Cyberflattery

सायबरफ्लॅटरी असा शब्द शब्दकोशामध्ये नाही. पुढेमागे तो येईल याची मला खात्री आहे. ते बघायला मी असेन किंवा नसेन. पण माझे तरुण वाचक नक्कीच असतील. ज्यांना सायबरक्राईम म्हणजे काय ते माहीत आहे त्यांना सायबरफ्लॅटरी उआ शब्दाचा अर्थ समजायला जड जाऊ नये. इंटरनेटच्या मायाजालात घडणा~या गुन्ह्यांना सायबरक्राईम असे म्हणतात. तशाच प्रकारे इंटरनेटच्या मायाजालाच्या माध्यमातून होणा~या खोट्या स्तुतीला सायबरफ्लॅटरी म्हणता येईल. एखाद्या व्यक्तीच्या गुणांचे स्वार्थ साधण्यासाठी खोटे कौतुक करणे हे काही माणसांचे वर्तन सर्व संवेदनाशील माणसांना जाणवतेच. जे उथळ स्वभावाचे असतात त्यांना आपली खोटी स्तुती केली जात आहे हे कळत नाही, आणि ते त्यामुळे आनंदून जातात. अशा लोकांना खुशमस्करे असे म्हणत असत. तंत्रज्ञानातील प्रगतीमुळे आजकाल व्यक्तीशः भेटून खोटी स्तुती करावी लागत नाही. सोशल नेटवर्किंग संकेतस्थळांवर ही गोष्ट सहजपणे आणि सफाईने करता येते, आणि ती मोठ्या प्रमाणावर होते आहे.
गूगलच्या ब्लॉगवर वाचलेला एखादा लेख आवडला तर त्याला १+ करण्याची सोय गूगलने केलेली आहे. मग त्या वाचकाच्या ग्रूपमधल्या सर्वांना त्या लेखाबद्दल समजते आणि ते सुद्धा तो लेख वाचतात. पण केवळ एखाद्या ब्लॉगरला खू्श करण्यासाठी जर त्याच्या लेखाला १+ केले,  तर त्याला सायबरफ्लॅटरी म्हणावे लागेल. शिक्षक आणि परीक्षक यांना या पद्धतीने खूश करण्याचे प्रकार नित्य अनुभवाला येतात. परीक्षाघोऊन गेली की १+ होणे तत्काळ बंद होते. शिक्षकाला ही गोष्ट समजत नसेल असे समजणे अपरिपक्वतेचे लक्षण होय. फेसबूकवर हीच गोष्ट एखाद्याचे पोस्ट लाईक करून केली जाते. ट्विटरवर एखाद्याचे पोस्ट रिट्वीट करून हे साध्य करता येते. माझ्यावर जेव्हाजेव्हा हा प्रयोग होतो तेव्हातेव्हा मला एकाच गोष्टीचे दुःख होते, ती म्हणजे त्या व्यक्तीला मी समजलोच नाही.

Two Different Takes On Fixing A Switchboard

For reasons best known to all who read newspapers, contractors often do a shoddy job when they do civil, electrical and interior decorative work for government and civic bodies. I don't know which of those reasons applied to the contractor who did the job of restoration and renovation of the hospital building. The electric switches fitted by him did not remain OK for long. They came off the walls. Then their front panels came off the bases. The local electricians would not touch them because they were told that the contractor would fix them. The contractor would not touch them because for reasons best known to him and those who made the payment, the total payment was done without asking the users about their satisfaction with the work.

One switch box in the emergency OT needed fixing of the front panel over the box. After waiting for a long time, I offered to fix it, since no one else would do so. I got the chief nurse to give me a thin wire, which they got off an old broom. I put its turns around the base and front panel, and tightened its tips together by twisting them together with pliers. It looked as follows.

It worked satisfactorily for a few weeks. But the people who pulled plugs out of the switch boxes did not push the front panel back while pulling. As a result the remaining part of the front panel came off. They did not have any more wire from any broom, and they did not have me around. So they adopted the usual technique that is used in the hospital to bind any two or more things together.. They stuck the loose parts together with adhesive sticking plaster, a very expensive stuff used to stick dressings over surgical wounds. Then it looked as follows.

I am sure there are many places in the world just like ours. In case they do not have innovative people like our people, this post should help them.

Storage Door

Conventional wisdom is that a room is for storage and a door is for closing the entrance to a room. However hospital employees are innovative. It is their ability to think out of the box that makes civic hospitals different. Here is an example.

