How to create a planet: Step by step instructions.

Tata Nano in black. Henry Ford would have loved this one!

Ever wondered how Tata Nano would look like if it was in black? Well, if your favourite colour is black, you can search the whole of the internet and still you wont find an image of a black Nano until now.
The image of  a "serene white" standard version Nano downloaded from Tata Nano website was Adobe photoshopped into black. The work is not perfect but you will get an idea of how a nano would look like if it was painted in black. Do you think it would look better in metallic black? Or may be, metallic deep dark green that looks almost black...

"Any customer can have a car painted any colour that he wants so long as it is black." -Henry Ford.

Another colourless, timeless reason why he would have loved a Nano:

"I will build a car for the great multitude. It will be large enough for the family, but small enough for the individual to run and care for. It will be constructed of the best materials, by the best men to be hired, after the simplest designs that modern engineering can devise. But it will be so low in price that no man making a good salary will be unable to own one — and enjoy with his family the blessing of hours of pleasure in God's great open spaces"

Source: Wikiquote

Countless families would not be orphaned because of two wheeler accidents had Nano costed below one lakh.

Project Ostrich De-classified

World Stroke Day 2011

29 th October 2011 is World Stroke Day

Point your smart phone with a qrcode reader application on to this cube to activate link. Feel free to download this design for stroke day campaigns at your hospital.

The World Stroke Organization (WSO) is calling for urgent action to address the silent stroke epidemic by launching the “1 in 6” campaign on World Stroke Day, 29 October 2010.

The “1 in 6” campaign celebrates the fact that not only can stroke be prevented, but that stroke survivors can fully recover and regain their quality of life with the appropriate long-term care and support. The two-year campaign aims to reduce the burden of stroke by acting on six easy challenges:

1. Know your personal risk factors: high blood pressure, diabetes, and high blood cholesterol.

2. Be physically active and exercise regularly.

3. Avoid obesity by keeping to a healthy diet.

4. Limit alcohol consumption.

5. Avoid cigarette smoke. If you smoke, seek help to stop now.

6. Learn to recognize the warning signs of a stroke and how to take action.

You can read further at http://www.worldstrokecampaign.org/2011/Pages/Home.aspx

The qr code was generated using http://qrcode.kaywa.com and then transforming the code using GIMP to create this cube design. Isn't it interesting that the qr code has a large error tolerance (redundancy of information or function) that it allows a custom design to be placed in it without loss of readability... much like the human brain!

If you don’t have PACS, take Alcohol! An effective way to archive your scans and retrieve them reliably and fast.

Hi!

So you don’t have picture archiving and communication system (PACS) in your hospital? It’s a shame, but don’t you despair. There is a cheap and effective mechanism to archive your patient’s images till PACS arrives.

I have seen than most of the departments are struggling and juggling with CDs of imaging data of patients – some of which do not open after sometime. You could always copy them as individual files to your computer but opening them is a hassle most of the time.

What you can do is use a CD drive emulator which makes a clone image of the CD and stores in your hard drive and mounts them as virtual CD drives whenever you want it. The advantages are many:

1. Hard drive access speed is many hundred times faster than a spinning CD. Scans open much faster. Trust me; you will save many hours of your life eventually.

2. You can run multiple scans simultaneously and compare them. (useful for teaching, reviewing old scans of a patient)

3. Archiving in hard drive allows all your scans to be in one place where you can search and find by patient details.

4. Backing up your hard drive is another layer of protection from the nuisance of corrupted / scratched CDs.

5. You can access your imaging data from anywhere in the hospital, if your hospital network is LAN connected. Just share the folder or drive where you have stashed away your alcohol barrels (mdf and mds alcohol image files) using the network places dialog boxes.(-poor man’s PACS costing around 0.00 $.)

This is what you got to do:

1. Download Alcohol 52% software from this link and install in your computer. (you can use other similar software too) (alcohol 120% is a paid software and one does not need this)

2. Whenever you need to see an MRI or CT, first ‘alcoholise’it –that is, make an image of it in the hard drive.

3. Once Alcohol dumps the image, the CD will be ejected. You can (and should immediately) give it back to the patient.

4. Mount the image as a virtual drive. (You can make many virtual CD drives as you want which will appear as multiple CD drives in ‘my computer’.

