Unboiling Eggs and Making Medicine Local

A few truths. Winning a Nobel prize is pretty hard. You can’t clap with one hand.  You can’t unboil an egg.

Well winning a Nobel prize is probably pretty hard. The one hand thing though? Everyone knows you can clap with one hand. And of course eggs can be unboiled with a bit of vortex fluid action to do unfold some proteins. You all knew about vortex fluidic tech right?

(In a second I’m going to go to the next little heading, but I’m going to point right at the bit where you noticed I’m slightly misquoting  “you can’t unscramble an egg” to suit my purposes. Let’s just awkwardly nod in the direction of that little switch and move on in a spirit of togetherness.)

Egg

Now you don’t need to cry over spilt eggs. Wait, that’s wrong too.

Unfolding Your Way to the Ig Nobels

We can’t say if unboiling an egg will warrant a Nobel of course but it has already garnered an Ig Nobel. If you’re not familiar with the Ig Nobels they are bestowed yearly to celebrate some of the more improbable bits of research. They’re designed to celebrate research that makes you “laugh and then think”.

If you’ve got a minute you can work your way through a list of winners, all the way from the first recorded case of homosexual necrophilia in a particular kind of duck to the Italian team who demonstrated mathematically that organisations would become more efficient if they promote people at random (2008, Management Prize) or the group who published the seminal work on treating uncontrollable nosebleeds by packing the nose with strips of cured pork (2014).

Bacon. Is there anything it can’t do?

Now when the Vortex Fluidic Device (VFD) hit the news it was for that impressive and seemingly implausible ability to unboil an egg. It’s not that simple of course. When you boil an egg, you rearrange the proteins. They tangle differently.

The team involved here added something to a boiled egg they prepared earlier to liquefy the egg white. They then used the VFD to spin the fluid incredibly fast. As the liquid spreads out layers of different spin speed are created. The shearing forces between those films encourages folding and refolding of the proteins until they pretty much go back to what they once were.

It’s easy to see how it fulfils the brief of making you laugh. What about the making you think?

The Serious Bit

This technique isn’t mostly about food rejuvenation. Early in the piece the researchers mentioned that there would be applications for pharmaceuticals and biomedical areas. Drug development is mentioned. Cancer drugs in particular with exciting stuff already released on that.

Well the team has subsequently published something that isn’t so much about cancer. It’s about local anaesthetics. Y’know the things in the cocaine family that make you numb before the dentist does their bit.

Why go there so early? It’s not exactly cancer. Well I expect it wasn’t made a priority on the basis of world significance but there’s still a lot that can be gained.

Perhaps an example. Every couple of years a team of colleagues heads to a rural spot in India to fix up feet. Feet like this.

IMG_1129

Bilateral congenital talipes equinovarus. Also known as clubfeet.

Fixing up feet like that in that setting requires a fair bit of cutting. Wedges get taken out of bones. Or bones just get removed.

A key part of making kids comfortable for that is the use of local anaesthetics and not just the cream on the skin that’s become popular for making a tattoo easier. Local anaesthetic administered more centrally (either in the fluid around the spinal cord or in the space just outside the spinal cord, an epidural) makes the lower half of the body numb for a while.

When we do those trips we tend to take as much of the supply with us as we can. That’s because we can’t always rely on local stocks. Run out and the operating stops. On one occasion local strikes and roadblocks prevented all restocking in our little outpost. Replenishing our local anaesthetic supply relied on a guy and a motorbike finding his way through a tea plantation overnight. (For reasons I can’t quite understand, that adventure seems like the rider needs to have a scarf. Definitely a scarf.)

A glimpse of a future where some medicines might be locally produced with a device about as big as a suitcase is fairly exciting. No more supply chain to fret over. Drug production in real time where it’s needed.

That sort of technology is way more exciting for medicine everywhere than the latest surgical robot. It’s a bit like repurposing drones to deliver medical supplies to spots where there aren’t roads. Technology that promotes better access to healthcare will provide far more benefit to far more people than the newest generation machine that goes bing.

And if you can recycle a few eggs along the way, that’s just a bonus.

 

Notes:

There’s more on unboiling eggs here via Scientific American. Or you can watch this video version.

The image by Daniel Novta is unchanged and I found it on Flickr. It is under Creative Commons.