The image shows a metal grill door (yellow arrow) in front, behind which is a wooden door (red arrow) with glass panes (black arrow). The idea of putting the grill door was to provide security. The glass panes could be broken by anyone, and a small person could slip in, steal things and get away. The glass panes were sometimes broken, and people peeped in, which could be quite embarrassing at times for the patients inside. The innovators have put detachable tops of two patient shifting trolleys (green arrows) between the wooden door and the grill door. This has achieved a number of things at one go.

1. Space is found for storage of those trolley tops. As everyone knows, space is very difficult to find in this city.
2. The glass panes are protected. No one can break them with solid trolley tops in front of them.
3. Thieves are kept at bay. If they try to steal despite this measure, they will be taught a lesson. If you note carefully, the trolley tops are leaning on the grill door a little. Which means if an unsuspecting thief manages to open the grill door, the trolley tops will fall on his head.

(I cannot say if the innovators had all of these points in mind when they did this. This is how the things appear to me.)

Intern Who Thought Out Of The Box

One of the pleasures :-( of being the head of a department is having to sign the log books of interns. The other pleasures include having to sign other documents, but let us stick to the first one here. The health university has given this pleasurable activity to department heads. The pleasure comes in triplicate. There are three places where the head of the department has to sign, after the person under whom the intern has worked has signed. Of these signatures, one is on a completion certificate. The other two are on identical pages, of which one is probably retained by the department that runs the internship program. These two pages are not consecutive pages in the log book. For making the pleasurable activity a little tolerable, the interns put pieces of paper near the spine of the log book, marking those pages - book marks or tags. They are actually not so thoughtful. The clerk and peon in the departmental office make them do it, so that the head of department does not get irritated trying to find the right pages. Usually the interns do it properly. Sometimes they don't put any book marks. Sometimes they put them in wrong places. Sometimes the bookmarks fall off. I have been doing this work from 2001. Even when there are book marks, getting the right pages open is a bit of a hassle. If you don't believe me, sit with 20-25 notebooks, tag them, and try opening them. After 14 years of this work, I found an intern who thought out of the box.

She had taken a card measuring about 4" x 5". She had cut three sides of another rectangle in the middle of this card. Then she had folded this part out like a trapdoor. Then she had put the base marking the last page requiring my signature, the flap marking the second page requiring my signature, and had marked the first page with a separate piece of card. Opening those two pages somewhat near each other was a breeze. I remembered her as a student, sitting in the front row during lectures and paying attention to the lectures. When the peon took away the log books after I had signed them, I suddenly thought about congratulating her for this idea. Unfortunately she had already collected her log book in those few minutes and gone away. This batch of interns had finished their internship. I am unlikely to see them again, unless they come to our institute for postgraduate studies. Hence this post. I hope she reads this or someone who does tells her about it. I am sure this intern will do well in life, because how can one who can think original thoughts not do well?

Black-and-White To Color Trick

Sometimes you have a black-and-white image that you want to be colored. There are actually two types of images - vector and raster. The vector images are easier to fill with color. You just have to use the fill or flood tool of a Paint program. You select a color with a color picker tool, click on the fill tool button, and click in the middle of the area you want to fill. It gets filled instantly. At least, that is the theory. In case of raster graphics, there are no such well defined boundaries around areas you want to fill. You need a more powerful graphics program like Gimp. It puts a transparent later over the original, and you paint in it using a brush tool. It is easier with a specialized tool like 'Black Magic', which does the same thing, but without you having to actually insert a transparent layer.
A problem with the Paint programs is that if you open a black-and-white image, the software recognizes it as a black-and-white graphic, and replaces the colors you choose with shades of gray. Gimp and Photoshop do the same thing. You can actually see the color palette, select a color of your choice, and then you end up watching a shade of grey where you wanted color. The only way to beat the software is to open a new blank image, which is a color image by default. Then you paste your black-and-white image in it. Now the color palette is enabled and you can put whichever colors you want in it. This works with both the Paint programs and more advanced ones like Gimp and Photoshop.

(Note: this one is applicable for those who run Windows XP like me. It is OK on Windows Vista and higher. I am unwilling to upgrade because Windows XP is otherwise working fine for me, and I don't want to throw away good money.)

