As a comparison in the UK there is robust mandatory reporting on "Retained foreign object post procedure" which is a so-called "Never Event" in the most recent publication (April 2024 to September 2024) this occurred 60 times[1] in the NHS in England. For a denominator there are approximately 21 million operation performed in a year by NHS England[2]. So roughly 0.002% of cases have an unintended retained object or roughly 1 in 50,000.
For further reading the Health Services Safety Investigations Body in the UK (like the NTSB but for healthcare incidents is the best worst analogy) looked at retained foreign objects and published in 2024: https://www.hssib.org.uk/patient-safety-investigations/retai...
> If electrocution is what caused the cardiac arrest, it is much better to give breaths than compressions. The heartbeat system resets itself before the respiratory system. The problem is then that the heart is back, uses up all its energy reserves, but there is no oxygen to replenish and the heart goes back into arrest.
Can you provide a reference or citation to this claim and practice?
It is always much better to give "conventional CPR" (breaths and chest compressions) if suitably trained.[1] If not suitably trained you are more likely to a) perform CPR and b) do it effectively if not providing mouth to mouth breathing.[2][3] You can argue about the nuance of particular patient groups where there is potentially a statistically significant benefit of providing conventional CPR over compression only.
Under no circumstances are there benefits to providing rescue breaths without chest compressions (as your comment seems to recommend).
I think it was a while ago down a rabbit hole from the "Kiss of Life" picture talking about respiratory arrest. However, I can't find a substantiated source anymore so I will absolutely defer to your sources.
> Google's automation systems mitigated this failure by pushing a complete topology snapshot during the next programming cycle. The proper sites were restored and the network converged by 05:05 US/Pacific.
I think this is the most understated part of the whole report. The bad thing happened due to "automated clever thing" and then the system "automagically" mitigated it in ~7 minutes. Likely before a human had even figured out what had gone wrong.
How would you otherwise do it? Anything that automatically pushes updates should monitor for rapid increase in errors afterwards and roll back if so. You should do at least that if you are working on a critical system.
Sure, in an ideal world this is how nearly everything would work.
Getting a complex system to a level of maturity where this is feasible to do at scale in real life and actually work well is a respectable and non-trivial achievement.
I don't know if Amazon or Azure are able to confidently and effectively put in such automatic remediation measures globally. My sense is there are humans involved to triage and fix unusual types of outages at every other cloud provider, including the other bigs.
Leaving a comment on a message board saying how things ought to work is one thing (there's nothing wrong with your comment, I like it!); I only want to highlight, bold, and underscore how successfully achieving this level of automatic remediation atop a large and dynamic system is uncommon and noteworthy.
> I will take this moment also to mention that "re-implement" isn't exactly right in that they modified the protocol slightly to allow for someone in control of the administration server to change a user's private key without their knowing, so that the admin can decrypt the E2E communications using the known key.
I think that is a very charitable assumption about the GP claim. The linked article describes a very specific implementation vulnerability around handling of offline messages that would appear to be routed in user experience being ranked higher than operational security by WhatsApp (understandably). In this case it also does notify the user once they are online, and the original phone is logged out alerting the compromised user.
The GP claim is far broader that all E2E communication can be compromised without user awareness permitting ongoing communication between two unaware parties to be monitored.
> I think that is a very charitable assumption about the GP claim. The linked article describes a very specific implementation vulnerability around handling of offline messages that would appear to be routed in user experience being ranked higher than operational security by WhatsApp (understandably).
Both points (security vulnerability and user experience prioritization) can be true simultaneously. This is the root of all plausible deniability when it comes to installing vulnerabilities in technologies.
I don't see why we should care at all about WhatsApp's intentions with the change when the effects are so pernicious. Facebook et al. definitely do not deserve the benefit of our doubt anymore.
This is true. But I would suggest your operational security has bigger issues than this potential vulnerability if you are using WhatsApp.
