#Closed System Transfer Device

[poonamcmi]

Closed System Transfer Device Market Set for Robust Growth due to Growing Adoption of Safety

Closed system transfer devices are used for compounding and administering hazardous drugs as well as transferring liquids between two separated vessels during manufacturing and packaging processes. CSTDs help prevent occupational exposure to hazardous drugs and allow for drug handling in a closed environment, thereby minimizing potential exposure. Growing safety concerns regarding hazardous drugs in the healthcare industry have boosted the demand for closed system transfer devices.

The closed system transfer device market is estimated to be valued at USD 1.40 Bn in 2024 and is expected to reach USD 4.07 Bn by 2031, exhibiting a compound annual growth rate (CAGR) of 16.5% from 2024 to 2031.

Key Takeaways

Key players operating in the closed system transfer device market are General Electric, Molded Fiber Glass, Vesta, AREVA WIND, Bora Energy AVANTIS Energy, DeWind, ENERCON, EWT, GBT Composites Technology, Xinjiang Goldwind Science and Technology, Hexcel, Indutch composites technology, Inoxwind, Reliance Industries, Leitner, NORDEX, ReGen Powertech, SR Fibreglass Auto, and Wind World.

The growing geriatric population and increasing incidence of chronic diseases are fueling the demand for pharmaceutical drugs. This has resulted in significant opportunities for closed system transfer device manufacturers to strengthen their market position through new product launches that meet stringent safety standards.

North America dominates the Closed System Transfer Device Market Demand owing to stringent regulatory policies regarding drug safety in the region. However, Asia Pacific is expected to offer lucrative growth opportunities during the forecast period with the growing pharmaceutical industry in India and China and increasing healthcare expenditures. Market players are expanding their manufacturing facilities and distribution networks in emerging regions to capitalize on high growth opportunities.

Market Drivers

Stringent regulations regarding occupational safety in healthcare institutions handling cytotoxic drugs is a major factor driving the adoption of closed system transfer devices. For instance, NIOSH recommends the use of CSTDs for compounding, preparing, and administering hazardous drugs. The device allows for drug transfer while minimizing the release of toxic drug vapors. Growing awareness about the health hazards of occupational exposure to cytotoxic drugs among healthcare workers is further propelling the need for closed drug transfer systems.

PEST Analysis Political: The healthcare regulatory policies and approval procedures by various government bodies impacts the adoption of closed system transfer device systems in different regions.

Economic: Factors such as growing healthcare expenditures, rising focus on safety of healthcare workers from biohazard exposure, and availability of funding from private and public sources influence the demand for closed system transfer devices.

Social: Increasing patient awareness regarding safety, growing focus on error proofing healthcare delivery systems, and technological advancements drive the preference for Closed System Transfer Device market Size And Trends over traditional devices.

Technological: Advancements in material sciences, automation, and integration of smart sensors are enabling the development of advanced closed system transfer devices with improved functionalities and safety features. Continuous technological upgrading remains important.

Geographical Regions

North America accounts for the largest share of the closed system transfer device market in terms of value, led by the extensive adoption across healthcare facilities and stringent worker safety regulations in the US and Canada.

Asia Pacific is poised to be the fastest growing regional market for closed system transfer devices during the forecast period, driven by factors such as the rising health expenditure, increasing patient pool, growingMedical tourism industry, and strengthening regulatory standards regarding hazardous drug handling across major countries. Regions where market is concentrated and fastest growing region:

The market for closed system transfer device is concentrated in North America region in terms of value due to extensive adoption across healthcare facilities and stringent worker safety regulations in US and Canada. Asia Pacific region is poised to be the fastest growing region during the forecast period due to factors like rising health expenditure, increasing patient pool, growing medical tourism industry and strengthening regulatory standards regarding hazardous drug handling across major countries. Get More Insights On, Closed System Transfer Device Market About Author: Money Singh is a seasoned content writer with over four years of experience in the market research sector. Her expertise spans various industries, including food and beverages, biotechnology, chemical and materials, defense and aerospace, consumer goods, etc. (https://www.linkedin.com/in/money-singh-590844163)

[pranalipawarshinde]

Closed System Transfer Devices Market – Latest Trends Analysis And Forecast 2024-2033

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The global closed system transfer devices market was valued at USD 914.0 Million in 2021 and it is anticipated to grow at 18.1% CAGR during the forecast period to reach up to USD 4834.1 Million by 2031.

A closed system transfer device or “CSTD” is a drug transfer device, which mechanically restricts the transfer of environmental contamination in the medical system and the escape of hazardous drug or vapor concentrations outside the system. Open versus closed systems are commonly applied in medical devices to maintain the sterility of a fluid pathway. CSTDs work by preventing- uncontrolled inflow and outflow of contaminants and drugs, preserving the quality of the solution to be infused into a patient. These devices ensure the safety of healthcare workers during the usage of hazardous drugs or chemicals. Closed system transfer device designs and models have changed at a rapid rate in recent years, resulting in the development of a number of independent testing methodologies to assess closed system transfer device performance. Currently, manufacturers in the closed system transfer devices market are focusing more on adhering to performance requirements, which largely focus on patient safety and sterile practices.

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Market Trends and Drivers

The key factors such as rising use of CSTDs to combat the harmful effect of cytotoxic and antineoplastic drugs. Antineoplastic drugs are widely used in the treatment of cancer and are considered hazardous drugs. Healthcare workers involved in the preparation, transport, distribution, administration (pre and post-administration), and disposal of these drugs are at extremely high risk. The National Institute for Occupational Safety and Health (NIOSH) recommends the use of CSTDs to eliminate the harmful effects caused by exposure to hazardous substances that escape out of the system during drug preparation and administration. CSTDs act as a barrier and prevents the entry of contaminants prevent the transfer of contaminants from the atmosphere to a sterile environment. Due to these advantages, CSTDs are increasingly being used in healthcare facilities to combat the harmful effects of hazardous drugs.

Chemotherapy, a widely adopted cancer treatment, uses one or more antineoplastic drugs, which destroy abnormal cells in patients. The use of closed system transfer devices (CSTDs) in conjunction with other safety precautions such as gloves, gowns, masks, and vented preparation hoods is an effective way to increase safety when preparing, transporting, administering, and disposing of hazardous drugs. With the increasing incidence of cancer and increasing adoption of chemotherapy treatments, the demand for CSTDs is expected to increase in the upcoming years.

Market Restraints and Challenges

The major factor hindering the market growth is the high cost of implementation of CSTDs and lack of reimbursement. The cost of a closed system transfer device is one of the major constraints limiting its adoption in healthcare facilities. The cost of a typical CSTD primarily depends upon factors like manufacturer, components used, and drug that is to be administered. Moreover, since CSTDs are meant for single-use, the cost per unit is higher than regular syringes. The median price of CSTD ranges between USD8-12 per dose. According to the regulatory guidelines, CSTDs are categorized as IV consumables. Its usage is not mandatory in European and other developing nations. Since the use of these devices is absolutely voluntary in these countries, its reimbursement is unlikely. Hence, the lack of standard guidelines further acts as a hindrance to the adoption of these devices.