Repairing A Potato Peeler

I wanted to take up woodcarving as a hobby. It would have given me satisfaction from doing something with my hands, other than delivering babies and performing operations, which I do for both happiness and making a living. The main problem was that I could not find any woodcarving tools in the local market. I gave up that idea because there was no way to make it work. But if I had those tools, I would have been able to at least repair our potato peeler much more easily. It was a simple instrument, with a metallic peeler fitted over the end of a cylindrical wooden handle. The metallic part remained fine, but the wood rotted inside the grip of the metallic part, and the handle came off. I tried to fit it again, passing small nails through them both. But the rotted end of the handle would not hold the nails. I could not find another piece of wood that would fit in place of the old handle. I had no tools to shape any other piece suitably.

Then I had an idea. I reversed the handle, so that its other end would fit into the metallic part. But it was broader than the cylindrical base of the metallic part. I had to shave off the extra portion so that it would fit. I was back to my old problem - no tools. I knew it would be a lot easier to buy a new one. But there would be no sense of achievement in it. Besides, the ones available in the market have flat plastic handles, which do not sit well in the fist when you peel potatoes. Luckily I had another idea. We have this machine that we use to sharpen our kitchen knives and scissors. If it could grind metal, why would it not grind wood? I tried and it did that very well.

In the figure above, 'A' shows the metallic part (golden colored) and the handle. Please do not say the other end of the handle does not look rotted. I had to spend a very long time making these 3D drawings. To show one end of the handle rotted would have taken ages. 'B shows the upper end of the handle ground all around such that the cylindrical part of the metallic part would fit over it. 'C' shows the two fitted together. I passed two small nails through the base of the metallic part and the handle within it. 'D' shows the finished potato peeler.
A note of caution for those who want to try this out. Try to fit the base of the metallic part over the handle periodically as you grind it, so that you do not make it too thin. If it gets too thin, you will have to find a new handle and start all over again.

Novel Solutions From a Printer

I wrote a book entitled 'Differential Diagnosis and Management Options in Obstetrics and Gynecology' a few years ago. Its two editions were sold out. Then the publisher did something funny. He did not reprint it, nor did he ask me to revise it. After 2.5 years, I thought it was time to revise the book. So I asked him, and came to know all this. The publishing house was quite big, and every time I communicated with it, there would be a new manager who talked to me. There was no explanation why this had been done. They had also printed my last edition on such horrible paper, like one used by tabloids, that it turned yellow after some time, and orange after a few years. They had no explanation for that too. They had no remedy for the loss of goodwill of the book and financial loss to me. I was unhappy with the publisher and decided to change him.
He gave me the publishing rights quite amicably. I think he was just not interested in publishing books any more. I revised the book. It was different from conventional books. It was in landscape mode. Each chapter was covered in just two pages facing each other. There would be an algorithm (flow-chart) on the page on the right side, and explanation of the algorithm on the page on the left side. A reader had to hold the book open, and read the pages alternately to understand the contents. Unfortunately a few algorithms got so big, that they encroached on the lower margin.
"See if the printed pages will look OK" I told my new publisher. He asked his printer to check it. Then he got back to me.
"The printer has three novel solutions to the problem" he said.
"What are they?" I asked disbelievingly. I could not find a single solution to it, and this person had three!
"The first is to remove some parts of the bigger flow-charts" he said.
"No. We cannot remove any matter" I said. "The stuff would not make any sense if we removed any matter from it."
"The second solution is to make the font smaller for those pages" he said. "It will be a reduction. You understand reduction?" he asked me, thinking reduction was a very technical term used by printers.
"I understand 'reduction' I said. I have been reading and writing in English for ages. I have written 21 books so far, all in English. We cannot reduce the font. I have used 10, and any smaller will not be readable easily."
"OK. The third solution is really novel. The printer says the book should open up and down instead of side to side. The spine of the book will be transverse, not the usual longitudinal." He meant like a laptop, I thought. For those of you who cannot visualize this idea, here is an illustration I whipped up.

A is the one he had suggested, while B is the way my book was to be.
"We cannot do it" I said. "It will still put matter in the lower margin. The other reason is that God has made our hands one on each side of the body. So it is comfortable to hold the book open sideways. To hold it open in up and down position will strain the hands and cause fatigue. A laptop remains open by itself, while a book won't."
"So what can we do?" he asked.
"Either we print it as it is, or we just put it in electronic format. to be read on laptops, tablets and smart phones."
I cannot sell eBooks" he said unhappily.
"OK. Then I will give it free to whoever wants it" I said.

Clean India Campaign and Us

It seems the Boss of the country has launched a movement for clean India. Perhaps people expected‘ clean’  to mean non corrupt. But it seems it is physical cleanliness, not the other one we just referred to. The thing percolated down, and the civic Boss ordered the same thing in the civic body. The circular received by everyone states as follows.

