I just heard about this from a co-worker whose son had a concussion.
I wonder if there's some kind of meta-study about how long it takes updates in consensus to be put into practice.
(And wonder further if there are situations where the consensus has gone back and forth over time. (As my mom, a career teacher of English to disable students, noted, consensus about teaching reading seemed to change every five years or so, on a schedule that coincided with publishers bringing out new textbooks.))
3: It's too soon to tell.
It's too soon to tell.
AIMHMHB Zhou Enlai thought, when he was asked this in 1971, that the question was about the Paris evenements of 1968, not about the French Revolution of 1789.
Lots of people got hit on the head in those riots.
A lot of people who got involved in the French Revolution never had to worry about being hit on the head again.
Re OP last, I've wondered if MD training isn't over-generalized, inherited from an era of scarcity, and if more specialization would improve the rate of consensus-dissemination.
My co-worker's son did see a concussion specialist at a concussion clinic.
I don't know if it is just my son's school or not, but to play high school sports he had to go to a concussion clinic and get a baseline assessment. I think kids around here probably get the latest in concision treatment because UPMC has figured out how to make money on it.
Can they open a campus in Hollywood?
13: We actually recommend that cases get gentle exercise and therapy nowadays.
It can do that after the judge hits it with the gavel.
The one thing that has stayed constant in concussion treatment is that you aren't supposed to hit people on the head after a concussion.
I got a mild concussion when my car was rear-ended 2/12, though I did not hit my head. I'm seeing a physiatrist at a concussion clinic.
She referred me to vestibular physical therapy, and I think it will be helpful, but it took more than a month to get to the physical therapy evaluation. When I tried to schedule a neurology appt, the first one was in June, so I went with the physiatrist instead. She did say that some people just get better with time.
Her recommendations were magnesium supplements, good sleep hygiene and using melatonin if that helped. She also recommended avoiding greasy fried foods. She would have treated headaches if ai'd had them.
The first week or so I really could not do much and screens were painful as was bright blue light, so using the f.lux app and wearing loose-colored glasses helped. Took a while to get them. I would do the 25% tint rather than the 50% tint if I had to do again.
14: There was a clinic the ED referred me to in Knecht's Posh Deep Blue Suburb that seemed to be a teen athlete money maker. Famous guy in his 80's as the head with another neurologist there once a month but mostly run by NPs with not much training to milk insurance and fill out forms.
I'm pretty sure that pushing myself to look at screens and bright light too soon would have been a mistake.
She also recommended staying hydrated.
21: Exactly
I'll also add that short-term disability paperwork really doesn't like it when the answer is symptoms will gradually get better and the patient will be able to work longer hours but they also need time for PT but I can't tell you for sure when they will be all better or give you an exact schedule.
I broke a windshield with my head once, but that was before doctors decided that was bad.
I had a brain CT this morning because I'm being referred to some sort of concussion clinic I hope, except the one my doctor wanted won't take my insurance. I also had to get a blood test to prove I don't have neurosyphilis, but I don't think that will be an issue. It's been interesting to see these concussion protocols spread out over the practices we've visited over the last few years. Nia was doing physical therapy for her knee next to kids doing concussion PT a few years ago and it was cool to see what they were doing. I'm pretty emotional about all this and should presumably have gotten treatment for myself earlier, but for instance I can no longer listen to more than one thing at a time, which is rough in a household with an 11-year-old who never stops talking and other people who want to talk sometimes. My personality has changed for the worse. I'm not just not the person I want to be, but it sometimes feels like I'm not myself. Blah. I could stand to be more hydrated. And I think some of the stuff about screens and so forth depends on how well you've adjusted visually. Last time (a year ago this week, which is also why I'm weepy and weird) apparently if I tried to follow a moving finger with my eyes, the eyes would just get jittery and then jump and it was a freaky thing to watch. That took about a week to resolve along with double vision, but light sensitivity and exhaustion lasted longer. I'm probably a bad patient for not tracking this better, but we'll see what the experts think when they've seen inside my head I guess. And when I can find one who will see me at all.
