Rose's Dirt

TV Shows.

2007-11-18T08:26:00.000-08:00

I don't own a T.V. but there are a few T.V. shows that I love to watch. I just thought I'd share....

How I Met Your Mother

http://alpha.cbs.com/primetime/how_i_met_your_mother/

Chuck

http://www.nbc.com/chuck

Anderson Cooper 360

http://www.cnn.com/CNN/Programs/anderson.cooper.360

SUSHI!!!!

2007-11-18T08:05:00.000-08:00

I love Sushi. I could eat sushi every day and not get tired of it.

My favorite Sushi places:

www.hapasushi.com

www.sushisasadenver.com

www.opalrestaurant.com

The History of Sushi, according to Sushi Man.

History of Sushi

Japan is an island nation, its surrounding seas warmed by Kuroshio, the plankton-rich Japan Current, and abundant with an astonishing variety of fish and shellfish. The island themselves are mountainous, and what little arable land exists is terraced and carefully cultivated to coax rice and a few other crops form the earth. Japan has always fed its dense population from the sea and the rice fields, its cuisine emphasizing what nature provides. Sushi, the combination of raw fish and seasoned rice that seems so exotic to foreigners, is a supremely logical food in Japan.

Sushi began centuries ago in Japan as a method of preserving fish. It is told that the origins of sushi came form countries of Southeastern Asia. Cleaned, raw fish were pressed between layers of salt and weighted with a stone. After a few weeks, the stone was removed and replaced with a light cover, and a few months after that, the fermented fish and rice were considered ready to eat. Some restaurants in Tokyo still serve this original style of sushi, called nare-sushi made with freshwater carp. Its flavor is so strong that it obscures the fish's identity altogether, and nare-sushi is something of an acquired taste.

It wasn't until the eighteenth century that a clever chef named Yohei decided to forego the fermentation and serve sushi in something resembling its present form. It became very popular and two distinct styles emerged Kansai style, from the city of Osaka in the Kansai region, and Edo style, from Tokyo, which was then called Edo. Osaka has always been the commercial capital of Japan, and the rice merchants there developed sushi that consisted primarily of seasoned rice mixed with other ingredients and formed into decorative, edible packages. Tokyo, located on a bay then rich with fish and shellfish, produced nigiri sushi, featuring a select bit of seafood on a small pad of seasoned rice. Although the ornamental sushi of the Kansai region is still very popular, it is nigiri sushi that foreigners are familiar with. Today, even Japanese consider nigiri sushi is the origin of sushi, the truth is different. Kansai sushi(Osaka Sushi) has much more history and techniques than nigiri sushi, few Japanese knows about this fact.

Colorado

2007-11-18T07:01:00.000-08:00

I love Colorado. I spent last weekend in Keystone at a conference and attempted some skiing with the limited amount of snow that they had received and made this season. I love being in the mountains and I wouldn't trade living in Colorado for anything.

But, my absolute favorite thing to do in this state is camping. I love camping. I'll go camping in a reserved site campground or even backcountry survival backpacking style.

Here's a link to the Colorado Parks website:

http://parks.state.co.us

From here you can look at pictures of campsites, read about their restrictions and even reserve a site up to 180 days in advance of your trip.

My favorite campsite in the state is Rocky Mountain National Park. The only drawback is that you can't have dogs on the trails there. They are only allowed in the campgrounds. But, if you can leave your dog at home the hiking there is incomparable. My favorite trail is the one that leads up to The Loch, which is the most photographed lake in Colorado.

If there's anything that you do in Colorado make sure that you experience our state the old-fashioned way; under a starry sky in a sleeping bag.

Awake

2007-11-16T07:43:00.000-08:00

Just a little bit about a movie that I would really like to see.

Hayden Christensen and Jessica Alba Pair Up for "Awake"

From Rebecca Murray,Your Guide to Hollywood Movies

Christensen and Alba to Star in "Awake" for The Weinstein Co.

Sep 1, 2005 Two of Hollywood's hottest young stars - Hayden Christensen ("Star Wars Episode III Revenge of the Sith") and Jessica Alba ("Fantastic Four") - are uniting for the movie "Awake" from The Weinstein Co and GreeneStreet Films.