Every XXXday, all officers and employees will clean the offices and their surroundings between 5:30 P.M. and 7:30 P.M. An observer will come from head office, and will see to it that people do this cleaning. There was furor over it. The doctors burst out as follows.

"The National Boss started it as a voluntary service. This seems to be a compulsion!"

"Naturally. If the civic Boss makes it a success, he will reach Delhi in some time."

“Who is going to wait from 4:00 P.M. to 5:30 P.M. doing nothing? Does he not know our duty gets over at 4:00 P.M.?”

“Who is going to do a servant’s job? Why is the big idea?”

“If doctors do servants’ job, what will the servants do? Doctors’ job?”

“If they fill up all vacancies of servants, they will not have to ak the doctors to do the cleaning.”

“The patients and their visitors throw things about and make the hospital dirty. We have to clean up after them or what?”

“I employ servants to clean our house. Now I have to do that work here as doctor?”

“Will the servants’ union assault us because we take away their jobs?”

“The premises are clean. Do we have to throw garbage around and then clean it? Like they did in Delhi, and the State Boss did in State headquarters?”

“Why can they stop people from littering, instead of asking us to clean up after them?”

‘It is not a part of my job description. I will file a writ petition against the civic Boss who has ordered this demeaning work be done by us.”

“We will be the first group of doctors in the world who do sweeping, dusting and stuff in the hospital.”

“What will they do if we don’t  do this stupid work? Sack us? Then who will treat patients? Sweepers?”

“Do we actually have to do this, or do we just pose with brooms for taking pictures? Like those politicians?”

“Sir, why are you not saying anything?” someone asked me.

“I have asked the Boss to clarify some points about this business. I am waiting for the answers. In the meantime, I have designed a new instrument for use by the civic doctors. It will look like this.”

“What is it?”

“It is a stethoscope and a broom combined together. I am going to call it stethobroom. All civic doctors will buy it. If I take out a patent for it, I will make enough money so that we can all employ private servants to do this cleaning work in the hospital in our place. Perhaps even enough so that we can all retire and leave the patients’ treatment to the sweepers.”

Innovative Hat Camera

Most of the open surgical operative still pictures and videos are shot using a camera that gives a line of vision that is somewhat different from that of the operating surgeon. The line of vision of the surgeon is the best, because he chooses the best one to operate well. When I worked on an atlas of operative techniques, the camera was held behind and by the side of my left ear, and when the operative field was to be photographed, I would move to the right and the photographer would move the lens of the camera to where my eyes had been before taking a picture. I positioned the video camera at a suitable angle when I shot operative videos. But I remained dissatisfied. When I explained my requirement to my son, who is a software engineer, but also a gamer, he understood the need immediately. There is such a view when one plays 3D games.
"Get a good webcam and fix it to the forehead" he said. "That will give you the view you need. You will not be able to zoom, but otherwise it will be very good."
That was a brilliant idea. The main problem was finding a method of fixing it to the forehead. I asked my wife to lend me her ENT examination mirror. I fixed the camera to the head strap of the mirror and wore it around my head. The view was good, but the weight was too much. I returned the mirror and tried to think of another solution. Google glass was a theoretical option, but not very practical because it was not available in the market at home, and it was terribly costly anyway. A few days passed, and suddenly I had an idea. A 3D image of the idea is shown below.

I took a hat with a visor. It had an adjustment band at the back. I hooked the webcam in that band and wore the hat back to front. It was a little wobbly, because the band was not designed to take that extra weight. So I put a big rubber band around my head, passing over the handle of the webcam. It fitted perfectly, the angle of inclination could be adjusted as required, and the images were excellent. I shot with this assembly about 100 pictures of different instruments and surgical knots for a new book I am working on. It was a bit of a bother when both of my hands had to be in the picture. But there was no one to help. So I placed the laptop near my foot and clicked the left mouse button with my great toe when an image was to be captured. It worked like a charm, except that toe business. I suggest you get an assistant for that purpose, unless you are a Yoga expert and can bend your lower limb joints impossibly.

A Neat Trick

We prefer to have no pests in the house. Unfortunately pest control does not take care of everything. We have a balcony garden with thirty plants. Plants bring ants. We are careful not to spill food particles anywhere so as to avoid attracting ants. But they come for something else - water. There is no stopping them.
We fill up water in a container, drawn through UV purifier, instead of switching it on every time we need water. Unfortunately the ants discovered this cache one day, and spread the word. I don't know how they do it. Perhaps they do it vertically genetically. Generation after generation of ants started entering our water container. They would be found swimming on the water surface in large numbers. They would form groups and swim together, like the gymnasts do in Olympics. Here is a picture, in case you do not believe me. We wondered why they would not drink water and go away. They must love swimming, we thought.