Regardless - you still haven't given a source for you original claim. "not deserving benefit of the doubt" does not qualify. If the linked article is in fact you source then in the future please do not exaggerate such claims as you have done. I would have expected a claim from the article to read (along with a link to the source!):
> WhatsApp have modified the protocol slightly auspiciously for user experience but this allows a third party attacker to intercept messages sent offline only alerting the sender after they have been disclosed.
The naiveté being expressed in the comments here and as the premise behind the ventilator is astounding. I though I would share some information to put things in perspective:
- If you are unwell enough to need a ventilator then the ventilator itself is going to the least of your worries. You will need the drugs and expertise to care for you. The current respiratory illnesses going around aren’t like polio and the iron lungs where all you need is help breathing.
- If you can sort the above to have any hope of survival you need a “modern” ventilator that can operate in way that this simple homebrew device is physically not capable of offering. Most of the improvement in caring for people with ARDS is based upon careful and tight control of ventilatory parameters to prevent secondary lung injury.
- Modern ventilators have a price tag of if you have to ask you can’t afford it.
So in summary this is a nice build but serves no practical purpose.
Particularly the “if you are unwell enough to need the vent, the vent is the least of
Your worries.”
The vent keeps you oxygenating while we address the (usually multiple, overlapping and interacting) severe issues that led to you needing the vent. This is ICU-level care. A vent without an ICU doc and appropriate medications (and ideally a resp tech and a nurse) might as well be an origami crane.
Hospitals will run out of one those other things, on average, before they run out of vents.
In Wuhan they ran out of hospital capacity and sent people home. People bought vents to administer to their relatives at home without medical supervision.
You need to dispose yourself of the false assumption that people who need vets would even be able to get through the door at an ICU during a serious pandemic.
I hope those folks, well-intentioned as they may have been, did not deprive actual hospitals from getting the equipment that they needed by doing this.
Could you please provide the reference? The ventilation procedure is very difficult and dangerous to carry out, and I've seen people confusing oxygen mask and related devices (as treatment for mild syndromes) with ventilators.
considering the cost of ventilators I doubt that people in Wuhan were using them in any numbers likely to be noted, thus yes, oxygen masks and related devices most probably.
I expected the answer that amateur solutions won't work from medical professionals and expected that to be correct.
But obviously, the question many people are concerned with now is "can't we triangulate?" When you have an epidemic threatened to overwhelm medical facilities and we know the physical construction of some these devices isn't by itself that complex, isn't there a way a more organized and knowledgeable DIY approach could work when the naive, uninformed approach certainly wouldn't?
If I understand what you're saying correctly, you're saying that in the case where one would be so sick as to require a ventilator, they'd be in a situation where the ventilator only buys more time before the condition worsens, but doesn't actually address the root cause of the problem. As such, even if someone were to find a hospital-grade ventilator that fell off the back of a truck and managed to properly use it, the non-ventilator care is what makes the difference in outcome, not the ventilator itself.
Not quite. The vent process itself requires careful management to provide net benefit (eg, controlling the level of sedation, avoiding secondary lung injury).
So while the non-vent care is what makes the difference, improper use of a hospital grade vent is more likely to do harm than good. Eg, Vents frequently clog. It requires a little bit of clinical experience to recognize that as what’s happening, and intervene appropriately. It’s not a complicated thing, and anyone that’s worked the ICU for a bit can recognize and handle it, but it would be a killer in the hands of a layman, and it’s only one out of a hundred issues.
Additionally, I’d hesitate to describe it as buying time, because that implies a linear sequence. Let’s say you have condition X that implies oxygenation and blood perfusion. Vent manages oxygenation while I work on maintaining perfusion and the underlying X, but if all I have is the vent, the patient will still die from lack of perfusion. The vent didn’t buy any additional time, it just closed off one route of death temporarily.
When a patient needs a vent, it’s very rare that the vent is the only route to death that is being proceeded along.
This was pretty stream of consciousness, but I’m typing in the bathroom, so ... sorry if it’s a bit of a mess.
It depends on the precise mechanism of failure, but generally a combination of fluids of various concentrations and extravasation characteristics, and drugs that either cause the constriction of blood vessels, or increased heart pumping strength, or both (these often pop up in popular media as “pressors”).