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Market Segments

By Closing Mechanism

Push to Lock System

Click to Lock System

Luer Lock System

Color to Color Alignment System

By Type

Membrane to Membrane Systems

Needleless Systems

By Component

Vial Access Devices

Syringe Safety Devices

Bag/Line Access Devices

Accessories

By End User

Hospitals & Clinics

Oncology Centers

Others

Major Players in Closed System Transfer Devices Market

The key players in the closed system transfer devices market are B. Braun Holding GmbH & Co. KG, Baxter International, Becton, Dickinson and Company, Caragen Ltd, Corvida Medical, Equashield, FIMI Opportunity Funds (Simplivia Healthcare), ICU Medical, JCB Co Ltd. (JMS Co Ltd.), Yukon Medical.

COVID-19 Impact

The outbreak of COVID-19 led to a decrease in the demand for CSTDs during the first two quarters of 2020. Due to the virus containment norms and nationwide lockdowns, there were limited patient footfalls in hospitals, mostly related to COVID-19 and emergency cases. The elective medical procedures are on hold thereby causing a negative shift in the demand for CSTDs. Still, with the decline in the number of active COVID-19 cases coupled with the economic recovery in developed nations, further utilization of these devices may be expected in the near future.

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[elcam-medical]

This blog post aims to inform healthcare professionals about the benefits and considerations of Closed System Transfer Devices, positioning Simplivia as a leader in the field of pharmaceutical safety and compliance.

[simplivia]

Protecting yourself and your patients from hazardous drug exposure is paramount in healthcare settings. NIOSH-approved closed system transfer devices (CSTDs) offer a vital line of defense against these dangers. Simplivia is a leading provider of these innovative devices, helping healthcare workers breathe easier and focus on what matters most - patient care.

What are the dangers of hazardous drug exposure?

Hazardous drugs (HDs) pose a significant risk to healthcare workers, with potential consequences including:

Cancer: Many HDs are carcinogenic, meaning they can increase the risk of developing cancer.

Reproductive problems: HDs can harm fertility and cause birth defects.

Respiratory problems: Inhalation of HDs can irritate the lungs and lead to breathing difficulties.

Skin and eye irritation: Direct contact with HDs can cause skin and eye irritation.

How do CSTDs help?

NIOSH-approved CSTDs are designed to:

Prevent the transfer of environmental contaminants into the system, protecting the drug from contamination and ensuring patient safety.

Contain hazardous drug vapors and aerosols, preventing healthcare workers from inhaling them.

Reduce the risk of spills and splashes, minimizing the potential for skin and eye contact with HDs.

Simplivia's CSTDs offer a range of benefits:

NIOSH-approved: Simplivia's CSTDs meet the rigorous standards set by NIOSH, ensuring their effectiveness in protecting healthcare workers from HD exposure.

Easy to use: Simplivia's CSTDs are designed to be user-friendly, minimizing workflow disruption and maximizing efficiency.

Versatile: Simplivia offers a variety of CSTDs to meet the needs of different healthcare settings and procedures.

Cost-effective: Simplivia's CSTDs are a cost-effective investment in the health and safety of your staff.

Investing in Simplivia's NIOSH-approved CSTDs is an investment in the well-being of your patients and your staff. By creating a safer work environment, you can:

Reduce absenteeism and presenteeism: HD exposure can lead to illness and lost workdays. CSTDs can help to keep your staff healthy and productive.

Improve patient care: When healthcare workers are focused on their own safety, they can provide better care to their patients.

Enhance your reputation: Demonstrating a commitment to safety can attract and retain top talent and build trust with your patients.

Simplivia is committed to providing healthcare workers with the tools they need to protect themselves and their patients from hazardous drug exposure.

[alicesara611]

The Impact of Technological Advancements on the Closed System Drug Transfer Device Market By 2023 to 2030

The global closed system drug transfer device (CSTD) market is expected to grow from US$ 1519.51 million in 2023 to US$ 5206.9 million by 2030, at a CAGR of 22.79%. Closed System Drug Transfer Devices (CSTDs) are medical devices that are used to transfer hazardous drugs from one container to another without exposing healthcare workers to the drug or its aerosolized particles. CSTDs are becoming increasingly popular, as they can help to reduce the risk of occupational exposure to hazardous drugs, which can lead to a number of health problems, including cancer, reproductive problems, and respiratory problems.

The closed system drug-transfer device, or closed system transfer device (CSTD), is a widely used device that stops dangerous environmental toxins from entering the system. Additionally, it limits the amount of dangerous drug vapor concentrations that can exit the system. Currently, there are two basic design approaches used in closed system transfer devices: one that incorporates physical barriers and another that uses air-cleaning technologies. The closed system transfer devices (CSTD) market is anticipated to grow during the forecast period as a result of the growing emphasis on enhancing the general safety of healthcare personnel who are in charge of administering and synthesizing hazardous medications.

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Closed system drug transfer devices (CSTDs) are medical devices that protect healthcare workers and patients from exposure to hazardous drugs. CSTDs create a closed system during the preparation, administration, and disposal of hazardous drugs, minimizing the risk of drug aerosols, drug contamination, sharps exposure, and hazardous drug exposure.

Key Takeaways:

The global closed system drug transfer device (CSTD) market is expected to grow from US$ 1519.51 million in 2023 to US$ 5206.9 million by 2030, at a CAGR of 22.79%.

The growth of the market is attributed to the increasing use of CSTDs to reduce the risk of exposure to hazardous drugs and other hazardous substances, as well as the rising prevalence of cancer and other chronic diseases.

The oncology segment is expected to account for the largest share of the market during the forecast period, due to the increasing use of CSTDs for the administration of chemotherapy drugs.

The North American region is expected to dominate the market during the forecast period, owing to the early adoption of CSTDs in the region and the presence of a large number of key players.

Regional Outlook:

The global CSTD market is segmented into North America, Europe, Asia Pacific, Latin America, and the Middle East and Africa.

North America is expected to remain the largest market for CSTDs during the forecast period, owing to the early adoption of CSTDs in the region and the presence of a large number of key players.

Europe is expected to be the second-largest market for CSTDs during the forecast period, due to the increasing awareness of the benefits of CSTDs and the rising prevalence of chronic diseases in the region.

The Asia Pacific market is expected to grow at the fastest CAGR during the forecast period, owing to the increasing prevalence of cancer and other chronic diseases, as well as the rising demand for CSTDs in emerging economies such as India and China.

Key Players:

The key players in the global CSTD market include:

BD Medical, Inc.

ICU Medical, Inc.

Equashield, LLC

Hospira

Chemolock

B. Braun Medical Inc.

Teva Medical Ltd.

Corvida Medical

OnGuard

Baxter International Inc.

Medline Industries, Inc.

Segmentation:

The global CSTD market is segmented based on type, application, and end user.

By Type:

Closed vial transfer devices

Closed syringe transfer devices

Closed IV admixtures transfer devices

Others

By Application:

Oncology

Non-oncology

By End User:

Hospitals

Ambulatory surgical centers

Home healthcare

Others

[meghanester]

Closed System Transfer Devices (CSTD) Market to Expand at a CAGR of ~15% | Driving Factors, Size, Revenue, Demand, and Opportunities During 2023-2035

Global Closed System Transfer Devices (CSTD) Market Key Insights

During the forecast period of 2023-2035, the global closed system transfer devices (CSTD) market is expected to reach an estimated value of ~USD 3500 million by 2035 by expanding at a CAGR of ~15%. The market further generated revenue of ~USD 800 million in the year 2022. Major key factors propelling the growth of the closed system transfer devices (CSTD) market are the higher utilization of closed system transfer devices to deliver antineoplastic drugs in the chemotherapy to treat the symptoms of cancer and the rising prevalence of cancer.