5. Click on the cd drive and watch scans as you normally do.

Departments that use a lot of scans like neurology, cardiology, RT, pediatrics, oncology etc might benefit.

A few tips:

1. Label the image file properly first time. This will make searches easier after a few years of accumulating scans.

Name age sex hospital number diagnosis or description date of scan

Or

Name_age_sex_hospital number_diagnosis_description of surgery_date of scan

(Do not use / < > ? etc)

Example:

Arnold 40 m Y353535 cyberdyne chip implant postopMRI 10Aug2025

2. Dedicate an entire partition (make it large, hard drives costs peanuts anyway nowadays)

3. Back it up regularly on a physically independent disk (and if you are the really paranoid/a-fixated types, back it up again on Bluray– I am not!)

4. Try not to see MRI or CTs first and then decide on copying. It’s faster to copy firstand then see it. You can always delete it if you don’t want it in the archive.

Hope this helps. Feel free to mail me if you run into turbulence. May be, if I have time, I’ll send you an instructional screen capture video. As of now you can take a look at the screen capture pics.

I had introduced Alcohol to my colleagues in my department four years back and I can assure you that they all are happily (and safely) addicted!

Regards,

MS Gopalakrishnan

Neurosurgery

23 Aug 2011

Can we EquiShare?: Equipment sharing rules in a Government hospital.

‘EquiShare”: Equipment sharing rules.

First things first: there are no rules and that’s why I am writing this. Second, not for a moment am I even pretending to suggest rules, rather, these are just thoughts on how best we can evolve a protocol of interdepartmental sharing of equipments based on a combination sound logic and pragmatism.

Logic base:

1.       Equipments in Government hospitals are bought with public money, and are not excusive property of a small number of individuals. It belongs to the patients who need it. ‘We’ just manage the life cycle of the equipment.

2.       More the number of users and larger the total duration of use, greater are the chances of malfunction and damage.

3.       Sub optimal utilization of costly equipment is often a hidden waste of money.

Obviously, there is apparent conflict between statements 2 and 3. (Damned if you share and damned if you don’t kind of paradox).  Since all equipments are bought with guarantees and pricy annual maintenance contracts, it is best to maximally use equipments as soon as it is installed. Optimal use is best assessed based on hours of active service rather than just the duration of potential availability of the device.

Time eats away everything:

Not being totally philosophical, but also taking natural entropy of chemical corrosion, out dating of technology and expiry of warranty contracts into consideration, the biggest error we tend to make is to securely keep equipment from its expected use. This probably stems from our desire to protect, preserve and perhaps hoard the valuable. Unfortunately, ultimately everything falls into disuse or decrepitude at the hands of time. (Same thing applies to virginity, cobalt-60 and cash under the pillow!)

So let’s just shift tactics and share stuff.

Divide and share!

I suggest that costly equipments be classified into three categories by the department which is managing its life cycle. (I am deliberately avoiding using phrases like “department which purchased it” to free ourselves from misplaced and over enthusiastic sense of possession that comes with the pain of chasing a purchase in a government set up)

Type A:

Equipment that is vital to every day functioning of the department’s clinical or research activity and for which there is neither standby nor spare. The clinical activity or procedure cannot be done without the use of this equipment

Type B:

Equipment that is vital to everyday functioning of the department‘s clinical or research activity and for which there is a standby or spare available. The procedure cannot be done without this equipment.

Type C:

Equipment that is only occasionally used OR something which is desirable for a clinical procedure but the procedure can also be done without it.

Sharing ‘rules’ may be as follows:

Equipment type	Cost	Share it?
Type A	Less than ten lakhs	No! Do not share.(except in an emergency)
Type A	More than ten lakhs to thirty lakhs	Yes, share it, but, at the discretion of the department managing it. Lean on sharing rather than denying.
Type A	More than thirty lakhs	Yes.
Type B	Any cost	Yes.
Type C	Any cost	Yes.

Note:

·         Departments may share stuff in a non-reciprocal manner too: Even if Department ‘X’ does not share equipment with Department ‘Y’, Department ‘Y’ can take a decision to keep sharing its resources with other departments including ‘X’, keeping in mind that it is patient’s need that is a priority rather than tit for tat games. (Although this is a violation of game theory, is it not!?).