We had to throw away that water and fill fresh water again and again. We do not believe in wasting water. But we do not believe in drinking contaminated water too. Then I remembered a story of a patient of my wife. He ran a small home laundry business. He had plenty of rats, not by choice. He could not afford to let the rats destroy customers' clothes. So he kept food for the rats in a dish every night before retiring. The rats ate that food and went away without damaging a single garment. We decided to try that on the ants. We started keeping a saucer with water in it next to the large water container. The ants stopped entering our water container. But they would not swim in the saucer too. We were stumped, though happy that our water was protected. When my vacation started, I decided to find out exactly what was happening. I watched the saucer. The ants would climb into the saucer, drink water, climb back down and go away. They would not stay in the house and trouble us, or get pest-controlled and killed.
"They could not climb up the steep sides of the water container and fell in the water. They can climb out of the saucer" I explained to my wife.
"Good" she said.
"This is great," I said. "not just good. Now we know something about ants that no one else did so far. We have protected our drinking water. We are doing good work by providing water to thirsty creatures. That is increasing our Good Karma. We are also saving lives of those ants who would have drowned. That is increasing our Good Karma even more."
"I hope you are not going to write this on the net" she said, not greatly pleased that our Good Karma was increasing.
"But I am" I said. "It will help someone else out there who has the same problem, but has not yet found the solution to it."

Leiomyomas With Pregnancy: Can Hysterectomy Be Done?

A woman with a large uterus containing multiple leiomyomas can pose a diagnostic problem if she gets pregnant. If she misses a period, one can suspect that she could be pregnant. If she has symptoms suggestive of a pregnancy, it would help. One may not be able to appreciate signs of early pregnancy in her case, because the uterus with leiomyomas would not soften appreciably so early in pregnancy, and an enlargement in size would not be appreciated. One can do a pregnancy test on urine and make a diagnosis. But what if she does not miss a period? She might have had irregular and heavy periods due to the leiomyomas prior to the pregnancy. If she gets threatened abortion, she will have vaginal bleeding which may be misinterpreted as menstrual bleeding or abnormal uterine bleeding. Then one does not suspect a pregnancy and does not perform a pregnancy test.
There are some patients who are elderly, and are scheduled to undergo hysterectomy for multiple leiomyomas. If they happen to get pregnant, and if the pregnancy is diagnosed, there is a therapeutic dilemma. Would one perform an MTP first, and a hysterectomy after the postabortal period is over? Or would one perform a hysterectomy and get rid of both the conditions at the same time?
I checked all resources - medical databases, books, journals, search engines like Pubmed and Google - and found nothing on this topic. I asked all faculty in my institute. They promised to answer this question, and only five of thirty three answered. The others may be considered to be neutral or unwilling to commit on this issue. Those favoring MTP first stated that the blood loss would be excessive if a hysterectomy was done primarily, the vascularity of the uterus being increased due to the pregnancy. Those in favor of performing only hysterectomy had a number of arguments to support their choice.

1. It would involve a single procedure instead of two, so that the risk of complications (including those of anesthesia) would be reduced.
2. If the fetus were implanted near the fundus, reaching it through the distorted uterine cavity could be difficult and the MTP could fail totally or partially (incomplete abortion).
3. There would be some risk of postabortal sepsis which could make recovery and subsequent hysterectomy more difficult.
4. The blood loss would not be significantly increased with hysterectomy as the only procedure, as there would not be any blood loss after ligation of the uterine vessels.

Since I have mentioned only one point in favor of MTP first, and four points in favor of hysterectomy primarily, perceptive readers must have guessed that I am in favor of the latter. Please let me know what your choice will be, should you get one patient like this.