Market Definition of Closed System Transfer Devices (CSTD)

Closed system transfer devices (CSTD) is a system to reduce the risk of drug aerosols during the transfer of medication from one point to another. It also minimizes the risk of sharp exposure, and hazardous drug exposure and contamination. Closed-system transfer devices are used to eliminate the transfer of environmental contaminants. These devices generally come in a few design concepts that use sir-cleaning technology or physical barrier to prevent the mix of harmful drugs in the work environment.

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Global Closed System Transfer Devices (CSTD) Market: Growth Drivers

The growth of the global closed system transfer devices (CSTD) market can majorly be attributed to the rising prevalence of urinary tract infections and pneumonia to need the administration of antibiotics to cure the symptoms. Pneumonia is common in children and they cannot swallow antibiotics where the administration through CSTDs becomes necessary. For instance, the annual rate of death caused by pneumonia in America is estimated to be around 45000 while approximately 1 million adults suffer from it every year. On the other hand, a higher adoption rate of closed system transfer devices to avoid the side effects of chemo drugs such as, infertility, kidney and liver damage, and others are estimated to fuel the market growth during the forecast period. For instance, it was estimated that nearly 22% of acute renal infections are caused by medicinal drugs.

The global closed system transfer devices (CSTD) market is also estimated to grow majorly on account of the following:

Increasing number of chemotherapy boosting the demand for antineoplastic drugs

Rising prevalence of cancer

Growth in the adoption of closed-system transfer devices

Complexity in the oral administration of certain drugs

Technological advancement in the field of medicinal drugs

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Global Closed System Transfer Devices (CSTD) Market: Restraining Factor

There is a high possibility of drug leakage during the administration that can negatively impact the health of the healthcare provider. Hence this factor is expected to be the major hindrance for the growth of the global closed system transfer devices (CSTD) market during the forecast period.

Global Closed System Transfer Devices (CSTD) Market Segmentation 

By Type (Membrane-to-Membrane and Needleless)

The membrane-to-membrane segment, amongst all the other segments, is anticipated to garner the largest revenue by the end of 2035. The growth of the segment can be attributed to the fact that this type has the lowest rate of risk of contamination since it also comprises a double-membrane containment system. Drug contamination can cause many types of infections such as, hepatitis C, HIV, and others. It is estimated that approximately 1.4 million new infections of hepatitis C occur every year.

By Technology (Diaphragm, Compartmentalized, Filtration, Others)

By End-User (Hospitals & Clinics, Oncology Centers, and Others)

By Region

The Asia Pacific closed system transfer devices (CSTD) market is anticipated to hold the largest market share by the end of 2035 among the market in all the other regions. The surge in the cases of cancer in the region and growing awareness of the early diagnosis of this disease leading to the high requirement of chemotherapy is estimated to expand the market size over the forecast period. It was noted in 2018, nearly 5 million deaths were accounted to cancer while 8 million new cases of cancer were diagnosed in the same year.

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The market research report on global closed system transfer devices (CSTD) also includes the market size, market revenue, Y-o-Y growth, and key player analysis applicable for the market in North America (U.S., and Canada), Latin America (Brazil, Mexico, Argentina, Rest of Latin America), Asia-Pacific (China, India, Japan, South Korea, Singapore, Indonesia, Malaysia, Australia, New Zealand, Rest of Asia-Pacific), Europe (U.K., Germany, France, Italy, Spain, Hungary, Belgium, Netherlands & Luxembourg, NORDIC (Finland, Sweden, Norway, Denmark), Ireland, Switzerland, Austria, Poland, Turkey, Russia, Rest of Europe), and Middle East and Africa (Israel, GCC (Saudi Arabia, UAE, Bahrain, Kuwait, Qatar, Oman), North Africa, South Africa, Rest of Middle East and Africa).

Key Market Players Featured in the Global Closed System Transfer Devices (CSTD) Market

Some of the key players of the global closed system transfer devices (CSTD) market are Becton, Dickinson and Company, B. Braun Melsungen AG, ICU Medical, Inc., Equashield, LLC, CODAN Medizinische Geräte GmbH & Co KG, Simplivia Healthcare Ltd., Corvida Medical, Inc., Caragen Ltd., Baxter International Inc., Pfizer Inc., and others.

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[mmr-14]

On the basis of technology segment, the diaphragm-based devices segment accounted for the largest share of the global closed system transfer devices market.

[megharesearch]

The Global Closed System Transfer Device (CSTD) market is anticipated to rise at a considerable rate during the forecast period, between 2023 To 2030. In 2022, the market is growing at a steady rate and with the rising adoption of strategies by key players, the market is expected to rise over the projected horizon.

[nnnaaahhhiiiaaa]

Spy Rivals in Love Pt.2 - vick (iris)

Summary | You, known as the 'Scarlet Lady,' are a spy for the NSS in Korea. Your greatest rival is Vick, an agent from an enemy organization. Although you both despise each other and face off with all your hatred, every time you meet, the tension turns into something more intense—a connection you can't ignore, despite everything that separates you.

Pairing | iris!vick x fem!reader.

Genre | 2000s era, enemies to lovers.

Warnings | explicit violence, use of weapons and chase escenes, strong lenguage, tension, blood, explicit sexual contest, nudity, sexual tension (lots of it), trust issues.

Author's note | English is not my first language, so I apologize for any spelling mistakes.

Vick slowly raised both hands, as if surrendering to the threat of your gun, but he kept smiling with that arrogant confidence that had always characterized him.

"Easy, Scarlet Lady," he said in a low voice, almost mockingly. "I didn’t come to ruin your operation. Just wanted to see if you still had your style. And damn, you do."

Your hand was steady, finger on the trigger, but something inside you knew you weren’t going to shoot. Not yet. He was an annoying adversary, sure, but also a useful informant when he wanted to be. Sometimes too useful.

"What are you doing here, Vick? Who sent you?" you asked harshly, not lowering your weapon.

"Let’s just say… our goals are aligned, for now." He lowered his hands and started walking toward one of the terminals without asking for permission, as if you weren’t pointing a gun at him. "I want that information too. But not for the NSS or any corrupt government."

"Then who for?" you shot back, eyes tracking him like a hawk.

"For me." He shrugged. "You have your reasons. I have mine. But if we collaborate, we might both get what we want without leaving bodies behind."

"And if I don’t want to collaborate?" The threat in your voice hung like a sharp needle.

"Then one of us dies here, in this quiet bunker, and the other escapes with everything. It wouldn’t be the first time we played this game."

He stopped in front of a console, turning the screen on with a few commands he seemed to have memorized. That caught your attention. He knew more than he was letting on.

"How did you get in?" you demanded, more than asked.

"Through the front door," he replied with a smile, not looking at you. "Of course, using another face."

That only confirmed your suspicions. You weren’t dealing with just any intruder. Vick was as slippery as you—maybe even more. Years of espionage, betrayals, and covert missions had made him unpredictable.

You pressed your lips together and slowly lowered your gun. Reluctantly.

