected to a breathing frequency monitor prototype" which in turn accurately monitors respiratory rate.

If this device does what I think it does, it will become the standard of care for post-surgical patients very rapidly.  We've been looking for a way to reliably monitor respiratory rate on the floors, once patients are discharge from the recovery room.  For example, a patient may receive pain medications from multiple sources, with unpredictable onsets.  How do we know their maximum respiratory depression won't happen after they've been delivered to their hospital room?

A patient can receive oxycontin and celebrex orally from a surgeon before their knee replacement surgery, then more fentanyl, morphine, and versed from us (anesthesia).  The surgeon may then inject bupivicaine and morphine into the joint at the conclusion of surgery (without necessarily telling the anesthesiologist). I might also do a femoral nerve block to further reduce post-op pain.  All of us are trying to do right by the patient but, given the right set of circumstances, are setting them up for significant respiratory depression post-op.  The ability to reliably monitor respiratory rate with this new Masimo monitor would be a huge patient safety advance.

The Society for Technology in Anesthesia abstract is here.

Own Your Own Cable Modem? Check The Speed!

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I have cable modem service to my home via Comcast. I bought my own modem, the Motorola 4100, about three years ago so I wouldn't have to pay the cable modem rental fees. Since the modem only cost about $50, I've saved about one hundred dollars over that time period.

I had Comcast come install two CableCards in my new Tivo Series 3 and the installers commented on what an old modem I had. They went on to explain that one advantage of renting a modem is that, when the modem limits download speed, Comcast will replace it with a faster one. Having just installed a new Airport Extreme Pre-N wireless router, this seemed like something to check out.

After reading the spec. sheets on both modems it looks to me like their download speed is the same (38 Mbps). However, the Motorola 5101 I just installed is faster in my tests. Maybe it's the DOCSIS 2.0 support. Well, I'm just an unfrozen caveman anesthesiologist but I know speed when I see it...16 Mbps:

If you bought your own modem several years ago, consider upgrading it. The results might surprise you.

Send Addresses From Google Maps To Your BMW

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well, in Germany anyway...

Are Alphanumeric Pagers Obsolete? That Depends.

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Ever since I was an intern I've worn a pager while at the hospital--and at a lot of other times, too. They used to be as big as a pack of three by five cards, but now they're quite tiny (think matchbox). But it's still an item you have to remember to put on each day, an item that weighs on your waistline. Back when there were only pagers that wasn't a big deal. Wearing a pager was a status symbol.

But now that belt or waistline space is more crowded. There's probably a cell phone and a PDA. There may also be a Spectralink phone or two for in-hospital calls. If you're really important, you may have more than one or two pagers. It's enough to make your scrubs sag.

Someone explained to me once (and I don't have a reference for this) that FCC law prevents device manufacturers from integrating a digital pager into another electronic device such as a cell phone or pda and that this was done to protect the paging industry. Is that true? Does anyone know?

My group still carries pagers because we know they always work, no matter where we are. In a surgery center in the basement of a medical office building or far out of town, away from cell towers, the digital pager will let us know someone wants to talk to us.

As the Palmdoc Chronicles points out in his post titled Alternative to Paging, there are more options than there used to be: SMS/Texting, Push E-mail, IM, Push to talk. To the best of my knowledge, however, none of them offer the reliability of paging. If someone needs to be intubated, or needs an epidural, or is coding, 'Sorry, did you IM me? I didn't get it' isn't going to cut it.

The one upgrade I would love to have to our pagers is the ability to send text messages over them. For example, instead of getting paged to '3968', calling that number only to be asked to go do an epidural in labor room 8, I could just receive the message on the pager: 'Epidural labor 8.' See? Our pagers are hospital provided and the service I describe costs more. I have not been sufficiently persuasive in my appeals to get them to spring for the extra feature. When I offered to pay for the cost of the alphanumeric service over and above what regular digital paging service costs, I was told we can't do that either because they can't 'split out' a subgroup of the pagers.

Now, I realize I'm just an unfrozen caveman anesthesiologist, but if you know that 40 pagers are using a service that costs ten dollars more per month and I cut you a check for $400 each month, wouldn't that make us even?

(Another Reason Why) I Like Desflurane

• Categories: Technology, Anesthesia practice, Medical errors
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I've posted before on why I think the desflurane Tec 6 vaporizer is a good design (it doesn't need to be turned off to be refilled). I'd like to add another reason to the list: it has alarms.

The Desflurane Tec 6 has a 'low agent' alarm and a 'no output' alarm, in addition to the ability to detect when it has been tipped (and therefore shouldn't be used). The other common agent, Sevoflurane, is delivered via a vaporizer that has none of these things. I am personally aware of two cases where no volatile anesthetic was delivered despite the vaporizer being 'open'. Two cases that would have been uneventful if desflurane and a Tec 6 vaporizer had been used. I'm going to ask the Society for Technology in Anesthesia listserv if there is any reason the Sevoflurane vaporizer couldn't have these features.

DaVinci Surgical Robots. A Hospital CEO Asks Advice.

• Categories: Health Care Finance, Policy, Technology
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Running a hospital: da Vinci Uncoded -- or, Surgical Robots Unite!

I just discovered this blog today via Medgadget and am already impressed. The large health system our group works in purchased a DaVinci last year. I don't know outcomes yet but it was apparent to me before the purchase that it was largely driven by regional competition in Central Pennsylvania. I think it's telling that many of the institutions which were the early adopters no longer use the systems.

I'm hoping to pick one up cheap in a couple of years so I can do labor epidurals from home. ;-p