 

 

 

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New Reflections on Old Invites

Well it’s been and gone. That merry band of a few who drop by to look at these posts might remember a post about that time I was actually invited to do a speaking thing at a conference.

You’ll also recall (or find out for the first time if you go back and look at that link) that I had a series of things to try and do. A sort of half-baked labours of Academic Faux-Hercules to try and achieve generic brand immortality with (not even the good kind of generic brand; more like the type of generic brand you know is going to break really soon and not match the ‘immortality’ label).

This then is my part-time academic scorecard, to be subsequently known as my PTAS review to make it fit academic lingo more easily.

Did I Embrace Unwanted Things?

I did the planned talk on that happy little lump of offal, the liver. And the morning tea spring rolls didn’t get flung at my head (this is a bonus because I checked and they don’t spring).

I do feel like I worked harder to find a way to make this talk work for the audience than I might have if I chose my own topic. Who am I to judge though? I turned it into a blog post for the Songs or Stories site here. All feedback welcome.

Score: The unwanted thing at least got a pat on the shoulder and a thumbs up, rather than a full body embrace. That’s more acceptable socially though so I give it a pass.

A slightly less athletic thumbs up than this, but still.

A slightly less athletic thumbs up than this, but still.

Did I work hard as a speaker?

Well I turned up. I rehearsed each talk a bunch of times, which is definitely an aim. For each talk I produced an accompanying referenced post online. Oh, and for the social media talk I rehearsed with my new co-presenter, we set up a loose script in advance, worked on a joint slide deck, advocated for more tech infrastructure and spent hours trying to set up a Livestream thing.

So I worked a bit, but also felt like I actually contributed to the program rather than just being there.

Score: Pass as measured by a face full of soft cheese in the airport lounge when I fell asleep.

Did I do better talks?

Always hard to measure from inside the belly of the beast (the same reason you don’t trust Jonah’s assessment the size of the whale that swallowed him I guess). I definitely delivered more closely to the style of talk I’d like, but I need more feedback from the punters.

Score: Still waiting for the verdict of the jury after they settle on which takeaway they’ll order for dinner.

Did I do the conference?

I spoke to people. I spoke to people I hadn’t met electronically before even. I shared meals. I heard new stories. I did not talk to anybody from a company that sells stuff (could call that as positive or negative).

It is massively easier to do this when you’re surrounded by “your type of people”. You know, the other people out there who like giving controlled substances to babies. We think the same.

Was I super proactive like the real pros are? Probably not. I’m not sure what the colour of the paint in the corners of the room was though.

Score: Pass, in that I was at least a fish swimming randomly around trying not to bump into things, not floating belly up. In the corner.

Did I seek opportunities?

Well speaking to people was a start. And I’ve shared a couple of things in follow-up. Did I come up with any definite collaborations? Well, not really. Those things can take a bit of time though, right?

Let’s assume it’s a starter for the sort of earthy sourdough bread where you end up hanging onto that starter for multiple generations of a family and at least one armed uprising. (Yes, I like my sourdough with a hint of frontier gunpowder.)

The one area we did really take up some opportunities was in the social media talk. The real highlight of this was the involvement of people online in the Twitter stream who made an effort to help “just because”. This really demonstrated that there are some amazing and supportive people out there (setting an alarm at 02:00 in Canada to chip in to a Twitter stream is a pretty amazing effort).

Oh, and a guy in Sydney live illustrating the session and sending it back to us. I’ve wanted to do that for 2 years.

Score: Would be a fail if measured today, but hoping it’s a slow burn.

This is the very cool work by Gavin Blake at Fever Picture for the Social Media session - scribed in real time from Sydney while we were in Johannesburg.

This is the very cool work by Gavin Blake at Fever Picture for the Social Media session – scribed in real time from Sydney while we were in Johannesburg.

All up, I’m better at being a person who talks and conferences for going to this conference. Of course, you’re only as good as your last gig. So do you leave on a high, or go around again?

 

Notes:

As I mentioned above, I produced a post for each talk. I think this offers a lot more for the audience, as you can embed some references and links that might actually be useful and the talk can live beyond the 30 minutes. It was a bunch of extra work, but for conference sessions I think I’d try to do this again. My examples are:

The Liver Talk

The Aid Trip and Practice Development Talk

The Social Media Talk (this one also includes a link to the Livestream event we created for it, though we eventually broke the connection with a couple of minutes left).