"Five minutes," you warned. "After that, you’re out. I don’t want to see you when the file transfer starts."

"How generous," he mocked, glancing sideways at you. "Always so professional."

"And you always so unbearable."

While he worked at the terminal, you moved silently around the room, checking for other access points or traps. The walls were lined with touch panels, some of which opened with a simple tap, revealing racks full of servers and classified files. Everything was more sophisticated than you expected.

Suddenly, a silent alarm flashed red in the corner of the screen Vick was using.

"What did you do?" you asked, spinning around.

"Nothing I wasn’t supposed to. But I think I just triggered an emergency protocol. We’ve got less than three minutes before reinforcements arrive."

"Damn you!" you exclaimed, rushing to the console and shoving him aside. "I told you not to mess this up."

"Relax, we can still get out of here. But you better run like old times."

You bit your lower lip in frustration while activating the rapid transfer system. The data began copying onto your external device, but the percentage advanced at a maddeningly slow pace.

"Come on, come on…" you muttered, clenching your fists.

From the hallway, you could already hear the guards’ footsteps—fast, coordinated. They were close. Too close.

And you weren’t done yet.

"Get ready to fight," you said without looking at him.

"With you or against you?" Vick asked, smiling as he pulled out his combat knife.

"For now… with me. But don’t let your guard down."

"I never do, sweetheart."

And with that, the two of you turned toward the door. The sound of boots grew louder. Lights started to flicker. Time was running out. And the battle was about to begin.

The guards burst into the room like a stampede, weapons ready, their shouts filling the air. But you and Vick were no longer just spies on a mission: you were a silent storm, a lethal choreography of precision and strength.

You slid under a table while firing your mini pistol, knocking out the first guard with a stun dart straight to the neck. Vick lunged at another with agile, almost elegant movements, twirling his knife between his fingers before disarming him and knocking him out with a single sharp blow to the chin.

One tried to catch you from behind, but Vick, alert, intercepted him, rolling across the floor with you just in time to dodge a burst of bullets. You ended up pressed against each other, breathing the same air in an eternal second, the world slowing around you.

"We always end up like this," he whispered with a breathless grin.

"That’s because you’re always a mess," you replied, though your tone lacked its usual edge. In fact, it trembled a little… like your lips.

The fight went on, but every enemy who approached fell like flies. You were fast and precise, and Vick, brutally graceful. Together, you were unstoppable. When the last guard hit the floor with a dull groan, the room was filled with a near-sacred silence.

Both of you were panting, drenched in sweat, bodies tense, but eyes locked onto each other. The transfer device beeped. Data complete.

"You did it," Vick said, stepping closer, still watching you.

"We did it," you corrected, lowering your weapon slowly.

The tension between you wasn’t new. It had always been there, since the first time you clashed during a failed mission in Prague. Since the second time he saved your life when he shouldn’t have. Since the third time you said you’d never trust him again—yet did anyway.

He took one step closer, and you didn’t back away. Your trembling fingers unfastened the belt of your suit, now unnecessary. The distance shrank. The panting turned into soft breaths.

"It was always you, Y/n," Vick murmured, voice deep and rough.

"And you were always an idiot for taking so long to say it," you replied.

There were no more words. None were needed.

Your lips met his in a kiss that exploded with all the rage, tension, desire, and unspoken history between you. It was a collision of broken pasts and uncertain futures. Your fingers tangled in his hair as he held your waist like he feared you’d vanish into smoke. The world faded, leaving only the two of you—among stolen data, fallen enemies, and a connection as dangerous as it was inevitable.

As you slowly pulled away, breaths still ragged, your eyes remained locked. No words were necessary, but still, you broke the silence.

"I’m not going to ask why you’re here… not yet."

"And I won’t lie to you," Vick said, brushing his fingers along your jaw. "But if you let me… I’ll explain everything. This time, no half-truths."

You hesitated for a second, but his eyes… that transparent, tired gaze, full of everything left unsaid for so long, was enough. You nodded slowly, lowering your gun completely.

"Let’s get out of here."

The walk was quiet, almost melancholic. At some point, Vick took your hand without saying a word—and you didn’t let go. You headed to a discreet hotel on the outskirts of the city, far from the noise, far from everything you were during your missions: cold, lethal, distant. Here, you were just two tired people, with broken souls, who had found each other once again.

The room was warm, with soft lighting and a wide bed that invited rest. As soon as the door closed, your lips met again—this time with more calm, more hunger. Your hands explored, memorized, remembered what you had longed for but never allowed yourselves to have.

Vick slowly undressed you from your latex catsuit, as if disarming you was an intimate act and not part of protocol. You helped him remove his jacket, sliding it off his shoulders while kissing his neck, feeling his skin shiver beneath your lips.

The movements were slow, almost reverent. He looked at you like you were a sacred secret. You touched him like you feared he might vanish with the dawn.

When you were finally skin to skin, there were only whispers and caresses. Vick held you as if you were fragile, and you returned every gesture with the same care. You made love without haste, as if the night was endless, as if your bodies spoke what your hearts could not.

Afterwards, tangled in the sheets, he rested his head on your chest, breathing peacefully for the first time in a long while. You ran your fingers through his hair in silence, remembering the time you said you’d never trust him again.

And yet, here he was. With you.

"Can I stay this time?" he whispered, barely audible.

"Only if you promise not to disappear when the sun rises," you said, kissing his forehead.

And he nodded, closing his eyes as your warmth surrounded him.

That night, finally, you were no longer enemies, allies, or spies. Just two souls, finding each other in the midst of chaos… at last.

[mostlysignssomeportents]

Amazon Alexa is a graduate of the Darth Vader MBA

Next Tuesday (Oct 31) at 10hPT, the Internet Archive is livestreaming my presentation on my recent book, The Internet Con.

If you own an Alexa, you might enjoy its integration with IFTTT, an easy scripting environment that lets you create your own little voice-controlled apps, like "start my Roomba" or "close the garage door." If so, tough shit, Amazon just nuked IFTTT for Alexa:

https://www.theverge.com/2023/10/25/23931463/ifttt-amazon-alexa-applets-ending-support-integration-automation

Amazon can do this because the Alexa's operating system sits behind a cryptographic lock, and any tool that bypasses that lock is a felony under Section 1201 of the DMCA, punishable by a 5-year prison sentence and a $500,000 fine. That means that it's literally a crime to provide a rival OS that lets users retain functionality that Amazon no longer supports.

This is the proverbial gun on the mantelpiece, a moral hazard and invitation to mischief that tempts Amazon executives to run a bait-and-switch con where they sell you a gadget with five features and then remotely kill-switch two of them. This is prime directive of the Darth Vader MBA: "I am altering the deal. Pray I don't alter it any further."

