<not for the squemish…>

I consider myself to have a high tolerance (albeit a low threshold) for pain: I can usually accept it and work my way through it when it arrives. Having experienced kidney stones and dental abscesses before, I know roughly where some of my own limits are.

My experience over the last week has been a little different, with some different outcomes that I wanted (and needed) to document.

Firstly, the definition of pain is always subjective. However the small amount of research I did to try and find a common, non-jargon-based language didn’t really reveal what I was expecting: if anyone knows of a simple, official 1-10 scale with clear examples, please comment below with a link.

The most useful I found was here (from 2002) and its author also expresses frustration about the lack of a common language. It’s a good article, and I’ve copied the table here for completeness

And so, onto the story.

On Tuesday one of my teeth started to ache. I recognised it as likely to be a root canal issue as my dentist had it on their list of to-do’s. With impeccable timing – Tuesday was our last board meeting of the year, and am in the midst of negotiating our biggest ever deal – I had to just start on the Nurofen and pace out the day. That night it stepped up and after a very interrupted night I started to alternate Paracetemol and Ibuprofen to get through the next day, and arranged a dental appointment for Thurs 9am.

Weds night stepped up again, about a (6) on the above scale, so almost no sleep, but pain I can certainly “meditate through” for a few hours. On Thursday my dentist duly identified an abscess and I started 500mg Amoxicillin 3x a day. Unfortunately Thursday night went up a notch (7) and was continuous, so to try and seek some stronger pain killers, I trundled myself off to A&E at about 11pm. A&E is never a good place to go, but after 3 hours of concentrated pacing (one of my pain management techniques is to walk and count out loud, small wins of control) I was given a course of 60mg Codine (heavy duty pain killers) and 50mg Diclofenac Sodium (reduces inflammation). To help them get into my system, I walked the 30 min journey home, they kicked in, and I went to sleep. For an hour. Then I was back to a continuous (7)… fitful sleeps, and the next morning my partner picked up a course of 400mg Metronidazole from my dentist (heavy duty antibiotics). The thing is with antibiotics is that they often take 24-48 hours to kick in.

Friday saw the intensity grow from a (7) to an (8) in the evening and, with my energy levels falling, inability to eat and increased tiredness, tipped me into a “must do something” state. Consultation (via my partner) with NHS Direct (which is excellent by the way) at 8pm led to direct referral to an all night emergency dental clinic… albeit a 40 minute cab journey away. Unable to see any alternative, I bundled myself into a cab and concentrated my way to the dentist, somehow filled in a form (no idea what it said) and that’s when things got really interesting.

The dentist could clearly see I was in distress, understood why and wanted to help. So he injected an anaesthetic to numb the area, to relieve the pain, then work on the tooth.

It’s difficult to remember now what it felt like, and still sounds like a very unreasonable claim, but this is where things went to a (9). At the point of the injection I felt like I was going to pass out. However, the step change thereafter – from a (9) to a Zero (no pain) was so dramatic (I could actually feel the anaesthetic moving through my jaw) that within seconds I was in shock: shaking, weeping, numb hands and arms.

After “an amount of time” and a glucose drink, I calmed down. The relief of having no pain was ecstatic. I then smiled my way through a partial root canal treatment, drifting in and out of sleep.

After that, feeling vastly improved (still numbed), I got the tube home and started to rest.

If only.

Bang. The anaesthetic wore off. The pain was worse than before. I’d say a (9) although still feel uncomfortable about that number because I can’t compare this to throat cancer(!), but it was more than an (8).

I subsequently learned from my normal (excellent) dentist, that while the emergency guys were obviously dealing with the situation in hand, you *never* inject and/or operate on an infected tooth. Even just the additional liquid from the injection adds more pressure to the abscess, never mind the drilling/etc.

So, in my on-the-ground state, my partner called for an ambulance, checking carefully that it was both appropriate to have one and that there would be someone at the other end to deal with the issue. They said “yes, we’ll be there immediately, get out onto the street”.

Note to all: never call an ambulance for a dental problem. They have no way to deal with it and dental units at hospitals seem to close at 10pm.

After standing on a cold December street for 40 minutes the ambulance finally arrived. I don’t remember waiting, just pacing and counting. They then said that there was nothing they could do and the dental unit was shut, and I needed to go back to the all night dentist. In a cab (since it was on the other side of town).