The image for the thumbs up was posted to Flickr Creative Commons by the US Navy and is produced  unchanged.

 

 

 

 

A Week in Research Life

At some point someone said “A week is a long time in …” and maybe finished with politics but more importantly left us with a ready made boring opening statement for almost every topic. A week probably can be a long time in politics but probably not as long as a week in grass germination documentary film-making or freehand toenail scissoring art projects.

This week really was a long time in research though. (My humble apologies, couldn’t resist. Let’s allow a brief awkward pause then carry on, repressing the history of my banality until it festers deep inside this blog.)

I’ve actually posted on what a part-time PhD week can look like. This particular week was a little different though. That’s partly a result of external things but also because the project is in a very different phase. So here’s a new story of a week in part-time PhDland.

Monday 

Well, it’s a full day at the hospital. Except for the breaks where I’m working on the ethics paperwork for a case report. Case reports used to be a bit more popular I’m told but medicine has moved on to focus on attempts at big trials. It’s a bit of a pity in areas when you’re dealing with very, very infrequent situations. Anaesthesia fits in that basket.

The other thing that is bubbling away is that whole national competitive grant thing run by the NHMRC. Everyone knows the decision is made and sitting on a desk. People probably want to plan. We actually made it past the first knock out round with our serious researchers who know things really drinking the buzz from the reviewers’ comments.

At least until midnight when we get the notification that we’ve been rejected.

Bugger.

Yes. That was pretty much how I felt, female Pallas cat.

Yes. That was pretty much how I felt, female Pallas cat.

Tuesday

That midnight missive is under embargo though so officially I can’t say anything. Not even to the many, many people on social media making their results clear.

Our project not getting up isn’t entirely surprising in a setup where around 12% are expected to get funding. It’s a niche area and the clinical types in the team just can’t help the track record stuff that much. It does throw a bit of a slump into the project though, as not getting funding makes you wonder where you’re going exactly.

In the meantime, there is a simple little project we’re running testing really compact devices for warming blood to give to patients. That warming step matters because the red version of the blood we give to patients to boost their ability to circulate oxygen and stuff around the body is stored at four degrees and if you give that straight into a vein you cool down very quickly. Cold patients create more problems.

Today though, the warming device is having a complete fritz. It’s not working and not bothering to give an indication that it isn’t working.

As it would. Simple research is even against us.

Wednesday

I actually bother getting the feedback scores for the grant today. After all the warm and happy thoughts we sheltered in for the last few months it’s a wake up call. We were certainly in the top half of applications, but not that close to funding in a round that is rumoured to have seen a further fall to a 10% a success rate. My one bonus is that on Friday I can go to my day job. No need to start an alternate busking career. Actually that’s everyone else’s bonus too.

Thursday

Finally Thursday is a day that is about the good things in research. A colleague and I head up a quite long motorway to my old uni town to meet people. The first people are helicopter people who might help with the PhD or just other projects where we think alike though hundreds of kilometres apart.

The second is a researcher in a very different field – communication. Bronwyn Hemsley has a whole team looking at the way people communicate in emergency medical settings. It’s partly about how the communication happens with patients but also about how it happens between the workers.

This sort of stuff could be pretty profound. The prehospital environment in particular requires a lot of very rapid communication moments with scared patients, unhelpful bystanders, more helpful emergency service colleagues of all sorts and all done in the sort of environment where the ‘jaws of life’ might be in action. (Incidentally people think they’re called that because they look like jaws but it’s actually because they’re run on hydraulics which need a compressor so they’re kind of always jawing off – they just won’t shut up. Maybe that’s the reason anyway.)

The great thing about that sort of chat is that over an hour we find a bunch of new ways to explore the questions, all while getting a bit of schooling on how to run a research team from a pro.

Thursday turns out to be a collection of all good things about research. And it’s about the people you meet.

Friday

By now, I’ve had days to dwell on that funding result and it feels like the national competitive grant people are just pointing and laughing at me. That’s total rubbish because they’ve got far bigger things to worry about.

Being open and communicative isn’t one of them though. Officially the embargo still runs. I’ve seen so many law procedural shows where people can’t talk about a case for a bunch of reasons. I bet it’s just like this. Except with more sports cars. Not many sports cars in research.

