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September 23, 2007

BehindTheMedspeak: Is it dangerous to put an epidural needle through a tattoo?

Kokok

Rachel Zimmerman's "Health Journal" column in the September 18, 2007 Wall Street Journal (my new favorite continuing medical education resource) offered what I thought was a reasoned, reasonable approach to an increasingly common problem: a tattoo smack dab in the middle of an expectant mother's back, right over the lumbar spine where an epidural needle needs to go.

Here's the piece.

    Why Some Expectant Moms Are Worried About Tattoos

    Pregnant women already have plenty to worry about. But now some doctors are pointing to another potential problem: tattoos.

    The issue is whether it's safe to stick a needle through a tattoo in the lower back for an epidural — an injection of painkilling medicine that can ease the discomfort of labor.

    There has been an explosion in recent years in women's lower-back tattoos — often ornate designs that take up a lot of surface area near the vertebrae where epidural needles are typically inserted.

    In 2002, a pair of Canadian anesthesiologists published a report that questioned whether administering an epidural through such a tattoo could be risky. The doctors speculated that complications like inflammation or nerve damage may arise if the needle pulled a bit of dyed skin along with it, and then deposited it into the nerve-rich region outside the spinal column.

    The small study of three women — which concluded that there wasn't enough evidence to determine if the practice is safe or not — set off a mini-wave of panic among expectant moms. After the report was picked up by Canadian television, women began sharing their concerns on pregnancy Web sites and chat rooms. In July, a story on the topic appeared in Pregnancy magazine, further fueling anxiety and sending many women to their practitioners for advice.

    Tattoos, of course, can be risky. Infection and diseases such as hepatitis due to unsterile equipment are known complications. Recently, scattered reports of tattooed patients getting burned during magnetic resonance imaging have surfaced. (Inks may contain metals, which could react during an MRI.)

    A 2006 study in the Journal of the American Academy of Dermatology found that nearly one-quarter of Americans ages 18 to 50 are tattooed. Among them, nearly 20% of the women have tattoos on their lower back, researchers reported.

    The national epidural rate is nearly 65% of the four million births a year in the U.S.

    William Camann, chief of obstetric anesthesia at Brigham and Women's Hospital in Boston, says tattooed women getting epidurals shouldn't worry as long as the ink has fully dried and the wound is healed. At that point, he says, the dye is inert and even the microscopic amount of skin that might be drawn into the body should pose no risk.

    The Food and Drug Administration says tattoo inks and pigments fall into categories that the agency regulates, but due to other health priorities, the agency hasn't specifically approved any inks. Two FDA-backed studies are under way to evaluate possible adverse reactions to the ink, and ways to test it for toxicity.

    Krzysztof Kuczkowski, chief of obstetric anesthesia at the University of California San Diego Medical Center, published an account in 2004 of a 34-year-old patient with tattoos covering her mid-lumbar area who received an epidural. Afterward she experienced unusual burning, tenderness and swelling where the epidural catheter had been placed. Dr. Kuczkowski believes the tattoo was the culprit. "It's possible there's a release of small particles that could contain metals or toxic compounds," he says.

    Anesthesiologist Mark Kostash, clinical professor at the University of Calgary in Alberta, says, "Nerves are so delicate and can be injured so easily, we want to minimize the risk that anything we do might cause damage." He adds: "If it was me, and I had a tattoo, I'd say, 'Go around it.' "

    In the 2002 tattoo article in the Canadian Journal of Anesthesia, the three tattooed women had no ill effects from their epidurals. But author Joanne Douglas says the research led some colleagues to change their practices at the British Columbia Women's Hospital in Vancouver.

    First, she says, anesthesiologists should try to avoid the tattoo. Or they can create a nick in the skin before the needle is stuck in, minimizing the chance of some skin getting pulled down with the injection. Finally, Dr. Douglas says, women should be told that while there is no proof complications will arise, there remains a potential risk.

September 23, 2007 at 04:01 PM | Permalink | Comments (0) | TrackBack

Bape in LA

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Eugene Kan wrote about the new store, A Bathing Ape's second (there's one in New York City) in the U.S., on hypebeast.com in an August 10, 2007 post, which follows.