So many companies got their business-plan at the Darth Vader MBA. The ability to revoke features after the fact means that companies can fuck around, but never find out. Apple sold millions of tracks via iTunes with the promise of letting you stream them to any other device you owned. After a couple years of this, the company caught some heat from the record labels, so they just pushed an update that killed the feature:

https://memex.craphound.com/2004/10/30/apple-to-ipod-owners-eat-shit-and-die-updated/

That gun on the mantelpiece went off all the way back in 2004 and it turns out it was a starter-pistol. Pretty soon, everyone was getting in on the act. If you find an alert on your printer screen demanding that you install a "security update" there's a damned good chance that the "update" is designed to block you from using third-party ink cartridges in a printer that you (sorta) own:

https://www.eff.org/deeplinks/2020/11/ink-stained-wretches-battle-soul-digital-freedom-taking-place-inside-your-printer

Selling your Tesla? Have fun being poor. The upgrades you spent thousands of dollars on go up in a puff of smoke the minute you trade the car into the dealer, annihilating the resale value of your car at the speed of light:

https://pluralistic.net/2022/10/23/how-to-fix-cars-by-breaking-felony-contempt-of-business-model/

Telsa has to detect the ownership transfer first. But once a product is sufficiently cloud-based, they can destroy your property from a distance without any warning or intervention on your part. That's what Adobe did last year, when it literally stole the colors from your Photoshop files, in history's SaaSiest heist caper:

https://pluralistic.net/2022/10/28/fade-to-black/#trust-the-process

And yet, when we hear about remote killswitches in the news, it's most often as part of a PR blitz for their virtues. Russia's invasion of Ukraine kicked off a new genre of these PR pieces, celebrating the fact that a John Deere dealership was able to remotely brick looted tractors that had been removed to Chechnya:

https://pluralistic.net/2022/05/08/about-those-kill-switched-ukrainian-tractors/

Today, Deere's PR minions are pitching search-and-replace versions of this story about Israeli tractors that Hamas is said to have looted, which were also remotely bricked.

But the main use of this remote killswitch isn't confounding war-looters: it's preventing farmers from fixing their own tractors without paying rent to John Deere. An even bigger omission from this narrative is the fact that John Deere is objectively Very Bad At Security, which means that the world's fleet of critical agricultural equipment is one breach away from being rendered permanently inert:

https://pluralistic.net/2021/04/23/reputation-laundry/#deere-john

There are plenty of good and honorable people working at big companies, from Adobe to Apple to Deere to Tesla to Amazon. But those people have to convince their colleagues that they should do the right thing. Those debates weigh the expected gains from scammy, immoral behavior against the expected costs.

Without DMCA 1201, Amazon would have to worry that their decision to revoke IFTTT functionality would motivate customers to seek out alternative software for their Alexas. This is a big deal: once a customer learns how to de-Amazon their Alexa, Amazon might never recapture that customer. Such a switch wouldn't have to come from a scrappy startup or a hacker's DIY solution, either. Take away DMCA 1201 and Walmart could step up, offering an alternative Alexa software stack that let you switch your purchases away from Amazon.

Money talks, bullshit walks. In any boardroom argument about whether to shift value away from customers to the company, a credible argument about how the company will suffer a net loss as a result has a better chance of prevailing than an argument that's just about the ethics of such a course of action:

https://pluralistic.net/2023/07/28/microincentives-and-enshittification/

Inevitably, these killswitches are pitched as a paternalistic tool for protecting customers. An HP rep once told me that they push deceptive security updates to brick third-party ink cartridges so that printer owners aren't tricked into printing out cherished family photos with ink that fades over time. Apple insists that its ability to push iOS updates that revoke functionality is about keeping mobile users safe – not monopolizing repair:

https://pluralistic.net/2023/09/22/vin-locking/#thought-differently

John Deere's killswitches protect you from looters. Adobe's killswitches let them add valuable functionality to their products. Tesla? Well, Tesla at least is refreshingly honest: "We have a killswitch because fuck you, that's why."

These excuses ring hollow because they conspicuously omit the possibility that you could have the benefits without the harms. Like, your tractor could come with a killswitch that you could bypass, meaning you could brick it at a distance, and still fix it yourself. Same with your phone. Software updates that take away functionality you want can be mitigated with the ability to roll back those updates – and by giving users the ability to apply part of a patch, but not the whole patch.

Cloud computing and software as a service are a choice. "Local first" computing is possible, and desirable:

https://pluralistic.net/2023/08/03/there-is-no-cloud/#only-other-peoples-computers

The cheapest rhetorical trick of the tech sector is the "indivisibility gambit" – the idea that these prix-fixe menus could never be served a la carte. Wanna talk to your friends online? Sorry there's just no way to help you do that without spying on you:

https://pluralistic.net/2022/11/08/divisibility/#technognosticism

One important argument over smart-speakers was poisoned by this false dichotomy: the debate about accessibility and IoT gadgets. Every IoT privacy or revocation scandal would provoke blanket statements from technically savvy people like, "No one should ever use one of these." The replies would then swiftly follow: "That's an ableist statement: I rely on my automation because I have a disability and I would otherwise be reliant on a caregiver or have to go without."

But the excluded middle here is: "No one should use one of these because they are killswitched. This is especially bad when a smart speaker is an assistive technology, because those applications are too important to leave up to the whims of giant companies that might brick them or revoke their features due to their own commercial imperatives, callousness, or financial straits."

Like the problem with the "bionic eyes" that Second Sight bricked wasn't that they helped visually impaired people see – it was that they couldn't be operated without the company's ongoing support and consent:

https://spectrum.ieee.org/bionic-eye-obsolete

It's perfectly possible to imagine a bionic eye whose software can be maintained by third parties, whose parts and schematics are widely available. The challenge of making this assistive technology fail gracefully isn't technical – it's commercial.

We're meant to believe that no bionic eye company could survive unless they devise their assistive technology such that it fails catastrophically if the business goes under. But it turns out that a bionic eye company can't survive even if they are allowed to do this.

Even if you believe Milton Friedman's Big Lie that a company is legally obligated to "maximize shareholder value," not even Friedman says that you are legally obligated to maximize companies' shareholder value. The fact that a company can make more money by defrauding you by revoking or bricking the things you buy from them doesn't oblige you to stand up for their right to do this.

Indeed, all of this conduct is arguably illegal, under Section 5 of the FTC Act, which prohibits "unfair and deceptive business practices":

https://pluralistic.net/2023/01/10/the-courage-to-govern/#whos-in-charge

"No one should ever use a smart speaker" lacks nuance. "Anyone who uses a smart speaker should be insulated from unilateral revocations by the manufacturer, both through legal restrictions that bind the manufacturer, and legal rights that empower others to modify our devices to help us," is a much better formulation.

It's only in the land of the Darth Vader MBA that the deal is "take it or leave it." In a good world, we should be able to take the parts that work, and throw away the parts that don't.

(Image: Stock Catalog/https://www.quotecatalog.com, Sam Howzit; CC BY 2.0; modified)

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2023/10/26/hit-with-a-brick/#graceful-failure

[simplivia]

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Increased Protection for Healthcare Workers: Shield healthcare workers from accidental needle sticks and protect their health with our integrated needle-shielding mechanisms.

Improved Workflow Efficiency: Streamline your drug administration process with our user-friendly design and intuitive features.

Reduced Costs: Save time and money by minimizing waste and contamination with our closed system approach.

Key Features of Simplivia's CSTDs:

Closed System Design: Prevents the escape of HDs and aerosols, ensuring a safer environment for patients and healthcare workers.

Needle-shielding Mechanisms: Automatically retract needles after use, protecting healthcare workers from accidental needle sticks.

Luer-lock Connectors: Ensure secure connections and prevent leaks.

One-way Valves: Eliminate the risk of backflow and contamination.