Saturday

We actually submitted a paper for review overnight. Enough’s enough though. Maybe a weekend would be an option? In fact we even get dinner out and it’s the sort of dinner where the lentils are so good they actually make the dish even better. Lentils. The week still feels a bit weird.

Sunday

The highlight of the day is probably going fishing on a thing organised by other people with my son. I actually don’t particularly like fishing but my attempts to make sure we haven’t caught anything haven’t actually dissuaded the little guy from thinking it’s awesome.

Then of course he touches a wriggling fish today. In the name of research.

He’s not so big on going back fishing now. On balance this is a good research result. Perhaps I shouldn’t quit yet.

Note:

The image here is of a female Pallas cat. It was on Flickr creative commons and is presented unchanged from Tambako the Jaguar’s post.

The Connections

You may already have an idea about anaesthetists. You might think we’re up the back of the theatre doing sudoku. Perhaps you think we just want people to shut up and the drugs are a convenient way to deliver some peace and quiet. Maybe you’re not quite sure what we are.

Perhaps we’re to blame for that. So maybe I should explain the things that anaesthetists do. Except that would take way too long.  Years of electronic tapping. But I can cover one part of our job. Anaesthetists produce connections.

Connections Anaesthesia Probably Isn’t Responsible For

This post is also about something else. This post is a little bit about autism. And a little about the different things you can focus on when you start with those two words: anaesthesia and autism.

If you do a quick search for those two words it won’t take long to find stuff claiming a big link between anaesthesia and the development of autism. On some sites it gets put in a basket with vaccinations. Or toxins. All sorts of things.

On the one hand you might assume I’ll be quick to dismiss this particular connection. You might think I’d be jumping at the chance to rip into a bit of pseudoscience. I’m just not sure taking a swing at people wrestling with something helps anyone.  So let’s not.

The other reason I’m not that keen to go down that road is there are legitimate questions to ask about the effects of anaesthesia on the developing brain. There’s more on this topic here, but the simple version is: we’re still elucidating the way anaesthetic agents work; in some animal models anaesthetic agents at big enough doses for long enough cause damage to neurones; researchers are still trying to figure out what this means in actual human-type creatures.

It’s also an understandable response when you’re trying to fill in a space where there is only a hole. You need some sort of truth to fill the hole and researchers haven’t done much of a job of making sense of that space for those families. The research is starting to catch up though.

In May this year a group from Taiwan published the results of a retrospective review looking for any association between general anaesthesia and autism. They looked back through a health database including 114,435 patients and then sifted out the 5197 who had an anaesthetic before the age of 2. They then matched a bunch of features  of these individuals to a cohort of controls. Not just a few controls either – 20,788 of them. The plan was to then follow them out to 5 years of age to see what the rates of autistic spectrum diagnoses were during that time frame.

Why those time points? Well, it’s generally held that the exposure needs to be before the diagnosis, and that most vaguely related things should have declared themselves by the age of 5. It’s worth noting that kids having anaesthesia after the age of 2 could still be in the control group because the time critical exposure still hadn’t occurred.

So what did they find? No difference in rates of an autistic disorder. No difference with repeat exposure to anaesthesia or surgery either. Age at the first exposure to anaesthesia? That made no difference.

Will this settle the concerns? Probably not, but it’s a start.

It’s also not the only important connection that we need to look at more.

Making Connections

To get to the point where you can give the anaesthetic to a kid, it helps to make a connection that lets you find a better way there. Sometimes parents help with that. Sometimes we get there in the light of bubbles. Sometimes we have a song.

Other times I bring a rocket. Well I usually start with the mask for the space crew, and then we add the space gas. (You all know it’s called space gas because it makes you feel like you’re starting to float up into space, right?)

Floating is good but you need to fire up the rocket to really get going. And sometimes you can smell the fuel for the rocket, which is a little bit smelly. Not as smelly as the stars when you get right up there of course. Once you’re really travelling you can smell the stars because everyone forgets to wash them. Have you ever seen someone washing the stars?

And then you’re asleep.

A connection helps you share the story. So what about those kids who you really, profoundly fail to make those connections with?

Here's one of the rockets I sometimes bring to work. [via the NASA Apollo photos just released]

Here’s one of the rockets I sometimes bring to work. [via the NASA Apollo photos just released]

Time and Space 

For the clinical anaesthetist, the most pressing research we need is how to make the whole experience better. Kids in the autistic spectrum (and it’s a big spectrum so let’s just allow for a huge amount of variability in this discussion) can find the hospital environment challenging. Turning up for an operation is a pretty extreme microcosm of hospital care.