Joby Harold wrote the script and is making his directorial debut with "Awake," which tells the story of a man (Christensen) who is awake but paralyzed during surgery. The American Association of Nurse Anesthetists says that the condition, known as anesthetic awareness, leaves the patient aware of the surgical proceedings. He can feel pressure and pain, and often the patient will suffer from post-traumatic stress disorder after such an experience.
Alba co-stars as Christensen's wife.

Producer Joana Vicente told Variety that "Awake" "will do to surgery what 'Jaws' did to swimming in the ocean." Filming is expected to begin next month.
Jessica Alba will next be seen in "Into the Blue." Hayden Christensen just completely his work in "Decameron" for writer/director David Leland.

Anesthetic Awareness according to Wikipedia

Anesthesia awareness
From Wikipedia, the free encyclopedia

Anesthesia awareness, or "unintended intra-operative awareness" occurs during general anesthesia, when a patient has not had enough general anesthetic or analgesic to prevent consciousness and the recall of events.

Background
In about 0.15% of patients undergoing general anesthesia, the anesthetic is inadequate to keep the patient unconscious during an operation. It may be inadequate from the beginning, or wear off during the operation. In this situation, a patient may feel the pain or pressure of surgery, hear conversations, or feel as if they cannot breathe. The patient may be unable to communicate any distress because they have been given a paralytic/muscle relaxant. Some patients become aware but do not feel pain or other unpleasant sensations.

The experience of anesthesia awareness
The most traumatic case of anesthesia awareness is full consciousness during surgery with pain and explicit recall of intraoperative events.
In less severe cases, patients may have only poor recollection of conversations, events, pain, pressure or of difficulty in breathing.
The experiences of patients with anesthesia awareness vary widely, and patient responses and sequelae vary widely as well. This experience may be extremely traumatic for the patient.

Similar Situations
Patients who have conscious sedation and/or regional anesthesia (such as spinal or epidural anesthesia), are expected to have some recall, and are not considered to have experienced anesthesia awareness. These patients are awake enough to indicate to the anesthetist if they feel pain during the operation. Many patients remember fragments of conversation they heard as they were drifting off into general anesthesia, while they were waking up, or while they were recovering in PACU (post anesthesia care unit). These patients do not recall pain or unpleasant stimuli of the surgery, but may be frightened by the belief that they were "awake" during the operation. In many cases Post Traumatic Stress Disorder (PTSD) may arise, causing the patient to require counseling for years.

Incidence
The incidence of anesthesia awareness in the United States is believed to be 20,000 to 40,000 cases per year, which represents 0.1 percent and 0.2 percent of all patients undergoing general anesthesia.

Outcomes
Patients who experience full awareness with explicit recall may have suffered an enormous trauma. Some patients experience posttraumatic stress disorder (PTSD), leading to long-lasting after-effects such as nightmares, night terrors, flashbacks, insomnia, and in some cases even suicide. There is evidence that early psychological counselling and support can reduce the amount of harm and chances of developing PTSD.[citation needed] The patient must be treated sympathetically and with compassion.
Patients may refuse to undergo another general anesthetic, and their experience may affect their relationship with doctors for the rest of their lives.
Prompt inspection of the anesthesia equipment and record is important and may help prevent future occurrences. It is also important that a case of suspected awareness be communicated to the patient's healthcare team, and that the event be scrutinised closely by senior anesthetic medical staff.

Risk factors/Causes
Paralytics/muscle relaxant use
The most common risk factor is the use of a paralytic/muscle relaxant. Under general anesthesia it is common for the patient's muscles to be paralysed (with a neuromuscular blocking drug) in order to allow the surgeon safe access to the body cavities (e.g. abdomen, thorax or cranium), or to ensure the patient tolerates mechanical ventilation, or to keep the patient absolutely still for microsurgery, e.g. on the eye. The paralytic agent does not affect consciousness, or the ability to feel pain, at all. A fully paralyzed patient is unable to move, to speak, to blink the eyes, or otherwise respond to the pain. Muscle paralysis does not typically interfere with the functioning of the autonomic nervous system. This may result in signs such as an increased heart rate (tachycardia) and blood pressure (hypertension), as well as dilation of the pupils (mydriasis), sweating (diaphoresis), and the formation of tears (lacrimation) in response to pain. Therefore, even though the patient may not be able to directly signal their distress, they may exhibit signs of awareness which may be detectable by clinical vigilance.
Many types of surgery do not require the patient to be paralysed. A patient who is anesthetised, but not paralysed, is likely to move in response to a painful stimulus if the anesthetic is inadequate for any reason. This can happen without conscious perception or memory of the painful stimulus. Therefore, anesthetic awareness is uncommon in patients who have not been paralysed.