Transparent Tubing: Allows for clear visibility of the medication flow, facilitating easy monitoring.

Wide Range of Compatibility: Works with various drug containers and vials.

Applications of Simplivia's CSTDs:

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[oddygaul]

Avatar: The Way of Water

You know, not that I have any particular faith that this series will make anything of it, but The Way of Water actually raises some interesting questions about the way consciousness and the transfer of self work in the Avatar universe.

My first watch, I treated Recom Quaritch as just an excuse to bring back the most charismatic antagonist the series had – that he was more or less the same one-dimensional character as before, with a quick handwave for how his return was possible. But they’re honestly doing more than that with his writing. This isn’t Quaritch back from the dead with a new lease on life; his “I am not that man” speech to Spider is not a shirking of responsibility, and his iconic skull crushing scene is not an uncaring show of stoicism. 

Recom Quaritch is terrified. 

When he sees Neytiri’s arrows, he is experiencing primal fear. When he sees Spider, left behind alone on an alien world, he regrets the callousness of his former self. He sees where Quaritch’s bravado led him, sees what the end result of his mistakes was, and decides to firmly reject that he’s the same person as the original. He has Quaritch’s memories in his mind, but he doesn’t feel they belong to him. When he crushes Quaritch’s skull, it represents a refusal to honor the man the RDA assumes him to be: Recom Quaritch is his own man, and he will make his own choices about his future.

I always appreciate it when sci-fi takes this approach towards ‘revival’ via a backed-up consciousness. A lot of my favorites explore its implications – the Culture books, for example, dive deep into the drawbacks of a backup-based system – but all too often, they’re glossed over and treated as a magical solution to death and danger.

I don’t care how thorough and precise your backup is, unless there’s some instantaneous, streaming consciousness-transferring device, if you die and your backup is placed in a new body, that is NOT you. Sure, to everyone else, it might as well be: as far as they can tell, you look and act the same as you always have. But YOU, your stream of consciousness, your awareness, the ongoing perception of the world that defines your life – that has ended, and no amount of backups can bring that back. It only makes sense that the revived’s sense of personhood might be drastically different.

It’s an interesting pivot, because the original Avatar sorta takes for granted the functionally seamless transfer of consciousness used in the Avatar system. Via the link unit, one’s mind can be ping-ponged back and forth between a human and Na’vi body as much as you want, in real-time, with only the sensation of waking up from a nap to show anything changed. Jake’s permanent transfer into his Na’vi body at the end works the same way, just using a big tree instead of the science tube: he simply closes his eyes as a human, and wakes up in his new body like nothing ever happened. The societal implications of this technology are staggering – people could functionally live forever by growing new bodies and instantly transferring over, for example – but it's used only as a plot contrivance.

That is to say, the first Avatar is fully disinterested in exploring the potential nuance of these ideas, and much more focused on really hammering home its comparisons between technology and the natural world; they want you to be thinking about the contrast between the Na’vi queues and the human link units, not some fiddly philosophical quandary. Still, now that The Way of Water has raised these questions, it would be cool if the future sequels – maybe the one set on Earth? – dig a little more into the horror inherent in recreating the minds of the dead.

Being in this headspace for this watch also made me realize how fucked it is to have an Avatar after the human it’s based on has died. In The Way of Water, we see Grace’s Avatar body, and it’s… well, it’s still there. It’s alive, submerged, and kicking… just with no mind inside, empty, a bespoke vessel made for one soul that just doesn’t exist anymore. Brutal.

—

Other thoughts:

The first Avatar relies on its adventure setpieces – Jake’s first bond with the ikran, the montages of running through Pandora by night – more than its action setpieces, which themselves are like, aight. Way of Water’s action, by contrast, legit kicks fucking ass start to finish. Consider:

-the slow-mo train derailing -the Metkayina ducking in and out of the water to avoid gunfire then leaping out to spear RDA chumps -the speedboats, crab mechs, and assault subs, all of which are infinitely more fun than Avatar’s clunky mechs, and the spectacular flips they do as they bounce across the surface of the ocean to explode on nearby rocks -the big whale doing straight-up Action Hero shit -Neytiri shooting a guy through another guy

Seriously, it’s killer. As someone that considers themselves fairly weary of fight scenes these days – so much of it is just noise with no art – I remain impressed after a rewatch.

[cursedreverie1945]

Modern Take on the Autopsy of Heydrich

As a result of his fierce repression of any opposition, with thousands of incarcerations and executions, within a relatively short time stability reigned in the Protectorate. The exiled Czech government made a decision to assassinate Heydrich.

On 27 May 1942, a poorly executed attack severely wounded but did not kill him. While traveling in his open car, Heydrich was injured on the left side of the chest by a grenade splinter. A passing lorry transported him to the nearest medical facility, Bulovka Hospital.

Rebuilt in 1931, this hospital had become one of the most modern institutions in Europe. The head of its surgical department, Prof. Jan Levit, an experienced surgeon, was dismissed following the “Cancellation of Accreditations of Jewish Doctors” order of 17 March 1939.

When Heydrich arrived at the hospital, Drs. Puhala, Slanina and the surgeon Snajder were on duty. Dr. Slanina conducted the first examination: “With a forceps and a few swabs, I tried to see the depth of the wound. I found pneumothorax, contusion of the lung and that the metal splinter, some 3 cm large, also transported pieces of upholstery through the diaphragm into his abdomen, damaging the spleen and the tail of the pancreas.”

The first step was to try to stop the hemorrhage by local pressure while Heydrich was lying on a table in the hospital director’s office.

A photograph of the scene shows several figures standing around the table in a septic environment: some in street attire, some with no head or facial cover; their hands, whether gloved or not, are not visible.

The patient was then transferred to the operating room and surgery was performed by thoracic surgeon Walter Dick and abdominal surgeon J. Hohlbaum, both experienced German practitioners.

Heydrich was anesthetized with a closed system, high pressure mask, and no indication of intubation. The chest was closed around a rubber draining Petzer tube connected to a suction device.

The Czech personnel were prohibited from entering the operating room or the floor where Heydrich was taken after his operation.

The abdominal surgeon sutured the diaphragm (a “four inch” tear), removed the splintered spleen, sutured the tail of the pancreas, and inserted a drain in the left corner of the abdomen. During the course of treatment, Heydrich received several blood transfusions as well as anti-gangrene and anti-tetanus injections.

Within two days the patient was recovering well; there is no record that postoperative X-rays were performed.

From this point, SS chief Heinrich Himmler’s private physician, Dr. Karl Gebhardt, an orthopedic surgeon from Berlin, was in charge. Gebhardt bypassed all the other surgeons, preventing the use of sulphonamide (Prontosil ® 1 *) when Heydrich’s temperature rose, and forbidding the transfer of the patient for re-operation at any other hospital. The omission of treatment with Prontosil was particularly noteworthy since “the SS and Hitler insisted on believing that the first commercially available antibacterial drug, developed in the 1930s by Bayer Laboratories of the IG Farben conglomerate sulphonamides were a ‘miracle drug’ (Wundermittel) which could prevent all infections if only correctly administered”.

In the postoperative days, a gradual fever developed.  On the seventh day the patient was able to sit up in bed to eat, but he collapsed suddenly and remained in a coma until the early hours of 4 June when he died.