As the autistic spectrum is actually a big range of conditions you see a big range of personalities and behaviours. And fears.

Some kids with a diagnosis in the autistic spectrum will have a degree of intellectual disability. Plenty won’t. Some have changes to fine motor control or the way they walk. Some have significant anxiety issues. Some can’t cope with touch. Some self-harm, particularly at times of stress.

All of these are part of a couple of main groups of characteristics: social communication difficulties (the sort that make a space story not always that exciting)  and ritualistic and repetitive behaviours.

So plenty of these kids will find social interaction and understanding really challenging. And usually they might find solace in a stable environment or repetitive movements or focussing on special, quite intense interests.

Step back for a second and consider what we ask of kids when they come for an operation. A procedure they don’t always understand. A total disruption to their routine. A long time with no food and a slightly shorter time with no drink. A quick succession of new adults doing a bunch of things you might not have tried before then finally a trip to a small room with lots of monitors and things on the wall. Then a mask, dizziness and the smell. And at the end it’s all so quick.

Contrast that with the things we probably should do for a lot of kids in the autistic spectrum. Prepare them slowly. Establish familiarity beforehand. Make sure the perioperative team understand particular things that make this patient more or less anxious. No sudden introductions to an environment with huge amounts of new stimuli. Maintain a degree of routine. Perhaps a premedication to help get things going. Get out of there as quickly as possible afterwards.

Where is the connection between those two scenarios?

The hospital setting is almost purpose-built to fail a lot of these kids at every step along the way. And these facilities are being built and expanded all the time. We need to carve out space for a slow, quiet lane in care. The needs that can be served by quick forward movement are always pressing.

So there’s another connection in anaesthesia we need to make. More research into ways to make the experience better for autistic patients so we can argue for the things they need.

Maybe starting with a bit more time to make that trip to space.

References and Notes:

I looked at a few papers for this one but the most useful were these ones:

Ko, W-R, Huang, J-Y, Chiang, Y-C, et al. Risk of autistic disorder after exposure to general anaesthesia and surgery: A nationwide, retrospective matched cohort study. Eur J Anaesthesiology. 2015;32:303-10. 

Taghizadeh N, Davidson A, Williams K, Story D. Autism spectrum disorder (ASD) and its perioperative management. Pediatr Anesth. 2015;25:1076-84.

And for a story around autism this Radiolab episode, “Juicervose”, is an interesting listen. I’m sure it can’t cover the experience of all people and families with an autistic spectrum diagnosis, but it’s still worth the time.

 

 

 

Reviews of Everyday Things – A Conference

Part of the academic education is supposed to be about developing a critical eye for things. You should finish a PhD able to wrap your brain’s sulci around an experience or some sort of argument and arrive at a reasoned assessment of its many elements. Or at least an ability to drop sulci into a sentence I guess.

This faculty could just be employed while actively pursuing academic work or engaging in a mental wrestle with a Rob Schneider anti-vaccination rant. Job done you could sink in to the other experiences of life, relieved of the need to exercise your brain in any way.  A bit like when you watch a Rob Schneider movie.

[OK, we can both spot the flaws there. Obviously you don’t require any more brain flexing to demolish a Rob Schneider anti-vax rant than to watch one of his movies. And no one is watching one of his movies. Let’s leave the multiple fails behind and move on.]

Developing a critical eye shouldn’t be confined to desk time. Following a principle I’m sure someone on an infomercial has already turned into a wodge of money-making glibness, why not train that brain during the experiences of every day? What can you learn from examining every experience in disorienting detail?

So to a review of a conference, because academic life will be full of them, and I might as well learn from them.

The Conference Location

This conference was a gathering of anaesthetists. What’s the collective noun for a group of anaesthetists? A slumber, maybe? It’s a generalist audience run by the Australian Society of Anaesthetists. This time around it was run up at Darwin which has a lot of things going for it. Not least of those was a bit of bonus summer.

That said the Top End is supposed to have a reputation for fringe-dwelling extremes of experience. Scheduling the welcome event at a place called “Crocosaurus Cove” certainly had potential. So to end the night without a crocodile being led through the crowd on a lead was, honestly, a bit of a let down. I bet they wouldn’t let you down like that in Vegas.