    A Bathing Ape Los Angeles Grand Opening Tee

    For the upcoming grand opening of the new Busy Work Shop retail location in Los Angeles, some special tees have been created to mark the entrance of America’s 2nd official Bape retailer. The t-shirts [above] feature a sunglasses-wearing ape with palm trees and will come in four different colors. No grand opening date has been set so California Bape fans should keep their ears open.

September 23, 2007 at 03:01 PM | Permalink | Comments (2) | TrackBack

faqts.com: Experts' Experts — to the max

Uhiijij

What's this?

A knowledge base with 31,333 members, containing 11,588 answers to 13,247 questions, based on 78,906 contributions.

September 23, 2007 at 02:01 PM | Permalink | Comments (0) | TrackBack

Headgator — Does Urban Meyer know about this?

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No matter, down in the Swamp there's no need for it.

From the website:

    Headgator

    This one product started the company.

    The most versatile headgear ever.

    Stays extremely warm while blocking out the cold and wind.

    Headgator is a simple tube that changes quickly into 6 different syles of headwear.

    Made of ProMAX IV, this lightweight, breathable, compact garment folds to pocket size.

    Fits comfortably under any hat or helmet.

....................

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Black, Navy, Royal, Grey, White, Purple, Forest or Brown.

$17.50.

But don't take their word for it.

Here's Andrea Sachs's review as it appears in today's Washington Post "It Came In The Mail" column.

    The Headgator, a multi-tasking swatch of fabric.

    What? The Headgator, a multi-tasking swatch of fabric.

    Aimed at: Outdoorsy travelers with cold-sensitive noggins and necks.

    How much? $17.50

    But does it work? To the untrained eye, the Headgator is a large rectangle of stretchy cloth that could be a napkin with a secret compartment to stash extra desserts, or a tube skirt for an Olsen twin. However, those with origami and/or sarong skills know the truth: With a tuck here and a tug there, the above-the-shoulders accessory can transform into six wearable designs good for cool weather.

    To be honest, we felt like Goldilocks trying it on: The neck warmer was too loose, the hood too tight on our throat, the balaclava too creepy (black fabric covering all but beady eyes). We were getting warmer with the hat style — if only the drooping flap of fabric didn't resemble the foot of a giant clam. The most wearable configuration was the ear band, a wider version of the sweatband, which works only if you have an enormous forehead. The folded Lycra fit snugly over our ears and kept out outside elements — except for noises, including any laughter directed at our head wrap.

September 23, 2007 at 01:01 PM | Permalink | Comments (3) | TrackBack

'The only thing you can truly erase these things with is a specialty Smith & Wesson product'

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Private investigator James Mulvaney on the futility of trying to delete things from a computer.

Read Brad Stone's September 15, 2007 New York Times front page story about digital snooping and you might agree; the piece (from the newpaper) follows.

    Tell-All PCs and Phones Transforming Divorce

    The age-old business of breaking up has taken a decidedly Orwellian turn, with digital evidence like e-mail messages, traces of Web site visits and mobile telephone records now permeating many contentious divorce cases.

    Spurned lovers steal each other’s BlackBerrys. Suspicious spouses hack into each other’s e-mail accounts. They load surveillance software onto the family PC, sometimes discovering shocking infidelities.

    Divorce lawyers routinely set out to find every bit of private data about their clients’ adversaries, often hiring investigators with sophisticated digital forensic tools to snoop into household computers.

    “In just about every case now, to some extent, there is some electronic evidence,” said Gaetano Ferro, president of the American Academy of Matrimonial Lawyers, who also runs seminars on gathering electronic evidence. “It has completely changed our field.”

    Privacy advocates have grown increasingly worried that digital tools are giving governments and powerful corporations the ability to peek into peoples’ lives as never before. But the real snoops are often much closer to home.

    “Google and Yahoo may know everything, but they don’t really care about you,” said Jacalyn F. Barnett, a Manhattan-based divorce lawyer. “No one cares more about the things you do than the person that used to be married to you.”

    Most of these stories do not end amicably. This year, a technology consultant from the Philadelphia area, who did not want his name used because he has a teenage son, strongly suspected his wife was having an affair. Instead of confronting her, the husband installed a $49 program called PC Pandora on her computer, a laptop he had purchased.