An autopsy was performed within four hours of his death, which examined only those parts of his body that underwent surgery, excluding the head and legs. The full text of the autopsy report is analyzed below. Only 3 or so pages of the original autopsy have remained.

Heydrich was a tall, athletic figure and active in sports; he was blond and had blue eyes and a long aquiline nose. It is surprising, for a high ranking SS officer who should have been medically assessed on a regular basis, that an “enlargement of the left ventricle of his heart to 20 mm (2 cm) in width was measured on autopsy, in contrast to 4 mm of the right ventricle”, indicating a longstanding pathology.

Also, several arteriosclerotic deposits were found, scattered in the branches of the coronary arteries, with a somewhat greater focus in the circumflex branch In the chest cavity several collections of pus-like fluid were found in the pleural angles and in the mediastinum. There was atelectasis of the left lower lung, a pericardial collection of about 100 ml, but more importantly, “on the pleural side of the diaphragm a fibrin encapsulated frill of hair was found.”

Blood thrombi were found in the pulmonary artery, surrounded by conglomerates of fat droplets The source of this thrombosis was found in the pelvic venous plexus. “In the esophagus, a sour odor, apparently from vomited stomach contents.”

The bronchi were “filled with foamy mucous” The tubes inserted into the patient’s chest and abdomen drained pus, which grew non-hemolytic Streptococcus, Staphylococcus and bacteria coli and proteus.

• Histology of the liver and kidneys revealed inflammatory leukocytic infiltrations, which were also found in the myocardium together with fragmented myofibrils. Necrotic fibers were noted in the diaphragm and thoracic muscles. Although mentioned in subsequent reports in the literature, there was no proof in the autopsy findings of anaerobic gangrene or of botulism.

[Reverie note - others that would have been exposed to botulism in the attack never had a problem.]

The medical reality in 1942, A retrospective review of the medical treatment that Heydrich received must be conducted within the context of 1942 knowledge and experience. What was the standard of German medical science in the early 1940s?

Indeed, most of the procedures in use today were available in 1942. Scientific work in Germany during the inter-war period was of the highest academic standard, and the Kaiser Wilhelm Gesellschaft in Berlin was one of the world’s leading scientific institutions.

Many sections were headed by Nobel Laureates: Otto Warburg for medicine (who surprisingly was not arrested), Fritz Haber for chemistry (who escaped to England), and Albert Einstein for physics (who escaped to the United States).

Despite the decline in standards at this institution in the 1930s, it was largely responsible for the discovery of the first antimicrobial chemotherapeutic agent, sulphonamide, for which the German Gerhardt Domagk was awarded the Nobel Prize in 1939.

Although military technology had advanced during the Nazi period, pharmaceutical production was deficient. In contrast, the Allies had field hospital access to sulpha (later on even to penicillin) in 1942, but this was not the case in the Reich. Sulpha was available to Heydrich.

Blood transfusions were routine practice, in accordance with the discoveries of the two blood groups (ABO and Rhesus) by the Austrian émigré Karl (Hess) Landsteiner (Nobel Prize laureate in 1930) and Alexander Solomon Wiener, both in the Jewish Hospital in Brooklyn.

Heparin, used for the prevention of venous thrombosis in immobile postoperative patients, was discovered in the 1920s by McLean and Howell in the U.S. Heparinization began to be used routinely in the USA in 1935 and in clinical practice in Stockholm in 1936.

In 1942, in the Dachau concentration camp, experiments were conducted with a thrombotic agent, and it is assumed that heparin would have been available as an antidote.

The pathophysiology of embolism was discovered in Berlin by Rudolph Virchow in 1858. Embolectomy was developed experimentally in 1918 by the surgeon Friedrich Trendelenburg and introduced in clinical practice in 1924 by his pupil Martin Kirchner in Konigsberg. “Many German clinics quickly adopted the emergency bedside Trendelenburg operation for physiologically compromised patients in whom PE [pulmonary embolism] was strongly suspected”.

Splenectomy was a centuries-old procedure in clinical practice. The management of abdominal and chest wounds had been developed by German surgeons before World War I. A new approach to abdominal injuries was described in 1900 by Boeckel and by another German surgeon, Borchardt, in 1904.

Both communications dealt with “gunshot wounds to the pancreas.” The definitive treatment was finalized in a series of articles in the Annals of Surgery in 1905.

The damaged pancreas required partial or total removal, with drainage to the exterior of fluid collecting in the retroperitoneal, lesser sac.

There is no record of any drainage being inserted in that space in Heydrich’s case. The cause of death in the official autopsy report by pathologists Herwig Hamperl and Gunther Weyrich, both professors at Prague University, determined the cause of Heydrich’s death to be “septicaemia due to virulent Bacteria that led to parenchymatous intoxication of the liver, kidney and myocardium”.

The management of Heydrich’s care and the autopsy findings have been disputed. Among those who raised questions about the management was a French surgeon who asked: “could he have been saved?”. Several reviews of this topic were published by historians, a neurosurgeon, a pathologist, and two anesthetists with obvious interest in intensive care.

These interpretations are interesting, but conflicting and inconsistent. To analyze each would not lead to a firmer conclusion. Instead, the present authors undertake a review of the original German autopsy report, translated by three linguists. Our interpretation of the autopsy report is presented here:

• The cardiovascular system: A preexistent, apparently unknown, hypertensive and atherosclerotic cardiovascular disease, with significant left ventricular hypertrophy, with a small amount of fluid in the pericardial sac. Although not sufficient for a cardiac tamponade, drainage of the pericardium would have improved the cardiac ejection. Inflammatory, myocardial damage was detected, possibly enhanced by the pre-existent arteriosclerosis. The presence of thrombosis in the pulmonary artery (augmented by fat accumulation) would no doubt be the main cause of sudden collapse, resulting in cerebral anoxia and terminal coma. The source of fat emboli in a patient with no bony fracture other than a broken rib cannot be satisfactorily explained. It might be that an existent hyperlipidemia in the system aggregated around the blood clots in the pulmonary artery. The thrombosis was not identified; neither embolectomy nor the use of anticoagulants was attempted.

• The respiratory system: The bilateral pulmonary edema, pleural and mediastinal purulent collections, atelectasis of the left lower lobe, would all lead to respiratory insufficiency.

• The digestive system: The acidic food regurgitation into the esophagus (in a patient eating just a few days after major abdominal surgery) led to aspiration and to a copious bronchial exudate reaction. No esophageal lavage or bronchial suction was performed.

• Septicemia and multi-system failure: Multiple coccal and bacterial cultures were obtained from the thorax and sub phrenic space. Some of these would have been sensitive to sulpha. The histologically detected infiltrates in the liver, kidneys, and myocardium could be interpreted as signs of parenchymatous damage. The sources of the microbial invasion could have been hematogenic due to the initial septic intervention or the result of the retained foreign material. This material was a “frill of hair” from the car’s upholstery, made of animal (horse or swine) hair, and would have been detectable on postoperative X-rays. It is our conclusion that the cause of death was pulmonary embolism, originating in the pelvic plexus (or in the unexamined lower limbs), due to pulmonary insufficiency and to a multi-system septic failure.

Since the autopsy investigation did not examine the head, the possibility of anoxic brain damage cannot be excluded. In legal terms, the medical approach of the German doctors provided substandard medical care to one of their highest officers. Was this inadequate treatment a result of unintentional negligence or a criminal act?