In fact there wasn’t really anything particularly ‘out there’. It was just a place with an excellent vibe. Disappointing.

The Content

If a week or so later you can’t really suggest if it was a good conference for the academics bit, what does that say? Some of that is a result of the fact that my particular bit of anaesthetics is a niche, so it doesn’t get so much space on a program. In fact all of the things actually related to kids’ anaesthesia pretty much fell at the end of the conference.

There were a couple of standout sessions though. Some of those related to the quality of the keynote speaker (a bit more on that below). The reason they were standouts though is that a lot of the sessions felt pretty ‘standard’. The thing is I don’t quite understand why medical types don’t seem to make the link that if you made your standouts pretty much what all of the talks were like, everyone would benefit.

None of it is rocket surgery either. Most of it is reflected in things I’ve put elsewhere. But for an updated version, there were a few things that stood out:

1. Do Less

It’s never clear to me if the problem with those talks where people try to summarise all of time, space and the spirit world in their talk ended up there all by themselves or felt compelled because of a topic they were handed. Those talks that stood out generally did less though. They had a single point to get across and they made it stick.

2. Don’t Bury the Big Bit

One of the talks I went to from a really clever and excellent person was a review of all of a topic. They stuck to a structure. That structure was something like “Here is the landscape of this topic. Here is the stuff we were always told. Now I will walk through why that is all almost exactly unchanged. This will take some time. Oh, and in the last 90 seconds I will mention a genuinely new bit of something that didn’t use to be ranked as highly as those old things but will actually change your practice.”

The thing that will change everyone’s practice isn’t the afterthought. That’s a highlight.

3. Don’t Apologise

In one talk, a speaker actually said “I’m sorry you can’t actually read this slide because of all the details on it.” Don’t apologise for that slide. Ditch it.

It seems like there’s only a couple of explanations for leaving a slide like that in. One is that the speaker feels they need it as some form of support. Putting up something I can’t read doesn’t support my positive impression of the speaker. The other is that rather than digest it themselves and turn it into something useful the audience can take away, they took the shortcut.

Don’t say sorry thanks.  Just fix it.

4. The Extras

This might seem a really small point but some of the little traditions should be allowed to slowly wheeze out their existence in the corner. Like the conference bag. Most people who make their way to a conference probably have access to a bag they could use. They are unlikely to need a bag of dubious quality extensively branded with the logo of a meeting that was anything but the planning and simultaneous launch of the first manned Mars mission.

Enough with the shoddy extras that don’t need to be extras. Ditch the bags. Human people can probably adapt. And didn’t Darwin teach us that those predisposed not to adapt will just become extinct? No? That’s a complete misrepresentation? Let’s move on anyway.

Here's that amazing little text - couldn't be better.

Here’s the amazing little text by John West – couldn’t be better.

5. The Legend

I wrote once before about all the things ways John West impresses me.  All too often you shouldn’t meet a hero. Not this time.

He is 86. He needed some questions repeated. He doesn’t walk so fast. And he was endlessly patient and engaging. People would come up and mention a topic and he’d latch on and ask them to e-mail more information. There’s more than a few people in the game that could learn from that example.

Then there were his talks. In a time where everyone with a TED fetish thinks that’s where the history of presentations started could have done with seeing this. He told stories. He showed the personal within the science. He didn’t rely on dot points. He surprised.

All those other people didn’t invent the rules of presenting. There were good people already doing it.

Oh wait. Yes it can.

Oh wait. Yes it can.

The critique? Some bits were good. Even the talking to people bits. Some bits were just as ‘meh’ as other conferences. There’s at least a few of those items that could be fixed by clearer direction and support from organisers. But it’s clear that changing the template for conferences is a bit like turning an ocean liner with a kayaker’s paddle.

Which coincidentally is in the plot of the next very unfunny Schneider flick.

 

 

New Invites

Invites are pretty great. Or sometimes pretty awful. If I was to be completely honest most invites I get, which I could probably individually list, come with at least a moment of [insert Sideshow Bob grumble].

It’s not that being invited somewhere isn’t excellent. It’s just that invites usually come attached with meeting people and people … well, I’m a big fan of humanity but having to meet new humans who happen to make up the humanity is the worst. (I know, it’s my flaw to fix.)