Gynecological Table To Orthopedic Table

The operation tables are basically same. They have different attachments for suiting needs of different patients. Our operation tables have a semicircular cut at the lower end of the table, where the leg sections come off. That permits surgery in lithotomy position. Orthopedic tables have trochanteric stirrups which permit surgery with the lower limbs extended and abducted. Generally we do not need theirs and they do not need ours. But we had a patient who had a lower limb problem that did not permit flexion at the knee and hip joints, and she needed a medical termination of pregnancy.
"Let us borrow those orthopedic stirrups from orthopedic OT" I said.
Unfortunately it was not possible because the orthopedic OT had only one pair of such stirrups and they needed the stirrups.
"Let our house officers hold the patient's legs straight during the procedure" the Associate Professor suggested. They agreed because they could not say no to a boss.
"We cannot have doctors doing such work" I said. "How long can anyone hold a patient's lower limbs straight out like that, and what if the grip becomes unsteady due to fatigue and the patient moves? It may cause a uterine perforation. Let us put the limbs on Mayo's trolleys at the sides. Their height can be adjusted."
There were not enough Mayo's trolleys for this purpose.
"What about the leg sections of the table?" the Associate Professor asked.
"The leg sections are removed during surgery by rotating them around a vertical axis first and then pulling them out of the table" I said. "We can just rotate them through a suitable angle and place the patient's lower limbs on them in extended and abducted position."
The following 3D image shows the OT table in standard position in 'A' and with the leg sections rotated in 'B' part of the image.

We did what I suggested, and the patient got operated on without any problem including any injury to the affected lower limb, as would have occurred in lithotomy position.

Door Stopper

A door stopper prevents a door from closing. Our operation theaters have automatic door closers, which keep the doors closed when no one is passing through. It makes moving about inconvenient to theater personnel, who open a door fully and tie its handle with a string to something unyielding on or near the wall. This is a door stopper of sorts. It causes stretching of the spring in the door closer permanently after a while, so that it does not function ever again. They do not know what their actions do, and they don't care when they are told what their actions do. They want the door open and they get the door open and keep it open. Period.
On the other hand, we need door stoppers in the house so that the doors remain open and don't bang closed with strong winds, especially in the monsoon. We have wooden stoppers fitted to the door frames, which wedge in the angle between the frame and the open door. Unfortunately their hinges become loose and it is a hassle to get a carpenter to repair them - carpenters want to be hired for the whole day, not just for a small job. I wonder if any doctors do that to anyone, especially to carpenters - get hired for the whole day, not just for removal of an appendix in half an hour or a toenail in five minutes. Anyway, getting a carpenter not being an option, I had to fix a door stopper somehow. Initially I tried putting folded pieces of thick card between the door and the floor. It worked until the card-wedge got thinner due to continued use, or the maid servant swept it away into trash. Then I had an idea. I use a lot of ballpoint pens to write patients' notes, do office work etc. The pens are use-and-throw type. I saved a cap of one such pen, heated its open end over a gas flame, and compressed it with pliers. Thus it turned into a wedge. It stayed put between the door and the floor when wedged there. It did not get soggy when the maid servant cleaned and she was smart enough to know it was not trash, especially after we told her so. Now it functions as a good door stopper. The following picture shows it in a 3D form from two different angles (A and B).

I could make as many of them as the OT personnel want, but won't because I care for the automatic door closers in the OTs.

How To Repair A Tap

The most common serious problem with a tap is wearing out of the threads of the gland nut shown below. As a result, the gland does not push down the jumper and the washer over the distal part of the jumper firmly, but keeps rotating through 360 degrees. The washer does not make firm contact with its bed and shut off flow of water. Then water keeps leaking even when the tap is closed. The only solution plumbers offer to this problem is to replace the tap with a new one. That is what we always did all my parents' life and all my life too, until I decided to experiment with it.
The following 3D image of an old-fashioned, conventional tap shows the tap in a dismantled state, with the shield removed. I opened the irreparable (as diagnosed by the plumber) tap in our house, and removed the jumper with the washer mounted on it. Then I put another washer over the tip of the jumper, so that there were two washers, one below the other. That is shown in the second illustration.

Then I put the jumper-washers assembly back and reassembled the tap. Voila! The tap was fully functional. It has been quite a few days, and the tap is still working fine.
I have another solution to this problem too. It is to increase the height of the jumper. I could do it by fixing a rigid plastic tube of proper size (to be decided by experimenting, or by trial and error) over its upper end. Then the lower end of the jumper-washer assembly will be lower than usual, and the washer would shut off the flow of water before the turns of the gland nut reach the worn out part.
I wish I had thought of all this years ago. Then we would not have had to throw away perfectly reparable taps and buy new ones which had no guarantee of lasting long.

Advanced Speech Therapy

We have one resident doctor who spoke without any breaks for commas or full stops. Despite telling him/her not do so over two years and one month, there was no change. Here is what happened during one of the ward rounds.

