Archive for: April, 2011

What I Am Reading: Flavia de Luce

Apr 29 2011 Published by under What I'm Reading

The year is 1950, and you are a 10 year-old girl who lives in the great house of the village. Your favorite spot is a Victorian chemistry lab, assembled by an eccentric ancestor, and you are the only person who enters there. You do things like distill poison ivy to irritate (literally) your vain oldest sister. You have a passion for logic, science, and poison. You keep finding dead people.

Your name is Flavia de Luce.

Flavia stars in three novels by Alan Bradley, a former electrical engineer who worked in television. The whole family has its oddities. The mother and heiress of Buckshaw, the family estate, died climbing in the Himalayas during Flavia's infancy. She left no will, leaving the family in uncertain financial status. The father's only remaining passion, stamps, occupies him. The two oldest girls are more conventional. The elder de Luce, Ophelia (aka Feely), plays piano and enjoys watching her reflection. Daphne (or Daffy), in the middle loves to read and plans to write novels.

Flavia's character can seem very modern. She has claimed her mother's bicycle and named it Gladys. She and the bike cruise the countryside, having adventures and solving mysteries, like the dead folks that keep turning up when Flavia hangs about. Flavia can also be wise beyond her years.

The latest novel, A Red Herring Without Mustard, came out in April. Here she talks about her chemistry lab, hidden in a wing of the Buckshaw that only she enters:

Stepping through the door into my laboratory was like gaining sanctuary in a quiet church: The rows of bottled chemicals were my stained-glass windows, the chemical bench my altar. Chemistry has more gods than Mount Olympus, and here in my solitude I could pray in peace to the greatest of them: Joseph Louis Gay-Lussac (who, when he found a young assistant in a linen draper's shop surreptitiously reading a chemistry text which she kept hidden under the counter, promptly dumped his fiancee and married the girl); William Perkin (who had found a way of making purple dye for the robes of emperors without using the spit of mollusks); and Carl Wilhelm Scheele, who probably discovered oxygen, and - more thrilling even than that - hydrogen cyanide, my personal pick as the last word in poisons.

Solving the murder in this case involves a peculiar fishy odor, which brings out the chemist in Flavia:

Propylamine (which had been discovered by the great French chemist Jean-Baptiste Dumas) is the third of the series of alcohol radicals - which might sound like boring stuff indeed, until your consider this: When you take one of the alcohols and heat it with ammonia, a remarkable transformation takes place. It's like a game of atomic musical chairs in which the hydrogen that helps form the ammonia has one or more of its chairs (atoms, actually) taken by the radicals of the alcohol. Depending upon when and where the music stops, a number of new products, called amines, may be formed.

With a bit of patience and a Bunsen burner, some truly foul odors can be generated in the laboratory. In 1889, for instance, the entire city of Freiburg, in Germany, had to be evacuated when chemists let a bit of thioacetone escape. It was said that people even miles away were sickened by the odor, and that horses fainted in the streets.

How I wish I had been there to see it!

Obviously, I love this precocious girl. She can be sweet, especially when she ponders her missing mother. She has a mean streak, though, and will use all of her skills to get revenge, especially on her conniving sisters.

I will end with one last passage from the latest book:

Thinking and prayer are much the same thing anyway, when you stop to think about it - if that makes any sense. Prayer goes up and thought comes down - or so it seems. As far as I can tell, that's the only difference.

I thought about this as I walked across the fields to Buckshaw. Thinking about Brookie Harewood - and who killed him, and why - was really just another way of praying for his soul, wasn't it?

If this was true, I had just established a direct link between Christian charity and criminal investigation. I could hardly wait to tell the vicar!

Guess we should add theologian to Flavia's accomplishments.

Book four's publication is set for November 1.