    The program surreptitiously took snapshots of her screen every 15 seconds and e-mailed them to him. Soon he had a comprehensive overview of the sites she visited and the instant messages she was sending. Since the program captured her passwords, the husband was also able to get access to and print all the e-mail messages his wife had received and sent over the previous year.

    What he discovered ended his marriage. For 11 months, he said, she had been seeing another man — the parent of one of their son’s classmates at a private school outside Philadelphia. The husband said they were not only arranging meetings but also posting explicit photos of themselves on the Web and soliciting sex with other couples.

    The husband, who like others in this article was reached through his lawyer, said the decision to invade his wife’s privacy was not an easy one. “If I were to tell you I have a pure ethical conscience over what I did, I’d be lying,” he said. But he also pointed to companies that have Internet policies giving them the right to read employee e-mail messages. “When you’re in a relationship like a marriage, which is emotional as well as, candidly, a business, I think you can look at it in the same way,” he said.

    When considering invading their spouse’s privacy, husbands and wives cite an overriding desire to find out some secret. One woman described sensing last year that her husband, a Manhattan surgeon, was distant and overly obsessed with his BlackBerry.

    She drew him a bubble bath on his birthday and then pounced on the device while he was in the tub. In his e-mail messages, she found evidence of an affair with a medical resident, including plans for them to meet that night.

    A few weeks later, after the couple had tried to reconcile, the woman gained access to her husband’s America Online account (he had shared his password with her) and found messages from a mortgage company. It turned out he had purchased a $3 million Manhattan condominium, where he intended to continue his liaison.

    “Every single time I looked at his e-mail I felt nervous,” the woman said. “But I did anyway because I wanted to know the truth.”

    Being on the receiving end of electronic spying can be particularly disturbing. Jolene Barten-Bolender, a 45-year-old mother of three who lives in Dix Hills, N.Y., said that she was recently informed by AOL and Google, on the same day, that the passwords had been changed on two e-mail accounts she was using, suggesting that someone had gained access and was reading her messages. Last year, she discovered a Global Positioning System, or G.P.S., tracking device in a wheel well of the family car.

    She suspects her husband of 24 years, whom she is divorcing.

    “It makes me feel nauseous and totally violated,” Ms. Barten-Bolender said, speculating that he was trying to find out if she was seeing anyone. “Once anything is written down, you have to know it could be viewed by someone looking to invade or hurt you.”

    Ms. Barten-Bolender’s husband and his lawyer declined to discuss her allegations.

    Divorce lawyers say their files are filled with cases like these. Three-quarters of the cases of Nancy Chemtob, a divorce lawyer in Manhattan, now involve some kind of electronic communications. She says she routinely asks judges for court orders to seize and copy the hard drives in the computers of her clients’ spouses, particularly if there is an opportunity to glimpse a couple’s full financial picture, or a parent’s suitability to be the custodian of the children.

    Lawyers must navigate a complex legal landscape governing the admissibility of this kind of electronic evidence. Different laws define when it is illegal to get access to information stored on a computer in the home, log into someone else’s e-mail account, or listen in on phone calls.

    Divorce lawyers say, however, if the computer in question is shared by the whole family, or couples have revealed their passwords to each other, reading a spouse’s e-mail messages and introducing them as evidence in a divorce case is often allowed.

    Lynne Z. Gold-Bikin, a Pennsylvania divorce lawyer, describes one client, a man, who believed his wife was engaging in secret online correspondence. He found e-mail messages to a lover in Australia that she had sent from a private AOL account on the family computer. Her lawyer then challenged the use of this evidence in court. Ms. Gold-Bikin’s client won the dispute and an advantageous settlement.

    Lawyers say the only communications that are consistently protected in a spouse’s private e-mail account are the messages to and from the lawyers themselves, which are covered by lawyer-client privilege.

    Perhaps for this reason, divorce lawyers as a group are among the most pessimistic when it comes to assessing the overall state of privacy in the digital age.

    “I do not like to put things on e-mail,” said David Levy, a Chicago divorce lawyer. “There’s no way it’s private. Nothing is fully protected once you hit the send button.”

    Ms. Chemtob added, “People have an expectation of privacy that is completely unrealistic.”