It’s part of the academic routine though so I’m actually pretty pleased to be invited as a speaker for the first time. Not that I’ve never done a speaking thing before. This time I’m one of the speakers who has to work though. It’s a bit daunting.

So as part of the ‘documentation of new academic things’ purpose of having this site, following is the brief list of “things being invited to speak has taught me about life, the universe and cephalopods throwing things at each other“. Actually there isn’t much it’s given me on the topic of “thing throwing cephalopods”. I’ll just have to settle for less excellent life lessons.

1. Embrace Things You Did Not Want

Early on I was given the opportunity to nominate things I might like to chat about. This is a conference for people who do the sleeping thing for kids remember. My list included anaesthesia for heart and lung operations, liver transplant stuff, trauma care and prehospital medicine.

My main topic, the one for my solo 20 minute talk is “Anaesthesia in patients with hepaticopancreaticobiliary disease having non-hepaticopancreaticobiliary surgery”. That milkshake should bring all the docs to the yard.

So at first I was a little lost. The thing is it’s their show and I’m there to contribute. This is a topic that actually has a lot of worthwhile stuff in it. Some of that stuff might also be a new title though.

2. Speaking is Hard Work

I have had the chance to do a single talk or workshop at a conference before. It takes time. In total I’m up for 4 sessions over 3 days this time around. That’s a huge step up in preparation. Apart from the session above there’s a 3 hour workshop that I’ll pitch in on, a breakfast session to chat about stuff you learn on aid trips and a joint talk on social media stuff. It’s really driving me to prepare a lot harder.

3. Do Better Talks

I’ve been to a few conferences. Sometimes there are a few speakers who leave me wondering if the conference mints could be manipulated to make them corrosive enough to burn a hole in the floor to allow an early escape. I do not want to be one of those speakers.

So for now I’m going to try to do better. I think some of this relies on not starting with the slides but starting more broadly with an arc that works for the audience. There’s a bunch of stuff I like about a blog I came across via a paediatric surgeon working in the UK who does a lot of the writing, Ross Fisher. It has short snippets of ideas for better presentations. A lot of it is heavily less is more. This could best be described as not my natural turf.

Better talks. It’s a work in progress.

4. Actually Do The Conference

I’ve read things elsewhere about the way people who really “do” the conference thing approach it. They check the program, figure out particular highlights, do electronic introductions ahead of time, arrange to meet particular speakers in advance and a range of similarly terrifying proactive things.

If you’re going to make the effort to go though I’m sure that’s a way to get a lot more out of being that close to all the stimulating people there. This time I will try to actually talk. To people even.

I guess I'm partly worried I won't make a good first impression. Like Kaiju here.

I guess I’m partly worried I won’t make a good first impression. Like Kaiju here.

5. Seek Opportunities

Moving on from point 4, one of the good things about being an invited speaker is there’s been a fair bit of chat in advance about particular sessions. That degree of chat will hopefully make the talking to people bit easier.

The challenge might be to broaden that conversation. Ideally it would be good to get the chance to find other people working in similar bits of research. It’s a slightly lonely part of the world, noninvasive tissue oximetry monitoring.

Otherwise there will hopefully be all sorts of people I meet and given that this time I plan to talk to these people, it’s about time I took those chats to seek new inspirations and maybe a few chances to work with bright sparks from elsewhere.

 

All of which brings me to the informal point 6. I wrote this all down partly because it’s out there now. Which means I’m sort of committed to doing it.

It doesn’t mean I won’t have a back-up escape plan that somehow relies on the mints.

Note: That turtle hangs out on flickr in the Creative Commons area. It was posted by Rodney Lewis and is unaltered here. 

 

 

 

 

 

Sleep that isn’t quite sleep – or is it?

If it was up to me it would be all about sleep. Not so much getting large amounts of luxurious, holiday-advert sleep. I have no expertise in that. The drug-induced kind that also permits operations, that lets surgical types do their “nothing heals like steel” routine.

If you’ve missed it when I’ve mentioned it other places, I think anaesthesia is a little bit amazing. Shrouded in a little bit of mystery, initially peddled (well in the version from the west) by a dentist with hopes for a medical showman’s way to fame and wealth and revolutionary to our understanding of what constitutes suffering. There’s not much I can’t turn into an example of how great anaesthesia can be. Well, numbats. I can’t find a direct causal link to numbats.

