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Management of opioid use disorder: 2024 update to the national clinical practice guideline [Guideline]

Background

In an evolving landscape of practices and policies, reviewing and incorporating the latest scientific evidence is necessary to ensure optimal clinical management for people with opioid use disorder. We provide a synopsis of the 2024 update of the 2018 National Guideline for the Clinical Management of Opioid Use Disorder, from the Canadian Research Initiative in Substance Matters.

Methods

For this update, we followed the United States Institute of Medicine’s Standards for Developing Trustworthy Clinical Practice Guidelines and used the Appraisal of Guidelines Research and Evaluation—Recommendation Excellence tool to ensure guideline quality. We carried out a comprehensive systematic literature review, capturing the relevant literature from Jan. 1, 2017, to Sept. 14, 2023. We drafted and graded recommendations according to the Grading of Recommendations, Assessments, Development and Evaluation approach. A multidisciplinary external national committee, which included people with living or lived experience of opioid use disorder, provided input that was incorporated into the guideline.

Recommendations

From the initial 11 recommendations in the 2018 guideline, 3 remained unchanged, and 8 were updated. Specifically, 4 recommendations were consolidated into a single revised recommendation; 1 recommendation was split into 2; another recommendation was moved to become a special consideration; and 2 recommendations were revised. Key changes have arisen from substantial evidence supporting that methadone and buprenorphine are similarly effective, particularly in reducing opioid use and adverse events, and both are now considered preferred first-line treatment options. Slow-release oral morphine is recommended as a second-line option. Psychosocial interventions can be offered as adjunctive treatment but should not be mandatory. The guideline reaffirms the importance of avoiding withdrawal management as a standalone intervention and of incorporating evidence-based harm reduction services along the continuum of care.

Interpretation

This guideline update presents new recommendations based on the latest literature for standardized management of opioid use disorder. The aim is to establish a robust foundation upon which provincial and territorial bodies can develop guidance for optimal care.




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Con: indwelling pleural catheters cause harm to patients

Indwelling pleural catheters (IPCs) have rapidly grown in popularity since their introduction for the management of recurrent pleural effusions. In malignant pleural effusions especially, there has been a shift away from measuring pleurodesis success and towards more patient-centred outcomes. Multiple randomised controlled trials have shown that despite lower rates of pleurodesis, symptom control and quality of life outcomes are comparable when compared to alternatives such as talc pleurodesis. IPCs have the added benefit of minimising inpatient hospital stays and reducing the need for recurrent pleural interventions, key priorities for patients with palliative disease. As a result, IPC treatment is associated with excellent patient satisfaction coupled with acceptably low complication rates. Furthermore, in patients with a short life expectancy they confer a cost benefit for the healthcare system.

Far from causing harm, IPCs are now recommended as first-line treatment by current clinical guidelines. In malignant pleural disease, guidance advocates IPCs should be offered as a first-line option with the focus on patient priorities and preferences. Ultimately IPCs provide a safe, effective, ambulatory option for managing recurrent pleural effusions.




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An elderly woman with acute respiratory failure and diffuse pulmonary changes




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Pro: indwelling pleural catheters cause harm to patients

Malignant pleural effusions (MPE) tend to recur and require definitive treatment with either chest drain and talc pleurodesis or indwelling pleural catheters (IPCs), which offer similar symptomatic benefits. In recent years, IPCs have become popular due to the presumed convenience of an outpatient procedure followed by home drainage leading to a misconception of IPCs being an ideal treatment for MPE. However, IPCs predispose the patient to multiple complications and have significant physical and psychological implications that are under-recognised. Patients require additional clinical reviews, hospital admissions and treatment for these complications related to IPCs. Additionally, there is a huge psychological impact of living with a home catheter that is a constant reminder of their cancer and this has been shown to affect quality of life negatively. Hence, IPCs should not be considered the "ideal" treatment for MPE management and clinicians should reflect the equipoise of the evidence for the benefits and accurately reflect the adverse effects of IPCs in their discussions with patients to facilitate informed decision making.