The autopsy report surprisingly starts with a comment, forensic rather than medical, exculpating the surgeons involved from any wrong doing. Why was this necessary? So that they could charge only the attackers with responsibility and thus justify the severe reprisals to come? Or, as mentioned by some historians, to cover up an internal rivalry at the highest levels of the SS hierarchy?. It is well known that Himmler, as SS chief and Heydrich’s immediate superior, had begun to feel that his own position was threatened by the ruthless ability and repeated successes of the younger man, such as the pacification of Bohemia/ Moravia.

Could Himmler have taken advantage of the unexpected wounding of Heydrich by sending his physician Gebhardt to hasten the Reichsprotektor’s death? The evidence from Heydrich’s medical treatment and autopsy suggests that Himmler may well have used Gebhardt as his instrument to dispose of a rival who Himmler feared would eventually supplant him. A complicating factor for both Himmler and Gebhardt, however, was Hitler’s genuine dismay when he learned of Heydrich’s death. Worse still, Gebhardt was accused of negligence by Dr. Theodor Morell, Hitler’s personal physician (Leibarzt).

Morell owned a factory that produced sulphonamides and argued that Gebhardt should have treated Heydrich with the drug. Gebhardt, on the other hand, insisted that sulphonamides were of little use and had not been required in Heydrich’s case. To maintain his standing in Hitler’s eyes, Himmler ordered Gebhardt to demonstrate the correctness of his position and so began Gebhardt’s barbaric medical experiments on concentration camp prisoners. Septic wounds were deliberately inflicted on male inmates at Sachsenhausen and then on female inmates, mostly Polish political prisoners, at Ravensbrück. Some of these victims were then treated with sulphonamides while others were not. Gebhardt’s procedures, like all the other unethical human experiments carried out by Nazi doctors, produced no results of scientific value but caused extreme suffering for the inmates who were subjected to them, with many dying and most of the survivors experiencing permanent mutilation. conclusions Reviewing the available clinical data and the autopsy findings, it seems probable that Heydrich became a victim of the same kind of medical malpractice at the hands of Gebhardt (possibly on the orders of Himmler) as was inflicted on the most powerless concentration camp prisoners. Such a turn of events would have been bitterly ironic for the architect of the “Final Solution,” had he been aware of it, but it was consistent with the medico-political ideology of Nazi Germany, as stated by Dr Brandt, which held that every individual was to be “completely used in the interest of society.” The surgical and pathological findings are highly suggestive of medical negligence. The question as to the extent of Himmler’s involvement remains unanswered, requiring further evidence.

Author and Journal information -

Focus IMAJ • VOL 16 • AprIL 2014 the attempt on the life of Reinhard Heydrich, Architect of the “Final solution”: a review of his treatment and autopsy George M. Weisz MD FRACS MA1,2 and William R. Albury BA PhD2 1 School of Humanities (Program in History of Medicine), University of New South Wales, Sydney, Australia 2School of Humanities, University of New England, Armidale, NSW, Australia

Slightly edited because I didn't want to post footnotes and repeated terminology,

[stormyweaver]

Computer Virus - Vo/x, Ha/zbin Ho/tel

I couldn't not post this eventually. Been rattling around in my drafts for a while so I figured it was time it see's more than just the light of a few people's gazes. Also idk great details about computers/television besides google so uh, yeah lol. (Contains illness and minor mentions of mess) Summary: Vo/x is reminded why he never lets his co-workers use his private tech. AKA Vale/ntino you asshole.

“Fug’ck’s sake…”

Vox swallowed hard - then immediately wished he hadn’t. The action brought a pronounced, throbbing ache along the swollen, tender flesh of his throat. What had started as a barely there tickle and a slight stiffness in his joints steadily morphed into a definite virus - one that decided to bring family and friends, because it felt like his entire being was bogged down with congestion, discomfort and malaise. 

In short: It fucking sucked, and he could only blame fucking Valentino.

Every time the asshole had an issue with his laptop, he always, always used Vox’s personal one - seriously, he was gonna need to triple encrypt it at this point to keep him out - and managed to download a fucking nasty malware via some kind of porn site. By the time Vox had connected his own system to the device, it was already too late, and by the time he’d found the source, it had already been transferred to him. Part of him couldn’t be pissed at Valentino. Like, truly couldn’t. Valentino would just start cussing him out; How should I know what the fuck a computer virus looks like? What the hell is malware, anyway? On and on and on, until finally Vox would grow weary and just ban him from using any of his devices EVER again. 

A sigh ghosted past Vox’s lips, followed by a sniffle - the sound so thick, sodden and heavy that it nearly had his skin crawling. To know that he didn’t even have a nose, let alone sinuses to get swollen and yet he felt so unbearably full to the brim with congestion… It was disgusting.

He almost wanted to sneeze, if to have a brief moment where his head didn’t feel so full to bursting. Almost.

Maybe if he could call it one-and-done, but nooo. He could never sneeze just once. They came in bursts, itchy expulsions that seemed to tumble out on top of each other, so damned excited to finally be let loose. And they left Vox panting, sniveling and mortified as he tried to mop the fluid that seeped from his vents and lips. Fuck, it was so gross.

Groaning, he shifted onto his side and tugged the duvet tighter over his shoulders - he hadn’t left bed for a good few hours but fuck it. The day was a wash the moment he’d slept through his alarm. Velvette and Valentino (the virus-peddling-moth-fucker) could manage without him for one damn day. His eyes were close to shutting completely, once again allowing the haze of sleep to take over - until he felt it. Just there, right behind his eyes; an inkling of prickling irritation. He whined, squinting and uselessly screwing his expression up as though he did have a nose to wriggle and twitch. Please, just let me sleep for a minute…

As if infuriated at the mere idea that Vox wouldn’t allow himself the pleasure of sneezing, the sensation all but exploded, and a sharp hitch flew past his lips. “Fuhhhck m’be, plhhheease…!” Okay, maybe that was a little weird to be gasping out in bed - alone but, he simply didn’t care. In the moment, all Vox could do was gasp and sputter, a few more lewd-leaning sounds spilling past trembling lips before the television demon’s system couldn’t stand to have the intense irritation linger a moment longer. “heh’IISSCHHH’HIEW!” 

The first sneeze always managed to take him by surprise, if nothing else than because he was still stunned he could even sneeze so hard without a fucking nose. He cringed, feeling the pillowcase beneath his head grow a bit damp - ughhh, fucking gross - but he had all of two seconds to dwell on the mess factor before a shiver rippled down his spine. “hHHZZSCHH’hiew! hHHZZ’NGSHHh! Hehh!! Ehhh’IZZSCHH’OOoo! Unnghh… fu’huuugck…”

A pitiful whine trailed after the last exhausting sneeze. It felt like someone had just sucked whatever was left of his damned soul out of his ailing body. And the congestion somehow seemed worse, sluggishly dripping onto his already soiled pillowcase. It plugged his ears and made his head spin even while laying down. 

Despite how Vox wanted to immediately throw himself into the pits of hell itself, he settled on nuzzling deeper into his covers and tugging the comforter forcefully over his head. 

Fuck a day off. At this rate, the other Vee’s were lucky if they managed to get him back in a week.