“Thisisgravidathreeparatwowithninemonthsamenorrheaandpaininabdomenlastmenstrualperiodnotknownwithacutepaininabdomennohistoryofbleedingpervaginum”

“Hey, wait. I cannot make it out what you are saying” I said. “Say it all again with pauses between words, and wherever you would place commas and full stops.”

“Thisisgravidathreeparatwowithninemonthsamenorrheaandpainin” he/she said.

“Stop!” I said. “Say it again with pauses as I told you”.

“Thisisgravidathreeparatwowithninemonthsamenorrheaandpainin”

There was no improvement. If he/she did this in MS examination, the examiner would surely fail him/her, I thought.

“Stop” I commanded. “You have to start again and say it all again until you do it right. I will spend the whole morning listen to you, if I have to, until you do it right. Now start again.”

“This is gravida three para two withninemonthsamenorrheaandpainin”

“Stop. Start over again” I said.

“This is gravida three para two with nine months amenorrhea and pain in abdomen. Last menstrual period notknownwithactepaininabdo.”

“Stop. Start again” I said.

“This is gravida three para two with nine months amenorrhea and pain in abdomen. Last menstrual period not known, with acute pain in abdomen. No history of bleeding per vaginum.”

“That is good. Now tell me more about her” I said. The improvement lasted that day and for two more days afterwards. He/she has understood that I will make him/her go through that again if he/she reverts to his/her old style of speaking.

I wish I had thought of this speech therapy two years ago.
(Note: 'He/she' is used to protect the identity of the person concerned.) 

Repairing a Sterilizer

My wife has a boiler type of sterilizer in her clinic, that she uses to sterilize metallic instruments before storing them. She gets them autoclaved before they are to be used. She could primarily autoclave them, but she does not use them often, and the effect of autoclaving does not last for more than 24 hours. She does not like to just get them washed and dried after use, because they can still harbor bacteria and viruses.
The sterilizer started leaking water one day. The electrician could not repair it, and advised us to get it sent to the manufacturer.
"I think the rubber washer has gone" she declared. "Can you fix it?"
"I would love to" I said. She knew I loved to fix things like this. So she smiled and handed it over.

The sterilizer had an electric resistance element inside it, which came out of one side through a circular opening. A disc shaped rubber washer was fitted between the element and the inside wall of the sterilizer, to prevent leakage and also for electric insulation. It had stiffened and broken into pieces from repeated heating and cooling. We removed it. But we could not find a suitable washer anywhere. Finally an electrical shop offered us a washer. It was thinner than the original one.
"What if I put two of these?" I asked the shopkeeper. "The combined thickness of the two should be equal to the original one."
"Yes. You should fit two washers" he agreed and sold me two washers. Good salesmanship, I can see it retrospectively. I fitted two washers, one above the other, between the element and inside of the sterilizer. My wife filled it with water and it leaked promptly. I started thinking about what had not worked properly. Finally I had an idea. 'Maybe water leaks between the two washers, and if I use only one washer, it won't leak.' So I removed one washer and refitted the element. My wife tried it, and it did not leak a single drop of water.
"So the thickness of the washer had nothing to do with it" I said. "One learns as one works, what?"
"Yes" she said, happy that I kept learning and solving her problems. :-)

LED for Ear Examination

Usually there is no power cut in Mumbai, and a torch is required but occasionally. I use a torch may be once or twice a year. In this idle period, usually the battery cells have leaked all their charge and the torch does not work when required. When our maid servant brought her young nephew for an emergency ear examination the other day, our torch did not work. My wife tried her mobile phone's torch, but the light was not enough. Then I had an idea.

My cousin had gifted us an LED laptop light source. We never used it, because we did not really need it. I connected the LED light source to the USB port of the desktop, switched on the mains, but did not boot the computer. The current passed through the SMPS to the LED light source, and it gave out intense white light.
"This is very good" my wife said. "It is even better than the examination light in my dispensary."
The maid servant was duly impressed, and I suppose so was the nephew. My wife gave appropriate treatment to the nephew and they went away happy. I was happy too because my original idea had worked, and also because I had opportunity for developing a new 3D model. The one shown above is the one I made.

New Tests for Plagiarism

There are professional tools on the net to detect plagiarism. Those are effective, but do not always work well. For example, if there are HTML files from which someone has copied stuff to be passed as one's own the tools will detect the theft. But if one has copied from a PDF file, the tools fail. I have developed some tools out of experience, and they do not fail. They do not necessarily tell about the source, but they do tell if there has been plagiarism. They are as follows.