I have a friend who's like four years out from a concussion and still struggling with symptoms every so often.
26: I think the one my boss got when. She played colllege basketball still bothers her.
24: I think the insurance issue is much less complicated when it's motor vehicle personal injury paying. Good luck!
24: For inexpensive and simple, I really think that magnesium supplements have helped a lot. I don't know the rest of your medical history, but barring some kind of kidney problem I highly recommend them. Obviously this is not medical advice.
She also recommended avoiding greasy fried foods.
I think doctors recommend that no matter the symptoms.
Speaking of injuries, I have very frequently walked over the bridge of electrocuted dogs. I guess it's good that I always wear shoes, especially in January.
I love that their reaction to a report of a lethal electrical current was not to send an electrician with a multimeter, but to send some completely unequipped dude to walk up and down the bridge until he got electrocuted, and when he didn't they just assumed the person with the smouldering charcoal dog was lying and did nothing about it.
I feel like there are a lot of injuries where the conventional wisdom moved from "rub dirt in it and take a lap" to "rest,rest,rest" and then to "get moving again as soon as possible."
After your dog is electrocuted, you need to get right back out there and walk.
Sympathies, Thorn. I hope they find only good things in there when they look.
28: That was my exact thought in the moment. Basically, lead a healthy life and lower your inflammation.
I had onion rings tonight, because vegetables are important for health.
I also jumped over the metal plates where the dog got electrocuted even though I was wearing shoes.
I do feel kind of sorry for the guy they sent to check, because they probably told him to step on the metal plate. It's only about ten inches wide, running across the walkway beside the traffic part of the bridge.
Bridges are struggling right now .. Jeez. https://www.nytimes.com/live/2024/03/26/us/baltimore-bridge-collapse
39: counterpoint: memorials to slave-owners *should* be ending up at the bottom of the sea, especially to slave-owners who write extremely popular songs about how much they're looking forward to tracking down and murdering their escaped slaves!
That's I-695. I don't see how they're are saying only 7 people are missing even hit at 1:30am. Baltimore is in trouble.
42: agreed; from the video the bridge seems to fall down very quickly and completely. It's not just one span that goes, it seems to be the whole thing apart from the approach piers, within seconds. But the report I read said at least seven vehicles in the water.
The boat just sailed right into the bridge it looked like.
Either, I think. (I mean, technically, neither, but it sounds weird to say it dieselled right into the bridge.)
Dieseled?
Seeing some reports (BBC, I think) that the ship lost power just a couple of minutes before hitting the bridge. Yikes.
Valuable new nitpickery: if something like this happens and a moving object like a ship collides with a stationary one, it's an allision. (If both participants are moving, it's a collision. (If you think they're the same thing, that's an elision. (But it's not true; it's an illusion. (For more on the legal context, look up the Oregon Rule. (That just there was an allusion.)))))
I refuse to be ashamed of my accomplishments.
If others were in on it, that's collusion. If something other than an ego was bruised, that's contusion. If you're uncertain about which pertains, that's confusion. If it all stems from a resounding thonk on the head, that's concussion. See the OP at your local eclectic web magazine.
How to Avoid Huge Ships special edition for bridges. "Don't be built over a shipping channel."
https://en.wikipedia.org/wiki/How_to_Avoid_Huge_Ships
This remake of the SNL Cajun Man skit sucks. But not as much as the original.
Indeed, my only regret is that Stone Mountain is so far inland.
It's cool how the inland Virginia county lines hug the mountain contours.
MV Dali? The bridge wasn't melty enough for you? The writers are getting lazy again.
Dieseled?
Are you correcting the speling, or querying the term? I would assume that the Dali was diesel-powered...
41, 42: The bridge was closed to traffic at the time; the vehicles and people who went into the water were an overnight work crew.
I think the point was that the ship had lost power.
But not at the moment of impact? The ship drifted into the bridge.
57: ah, right. Thanks. "Drifted", then, I guess.
56: something of a stroke of luck!
Lsot power as in propulsion, or power as in electrical power for steering?
The news I saw said they lost propulsion.
