Falling Down

Image credit: http://en.wikipedia.org/wiki/Image:Falling_down.jpg

A significant portion of my business lately has come from Falling Down. No, not the old Michael Douglas movie, but rather the actual falling down of patients, mainly the elderly. I cannot tell you how many dozen examinations I have read over the past several weeks that were prompted by an old person falling. The average age for this particular problem is creeping up, although the range is widening overall. I’m seeing more and more exams on those in their late 80’s and early 90’s, although I haven’t seen any on those 100 and over for a while.

According to the CDC as quoted by eons.com, falling down is “the leading cause of injury-related death in people over 65, primarily the result of hip fracture complications. (B)y by 2020, medical costs from hip fractures alone—resulting from falling accidents—are expected to cost the healthcare system between 20 and 50 billion dollars.” Big problem. Really big problem.

It may be a stupid question, but why do old people fall down? And how can we prevent this from happening? There are several answers out there….

From www.laterlife.com, we find this:

Scientists at the University of Birmingham have been investigating this troubling phenomenon, and they’ve found that vision plays a part.

It seems that the normal thing to do, when walking through cluttered environments, is to look ahead to locate safe places to put one’s feet. But older people need to look much sooner to these targets, possibly through a slow-down of reflexes or a need to make sure that the way is clear.

Result is, they are in danger of looking ahead before they have sufficient visual information to negotiate the step immediately in front of them. And this makes for a higher risk of tripping and falling.

The eons.com article adds:

There are intrinsic changes associated with the aging process. The changes that increase the risk of falling are a degrading musculoskeletal system, sensory function, and gait changes associated with aging.

There are actually many factors that contribute to slip-and-fall accidents in the elderly. Medication side-effects can cause balance problems or dizziness, which can lead to falling. Elderly people have more chronic illnesses. Arthritis, for instance, is one of the major factors in falling. Pain associated with joints can cause falling. Fatigue, osteoporosis, dementia, and all sorts of things that more commonly strike the elderly, can lead to falls.

As my wife’s grandfather, who passed away at age 93, used to say, “Getting old isn’t for sissies.”

So, what can be done about this? There is a long list of precautions to consider, such as these exerpted from the eons.com article:

Minimize changes in walking surfaces, and use slip-resistant coverings

Use lighter-colored floor surfaces to create color contrasts between walls and floors

Increase lighting and reduce the contrasts in lighted areas

Securely install grab-bars positioned for support

Don’t wax floors

Avoid climbing and reaching to high cabinets

Always keep a night-light on in your bathroom

Use bathroom rugs with nonskid backing

Install light switches at the top and bottom of stairs

Be sure carpeting is tightly woven and installed so it doesn’t move or slide

And so on. Perhaps the most important recommendation for the older generation is to maintain good health, and not to let the fear of falling get in the way of exercising, and enjoying life. You see, there’s a lot more to look forward to as we get older than having some cranky radiologist read your hip radiograph!

Sniping for Fun and Profit

Cute, isn’t it? But that’s actually not the sort of sniping I’m talking about. Rather, I am referring to those low-lifes who are my nemesis on eBay… Let me elaborate.

I love dabbling on eBay. I love to pick up bargains, hard-to-find collectibles, necessities of life, what have you. Now, I’m not addicted or anything; I can quit any time I want to. Really. No, really!

Anyway, for years now, I’ve been trying to find an affordable piece of the Star Trek universe, preferably one that had something to do with medicine. Perhaps a screen-used scanner, or Dr. McCoy’s uniform, or surgical scrubs. These things do appear on eBay all the time, and I have bid on a few. But, I haven’t won any of them, and it’s all because of the bloody snipers!

So, what’s a sniper? eBay itself offers this definition of sniping:

Placing a bid in the closing minutes or seconds of an auction-style listing. Any bid, placed before the listing ends, is allowed on eBay. To protect yourself from being outbid at the last moment, enter the maximum amount you’re willing to pay for an item up front, and eBay will bid automatically for you, making sure you’re the high bidder until your maximum is reached. This system is sometimes called proxy bidding.

eBay has no problem with this practice, and why should they? The seller is happy, the sniper is happy, it’s only the unsuccessful buyers like me that aren’t happy! But think about how this works, and you may see it from my point of view.