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Management of central sleep apnoea: a review of non-hypercapnic causes

Central sleep apnoea (CSA) is characterised by recurrent episodes of airway cessation or reduction in the absence of respiratory effort. Although CSA is less common than obstructive sleep apnoea, it shares similar symptoms. CSA can be secondary to various medical conditions, high altitude and medication exposure. CSA can also emerge during obstructive sleep apnoea therapy. There are a range of treatment options and selecting the right therapy requires an understanding of the pathophysiology of CSA. This review explores the aetiology, pathophysiology and clinical management of non-hypercapnic CSA.





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South Sudan civil war causes Africa’s worst refugee crisis

Watch Video | Listen to the Audio

The United Nations says South Sudan’s four-year-old civil war has left half of the nation’s population — 6 million people — in need of humanitarian aid. The conflict began when South Sudan’s army split between factions loyal to President Salva Kiir and former Vice President Riek Machar. The two men mobilized their respective tribes, the Dinka and the Nuer. The war has caused what is now one of the world’s worst refugee crises.

SIMONA FOLTYN: Civil war is emptying huge swaths of South Sudan. The violence has uprooted four million people, including two million who’ve fled to neighboring countries. In the last year, more than a million South Sudanese have poured into northern Uganda alone, crossing makeshift bridges like this one to flee fighting, hunger, and brutal attacks on civilians.

SEME LUPAI, REFUGEE: They started fighting very, very severely. So that made us to escape with our properties to this side.

SIMONA FOLTYN: When Seme Lupai’s family went to one of the refugee camps, initially, he stayed behind to look after the family’s most precious commodity — their cattle. He hid for a year to escape the violence. The refugees carry whatever they can salvage — mattresses, pots, clothes, notebooks — remnants of once peaceful lives turned upside down. At checkpoints, Ugandan soldiers search their belongings for weapons, before the refugees proceed to reception centers. After entering Uganda, the refugees sign in at small waystations. For many, it’s the first night spent in safety after walking for days to escape fighting. Levi Arike fled with his wife and four children.

LEVI ARIKE, REFUGEE: When the gunshots started, we laid under a tree with the whole family, because there was nowhere else to hide. We waited for the fighting to stop, and then we got up and started walking to Uganda.

SIMONA FOLTYN: Uganda now shoulders most of the burden of Africa’s biggest refugee crisis, managing a constellation of camps which require food, water, healthcare, and policing. At Imvepi Camp, now home to more than 120,000 South Sudanese, new arrivals receive vaccinations, hot meals, and basic items such as soap and plastic tarps to build a house. The government also gives each refugee family a small plot of land, about a twentieth of an acre, where they can build a tent shelter and grow crops to eat or sell. But the land often proves too rocky for farming.

SIMONA FOLTYN, IMVEPI REFUGEE CAMP, NORTHERN UGANDA: After completing the registration process, the new arrivals will receive their plot, to start a new life as refugees in Uganda. While they are safe here, there are many challenges ahead, not least processing the trauma of what they experienced back home.

This woman, who we’ll call “Agnes,” agreed to tell us about her harrowing experience. She says four government soldiers from President Salva Kiir’s Dinka tribe stopped her as she was fleeing South Sudan and raped her right in front of her family.

AGNES (translated to English): When they started raping me, they told me not to raise alarm, otherwise they would shoot me. Still when I’m sleeping, I’m dreaming of the Dinka, that they are coming to rape me again.

SIMONA FOLTYN: How often do you have those dreams?

AGNES: Daily, every time I lie down, those dreams come.

SIMONA FOLTYN: A recent Human Rights Watch report on South Sudan found “…a clear pattern of government forces unlawfully targeting civilians for killings, rapes, torture…and destruction of property..” The victims are from ethnic groups suspected to support the rebels.

AGNES: They are doing it, because they know very well that those soldiers are our brothers. So they do it to punish them..

SIMONA FOLTYN: Although the rebels, known as the Sudan People’s Liberation Army In Opposition, purport to protect local communities, there are also reports of their fighters assaulting civilians near the Ugandan border. Josephine Yanya told us she didn’t feel safe in the presence of either side’s soldiers. Her family and neighbors fled their village after government soldiers killed her uncle.

They hid in the mountains only to find themselves under attack again, this time by opposition fighters from the Nuer tribe loyal to former vice president Riek Machar. Yanya says ethnic Nuer soldiers from the SPLA-IO rebel group raped a member of her group and stole her father’s’ cattle.