The medics were very empathetic and did what they could: 10ml of oral morphine. But it didn’t touch the pain. And they flagged down a cab…

40 mins later I was back in the dental surgery. It’s now 1am Saturday, and a different dentist, who … anaesthetised me.

Same reaction as before. (9) + shock + calm.

Peace was now not the only outcome, but substantial delirium. The cocktail of pain, morphine, pain killers, lack of sleep/food/etc. meant my most concerted efforts to concentrate were futile. Sentences were slow/slurred, even if visualised well in my head.

“Did I want an extraction or to leave it?” was my choice.

I suppose I should feel happy that even under these conditions, a part of my sanity had already worked out that that would be terrible, not just because of the loss of a tooth (even though a part of me wanted that payback so very desperately!), but because I was working out why the last visit hadn’t worked.

“No” was my answer, so in my somewhat befuddled mess of a state, I got another cab, 40 mins, home.

Home, I slept, the second (double-dose) of anaesthetic wore off while I was asleep and I can only imagine that the antibiotics magically had kicked in to reduce the basic cause of infection.

Saturday 9am I woke up, totally exhausted, but not in excruciating pain. My normal dentist saw me at 11am and imparted the words of wisdom about having to wait it out until the antibiotics kick in, even if it seems impossible at the time. There really isn’t another option.

Home by noon, and starting to get the rebound effects of the last few days I went into extremely deep lethargy and narcolepsy. I couldn’t keep my eyes open for more than a few seconds before plunging into fitful/lucid dreaming/ sleep.  My entire body ached. I couldn’t really move.

Given the lack of nutrition I knew I had to at least drink, however it would take me over 2 hours to actually make it across the bed to the glass in-between sleep, waking, realisation and trying to move. And, unfortunately, my body had reacted so badly that I wasn’t able to retain even water…

18 hours later I knew I was also feeling the impacts of dehydration, and again NHS Direct were great, at 5am, over the phone diagnosing and sourcing a local doctor to prescribe additional medication.The only glitch being: I had to pick it up from the local hospital. At this point I couldn’t pick my head up from the bed, so back to sleep it was.

And of course, if you can’t keep down water, you can’t keep down antibiotics. I remember thinking … “oh crap” … as I drifted back to sleep again, but was comforted by the last words my dentist had said to me on Saturday: “it will not be as painful again, you are over the worst of it”. Fortunately, she was right.

Throughout Sunday and early Monday, my condition was steady-state: utter exhaustion and all-over aching. Gradually, with some moments of quite deep shock/emotional release, it started to pass.

Monday afternoon I was, finally, able to digest water, and that started a proper, but gradual recovery.

What did I learn/what would I do differently?

I’d get onto antibiotics (all of them) sooner.

I’d not call an ambulance for any dental-related emergency, regardless of how severe.

I’d somehow insist that any emergency dentist did not inject anaesthetic. Apparently this not only increases the long-term pain, but introduces the potential to spread the infection to other areas.

I don’t know how to reconcile that level of pain with no action/waiting. I know in retrospect that it’s “one of those things”, and quizzed my normal dentist about it a lot. However, “in that moment”, I could easily imagine asking for a full extraction.

I have no idea how I’d deal with something similar again. My pain management process is always to focus on accepting the pain, taking it on board, then thinking about how I’ll reflect on it later (as this blog post is doing). There always has to be a future point to anchor to.

Reading up on pain, and seeing the definitions above, I was quite shocked to see suicide mentioned so many times. It’s not something I think could ever conceive of, but I could easily imagine that prolonged exposure to this kind of intense, crushing, omnipotent pain could entirely take over your whole perspective of life.

My admiration of those who suffer this on an ongoing basis has certainly increased.

Take care.

Many late night discussions over the last year from FOWA, IT@Cork, eTech, Green:net to Geekyoto, and with the AMEE team have led me to think on topics like

• “digital inheritance”
  (e.g. what if you could inherit your grandfather’s iPod?)
• dematerialisation
  (digital products and products transforming into services)
• desiring what we need
  (as opposed to the consumer movement that drove us from a needs-based culture to a desire-based culture)
• modelling flow rather than inflation
• and change and adaptation in an elastic society
  (to redefine the notion of “growth”)

Far, far too much to try and summarise here, but hopefully good springboards for discussion. A recurring theme is the transformation from products to services  (eg. the instant car rental schemes where you can rent for 30 mins). Digital music has already dematerialised the physical product of music to replace CDs.