When an item is listed for auction on eBay, a time limit of one, three or seven days is selected for the sale. Bids trickle in over this period. But, it is at the last possible minute that the sniper swoops in and tries to outbid, leaving others no chance to top him or her. Now, eBay’s response about the proxy bidding system is well-taken. If I can only stomach spending $500 for McCoy’s old tattered uniform, then that’s what I bid as my maximum. But I’m going to feel really bad when Mr. Sniper cuts in 10 seconds before the auction is over and gets it for $501. This is the problem with the system: there is always someone out there willing to pay just one more dollar (or five when things get into the higher priced realm) for the item in question. In addition, some of these auctions end during working or sleeping hours (No, they are NOT the same, thank you), and it is impossible for me to sit on the computer and snipe, or snipe back, as the case may be.

There are those who live and die by sniping, and justify the practice till the cows come home. This site, for example, basically says that snipers aren’t doing anything wrong, so leave them alone. Personally, I disagree. There is a certain degree of unfairness, of violating the spirit of the thing, by sitting and laying in wait, ready to outbid the bidder by the smallest increment possible. Why is it unfair? Because there is no possibility for said bidder to “fight back”, except perhaps to place a ridiculously high proxy limit. Maybe that is the answer after all.

Technology has provided a solution, or perhaps aided the problem. There are a number of automatic bidding programs out there that will electronically snipe for you. I won’t link to them because I think it is a nasty practice, but feel free to Google the concept yourself.

So, since I’m not happy with the status quo, how would I change things? In my bidding travels through the net, I have found a site for guns and knives and such called GunBroker.com. (You would be amazed at the weapons available on the ‘net!) They have a little something called the “15 minute rule”:

In a typical auction setting, there is always a called out counting that happens to allow buyers time to decide to place higher bids. This ‘final call’ is reset each time someone places a bid. . . .(B)ecause of delay caused by the Internet and other possible technological speed bumps, we have a 15 minute final call time.

. . .If there is bidding activity on the auction within fifteen (15) minutes of when the auction is scheduled to close, the auction automatically switches into a special mode analogous to the ‘going, going, gone’ period of a live auction. In this mode, the auction is automatically extended until there have been no bids placed within fifteen (15) minutes. . .The 15 minute rule makes auctions more fair, by allowing all bidders an equal opportunity to place their best bid. In other online auctions where an auction ends exactly at a given time, some bidders will hold their bids until the last minute or so, in the hope of winning an item on the cheap. This is referred to as ‘sniping’. The 15 minute rule gives all bidders an equal opportunity to place their best bid on an item before the item closes. This way, no bidder loses an item to sniping, and the seller can be assured that he has gotten maximum value for the item.

In a recent survey, a feature similar to our ’15 minute rule’ was the #1 most-requested feature addition that eBay (R) users would like to see added to the eBay (R) site.

I’m really not sure why eBay won’t do this. It seems a great deal more “fair” than the sniper system. Perhaps eBay is worried about auctions continuing forever, but I really doubt that would happen. At least every participant has a fighting chance, and isn’t guaranteed to get away with something based on a loophole. (Remind you of any other practice I’ve been writing about?)

Oh well, I guess I might as well get hold of one of those sniping programs….

The Ultimate Pointing Device

I have posted here and there about the various pointing devices on the market and how they work (or don’t) within the PACS environment. They all attempt to translate your thoughts into motion on the screen in some manner. Wouldn’t it be nice to eliminate the mechanical middlemen and just “think” your way through a study?

As reported in Medgadget, our friends at Microsoft are working on just such a project. No, their goal is not a new PACS interface, of course, but this would certainly be a great application for such technology.

The project is in a very preliminary state, but the essence is this:

We have built software infrastructure that acquires the signal from our EEG devices, transforms our data into relevant features for our machine learning algorithms to build predictive models, and classifies new data in real time. The system also allows us to easily store, playback, and visualize raw as well as classified data.

They have used this primitive prototype to control various tasks, including playing the video game Halo. That’s not bad.

Some comments made on this topic suggest that the technology will be used for mind-reading, and other nefarious purposes. I seriously doubt, however, that such capabilities will be present for quite a while, as in decades at least. Would you trust Microsoft with the keys to your brain? Perhaps, as long as they don’t try to apply patches or service releases!

In the meantime, consider the possibilities of powering through your daily stack by concentrating on the images. I guess this means I’ll be even more sedentary than I am already. Maybe Microsoft can come up with some virtual muscle stimulation.