> a hospital-grade ventilator that fell off the back of a truck and managed to properly use it
Step 1 is inserting an ET tube in the patients mouth and down past the vocal cords without killing them in the process. So hope your truck also drops a laryngoscope.
Step 2 is picking the 6-7 parameters on the vent so you don't burst the lungs like an overfilled balloon or suffocate the patient because their throat is now sealed and you aren't providing enough O2. So steal a doctor from the truck too.
Theres all that and then the fact that the ventilator itself can make you sick. The number of patients (among hundreds) I have known on long term ventilator support that didn’t have a case of pneumonia in five years I can count on one finger.
Not to mention ventilators will damage your lungs if not correctly configured.
Can you elaborate on what else is done to treat those patients? I was under the assumption that the pandemic situation is caused by a virus and that not much can be done against a virus besides waiting for the body to heal itself.
(Which is not entirely true, since AIDS can be treated nowadays.)
You’re correct there’s not a lot to be done for the virus itself - in that situation, care tends to become about protecting the various organs suffering in the process, to get the patient through it.
For example: a patient presents with acute respiratory distress and sepsis due to the flu, covid, whatever. The fluid in the lungs will be creating a burden on the heart; the general inflammation will be pissing off everything, including making blood vessels both leaky and dilated.
The burdened heart is now prone to being overtaxed. With leaky vessels, it’s also prone to being under supplied. And oxygen isn’t coming across the lungs well. A mismatch between its blood/oxygen supply and demands causes what’s called a demand ischemia - you can think of it as a kind of heart attack. This further weakens the heart.
This shortage of both supplied blood, and oxygen in the blood, plus systemic inflammation, can hit every other organ: kidney, liver, gut, etc.
This is where you can start to see some shock liver kick in. Which means one of our core mechanisms for metabolizing drugs (and everything else) is telling us to fuck off.
The same shock effect can hit kidneys. Reduced perfusion not only hurts kidneys, but means waste dumping into urine is being decreased, or not happening. We try to prop up kidney function. We also add fluids to try and increase perfusion (but if we have had an ischemia, the same bulk of fluid that is needed to maintain perfusion pressure can also act as a burden on a weakened heart.)
If the gut goes significantly ischemic, it can die. Even if it doesn’t die, local inflammation and reduced food intake can make it leaky. You’re not necessarily seeding bacteria into the blood that way (studies of pancreatitis w associated sepsis suggest that’s not a major contributor), but the gut associated lymphoid tissue is definitely going to be kicking into high gear and promoting our inflammation storm even more.
So, we try to carefully maintain perfusion, which involves monitoring and calibrating our support for heart, kidney, lung, etc. in an ongoing and dynamic fashion. And not uncommonly, besting down infections that develop along the way, because a bunch of plastic in the body is a badness.
I don’t work much in the ICU, so if I’ve misrepresented something and we have an intensivist on hand, I defer to them.
While a bad ventilator in the wrong situation may be worse than no ventilator, sometimes no ventilator means you are dead.
It is highly unlikely that anyone will build this and attempt to treat a patient at home without reading anything.
> Modern ventilators have a price tag of if you have to ask you can’t afford it.
That seems like an excellent reason for more people to look in to and think about how to reduce cost of a useful ventilator for emergency use, as an essential (but not sufficient) part of supporting large numbers of concurrent patients suffering ARDS.
Yes, if you are hypoxemic, your brain's going to be telling you to hyperventilate, which means they'll have to administer drugs to prevent you from fighting the vent. Yes, at present, there is no automated system that would be able to support a patient in any meaningful way.
> It is highly unlikely that anyone will build this and attempt to treat a patient at home without reading anything.
I’m not going to pretend that 0% of the human population could manage a ventilated patient with nothing but the appropriate texts, but it’s pretty damn close to 0%. Hell, a fresh third year med student would almost certainly kill a patient in that situation, and they’re at least supposed to understand the relevant physiology and drugs.