JOSEPHINE YANYA (translated to English): Before we were thinking that the rebels would protect us, but if they are lacking food, they just come and take things by force.

SIMONA FOLTYN: With nowhere left to hide, Yanya fled to Uganda with her son.
But instead of finding a place to rebuild their lives, they are in limbo. And aid groups don’t have enough food to distribute.

JOSEPHINE YANYA (translated to English):We are getting small food rations. I know it won’t be enough even for one month.

SIMONA FOLTYN: According to the United Nations, the international community has given less than a-third of the $1.4 billion dollars needed for the refugee response in South Sudan’s neighboring countries. These refugees foresee more hardship and have no idea when they might return home.

JOSEPHINE YANYA (translated to English): I’m always praying for peace in South Sudan, and until then, I’ll just stay here.

The post South Sudan civil war causes Africa’s worst refugee crisis appeared first on PBS NewsHour.




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Housebuilder completes 'one of the largest' new Highland homes projects since 1970s

A rural housing project branded as ‘truly transformative’ has been completed




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Hundreds of houses on golf club land 'much-needed', claims developer

Up to 650 houses could be built on land at the golf club




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Limogate: Neil Gray to address use of ministerial car for football trips

Health Secretary Neil Gray will address concerns around his use of a ministerial car to attend football games at Hampden.




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Famous Doddie Weir trousers worn to promote charity's new Balmoral partnership

The concierge team at The Balmoral have helped raise awareness for a special event to raise money for charity in memory of Scotland legend Doddie Weir.




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Fiddle played by Robert Burns to be used in US performance for first time

A baroque fiddle believed to have been played by Robert Burns will be performed live on stage in the United States for the first time.




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RPG Cast – Episode 542: “Hell House? Hold My Beer”

There's not a ton of news right now, which isn't a big surprise considering the current challenges of making games. Instead we deep dive into our current games, with Jonathan, Josh, Kelley and Peter leading the charge. Anna Marie and Chris share hosting duties to wrap up this week's panel.

The post RPG Cast – Episode 542: “Hell House? Hold My Beer” appeared first on RPGamer.




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RPG Cast – Episode 590: “Get Back in the House, Yona!”

Joshua asks “Am I fighting a house?!” (spoilers: he is). Chris is on the wrong side of 40, and somehow forgets JRPGJuly. Kelley espouses “Exposure: The Cryptocurrency of Artists.” Anna Marie is teaching the whole RPGamer staff how to speedrun FF4: Free Enterprise. Yes, things got a little…weird this week.

The post RPG Cast – Episode 590: “Get Back in the House, Yona!” appeared first on RPGamer.




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RPG Cast – Episode 652: “Because Dragons”

Josh is bringing Rabbids back. Also, RIP Kelley as her kitty goes on a rampage. Chris is a human in real life, but still has MMO sickness.

The post RPG Cast – Episode 652: “Because Dragons” appeared first on RPGamer.



  • News
  • Podcasts
  • RPG Cast
  • Mario + Rabbids: Sparks of Hope
  • Shining Force III
  • The Legend of Heroes: Trails in the Sky
  • The Legend of Heroes: Trails to Azure
  • World of Warcraft: Shadowlands


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RPG Cast – Episode 672: “Collecting Kids to Fill the Old Murder House”

Kelley wants a Hello Kitty Skyrim mod. Chris visits Harrison Ford's favorite club on the citadel. Jason wants to fight along side the dude with a bucket on his head. RIP Palm OS.

The post RPG Cast – Episode 672: “Collecting Kids to Fill the Old Murder House” appeared first on RPGamer.




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‘Real Housewives of Salt Lake City’: Is Heather Gay a Hypocrite for Taking Ozempic?

Photo Illustration by Thomas Levinson/The Daily Beast/Bravo

The Real Housewives of Salt Lake City is TV’s best soap opera, week after week offering twists more shocking than secret twins and characters returning from the dead. That’s because it’s all real, happening in the most haunted suburb in the continental United States.

Where else do two women connect over knowing the long-lost birth father of one’s child? Is there another city where women squabble over body positivity in a parking lot off the side of a snowy mountain? Surely, there’s no other place on Earth where Lisa Barlow could come across anywhere near a voice of reason.