The WP says that the bridge was shut only after the Dali issued a mayday, but that was enough time to clear the traffic but not the workers.
58, 59: Or, I guess I'm now seeing that the bridge closure was caused by a mayday signal from the Dali? I don't know, it'll take a bit for everything to be clear. The CNN story I read this morning definitely had the Coast Guard commander describing rescue attempts for a construction crew, though. (Two survivors have been pulled from the water so far, one with serious injuries.)
You can see in the video that several trucks passed over the bridge in the minutes before the ship hit.
61: potentially both. There's a video of the ship heading towards the bridge and suddenly all its deck lights go out about a minute before impact.
Which is odd, because the electrical power on all but the smallest ships comes from an auxiliary engine, not from the main engine or engines that propel the ship.
Oof. That's a lot of momentum without any way to steer it.
The emergency paddle was insufficient.
I bet there's a few insurance company offices in a blind panic about now.
Bloomberg says it was insured by Britannia P&I.
Whatever happened happened at exactly the worst possible time. They didn't lose power for more than a minute or so and at almost any other point in the voyage they'd have been fine or at worst run aground.
I'm not sure exactly where they started, but there are other bridges.
Prom night, '94, I remember all the parents tricked the students into going on a party cruise after the dance to discourage us from drinking all night. The cruise went from the Inner Harbor down under they Key Bridge and then back again. It was very romantic and pretty, although my date was my ex-girlfriend, and that was a strategic miscalculation.
I was very sunburned. My friend borrowed a GTO and a bunch of us guys spent the afternoon before prom driving around with the top down.
76: Actually, 94 was a long time ago.
47, 49: https://www.youtube.com/watch?v=HbhvZ2y1V80
'94 was only like a decade ago. Twenty years max.
74 WaPo map has the ship starting at the Seagirt Marine Terminal, at Point Breeze, so this was the only bridge.
Seagirt apparently handles 97% of container traffic in Baltimore.
I wonder how long the port will be shut down, and how big a supply chain impact this is going to be.
In the video I saw, probably a version of what's linked above, you can see traffic across the bridge until suddenly there's a pause shortly before impact. If that's a closure based on a mayday signal I'm impressed they could act that quickly.
The pre-broadband-internet years really do seem like the distant past in a way that, say, 2004 does not. 20 years of GMail? HORRIFYING.
(bridge collapse, also horrifying, but in a less uncanny way.)
There are at least five different punctuation/capitalization errors and/or infelicities in that comment. I give up.
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This, in turn, gets to one of the fundamental truths of the Trump era. There is exactly one force in this country that has disciplined Trump and held him accountable for his actions. It is the public.
The American people have been the single most reliable obstacle to Trump's effort to impose himself, and his will, over our institutions. Let us hope that they have not given up the fight.
Is it true?
|>
I guess, insofar as he wasn't re-elected in 2020?
Not being president is a big damn deal! A way bigger damn deal than some fine he'll end up having his supporters (foreign and domestic) pay.
I don't think the loss of that section of 695 will be all that bad for east coast travel. Most of the through traffic already goes through the Harbor Tunnel or the Fort McHenry Tunnel. Congestion will be a bit worse in the tunnels, but its already pretty bad. Now it will be bad for a higher percentage of the day. I think it will be analogous to the loss of that section of I-95 in Philadelphia that happened not long ago. Local problem to be sure, but systemically a less important highway than you would think.
MTA: https://www.youtube.com/watch?v=RkjZImSG7j4
The only silver lining to the bridge collapse is David Simon spitting venom at fools on Twitter.
Didn't the public, in a way, also get Trump off his tv show? Although I guess that backfired in that I'm not sure he would have run for president if he'd stayed on tv.
It occurs to me that that pier should really have been able to withstand a head-on allision. Which raises the question, was the bridge ill-designed, or have the ships gotten that much bigger (and taller) since c.1970? I'll go way the fuck out on a limb guess that (1) it's the latter, and (2) there is already a years-old report from DOT or someone identifying another 10,000 piers with the same problem.
I suspect there isn't a bridge on earth would survive a head-on collision from a fully loaded cargo ship traveling at speed.