Inspired by the powers of ten, I’ve been wondering how in the world might make the 90% reduction in CO2/GHGs that’s required to address climate change. This is an order-of-magnitude change in the way we currently live.

We need to all make “powers of ten” changes to our lives, from the CO2 intensity of our power production, to the way we relate to products and services.

So, to my latest call to action…

“Turn every product into a service for 10 people”

I’ve christened this Δten / Δ10 / Delta Ten, so it can be talked about in those management consulting meetings where 6σ (Six Sigma) is mentioned.

In fact, maybe Delta Ten should be an add-on to Six Sigma?

“Delta Ten seeks to improve the sustainability of process outputs by identifying and removing the causes of inefficiencies (errors) and variation in manufacturing and business processes, and extends this to usage patterns (e.g. resource sharing and re-use), consumption and waste, by using strong reductionist techniques to diminish the use of energy and materials by a factor of ten.”

• delta 1 = 10% efficiency increase (10% reduction in materials, increase in energy efficiency, or energy consumption through re-use)
• …
• delta 9 = 90% efficiency increase (90% reduction in materials, increase in energy efficiency, or energy consumption through re-use)
• delta 10 = The process is rendered wholly and demonstrably sustainable through the effective and credible management of resources (e.g. renewable energy, managed forestry, effective waste management, and cradle-to-cradle/biomimetics).

A delta 10 means you have created an environmentally-intelligent service, not a product.

Anyone like to help?

A better voting version of this

Online Surveys & Market Research

Watch it here:

http://www.ageofstupid.net/screening/pp/london_vue_acton

(copy of my post on the O’Reilly Radar)

We’re all aware of the emotive language used to polarize the climate change debate.

There are, however, deeper patterns which are repeated across science as it interfaces with politics and media. These patterns have always bothered me, but they’ve never been as “important” as now.

We are entering an new era of seismic change in policy, business, society, technology, finance and our environment, on a scale and speed substantially greater than previous revolutions. The sheer complexity of these interweaving systems is staggering.

Much of this change is being driven by “climate science”, and in the communications maelstrom there is a real risk that we further alienate “science” across the board.

We need more scientists with good media training (and presenting capability) to change the way that all sciences are represented and perceived. We need more journalists with deeper science training – and the time and space to actually communicate across all media. We need to present uncertainty clearly, confidently and in a way that doesn’t impede our decision-making.

On the climate issue, there are some impossible levers to contend with;

1. Introducing any doubt into the climate debate stops any action that might combat our human impact.
2. Introducing “certainty” undermines our scientific method and its philosophy.

When represented in political, public and media spaces, these two levers undermine every scientific debate and lead to bad decisions.

Pascal’s Wager is often invoked, and this is entirely reasonable in this case.

It is reasonable because of what’s at stake: the risk of mass extinction events. If there is a probability that anthropogenic climate change will cause the predicted massive interventions in our ecosystem, then we have to act.

The nature of our actions must be commensurate with both the cause and the effect. The causes are many: population, production, consumption – as are the effects: war, poverty, scarcity, etc.

Our interventions will use all our means to address both cause and effect, and those actions will run deep.

Equally, we must allow science to do what it’s designed to do: measure, model, analyse and predict.

From a scientific perspective we must allow more room for theories to evolve, otherwise we’ll only prove what we’re looking for.

However, if we ignore the potential need to act, the consequences are not something anyone will want to see.

It’s not something we can fix later (for me, “geo-engineering” is not a fix, it’s a pre-infected band-aid).

Given the massive complexity of the issues, and that – really – anthropogenic climate change is only one of many “peak consumption” issues that we face, there is no way we can accurately communicate all the arguments that would lead to mass understanding.

However, the complexity issues are no different from those we face in politics. They are not solvable, but they are addressable.

We can communicate the potential outcomes, and the decisions that individuals need to make in order to impact the causes.

Ultimately it’s your personal choice.