Share

3 responses so far

Must Read Now: Budget Cuts and Children

Apr 28 2011 Published by under Politics

Click for Source

Today's issue of the New England Journal of Medicine includes an editorial from George J. Annas and Wendy K. Mariner, preeminent bioethicists at the Boston University School of Public Health (home of the Fighting Terriers):

 

Women and Children Last - The Predictable Effects of Proposed Federal Funding Cuts. N Engl J Med 364:17, 2011  (10.1056/NEJMp1102915)

The authors examine proposed cuts in the House budget bill, including elimination of Title X clinics, federal funding of Planned Parenthood, 10% cuts to the supplementary nutrition program for women, infants, and children (WIC), and $50 million cuts from prenatal care for low-income women and health care for poor children. The whole piece runs less than 2 printed pages, including references, so you should read it all here. I have selected some quotes to make you click on through:

The amounts of money saved by these cuts would be trivial, but the damage to the health of low-income women and children — especially from the loss of direct federal funding for food and preventive health care — could be devastating. The proposed cuts are simply cruel.

------------

Planned Parenthood clinics spend approximately 3% of their budgets on abortion services. (An antiabortion budget cutter could thus justify reducing the organization's federal funding by 3%, but no more — unless the cut was meant to be punitive.)

------------

Two years ago, before the current debate over ACA funding, a Guttmacher Institute study concluded that eliminating Title X clinics (and Medicaid funding for contraception counseling) would result in an additional 860,000 unintended pregnancies and 810,000 abortions per year among low-income women. The study also found that from a strictly budgetary perspective, helping low-income women prevent pregnancies saved almost $4 for every $1 spent. Rational policymakers who oppose abortion and support fiscal restraint should thus also support current federal efforts to reduce unplanned pregnancies.

 

So these proposed cuts are trivial, cruel, and punitive. They primarily affect a group with little political influence, poor women and their children, but they allow some politicians to strut "pro-life" credentials. Pro-life? Cutting services to prevent pregnancy will result in more pregnancies, but once pregnant, prenatal care and postnatal support will also be less available for these low-income women and their children.

Pro-life, my ass.

Share

4 responses so far

Real Life Slows Blogging

Apr 27 2011 Published by under [Education&Careers]

As it stands today, our Omaha house will be on the market next week. Tonight the photos for the online listing get taken, so the house has to be decluttered and almost ready to show. The past two nights I have crammed carry-out dinner in my mouth, washed it down with water, and headed off to scrub stuff, pack stuff, and dispose of stuff.

Between staging the house and my day job, blogging sometimes gets left behind.

Click on over

Today's real post is over at AWEnow, my site dedicated to equality for women in academia. It examines my own field, academic medicine, and the slow rate of growth of female faculty and female academic leadership. If current rates continue, women will compose half of medical college deans in the next century! That seems way too slow to me; it's not like the powers of academic medicine have to clean their house and can't make time to promote women...

Click on over; I even made a little video of the data. More coming at WhizBANG! tomorrow, I promise.

Share

2 responses so far

Fresh Harvest or Stale Chaff?

Apr 25 2011 Published by under [Information&Communication]

Sorting through the literature challenges most medical professionals. My "pure science" friends usually have a set search in PubMed that updates on a regular basis so they can find relevant new findings for their research.  That strategy helps in my lab-life, but as a practicing nephrologist I often do not know what I need to know until I need to know it. [What a sentence; my apologies in advance to the grammar police.]

The AMWA Journal started a new section this issue to reprint relevant articles from other journals. The first entry in this section caught my eye:

How to search and harvest the medical literature: Let the citations come to you, and how to proceed when they do. Citrome et al. Int J Clin Pract 63:1565, 2009

The article discusses electronic table of contents (eTOCs), automated alerts, stored searches, newsletters, and other available online resources. Article evaluation is addressed in rather standard ways, via title and abstract scanning, along with endorsements by evidence-based medicine groups and other authorities. Electronic storage and indexing is discussed, and online tagging sites noted as a final step. The general approach to their literature harvesting plan is shown in the figure:

I am disappointed by this piece. The general advice is sound; I have eTOCs of major journals in my field emailed when available, as well as keyword notifications from a number of sources. If a title looks appropriate, I click through for the abstract and, often, the article itself. For papers I want ready accessible, I have a PDF library in my Dropbox. If I know I will be able to retrieve the publication online (I belong to a society that publishes the journal, for example), then I may just index it.