Google says the ship was 984 feet long and 157 feet wide.
The span, no, but the piers? And even more so their footings (?) below water. I note the freeboard as well. The Dali does appear to have been stopped by whatever it hit underwater, but to have ridden up high enough still to have hit the bridge.
Absolutely not. Someone was calculating the momentum and claimed that 175k tons at 9 mph is equivalent to a medium (8lb) bowling ball at Warp 0.2. Let's check:
175000 tons * 2000 = 3.5E8 pounds * 9 mph = 3.15E9 lb*mph
C=671000000 mph * 8lb = 5.3 E9 lb*mph
Pretty close.
There's some argument about whether that momentum could have been deflected with the right kind of barriers or similar which I can't judge. Without it, though, there's no bridge pier on earth that stands up to that momentum, and the span design and counterbalancing guarantees that when one pier fell the whole span falls.
Ops forgot the 0.2 which would be 1E9 so it's actually a full size bowling ball (15lb) at ~0.25c.
That reminds me of the ending of Speed 2.
The bridge would also not withstand Keanu Reeves at warp 0.02.
99 to 100. Prebuttal brought to you by time dilation.
Reeves had better sense than to be in Speed 2. I think he was replaced by Jason Patrick.
I would bet the that resources would be better spent making it less likely giant ships lose propulsion than armoring the bridges.
Does insurance pay the port for lost business?
Good safety systems are redundant. And all the bridges need rebuilding anyway because climate change and Reaganomics. And Mobyplan requires ongoing expenditures on labor and regulation, which are expensive, whereas giant concrete crash barriers require one-off expenditures of capital, which is cheap.
I think he was replaced by Jason Patrick.
One by one, we all will be.
A timely reminder that Russian vessels carrying worse things than containers are plying the world's waters without disaster insurance.
I guess it's just "Patric". Also, he's Jackie Gleeson's grandson.
110: Presumably not allowed into American ports.
The Baltimore bridge disaster: what happened and who will pay?
The crash suggested the protection around the bridge's piers -- or main supports -- from ships was "inadequate", said Robert Benaim, a fellow of the UK's Royal Academy of Engineering. Normally features such as artificial islands or steel "sacrificial dolphins" embedded in the river floor would be built to divert vessels on a collision course, he added.[...]
The insurance sector is expecting a hefty bill. Several industry figures that spoke to the Financial Times said it was still too early to give a reliable estimate, but insurers could compensate significant losses including damage to the bridge, disruption to the port and any loss of life.
That's good. They should give Maryland something for the lost bridge tolls too.
Hear me out: the bridges could have airbags
People keep driving into my retaining wall. So I have some sympathy for Baltimore.
112: No port is a puddle, entire of itself; every port is a piece of oceanus, a part of the sea. If a drop be polluted with Urals, Pittsburgh is the less, as well as if a turning basin were, as well as if a boathouse of thy friend's or of thine own were: any port's spill diminishes me, because I am involved in portkind, and therefore never send to know for whom the bell tolls; it tolls for thee.
https://twitter.com/DiaBraveSid/status/1772829568266535365
Kinetic energy is what needs to be accounted for, not momentum, and the bowling ball has much more of it.
https://x.com/rezekjoe/status/1772789097217565042?s=46&t=nbIfRG4OrIZbaPkDOwkgxQ
Given how much taller that ship is than the bridge, hard to imagine how they thought it would get through!
Better angle here, you can see how it would have had enough clearance https://x.com/rezekjoe/status/1772807126676566059?s=46&t=nbIfRG4OrIZbaPkDOwkgxQ
In today's third-world country democracys better than America news:
https://apnews.com/article/senegal-election-polls-1a9ab8ceab4ecde9b9cce412717dce31
123: I mean, the main clue that it wasn't too big to go under the bridge is that the ship was leaving Baltimore, a port which it is only possible to enter by going under the bridge.
Of course, but that is a better pic showing the relative mass of the ship in relation to the bridge
that is a better pic showing the relative mass of the ship in relation to the bridge
Yes, the ground-level film really doesn't give you an idea of the size of the ship - looking at it from that perspective you can easily see how the bridge didn't come off best
Mocking aside, credit to the authorities for getting the bridge closed that quickly. Especially considering some of them were audibly drunk.