·         ‘Discretion of the department’ means that the decision was arrived at a departmental meeting factoring in majority view of all individual consultants/users  involved rather than a single individual’s idiosyncrasy or apparent wisdom)

·         Costs mentioned are of course just my sense of value and considering speediness of various tender processes. You could think of a better way. I thought anything above thirty lakhs is just too costly to be lying underutilized. It has to be time shared by all valid users as a rule. Anything below ten lakhs can be acquired by any department fairly easily and is not worth taking a risk sharing if it shuts your own shop down

·         There may be other factors like high risk of damage on physical shifting of some heavy stuff to another building/level. But again, lean on the concept of sharing than denying, if reasonable efforts can be taken to avoid damage.

I would even take the liberty to suggest that departments be encouraged to give a monthly report of   costly equipments it successfully shared with others (and for what duration and purpose, and what it chose not to share, and why) to instill a sense of positive cooperation. Responsible and maximal use of resources is in every one’s interest. What do you say? Can we Equishare?

Regards,

MS Gopalakrishnan

Neurosurgery.

Lost your BSNL wifi network security key? Whats under the asterix?

You no longer remember your wireless network security key and you need to enter that password in a new laptop or any other internet device. If your current laptop is connecting to the network wirelessly, then you need to find the network password as follows.

Start > control panel > Network sharing centre > view status of wireless network connection > Security

The network security key will be hidden as asterisks.

Now, to reveal this password, download and run the program 'WirelessKeyView' which is a free download at cnet

This program will show the password [Both Hex and ascii].

Below are the screen shots to help you. {or me if I forget this myself !}

Brain, The World Within.

Balloons that burst in the brain

Brain

.. to be uploaded

Gestasion adjusted date for premature infants

Click above to see the screen capture or visit cdc site

Head circumference percentile calculator

By infantchart.com

Surgical exposure of the median nerve: cadaver dissection. Power point slides. Aug 27

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Surgical exposure of the median nerve: cadaver dissection video

Cadaver dissection video of

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surgical exposure of the median nerve

Brownie, Tea, Ashley and the Pondy sea

A happy Toshiba

Children took the bus away... but the bus lived happily ever after...

Hancock's confession

Dear sir,


There is nothing official about this letter and is not through the usual "proper channels". Its just a personal letter conveying the sentiments of one John Hancock. You will know him if you have watched that movie by the same name.


Let me tell you a story...

Before I do that, let us meet the characters...


Hancock: He is essentially a drunkard, now reformed, with superhuman powers. He has the ability to stop speeding trains dead on its tracks or stop an avalanche. Yet, even with great powers, he is just a human, with human failings, ego, whims and fancies.


The child: Found by his foster parents, naughty and playful, always had to be under adult supervision lest he should fall into the hands of mortal danger.


Parents: Takes good care of the child, but ever so often, they keep wondering whose child it is. It could even be Hancock's if not their rich neighbour's. Parents, technically foster parents, have built a house by the foot of the mountain. This house has no compund wall and has only a few rooms. This week they had guests too.


The Boulder: A huge one, precariously placed at the foot of the mountain. When the earth quakes, it can roll down and crush the child.


The child's rich uncle: Could afford to build a beautiful house with strong compound walls that can slow the boulder down while the guards call for help. At house warming, he had promised his neighbours that he will take care of children when the earth quakes and boulders come tumbling down.


The story...


It was an unusually tumultuous weekend. The child kept playing by the foot of the mountain where death lurked. Parents were afraid of the danger of falling rocks. They called up to Hancock to fly out there and see if the boulder would fall. Hancock flew in there, and thought for a moment "Shall I flick this rock off?" ... Yet he thought... this child should be safe within closed doors or may be within the compound walls of his rich uncle's house. He flew off saying: "just call me if that boulder fall and Ill take care"


Parents took the child to their rich neighbour and asked for shelter. But the rich uncle told: " let that Hancock fly there and throw the rock away. I'm telling you, that rock is about to fall". Then he left for town. Hancock heard this and thought: "What does this man know about falling rocks? Has he ever stopped one?"


Next day, Hancock took the child with his parents for lunch at the uncle's house. The lady of the house felt pity and let the child stay for the weekend. He played there for two days safe and sound. Hancock thought he did fine and went back to stopping trains and avalanches saying:

"just call me if that boulder falls and Ill take care"


When the child's uncle came home, he was furious to see the child playing in his house. Swiftly, the child found himself in his parents' house with no compound walls and no guards. The guest rooms were all occupied. Hancock's house too was a crowded mess as usual and it was anyway not a place for kids to play.