My choice is based on my personal exposure to the science, business, data, policy, media, and broader issues around sustainability. That choice is to do my best to catalyse change as fast as I possibly can.

We all need to actively engage in improving communication, so that everyone – potentially everyone on Earth – can make informed choices about the future of the planet we inhabit.

–
Recommended reading:

http://www.realclimate.org/ is a great resource.

Today, the UK Government launched a campaign “to create a more science literate society, highlighting the science and technology based industries of the future”

Below are some highlights from a great summary on the 2degrees site (which requires registration and I’d recommend if you want to get involved).

I’m just back from IT@Cork  where amongst many things I learned that Ireland has one of the most advanced electricity grids in the world – they’re very close to being able to execute Demand Response which, if implemented at scale (internationally), would have a massive impact on energy management, efficiency and reduction. The UK Act will help move this agenda (and others) forward not just in the UK, but internationally.

Credit: Allen Shaw

“The Climate Change Act 2008 is a historic piece of legislation. It is the first of its kind anywhere in the world and, if successful, a model likely to be replicated in other jurisdictions.

A key element of the legislation is the provision for the carbon reduction commitment which this network is all about understanding – and includes the statutory powers to, for instance, develop UK centred carbon trading to fulfil the obligations within the CRC

… the scale up in the deployment of renewables is extremely aggressive and presents significant investment opportunities.

One of the most valuable features of the new Act is the greater certainty on strategy provided by the requirement to specify three five year carbon budgets that will be legally binding and scrutinized by a powerful Climate Change Committee. As the Minister of State for the Environment, Phil Woolas stated:

“The Bill establishes legally binding long-term targets and medium-term budgets to provide greater clarity for UK industry, and that will enable businesses to plan effectively and invest in the technology that is required to move towards a low-carbon economy and to reap the potential economic benefits that are on offer. It will ensure that we adapt to unavoidable climate change as well.”

The Act in more detail:

The Climate Change Act focuses on a number of policy areas:

• Energy efficiency with the Carbon Reduction Commitment (CRC) as flagship policy
• Renewables expansion (increased ten fold by 2020)
• Transport policy
• Low carbon technology
• Zero carbon buildings
• Public awareness and mobilization
• Adaptation

The calendar of activities is:

• 1 December, 2008 the new Climate Change Committee (CCC) delivers advice for the first three carbon budgets.
• 2009 budget first three carbon budgets delivered.
• Mid 2009 detailed proposals presented on carbon budgets.
• September 2009 Climate Change Committee annual report.
• January 2010 government publishes first response to CCC report.

Key features include:

• 80% reduction in carbon emissions by 2050 (26% reduction by 2020).
• All primary greenhouse gases to be included (check)
• A carbon reduction commitment on businesses with half hourly metered consumption > 6,000MWh / year with support for emissions trading
• Provision for inclusion of aviation and international shipping in climate policy.
• Restrictions (amounts still to be determined) on the amount of carbon reductions that can be met by credits earned overseas.
• A Climate Change Committee convened and empowered to advise, scrutinize and report – and hold the government to account.
• Five year carbon budgets to be published three periods at a time – these are legally binding on government.
• Government to report at least five yearly on the degree to which the UK is at risk from climate change.
• Statutory powers to require public bodies and utilities to take action on adaptation.

Other powers bundled with the legislation:

• Provision to enforce charging for single use carrier bags
• Provision for variable charging of domestic waste
• Amendments to the Renewable Transport Fuels Obligation

I’ve been a SoundCloud member since Feb 2008. My most recent login threw up a “we have new T+Cs” message with no option to continue unless you said yes. Here’s the standard stuff

1.  USER hereby grants SOUNDCLOUD and its successors and assigns a worldwide, perpetual, non-exclusive, irrevocable, royalty-free, fully paid up, license to use, copy, transmit or otherwise distribute, publicly perform, digitally perform, publicly display, distribute, stream, download and/or otherwise make USER’s Content available to other users of SOUNDCLOUD’s Website and Services.
2. USER also grants each and every other registered user of SOUNDCLOUD’s Website a worldwide, perpetual, non-exclusive, irrevocable, royalty-free, fully paid up, license to use, copy, transmit or otherwise distribute, publicly perform, digitally perform, publicly display, distribute, stream, download USER’s content and/or otherwise to make USER’s Content available to other users of SOUNDCLOUD’s Website and Services as set forth herein.