That would have worked better if I'd split it in two.
131.last Jeez, you're not kidding https://x.com/dcnewslive/status/1772717393137062123?s=46&t=nbIfRG4OrIZbaPkDOwkgxQ
So, turns out dolphins don't look like dolphins at all. Nor, relatedly, do starlings look like starlings.
Dolphins don't look much like dolphins either. Nor do dolphins!
I would bet the that resources would be better spent making it less likely giant ships lose propulsion than armoring the bridges.
In addition to above, shipboard problems aren't the only failure mode. It seems the last time this happened in the US it was because a squall blew the ship off course; this also caused at least part of the Ever Given grounding.
The newer (especially container) ships have much bigger wind loads and so are more likely to get deflected (I'm guessing climate change makes squalls more likely at least some of the time, but this point holds even if not); and even if given very good real-time forecasting, the masses of the ships are such that even prompt reactions may not suffice to prevent deflection and allision.
Dolphins; starlings.
I had this picture of great graceful curves of stainless steel gently nudging wayward hulls back into the channel.
If you're in a port and there's a squall forecast, you just stay tied up unless the sheep liver says to go.
They didn't sound drunk to me, just Balmer. Heartbreaking -- they mention getting the construction crew off the bridge and there just wasn't time.
Okay, maybe I'm prejudiced. I blame David Simon.
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An EAC communiqué issued from Kinshasa stated that the two heads of state "called for a rapid solution to the secretarial crisis in the region, which is adversely affecting the functioning of the bloc".|>
Going back to OP, I'm writing from a hospital waiting room where this is the fifth day I've been spending hours. My dad was a motor scooter collision and doesn't seem to have extensive physical injuries, but had a ventilator put in & hasn't really woken up yet - he opens his eyes and moves around some from time to time, but they can't try to take the tube out until he starts responding to basic commands like to nod or raise a finger. Every day that goes by we wonder more about the underlying damage, but the doctors say it can take this long. I flew down the day after to be with my mom, but have to fly back tomorrow night (my brother will then tag in). The ambiguity and waiting has been pretty hard. If no change Friday, there might be a tracheostomy so he can breathe through a tube in his chest and coming to won't be such a horrific experience for him.
Or according to ajay, perhaps "allision" as the police said witnesses said he rear-ended a car stopped at a light, at an intersection that moves quite slowly overall. So we also worry if he had some kind of episode prompting the crash to begin with.
I'm sorry to hear this. I hope he recovers soon.
Oh shit Minivet, best wishes for your dad making a full recovery
All the best for you, Minivet.
That's so scary, Minivet. I'm so sorry. I hope you all get some positive signs soon.
I'm so sorry, Minivet. I hope he's okay.
I'm so sorry, Minivet (also sorry for the travel/remoteness, which always adds stress). I'll keep you all in my thoughts.
Oh, geez, Minivet, that sounds frightening. Wishing you both the best, and hopefully he recovers soon.
I'm so sorry, Minivet. Hope you can see some positive developments soon. I know it must mean a lot to your mother that you have been there supporting her.
I'm so sorry, Minivet. Wishing he has a full recovery.
That sounds so rough, Minivet! Hoping for a full recovery.
I hope you get some good news soon. Sympathy.
Belatedly, 100 reminded me of some absolutely infuriating pedantry, which is that there are five separate ways of measuring cargo ships in tons - gross register tonnage, deadweight tonnage, gross tonnage, net register tonnage and net tonnage - and none of them answer the question "how much does this cargo ship weigh, in tons". Register tonnage is measured in tons, but those aren't actual tons like 2240lb or 2000lb or whatever, they're register tons which are a measure of volume.
It looks like the more standard term for that concept w/r/t ships is "displacement" or displacement tonnage?
"Tonnage" is a longstanding way of measuring cargo ships going back centuries, but yes, it's a measure of volume rather than weight and it's confusing that it uses the same term as a weight measure.