Light anesthesia
For certain operations, such as Cesarean section, or in hypovolemic patients or patients with minimal cardiac reserve, the anesthesia provider may aim to provide "light anesthesia." During such circumstances, consciousness and recall may occur because judgments of depth of anesthesia are not precise. The anesthesia provider must weigh the need to keep the patient safe and stable with the goal of preventing awareness. Sometimes it is necessary to provide lighter anesthesia in order to preserve the life of the patients.

Improper equipment maintenance/anesthetist error
Human errors include inadequate drug dose, inadequate monitoring, and failure to refill the anesthetic machine's vaporisers with volatile anesthetic. Other causes of awareness include unfamiliarity with techniques used, e.g. intravenous anesthetic regimes, or inexperience. Poor anesthetic technique is a combination of any of the above, but also includes techniques which could be described as outside the boundaries of "normal" practice. The American Society of Anesthesiologists recently released a Practice Advisory outlining the steps that anesthesia professionals and hospitals should take to minimize these risks. Other societies have released their own versions of these guidelines, including the Australian and New Zealand College of Anaesthetists .
Machine malfunction or misuse may result in an inadequate delivery of anesthetic. This may be caused by an empty vaporizer (or nitrous oxide cylinder) or a malfunctioning intravenous pump or disconnection of its delivery tubing. Problems with flowmeters or monitors may also contribute to risk of awareness.
To reduce the likelihood of awareness, anesthetists must be adequately trained and supervised while still in training. Equipment which monitors depth of anaesthesia, such as bispectral index monitoring, should not be used in isolation.

Patient physiology
Possible causes of awareness include drug tolerance, or a tolerance induced by the interaction of other drugs. Some patients may be more resistant to the effects of anesthetics than others. Younger age, tobacco smoking or long-term use of certain drugs (alcohol, opiates, or amphetamines) may increase the anesthetic dose needed to produce unconsciousness. There may be genetic variations that cause differences in how quickly patients clear anesthetics, and there may be differences in how the sexes react to anesthetics as well. Anxiety prior to the surgery can increase the amount of anesthesia required to prevent recall.

Prevention
The risk of awareness is reduced by simple steps and good clinical practice: well-trained personnel; careful checking of drugs, doses and equipment; good monitoring, and careful vigilance during the case.
Recent advances have led to the manufacture of monitors of awareness. Typically these monitor the EEG, which represents the electrical activity of the cerebral cortex, which is active when awake but quiescent when anaesthetised (or in natural sleep). The monitors usually process the EEG signal down to a single number, where 100 corresponds to a patient who is fully alert, and zero corresponds to electrical silence. General anaesthesia is usually signified by a number between 60 and 40 (this varies with the specific system used). These newer technologies include the bispectral index (BIS),[3] EEG entropy monitoring, auditory evoked potentials, and several other systems.
The most recent technological advancement in awareness monitors is the SNAP II. The Snap II monitor is the only monitor to evaluate high and low frequency EEG in real time to create an objective metric SNAP Index, which helps measure the state of the brain and assess the level of consciousness. The SNAP monitor captures the most useful information in low-frequency EEG and utilizes high-frequency component in return to consciousness
Studies have shown that a low frequency band in the 1-15Hz range of 0.40 indicates declining alertness while high frequency range between 201-500Hz can be a marker of cognitive function and or capacity which the SNAP utilizes in return to consciousness. The SNAP monitor also minimizes the bands that are most heavily contaminated by Electromyography (EMG), which causes interference in other monitors.
A study done by the British Journal of Anesthesia in June 2006,[4] stated, “ the SNAP index 1 min before awakening had returned to or exceeded the baseline awake value in 64% of the subjects, and in 90% of the subjects at awakening. The corresponding percentages for the BIS were 8% at both times. Therefore the SNAP II may have an advantage compared with the BIS in predicting imminent awakening when compared with the awake baseline values. The faster return to baseline found with the SNAP device may be a result of the inclusion of the high-frequency EEG component in the Calculation of the index, as frequencies as high as 128Hz have shown a high prediction probability for separation of awareness and unresponsiveness .”
None of these systems are perfect. For example, they are unreliable at extremes of age (e.g. neonates, infants or the very elderly). Secondly, certain agents, such as nitrous oxide, ketamine or xenon,[citation needed] may produce anesthesia without reducing the value of the depth monitor. This is because the molecular action of these agents (NMDA receptor antagonists) differs from that of more conventional agents, and they suppress cortical EEG activity less. Thirdly, they are prone to interference from other biological potentials (such as EMG), or external electrical signals (such as diathermy). This means that the technology does not yet exist which will reliably monitor depth of anaesthesia for every patient and every anaesthetic.