But that all happens here in Salt Lake City. Five episodes in, Season 5 has continued to evolve into the most captivating season in modern Real Housewives history, carried by the ever-changing bonds between our OGs and a team of wonderfully bizarre newbies.

Read more at The Daily Beast.




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Menendez Family Members: We Had ‘Gut-Level’ Fears Erik and Lyle Were Sexually Abused

Ted Soqui/Sygma via Getty Images

Relatives of Lyle and Erik Menendez spoke in an interview Wednesday about their long-running fears that the brothers had been abused for years before they killed their parents.

After a press conference in which they’d called for the imprisoned siblings’ freedom, the family members told Chris Cuomo on NewsNation about how their suspicions only deepened as time passed.

“Over the years we really did know that there was abuse at gut-level. But as time goes on and we all talked to each other more and more, it validates the fears and the gut-level reactions that we had,” the brothers’ cousin Karen VanderMolen-Copley told Cuomo. “That solidified the knowledge that the sexual abuse actually did occur, because that’s not something you want to believe, and then once you talk to each other it becomes more and more obvious.”

Read more at The Daily Beast.




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You can now make video clips using Steam's built-in game recording feature, as an update rolls it out to all users

Steam's built-in game recording feature has been usable in beta since the summer, but it has now been properly launched for every user, following a client update to Steam yesterday. It's basically another method of capturing funny ragdoll glitches and posting them on the "lol-games-are-dumb" channel of your friend's Discord. Or for posting that flukey knife throw in Call Of Duty to Twitter, as if you really meant to kill the man from across the map all along. Or saving a clip for your personal records, like the footage of that time you yeeted an innocent citizen off the 50-foot wall of a castle town in Dragon's Dogma 2. We all do that, right? Right?

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Alan Wake 2’s The Lake House is a dark, brilliant parable on the devaluation of art and artists

There must be hundreds of typewriters in the hall, their collective clacks a tidal wave of soulless automation, rising up to greet agent Kiran Estevez as she enters, pistol and flashlight in hands. Exploring rooms to the side, Alan Wake 2: The Lake House’s star finds whiteboards and documents revealing the typewriter’s purpose: to mimic Wake’s writing. Pages are graded along criteria such as ‘style’, ‘tone’, and ‘content’, then “fed into the algorithm” as references until “near-identical stories” to Wake’s can be produced.

“If Jules could simply cut the painter open and pull the painting out of him, he would,” reads one of the real Alan’s typewritten pages. That’s Jules Marmont, the obsessive head of the titular FBC centre. The Marmonts - Jules and his wife Diana - are running experiments to forcibly and synthetically create works of art, aiming to mimic creative passion convincingly enough for the paranatural entity inside Cauldron Lake to respond, as it has in the past.

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Take-Two are selling Private Division and closing Roll7 and Intercept, because they're in "the business of making great big hits"

Take-Two Interactive have sold their publishing label Private Division to an unnamed party, along with five of Private Division's "live and unreleased titles". The GTA 6 publisher have also finally confirmed that they have shut down OlliOlli World and Rollerdrome devs Roll7 together with Kerbal Space Program 2 creators Intercept Games, months after performing mass layoffs at both studios.

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Man accused of killing Muslim teen indicted on capital murder charges

An attendee leaves flowers for Nabra Hassanen, a teenage Muslim girl killed by a bat-wielding motorist near a Virginia mosque, during a vigil in New York City. Photo by Brendan McDermid/Reuters

A grand jury has formally charged a 22-year-old man with capital murder and rape in the death of Nabra Hassanen, who was killed on her walk back to a Virginia mosque.

The Fairfax County Circuit Court indicted Darwin Martinez-Torres of Sterling, Virginia, on Monday on four counts of capital murder for killing Nabra, who was with friends while they had a meal before Ramadan services. Dozens of people had gathered outside the courthouse today, chanting “Justice for Nabra.”

Virginia law has specific conditions for pursuing the death penalty, but the Associated Press reported that the grand jury’s indictment described in graphic detail how Nabra’s killing was grounds for a death penalty against Martinez-Torres. The indictment appears to acknowledge for the first time that the 17-year-old Muslim teen was raped. Under state law, the combination of a rape charge with a premeditated murder charge means the death penalty can be pursued.