    James Mulvaney agrees. A private investigator, Mr. Mulvaney now devotes much of his time to poking through the computer records of divorcing spouses, on behalf of divorce lawyers. One of his specialties is retrieving files, like bank records and e-mail messages to secret lovers, that a spouse has tried to delete.

    “Every keystroke on your computer is there, forever and ever,” Mr. Mulvaney said.

    He had one bit of advice. “The only thing you can truly erase these things with is a specialty Smith & Wesson product,” he said. “Throw your computer into the air and play skeet with it.”

September 23, 2007 at 12:01 PM | Permalink | Comments (1) | TrackBack

Why Winnie the Pooh is the very model of a modern major CIO*

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*Chief Information Officer (I too was baffled until I had my crack research team turn their collective intelligence to the acronym space — but I digress).

Ade McCormack's September 19, 2007 Financial Times column explored whether Taoism has a place in modern capitalism.

He wondered, "What kind of CIO is needed to lead a Taoist IT [information technology] department?"

His answer follows.

    So what kind of CIO is needed to lead a Taoist IT department?

    For that we need to visit the Hundred Acre Wood and borrow the characters of the author AA Milne. I am of course referring to Winnie the Pooh and his friends Tigger, Piglet, Owl, and Eeyore.

    The Taoist-Pooh parallel is not a new concept, but I think it is worth bending to the world of IT and business.

    Let us meet the candidates. Winnie the Pooh appears to be generally content, non-judgmental, and focused on the here and now. Poohs tend to be very laid back, perhaps irritatingly so. Piglet is eager to please and wants to be liked and so is very obliging. Owl is confidence personified but is often incorrect in his assumptions. Tigger is very enthusiastic and has a very can-do attitude, despite the reality that in many cases he can’t-do. Eeyore is philosophical though something of a fatalist and a pessimist.

    At interview, Tiggers and Owls easily impress. Staff warm to their confidence and sagacity.

    Eeyores rarely get through the door. However they are often found in organisations. Such people may have arrived as Tiggers, but have failed to understand the political elements of their role and have, in effect, given up trying.

    Piglets are good candidates if you want compliant CIOs; they will do what you tell them. But in an IT-centric world, you need a CIO who does what needs to be done and does not get sidetracked by boardroom whims.

    This leads us to Pooh, who indeed embraces many of the Taoist characteristics. He is most likely to be driven by reality rather than his or his boss’s ego.

    He may not have the sense of urgency and enthusiasm some would like, but his living in the moment style is likely to lead to better operational delivery.

    He is also more likely to adapt to changing markets, as he is not focused on a rigid plan.

    Poohs represent a new breed of CIO. They work the way that suits them and so cannot be managed by traditional means. But that is fine because these are in many cases no longer relevant.

    The key skill of the CEO is to work out what motivates the CIO. They need to be aware that Taoist CIOs are unlikely to covet money, power or influence.

    However, even Winnie the Pooh has a “weakness”. Listen carefully during interviews and you will uncover their motivations.

    Being aware that next generation CIOs are a little different, it should come as no surprise during the salary negotiations when your candidate exclaims “Show me the honey”.

September 23, 2007 at 11:01 AM | Permalink | Comments (1) | TrackBack

'My exit strategy is death' — Craig Newmark, founder of craigslist

Hijpijui

His website, featuring 15 million listings in 450 cities, gets 6 billion page views a month.

Yet Newmark (above) is deaf to all proposals for an IPO or buyout.

As it is, without even trying, craigslist's annual revenue is around $50 million.

Newmark's exit strategy mantra was designed to end discussions about selling before they start.

It would appear to me to be nicely designed, short and to the point, crisp and clean and clear — just like craigslist.

September 23, 2007 at 10:01 AM | Permalink | Comments (0) | TrackBack

Cypress Stool — Mood ring for your butt

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Designed by Nuno Goncalves Ferreira and Erin Hayne of Mississippi-based Visual Reference Studio,

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this cypress tree stump-inspired piece has a temperature-sensitive cover

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that changes color (black to blue or red to violet) when you touch it.

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Price upon application: info@visualreferencestudio.com

[via ohgizmo, gadgetsngizmos and gizmodo.]

September 23, 2007 at 09:01 AM | Permalink | Comments (0) | TrackBack

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