Pretty great animal that brings its own leaves but it is possible anaesthesia would improve it.

Pretty great animal that brings its own leaves but it is possible anaesthesia would improve it.

Things Anaesthesia Isn’t

One thing that most people agree on is that anaesthesia isn’t sleep. It’s distinctly different, right? Well there’s a really excellent thing written by Jessa Gamble here examining one element of this – can anaesthesia satisfy the need for sleep?

Starting with testimony around the Michael Jackson case where a particular agent, propofol, was much discussed there’s a series of examples indicating that maybe general anaesthesia can be as regenerative as a good night’s sleep. So maybe you should all back off propofol, huh? (Poor old propofol – first it has its milky innocence smeared by an association with sexual hallucinations and then it ends up linked to a not-at-all trained cardiologist acting as a sleep consultant in an apparently pretty bizarre world.)

So if those pieces of evidence which provide the background links in that piece first mentioned are all about the restorative value of general anaesthesia, why aren’t there more informercials offering sweet, sweet drugs to dream years of fatigue away?

Subtle Distinctions

It’s just possible that a phenomenon we’ve spent more than a century struggling to understand might also have different effects on sleep given a different start point. It’s also true that anaesthesia generally isn’t something we’re offering in isolation and those other bits might matter too.

The article from The Last Word on Nothing is examining a specific question – can anaesthesia restore sleep debt? It covers some literature, a lot of it from animal work, where the subject receiving the anaesthetic starts from a point of sleep deprivation (and remember the starting point for that article was a particular case where propofol was being used for someone who hadn’t been sleeping). The suggestion is that giving an anaesthetic in this setting of sleep deprivation is effective at getting things back to an even keel.

I’m not sure that this also applies to the patient who turns up without sleep deprivation. Over the few days after anaesthesia in this setting, does the individual get the benefits of natural sleep or does sleep disturbance result? It might be their understanding around this clinical situation that led the experts mentioned to talk about anaesthesia as ineffective for those wanting slumber to make things more pleasant.

The Days After

Clinicians’ perspective on sleep disturbance after anaesthesia is related to research after surgery. In this setting sleep structure is altered. After anaesthesia for surgery, rapid eye movement (REM) sleep is generally lacking for a few nights, building a deficit specifically in this component of sleep. A few nights later, REM sleep suddenly returns in greater amounts to repay this debt. During this time the excess REM sleep can be associated with breathing disturbances, particularly in those who also have obstructive sleep apnoea.

This sort of sleep disturbance goes across age groups and different agents. 4-6 month olds took up to 10 days to return to normal sleep patterns after surgery for mouth conditions. This was in a comparison between different regimes to achieve the happy surgical snooze.

The agent for the anaesthesia can also make a difference. Propofol in the trials where we’re not talking about humans seems pretty even-handed with REM sleep. For other agents duration seems to matter. There’s a lot of things chipping in to the picture though. I haven’t even got into the bit where the opioids we use for pain relief also mess with sleep. Everything interacts. Why can’t sleep just be sleep?

Drugs for the Subconscious

The one thing that is easy to accept is that it is those drugs that hit the brain that mess you up. Oh, except for this one thing.

When you provide comfort for surgery and avoid general anaesthesia and opioids, you still get messed up sleep. In this one, they gave a spinal anaesthetic for lower limb surgery (where local anaesthetic introduced to the fluid around the spinal cord blocks the sensation that anything is happening) and then avoided all opioids for days afterwards. Sleep study in the days after still showed major distortion of the sleep architecture. Pretty similar for this study. And in this one for gynaecology surgery.

This might be because it’s also known that surgery itself can cause sleep disturbance and bigger surgery leads to more sleep derangement than smaller operations. I guess everything about surgery messes with sleep. I didn’t even get to the machines that go bing on the ward.

Which leaves us …

Still searching for understanding. Anaesthesia, which we’re still trying to understand, is not entirely like sleep. Except for when it’s very much like recovery sleep.

Of course there’s the other times when it entirely messes with your sleep. Not forgetting those sleep affects when having “not general anaesthesia”. Or the disruption caused by that surgery thing you were trying to avoid putting up with experiencing by having a “sleep” with the anaesthetic.

I hope that clears it up.

Probably the best response.

Probably the best response to all of this