Controversies
Currently, the anesthesia provider community accepts that anesthesia awareness occurs, however there is not much of a consensus on the incidence or on how often patients experience long term mental distress. A study from Sweden in 2002 attempted to follow up 18 patients approximately 2 years after previously diagnosed awareness under anesthesia.[5] Four of the nine interviewed patients were still severely disabled due to psychiatric/psychological sequelae. All of these patients had experienced anxiety during the period of awareness, but only one had complained about pain. Another three patients had less severe, transient mental symptoms, although they could cope with these in daily life. Two patients denied any sequelae from their awareness episode.

Research
New research has been carried out to test what people can remember after a general anesthetic in an effort to more clearly understand anesthesia awareness and help to protect patients from experiencing it. A memory is not one simple entity; it is a system of many intricate details and networks. Memory is currently classified under two main subsections. First there is explicit or conscious memory, which refers to the conscious recollection of previous experiences. An example of explicit memory is remembering what you did last weekend. When it comes to an anesthetized patient, a doctor may ask the patient after undergoing general anesthesia if he or she could remember hearing any distinct sounds or words while under anesthesia. This approach is called a "recall test" because patients are asked to recall any memories they had during surgery. The second main type of memory is implicit memory or unconscious memory, which refers to the changes in performance or behavior that are produced by previous experiences but without any conscious recollection of those experiences. An example of this is a recognition test, where patients are asked which of the following words were played to you during your surgery. As a further example please note the following scenario. Patients were exposed during anesthesia to a list of words containing the word "pension". Postoperatively, when they were presented with the three-letter word stem PEN___ and were asked to supply the first word that came to their minds beginning with those letters, they gave the word "pension" more often than "pencil" or "peninsula" or others. [citation needed]
Some researchers are now formally interviewing patients postoperatively to calculate the incidence of anesthesia awareness. Most patients who were not unduly disturbed by their experiences do not necessarily report cases of awareness unless being directly asked. It has been found that some patients may not recall experiencing awareness until one to two weeks after undergoing surgery. It was also found that some patients require a more detailed interview to jog their memories for intraoperative experiences.

Awake craniotomy
Under very unusual circumstances, neurosurgeons may wish to wake a patient during an operation in order to test the function of specific parts of their brain while they are awake. This procedure is called an awake craniotomy.
Normally the patient is counselled extensively before such a procedure is contemplated. The patient is anesthetised and kept under general anesthesia while the skull is opened and the brain exposed. Then the anesthetist deliberately lightens the anesthetic. It is normal for opioid drugs (such as remifentanil) to be used, so that the patient does not experience pain. A depth of anesthesia monitor such as BIS may help to guide the process. Typically the anesthetic is lightened to the point where the patient can obey simple commands. When the surgeon has identified the appropriate parts of the brain, the anesthetic is deepened again until the end of the operation.