1. The article has two parts, which may be admixed. One part has perfect English grammar and composition. The spelling is faultless. The statements hold profound wisdom (if the original source had profound wisdom). This is the stolen stuff. The other part has perfectly horrible English grammar and composition. Three or more words are joined at places, because the space bar has not been hit between the words. The spelling is atrocious. Punctuation marks are immediately preceding words rather than after the previous words. There is often no wisdom in the content. This is the original part of the article.
2. There is a special test to detect theft from PDF files. The formatting of a PDF file is such that words do not flow automatically into the next lines when text copied from a PDF file is pasted into a word processor document. So one finds words broken by hyphens in the middle of lines. Look at the example shown in blue. There are professional to- ols on the net to detect plagiarism. Those are effective, but do not alw- ays work well. For example, if ther- e are HTML files from which someone has copied stuff to be passed as one's own the tools will det- ect the theft.
3. The good part of the article does not remain true to the theme of the article. The stuff stolen from another article is often good for the topic of that article, but the topics of the two articles do not match well. As a result, the stolen stuff appears irrelevant.

If the stuff has been stolen from a book in print, the typing can be atrocious, but the content can be good. Luckily, a person who is too lazy to write something on his/her own is also too lazy to type anything, when there is stuff ready to be copied from and pasted. So plagiarism from printed material is less of a worry for an editor.

Syringe Suction Vacuum Drain

We use a low suction tube drain in the subcutaneous tissue during surgical closure of an anterior abdominal wall incision, when the thickness of the fat layer is 2.5 cm or more. It prevents would breakdown by collection of blood / fluid in the fat plane. Such suction drains are commercially available. They cost a bit of money, but then, what does not cost a bit of money these days? Some of us use a low suction drain built locally using syringes. The originator of this idea is not known. However here is a masterly article in our online, free, open access journal - JPGO. You can read all about it and see the drain at the following web address.
Syringe Suction Vacuum Drain: A Cheap Alternative
I am writing this article for two reasons. The first one is to direct my readers to our journal, where innovative ideas are presented. The other is to show my 3D model of this drain. It looks as shown below.

It requires one syringe, two additional pistons of syringes, a drainage tube, and a clip to occlude the drainage tube. The following picture shows the finished product, in which the three pistons are stuck to one another using adhesive tape.

I am no less proud of my 3D model as the originator of the idea must be of his/her idea. :-)

Abdominal Vaginal Cesarean Section?

A cesarean section is delivery of a viable baby by making an incision into the maternal abdominal and uterine walls. This distinguishes it from delivery of a baby that is ectopic in the peritoneal cavity (advanced abdominal ectopic pregnancy), which is delivered by just making an incision in the maternal abdominal wall. What I am going to describe now is a unique case, quite different from the other two. In this case the baby was delivered by an incision into the maternal abdominal wall and anterior vaginal wall.
It happened in the emergency hours. The woman had been in labor for a long time. The cervix had been fully dilated and effaced for a couple of hours. The baby had been jammed in the maternal pelvis. They took the patient up for a cesarean section for non progress of labor. They followed the standard steps. The divided the peritoneum between the uterus and the bladder and pushed the bladder down. Then they made a transverse incision on the distended 'lower uterine segment' and delivered the baby. But when they started to suture the 'lower segment' incision, they discovered that the incision was not in the lower segment. It was in the anterior vagina. The edge of the vaginal part of the cervix was above the incision.
"It was almost paper thin" said one of them the next day morning during our ward round.
"Stretched out vagina would be that thin" I said. "Have you realized what happened?"
"...." they probably had realized what had happened, but were reluctant to put it in words.
"The fetal head had passed through the cervix and was in the upper vagina. The baby was not delivering because of pelvic contraction below that level. You made an incision in the vagina abdominally and delivered the baby. This must be the first case of this event in the world literature."
"...." they either did not think it was the first case in the world literature, or were not thrilled by that idea.
"You can publish this case in a scientific journal" I said enthusiastically.
"....." they did not seem to think much of the idea.
"This woman has some advantages over other women who undergo a cesarean section" I said. "She will not be at risk of complications like placenta previa, accreta, increta or percreta, and also of rupture of the scar in a future pregnancy."
This should have pleased them, but all I could see there was bewilderment. Perhaps they thought I was being sarcastic.
"What can we call this?" I asked. There was no answer. "We cannot call this abdominal vaginal cesarean section, because a cesarean section requires a uterine incision. We can call this abdominal vaginal delivery."
I moved on with the ward round, not waiting to see their expressions.