The vent is a tool for adjusting a couple of physiologic parameters, in the context of what is usually severe and complicated disease. It doesn’t manage anything by itself, and it’s not a RTFM situation.
>It is highly unlikely that anyone will build this and attempt to treat a patient at home without reading anything
unless if they had read some stuff about what was required in treatment they decided making a ventilator was worthless, which is basically what people knowledgeable about treating patients are suggesting.
> - Modern ventilators have a price tag of if you have to ask you can’t afford it.
Not sure about the efficacy, but I was reminded of this discussion ("A doctor in Bangladesh has found a simple way to treat infant pneumonia"):
https://news.ycombinator.com/item?id=17945071
You the nail right on the head. Especially regarding VALI. Personally, I’d also be worried about any residues in the system (e.g. lubricants, grease, etc.) being blown into your lungs. That’d be an excellent recipe for a hellish aspiration pneumonia on top of the underlying illness.
Not asking about DIY, but since you are more knowledgeable about medicine than I, you might know. Dialysis exists. Could a variant of a dialysis machine oxygenate blood and scrub it of carbon dioxide to treat an ARDS patient? Is the main problem that dialysis can't move a high enough volume of blood to keep a person alive?
I fail to see the security issue here, the Equifax certificate in question (thumbprint: d23209ad23d314232174e40d7f9d62139786633a) has been revoked (on Windows 10 at least) - it is in the system store to protect users by being marked as revoked and thereby marking all child certificates and signatures as invalid.
I strongly suspect all the other listed certificates are also marked as revoked but I couldn't be bothered wasting my time checking.
I'm sorry but is everyone here sucked into the "reality-distortion field" that Tesla Auto Pilot seems to be generating? Nothing happens in this video that a competent driver wouldn't have done.
Detailed Explanation:
In the UK part of the driving theory test is a "Hazard Perception"[1] exercise that test candidates awareness of hazards around them by playing short video clips and getting the candidates to click when they first spot a hazard they would need to respond to.
When watching the linked video I 'click' at 0:04 when I see the multiple brake lights though the car directly in-front. This coincidentally is when the Tesla responds with its audible warning.
The factors that lead to the Tesla not being involved in an accident in this video were not related to Auto Pilot but due to a competent driver: 1) Maintaining appropriate breaking distance from the car ahead to i. be able to stop in-time but without being tail-ended due to fast breaking ii. have 'thinking distance' to allow for slowed reaction timing 2) Watching the road ahead and noticing solid breaking of ahead vehicles though the directly in-front vehicle. There is NO AUTO PILOT MAGIC IN THIS VIDEO
I do not dispute that in other circumstances and perhaps other videos Tesla Auto Pilot HAS prevented and accident that a human would not have. This video is NOT such an example.
You comment describes exactly why this is so amazing - the autopilot executes the same as a competent driver! It's magic because it's the first time in human history that we've had such skills available in a car autopilot.
It's like saying cruise-control is worthless because any competent driver can maintain their speed - you're missing the point.
We're achieving parity between autopilots and human drivers, except the autopilot will never be distracted or tired, and always operates with the skill of a competent driver (and many drivers are not competent).
>You comment describes exactly why this is so amazing - the autopilot executes the same as a competent driver!
I can agree with this. Too bad it isn't the default sentiment instead of over-the-top optimism or cynicism.
I don't think anyone here is surprised that people get into stupid, easily avoidable car accidents all the time. The argument seems to be about where the technology currently sits. In this video the Tesla braked and avoided rear-ending the colliding cars; so did the vehicles with no autopilot in the right lane. This is "impressive" to some people, but it's also the bare-minimum level of acceptability for self-driving vehicles.
> it's the first time in human history that we've had such skills available in a car autopilot
I doubt this assertion is true: lot's of cars with plain old cruise control can select a safe following distance and detect when the car ahead is braking. Roof-mounted LIDAR can see several cars ahead (and behind) and it would be negligent to to apply the same collision avoidance logic to car n+1
I think we'd all agree this isn't magic; the point is that it works in spite of the driver. A "competent driver" is going to be especially alert during an exam, but over the course of countless errands and commutes, their guard could be down, their reflexes may suffer due to lack of sleep, etc.