An Article from US News

Anesthesia awareness: Brain monitors get a 'tepid ' endorsement
By Avery Comarow
10/26/05

In early August, U.S. News explored the unsettling phenomenon known as anesthesia awareness. It's just what it sounds like—finding yourself conscious while you're having surgery. The story looked into a brain-monitoring technology designed to prevent that from happening and whether the American Society of Anesthesiologists would put its collective muscle behind the technology at the group's annual meeting in October.
This Tuesday, at the now concluded meeting in Atlanta, the ASA issued its answer, and it was neither a wholehearted "Yes" nor an emphatic "No." Coming down squarely in the middle, the society's house of delegates approved a "practice advisory" that leaves it to individual practitioners to decide whether to use the technology.
How often a patient awakens or never loses consciousness during an operation can't be known. The ASA cites studies concluding that the rate is about 1 to 2 for every 1,000 patients. But patients undergoing surgery generally receive paralytic drugs to keep them motionless while delicate work is going on. If someone whose body is paralyzed gains consciousness, there's no way to signal doctors or nurses, even by blinking rapidly or waving a finger. Anesthesiologists have numerous monitoring devices at their disposal, but none directly assess consciousness.
None, that is, except devices that evaluate brain waves, which are only gradually finding their way into operating rooms. By far the biggest player is Aspect Medical Systems, a Newton, Mass., manufacturer of bispectral index, or BIS, monitors. A plastic sensor on the patient's forehead sends brain waves to a computerized unit that combines them and converts them to a number from zero to 100, with 100 representing full consciousness. The company recommends keeping patients in a range of 40 to 60.
Many anesthesiologists consider BIS monitors unproven. Still, Aspect Medical CEO Nassib Chamoun says he was pleased by the ASA's action in Atlanta. It was a tepid endorsement of brain monitors, but, he says, the delegates could have voted down the advisory altogether: "To be recognized in a practice advisory is a great step forward, and as much as can be expected at this point." And as the delegates who voted represent practicing anesthesiologists, their action "reflects the views of the members."
That's because for better and for worse, organized medicine can be slow to adopt innovation. Take pulse oximetry, which uses a probe slipped over a finger or earlobe to monitor the blood's oxygen level during surgery. No anesthesiologist would be without the device. But it took the ASA until 1987 to begin evaluating pulse oximetry, when it already was employed in 80 percent of operating rooms. By 1992, when the ASA officially approved the technology, hardly an OR or intensive-care unit was without it.
Chamoun sees a parallel with BIS monitors, which he says are present in about 40 percent of hospital ORs and are used on about 12 percent of all patients who receive a general anesthetic. That amounts to about 2.4 million patients a year out of 20 million who undergo surgery with a general.
New ASA President Orin Guidry, an anesthesiologist at Ochsner Clinic in New Orleans, personally believes that certain patients should be monitored. Among them: cardiac patients under light anesthesia to keep the heart from being stressed; trauma patients for the same reason; emergency cesarean patients whose anesthesia has to be minimized to protect the baby—and patients who express concern about awareness. "They are reassured when we tell them we will use a monitor," says Guidry.
The ASA delegates also recommended this week that the group look into the feasibility of a clinical trial, or trials, large enough to put BIS monitors to the test. But because the probability of awareness is deemed so low, a huge number of patients would have to be enrolled—"some 750,000," says Guidry. "Can this question be answered in a way society can afford?"
To patients who have experienced one of these events, the point is moot—those who know about BIS monitors don't understand why they aren't omnipresent. Carol Weihrer, who was completely conscious most of the time her diseased eye was being removed, has been a constant critic of the profession, which she believes has acknowledged neither the problem nor the remedy.
Weihrer agrees, however, that adopting the advisory "was a big pill for ASA to swallow—to admit that there is a problem. But it's just a baby step." Weihrer, who after her experience created a Web-based effort called Anesthesia Awareness Campaign, wants to see ASA emphasize to its members the need to ask all anesthesia patients whether they awakened during surgery, to investigate all such reports, and to provide psychological counseling when necessary. Those actions were mentioned in the report adopted by ASA this week, but not as mandates.
Meanwhile, says Weihrer, "until BIS monitors are in every OR, my work will not be done."

The Path Not Taken

2007-11-15T07:48:00.000-08:00

I love this poem because it reminds me of people I have known throughout my life that are no longer with me.

I wonder what people will say about me when I die. I wonder if they will say that I affected peoples lives and that I made a difference. I wonder if they will say that I did just enough to get by and no one will really notice when I'm gone. It may sound a bit dark but I try and think of that when I make decisions about my life and my future. I try to think about what is best for me but how my decisions will affect other people. I would love to make a difference in this world.

So, in memory of Gail, Rick and Cedrick.

Two Roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;
Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,
And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.
I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood,
and I-I took the one less traveled by,
And that has made all the difference.