In the dead of night, the child did go out and play at the foot of the mountain. Parents slept sound, his uncle was asleep, and Hancock did the same after a hard day at work. The boulder came crashing down ever so silently and swiflty, crushing the child. No one called for help. Hancock heard nothing. No one heard anything.


The next morning, at the funeral by the river, it was the custom of the community to cut the cake of responsibility and drink the wine of regret.


Hancock found himself gulping down wine by the bottle and his dry throat managed to swallow three pieces out of five, when he cut the cake. One piece was left for the parents and a slightly larger piece was left for the rich uncle.


From,

MS Gopalakrishnan.

The cup is full

Not everyone panics when your room fills with beer...
Canon A 95, no flash. Reflection on a window by the sea. Le Soleil, Pondicherry

How can I become a neurosurgeon? Should I take up General surgery first?

How can I become a neurosurgeon? Should I take up General surgery first?

This is the exact same words that an MBBS student asked me the other day. He didnt tell me why he wanted to take up neurosurgery. He said he didn’t have any particular reason. Or maybe he didn’t want to tell me. In any case, it didn’t matter to me. Rational thought and expressed reasoning are not for everyone. For some it’s a calling and that’s fine. That's legit.

More importantly, we have to answer the second question: Should he take up general surgery first? If one has decided on taking neurosurgery as the end speciality, does one really need to go through three years of general surgical training before going through another round of entrance test and three more years of dedicated neurosurgery MCh training?

Lets break this question up…

Why is neurosurgery different from any other surgical field?

I feel that it is because the surgical motor skill that is required is quite different. It is unlike any of the catching-a-bleeder-tying-it-and-dissecting sort of thing that you do in general surgery.
Joints and muscles maketh the man!

May I take the liberty to propose a ‘Motor classification of surgeons” depending on the movements that are required at various joints?

1. If you are a ‘’shoulder-surgeon”, you are a good orthopedician
2. If you are an “elbow-surgeon”, take up general surgery, surgical gastro or cardiothoracic surgery
3. If you are a “wrist-surgeon”, its plastic surgery for you.
4. If you are good with fine finger generated surgical movements, neurosurgery and microvascular surgical fields may be good for you. You are basically restricted to metacarphalangeal and interphalangeal joints and rest of the joints are better stabilized and rested.

Neurosurgery is also not for the claustrophobic and the impatient. Expect narrow corridors and long hours on the operating microscope.

Neurosurgery is not for the morbidity-phobic surgeon either. It’s a fact that despite all the care one takes, one might end up injuring a patient forever… and many patients in a career. This happens in neurosurgery more than any other surgical field, mainly because of the density of functional tissue in the operative field.

Again back to the second question, does one really have to prime oneself with general surgery before taking up neurosurgery?

I believe that it is not necessary. If you have really decided on taking up neurosurgery, why not plunge straight in and save at least one year and be more focused on the subjects that matter – neurology, neuroradiology and operative neuroanatomy.
I am sure that many of you will not agree with me. What about ‘the broader outlook’ to patient management that a post MS general surgery resident is supposed to possess? May be there is a difference. May be you are better off managing a multiply injured patient. But how often has one managed a patient with blunt abdominal trauma and head injury and how often have you operated on a blunt injury patient while managing head injury? May be one can better diagnose the condtion and manage shock and resuscitate better. But does this really require three years of learning hernioraphy, mastectomy and abdominoperineal resection?

But there are caveats. It’s possible that a person who is post MBBS may have deep, nagging doubts throughout the five years whether the decision he has taken was too brave and whether he is up to it. And in the unlikely and unfortunate event of dropping out of the course, one will have nothing but MBBS left even if you have spent many years in the course. Yet, once he has completed the course he might be more focused on the subject and will have saved one year.

Skill, of course depends on the resident.

Lets see another angle to this question.

What type of residents do consultants prefer? For example, Sree chitra [SCTMST] favours post MS candidates of late. I’m not sure of the reasons. May be someone can enlighten on this point.

Another gap in life

I am dangerously amnesic.