Police have said that Martinez-Torres, who is an undocumented immigrant, got into a confrontation on June 18 with a group of teens walking back to the All Dulles Area Muslim Society after grabbing a late meal. He is accused of returning later and beating Nabra with a baseball bat. Police said Nabra’s body was later discovered in a pond. A search warrant affidavit revealed that Martinez-Torres admitted to killing Nabra and had led authorities to where he dumped her body, AP reported.

Nabra’s parents and Muslim advocates have said that Nabra’s death was motivated by hate, but police has said that they will not treat the killing as a hate crime. Instead, police have said it was a road rage incident.

“The reason this guy he hit my daughter is because she’s Muslim,” Nabra’s father Mahmoud Hassanen told WAMU. “Why [didn’t he] hit the boy who bothered him?”

Nabra’s father added that he hoped for the death penalty, while her mother said she wanted Martinez-Torres to serve life in prison.

“I just want people to remember her, and don’t forget her,” Mahmoud told WAMU. “I think nobody can forget her too, for what she did in her life.”

A preliminary hearing for Martinez-Torres reportedly turned emotional on Friday, with Nabra’s parents both shouting at the suspect in court. Nabra’s mother Sawsan Gazzar apparently threw a shoe at Martinez-Torres during the proceedings.

READ MORE: D.C. memorial for slain Muslim teen was set on fire, officials say

The post Man accused of killing Muslim teen indicted on capital murder charges appeared first on PBS NewsHour.




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Escaping Harvey Weinstein was a ‘cat-and-mouse game,’ says Katherine Kendall

Watch Video | Listen to the Audio

HARI SREENIVASAN: Let’s turn to the continuing fallout and reaction to the Harvey Weinstein story.

Yesterday, Weinstein resigned from the board of his production company following numerous revelations of sexual harassment and several allegations of assault.

More than three dozen women have said Weinstein harassed them. While Weinstein has admitted to behaving inappropriately, he has said he didn’t physically assault anyone.

One of those women is Katherine Kendall. She was a 23-year-old actress who met Weinstein in 1993. She alleges that he invited her to his apartment in New York, where, she says, he took off his clothes and asked for a massage.

As other actresses began coming forward about their painful experiences, she also went public with her own story.

She joins me now from Los Angeles.

First, thanks for joining us.

And I don’t want to relive something that’s painful for you, but you are taking a public stance on it.

For people who don’t know your story, what happened?

KATHERINE KENDALL, Actress/ Photographer: Well, I was you know, a young actress, and I had had a formal meeting at the Miramax office earlier that day.

And then, at the end of the meeting, which I thought went really well, he invited me to come to screenings. He said: “Welcome to the Miramax family. You know, come to premieres, screenings, et cetera. In fact, there’s one this afternoon. Would you like to come?”

And I said, “Sure.”

And I ended up going to see a movie with him. It ended up just being a movie, not a screening, but the film “Red Rock West.” And, you know, that’s right when I had this sort of sinking feeling that something wasn’t going right.

And then, after the movie, we walked for a few blocks. And he said he needed to go up to his apartment to get something, and would I just come with him real quick? And I sort of said no, and we went back and forth on that for a minute. It was sort of a negotiation with him always, trying to sort of stand my ground, but then be convinced it was OK.

I did go into his apartment. Once there, we talked for a long time about art and movies. And I felt like he was treating me like an intellect.

And I felt like the meeting was going really well, and sort of continued. I didn’t feel unsafe once I was in there. And, at one point, then, he got up to go to the bathroom. And he came back in a robe and asked me to give him a massage.

And I was extremely uncomfortable. And I was like, oh, God, no, I’m not comfortable with that. And we went back and forth on that.

And then he went back to the bathroom again, and came back this time completely naked. And, you know, that changed it entirely for me, too. It just took it to the next place. It was completely disorienting. And I was scared, you know? I was really scared.

And then it became sort of a cat-and-mouse game of, like, how am I going to get out of there?

And I’m — it’s hard to make sense of what someone is trying to do to you when they’re fully naked, and they’re…

HARI SREENIVASAN: Yes.

KATHERINE KENDALL: You know, I’m 105 pounds. He’s a large man standing between me and the door.

And, I mean, I felt very resolute, like, I will definitely get out of here somehow. But I’m not — I’m not sure — I’m not sure what’s going to happen here. You know, a lot was going through my head.