Which is all very predictable and quite hard to avoid if you do anything online – the usual definition of “Service” as “anything we want” is normal, if questionable. Now here’s the interesting bit;

3. This license does not grant SOUNDCLOUD the right to sell USER’s Content or otherwise distribute it outside of SOUNDCLOUD’s Website or Services, provided however, that streaming of Content on third party Websites via embedded widgets or the SOUNCLOUD Application Programming Interface (API) or similar tools shall not be deemed a distribution outside of SOUNDCLOUD’s Website or Service.

which on the surface looks necessesary for them to offer an API, however the way it’s worded means that they are explicitly carving out the ability to distribute USER’s Content via the API… and who’s to say they can’t charge for ads on such streaming (and you’d expect the sites embedding the streams to sell ads). Another good example of the deal-flow from £ to content-producer still not being realised.

I presented at <head> at the London Hub (in person) on Friday, and today online (from home). I wanted to capture some of my thoughts immediately before I forget:

This is the first time I believe I’ve seen what I’d call true p2p broadcasting.  Perhaps a coming of age.

Having spent (too) many years webcasting everything from Glastonbury to conferences to Parliament, I have to say that this went very well. I started doing “webcast chats” at Virgin Net in 1996, which worked – and helped me learn how to mash up broadcasting with chat rooms – but the video was still “one-way”. The distributed-source nature of HEAD really changed this context.

As a presenter, I found the experience relatively seamless*. The great benefits of presenting from home included;

- not having to travel the venue, hang around, and travel back.

This is a vast benefit. It’s very low stress, even travelling across London is stressful. No (/minimal) missing out on family time at weekends.

- No CO2 footprint.

- No £cost.

The negative bits? Missing out on serendipity.  This was mitigated, in part, by the Hubs – which is a great idea – and the chat room. It actually felt a bit more human than standing on a stage.

I enjoyed this more than most conferences I’ve spoken at, and had more (and better) questions via the chat room. I also felt much more comfortable stopping “presenting” and actually listening to the questions. Maybe physical conferences should present the back-channel to the presenter on their tele-prompt?

The distributed nature of the presenters coming into the video stream really helped to create a feel of community. Being able to jump between rooms was also very handy.

Things that would make it better;

1) As a presenter, being able to see and/or hear the viewers; somehow. I’m not sure how. More emoticons, a “sucks more/less” slider? This would really help with gauging feedback. Put pressure on your presenters to be better – this can only be a good thing.

2) As both audience and presenter – a cross-room chat back-channel. I’d love to see the chatter from other presentations to see if there were points of serendipity I could pull out (while presenting). As an audience member I’d like to see all the chats.

3) Better software* integration to manage my view vs everyone else’s view and how it can be customised.

4) Presenter’s need to be retrained – this will take time. Aral made a training video, which was great, but we need to extend this to a whole new “stage” (e.g. getting good lighting, decent cams, etc.). I hooked up 2 webcams so I could jump-cut but manage it well while speaking – but I have a motorised cam, so could have given position control to the audience.

In summary, this was a great experience (especially for a first conference) and one I’d definitely repeat.

I also estimate that this approach saved between 1,000 and 5,000 tonnes of CO2.

Well done to Aral and the whole HEAD team.

*Adobe still have a huge amount of work to do to get it right (there were some pretty basic features missing from the online app).

Cape Farewell sets off today with a slightly different crew to norml; including Jarvis Cocker, KT Tunstall, Laurie Anderson, Ryuichi Sakamoto and many other remarkable individuals.

Hopefully I’ll have something more to write about soon, but in the mean time, good luck Chris and no I’m not jealous at all…

(source: http://nsidc.org/arcticseaicenews/)

The Arctic sea ice cover appears to have reached its minimum extent for the year, the second-lowest extent recorded since the dawn of the satellite era. While slightly above the record-low minimum set in 2007, this season further reinforces the strong negative trend in summertime sea ice extent observed over the past thirty years.

NSIDC will issue a formal press release at the beginning of October with full analysis of the possible causes behind this year’s low ice conditions, particularly interesting aspects of the melt season, the set up going into the winter growth season ahead, and graphics comparing this year to the long-term record.