Autopilot doesn't get tired, and never lets its guard down. That's what matters.
My intention was in no way to underplay or diminish the achievement of Auto Pilot but to simply make the point that: In this video, of this event Auto Pilot adds nothing. In this case the driver was "alert and competent". This video does NOT showcase or demonstrate Auto Pilot preventing an accident, reacting faster or better than a human.
That is my point. People seem to be extolling how Auto Pilot saved that day in this video. It didn't.
How do you know? Driver could have been looking back at his kids for all we know when the car beeped and he then paid attention.
And yes, I would say that the autopilot reacted faster than a competent human driver not expecting a crash while watching a 30 second clip. Probably by time measured in seconds.
I do agree safe following distance made the auto-breaking pretty irrelevant in this specific case as there was plenty of time for a human to react. But it's still impressive to see things working, and a bit of positive public PR hype over this tech can't be an entirely bad thing.
I agree that some of the headline around this video are a bit overstated, but it is nevertheless a deserving credit to Tesla's autopilot system for handling the incident so well. I also agree that an "alert and competent" human driver would handle the situation the same way, but I don't think it's safe to assume that all or even most drivers are usually "alert and competent".
Imagine if you could be confident that the cars sharing the road with you were all "alert and competent" at all times because they were using a solid autopilot system.
You have highlighted a fundamental misunderstanding people have about Auto Pilot in its current form it is an SAE Level 2[1] driver assistance function.
It is not supposed to be functioning in spite of the driver. The driver is in charge and should be responding to events. It is dangerous to behave otherwise - examples include pretty much all Tesla Auto Pilot attributed fatalities.
[1] Level 2: The driver is obliged to detect objects and events and respond if the automated system fails to respond properly. The automated system executes accelerating, braking, and steering. The automated system can deactivate immediately upon takeover by the driver.
Well, yes. The amazing part is that the Autopilot does things that a competent driver would do.
Very often, humans do not do those things. And despite the carnage that results, over more than a century of experience with automobiles, we have not managed to make people significantly better drivers, nor come up with a licensing scheme that does more than weed out the most obviously medically-disqualified or incompetent people. At least here in the US, you take your drivers test (which is a ridiculous, comic farce) exactly once in your life, after which you can basically drive until you are blind, comatose, or--very rarely--you kill someone. But rarely the last one, not because people don't kill each other, but because it rarely results in a license suspension. We've just tacitly accepted that people are bad at driving.
The UK driving test is significantly more rigorous than the US, and it shows: UK drivers are amongst the safest in the world (2nd lowest road fatalities per 100k people; top five per 100k vehicles). The US isn't even in the top fifty (and for calibration to the American reader: Canada is in the top 30, but hey, at least the US beats out Mexico). At the end of the UK practical examination process I would expect all new drivers to be "competent" by this standard.
As a Brit, though it would be nice to think we drive better, I think most of the effect is down to road engineering. Roundabouts have lower fatalities than traffic lights for example.
> Nothing happens in this video that a competent driver wouldn't have done.
If you go by the street definition of driving competence, then you get exactly the accidents like the one on this video.
Safe driving distance. The primary thing most "competent" drivers don't give a fuck about. Second being speed limits.
And yes, I understand many people drive that way not because they want to, but because other drivers aren't leaving them a choice. Ironically, this area is already heavily regulated. What I believe is needed is much, much stronger enforcement of those regulations.
I suffered from this and now have set up a filter on the forwarding account that goes something like: 'Matches: from:(*) Do this: Never send it to Spam' so it forwards absolutely all email. My personal account then dumps then filters stuff in to spam folder that I do check.
For further reading the Health Services Safety Investigations Body in the UK (like the NTSB but for healthcare incidents is the best worst analogy) looked at retained foreign objects and published in 2024: https://www.hssib.org.uk/patient-safety-investigations/retai...
[1]: https://www.england.nhs.uk/long-read/provisional-publication... [2]: https://digital.nhs.uk/data-and-information/publications/sta...