And he said, well, if you won’t give me a massage, will you at least show me your breasts? And it was just — you know, it was, all in all, an extremely humiliating experience for me.

And even though I got away, I felt like something had still — like something horrible had just happened to me.

HARI SREENIVASAN: You know, in the immediate aftermath, did you tell someone about it? Because you have said before that you felt ashamed…

KATHERINE KENDALL: I did.

HARI SREENIVASAN: … even though you were the victim.

KATHERINE KENDALL: I did.

It’s really interesting how that happens. And I think — you know, I’m older now, and I have done some work on myself. And I have learned that a lot of people feel that way.

It’s — it’s not — it wasn’t just me. But the just me feeling that this is my fault, this must have only happened to me, there’s something wrong with me, is so common when someone perpetrates against you.

HARI SREENIVASAN: What were the…

KATHERINE KENDALL: And I did. I told my mom.

And I told some good friends. But, you know, one of the things that happened was, I didn’t want them to tell anybody. You know, people wanted to help me, but they didn’t know how, and I didn’t want them to try too hard, because I didn’t want it to backlash.

I was scared. And I think that it’s important to remember that we don’t really come from a culture that supports women in talking about sexual harassment, in my — in my experience, that is. And, you know, I just haven’t felt like it was something I was going to get support on…

HARI SREENIVASAN: You know, how long…

KATHERINE KENDALL: … in the bigger picture.

HARI SREENIVASAN: Yes.

How long did this feeling last? Or, I guess, what are the longer-term ripple effects here? Did it shake your confidence in your abilities?

KATHERINE KENDALL: I think it did. I think it did. I think it did.

I think it made me feel like, wow, you know, that was a wash. He wasn’t interested at all in what I had to say, or, you know, he didn’t see any talent there or intellect there. He was assessing the situation the whole time for something else.

And I think that — that did hurt. You know, I wish it didn’t.

HARI SREENIVASAN: Yes.

KATHERINE KENDALL: But he had produced so many movies that I thought were wonderful. And it was — it’s hard when someone has made art that you love, and how do you stay attached to liking their art, but feeling conflicted about them?

And, yes, I think it does have long-term effects. I think you tuck it away. And then, for me, also, I realized that it came back when I would see his name or see him in person. I would start to sort of tremble all over again.

I mean, I wouldn’t think about him on a daily basis or anything for years, and then I would see him, and I would think, oh, I don’t feel well. I got to get out of here.

HARI SREENIVASAN: Right.

KATHERINE KENDALL: You know, it would bring up so much emotion.

And the most recent one was the woman in New York, the Italian model. I felt so, so enraged when I saw what happened there, and that they sort of — the police had him, and that then he got away. And then she was being dragged through the press as somebody who just, you know, wanted a payout, et cetera.

HARI SREENIVASAN: You know, in the wake of that, there was — a friend of yours had tweeted, “At some point, all the women who have been afraid to speak out about Harvey Weinstein are going to have to hold hands and jump.” This was back in 2015.

And from your Twitter account, you said, “Agreed.”

It seemed like you almost had the opportunity to come forward.

What made you want to come forward now? Has this become a turning point in the industry?

KATHERINE KENDALL: This is a turning point. It’s a turning point.

There are so many times when I thought about it, and then felt like — there were times when I thought about it and said, well, I have nothing to lose, I will just do it. And then I thought, I — I just didn’t have the strength or the courage yet.

And I think somebody like Jodi Kantor doing the story for The New York Times, the fact that she thought it was a story at all was startling to me and made me feel like, wow, something is going to be done.

And I knew she had told me — I mean, they were looking for women that this had happened to, because they’d been hearing rumors for so long that it happened to so many people. And she had told me other people were coming out.

And I thought, I can’t — when I watched Rose McGowan or any of the other actresses come forward, I just — or Ashley Judd — I just thought, they look strong to me, and I don’t want to be the one that stays silent.

HARI SREENIVASAN: Well, Katherine Kendall…

KATHERINE KENDALL: I want to stand beside them.

HARI SREENIVASAN: Katherine Kendall, thank you very much for speaking with us.

And, hopefully, there are other people that are empowered by you coming forward.

KATHERINE KENDALL: I hope so. Thank you.

The post Escaping Harvey Weinstein was a ‘cat-and-mouse game,’ says Katherine Kendall appeared first on PBS NewsHour.




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‘Shazam for whales’ uses AI to track sounds heard in Mariana Trench

An artificial intelligence model that can identify the calls of eight whale species is helping researchers track the elusive whale behind a perplexing sound in the Pacific




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What voice assistants like Alexa know about you – and how they use it

Voice assistants can build profiles of their users’ habits and preferences, but the consistency and accuracy of these profiles vary




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Useful quantum computers are edging closer with recent milestones

Google, Microsoft and others have taken big steps towards error-free devices, hinting that quantum computers that solve real problems aren’t far away




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Microscopic gears powered by light could be used to make tiny machines

Gears just a few micrometres wide can be carved from silicon using a beam of electrons, enabling tiny robots or machines that could interact with human cells




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Battery-like device made from water and clay could be used on Mars

A new supercapacitor design that uses only water, clay and graphene could source material on Mars and be more sustainable and accessible than traditional batteries




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Tiny battery made from silk hydrogel can run a mouse pacemaker

A lithium-ion battery made from three droplets of hydrogel is the smallest soft battery of its kind – and it could be used in biocompatible and biodegradable implants




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AI can use tourist photos to help track Antarctica’s penguins

Scientists used AI to transform tourist photos into a 3D digital map of Antarctic penguin colonies – even as researchers debate whether to harness or discourage tourism in this remote region




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The Real Housewives of New York City Recap: Pregnant Pauses

Can we trust whatever is going on with Becky Minkoff?




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Why Simone Giertz, the Queen of Useless Robots, Got Serious



Simone Giertz came to fame in the 2010s by becoming the self-proclaimed “queen of shitty robots.” On YouTube she demonstrated a hilarious series of self-built mechanized devices that worked perfectly for ridiculous applications, such as a headboard-mounted alarm clock with a rubber hand to slap the user awake.

This article is part of our special report, “Reinventing Invention: Stories from Innovation’s Edge.”

But Giertz has parlayed her Internet renown into Yetch, a design company that makes commercial consumer products. (The company name comes from how Giertz’s Swedish name is properly pronounced.) Her first release, a daily habit-tracking calendar, was picked up by prestigious outlets such as the Museum of Modern Art design store in New York City. She has continued to make commercial products since, as well as one-off strange inventions for her online audience.

Where did the motivation for your useless robots come from?

Simone Giertz: I just thought that robots that failed were really funny. It was also a way for me to get out of creating from a place of performance anxiety and perfection. Because if you set out to do something that fails, that gives you a lot of creative freedom.


You built up a big online following. A lot of people would be happy with that level of success. But you moved into inventing commercial products. Why?

Giertz: I like torturing myself, I guess! I’d been creating things for YouTube and for social media for a long time. I wanted to try something new and also find longevity in my career. I’m not super motivated to constantly try to get people to give me attention. That doesn’t feel like a very good value to strive for. So I was like, “Okay, what do I want to do for the rest of my career?” And developing products is something that I’ve always been really, really interested in. And yeah, it is tough, but I’m so happy to be doing it. I’m enjoying it thoroughly, as much as there’s a lot of face-palm moments.

Giertz’s every day goal calendar was picked up by the Museum of Modern Art’s design store. Yetch

What role does failure play in your invention process?

Giertz: I think it’s inevitable. Before, obviously, I wanted something that failed in the most unexpected or fun way possible. And now when I’m developing products, it’s still a part of it. You make so many different versions of something and each one fails because of something. But then, hopefully, what happens is that you get smaller and smaller failures. Product development feels like you’re going in circles, but you’re actually going in a spiral because the circles are taking you somewhere.

What advice do you have for aspiring inventors?

Giertz: Make things that you want. A lot of people make things that they think that other people want, but the main target audience, at least for myself, is me. I trust that if I find something interesting, there are probably other people who do too. And then just find good people to work with and collaborate with. There is no such thing as the lonely genius, I think. I’ve worked with a lot of different people and some people made me really nervous and anxious. And some people, it just went easy and we had a great time. You’re just like, “Oh, what if we do this? What if we do this?” Find those people.

This article appears in the November 2024 print issue as “The Queen of Useless Robots.”




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