My index system is in flux. I bought EndNote as soon as I had a computer. Those in my age bracket who have used typewriters for preparation of grants and manuscripts immediately recognized the value of this type of software. Lately, I have also established a Mendeley Library. This web-based reference manager appears to do everything EndNote can, but with the power of the hive-mind as well. Its Web 2.0 twist involves users providing tags and other meta-data to published literature. I have only played with Mendeley for a few months, but I can see great potential for this type of information in medicine and medical science. I hoped the Citrome piece would include more on these sharing sites for primary steps in literature harvesting, but these authors saw sharing as merely an added final step.

One thought I particularly enjoyed:

A major challenge that remains is determining what is worth reading beyond the abstract and what is worth saving. On a cautionary note, restricting thechoice of journals to what you consider as most worthy works only moderately well, as gems can be found in the most unlikely of places, and publication in a first-tier journal is not always a hallmark of quality.

The article did not change my ways; it pretty much summarized what I already do. How do the rest of you go about harvesting the literature? I am especially interested in finding out how others use Mendeley and other such sites as primary literature search tools - or do you?

Share

5 responses so far

Beats the Alternative

Apr 23 2011 Published by under [Medicine&Pharma]

My birth occurred 5 months before our current President's, so I get to experience half-century-hood and give him advice. He may not have time for a mid-life crisis, but I assure him that a red sports car is unnecessary. Really, 50 is no big deal. I feel good, my work and personal lives are happy, and I am looking forward to my empty nest. Besides, the only alternative to turning 50 is dying first; I would rather be 50, thank you!

Mr. Obama may not have the time or inclination for a pierced ear, motorcycle, or blonde paramour, but one thing he should make time for is a screening colonoscopy. I had mine yesterday, and it simply wasn't as bad as it sounds.

Click for source

You will receive instructions from your doctor. In general, any drug that my interfere with blood clotting is off-limits for 3 to 5 days prior to the procedure. Recent clots, stents, or other cardiovascular events may warrant a delay in the colonoscopy. You will also be instructed to avoid red, blue, or purple liquids for several days ahead of the scope. About 24 hours before, you stop solid food and drink only clear liquids, ones through which you can read a paper. Now, vodka and gin may be clear, but they also forbid alcohol. Probably not a bad idea with what the evening holds; believe me, you want your judgement and your aim unimpaired.

The worst part of the procedure involves cleaning out your colon. Some spas offer all sorts of "colonic irrigations" but no enemas cleanse as thoroughly as our "friend" GoLytely. This solution includes a bunch of electrolytes and poly-ethylene glycol, a nonabsorbable agent that induces explosive diarrhea. The standard jug, shown in the photo, mixes up into 4 liters (~1 gallon) of the dreaded "internal dynamite." The standard solution can be mixed with warm water and refrigerated the night before; I have been told it is most palatable when chilled. I also drank it with a straw. It felt and tasted like thick water with a slightly salty aftertaste. GoLytely will not replace bourbon and Diet Coke in my life, but it certainly was not the most vile concoction I have consumed.

The biggest problem is that you must consume a gallon of this stuff in 2 to 3 hours. The first 3 liters went down pretty easily. By the last glass, I wanted nothing more than to curl up and sleep. Of course, at that point, sleep was impossible because other things were happening. Big time. No cramping occurred, but the "outflow area" got irritated. I highly recommend a package of the soft, soothing wet-wipes they sell next to the toilet paper in your local store. They also said I could use Vaseline to soothe the area, but it was on another floor of the house. I also suggest good books or a television in the bathroom for distraction during your bowel scrub.

About 5 hours after starting to "drink the Kool Aid" I went to bed with a clean conscience and even cleaner colon. About 2 hours of those 5 involved direct contact with the toilet, with another 1.5 hours of not walking too far away. Experiences may vary; my "onset of action" occurred much longer after the first sip than many others. I also felt very cold with chills during the last half of potty-time; keeping an extra hoody near the the bathroom would have helped.

The next morning I went in to the endoscopy suite, received some really nice drugs through my IV, and woke up less than an hour later with a clean bill of health. After a friend drove me home, my parents brought lunch over, and I watched old Doris Day movies on TCM for most of the afternoon. Last night I fell asleep earlier than usual. Today, it's like the whole thing never happened, other than my smug attitude toward my peers who have refused to do it yet. Wimps!

So Barack, please get your colon checked. It's important for your health and you could set a great example for the whole country. And knowing a bit about colon cancer, I assure you, it beats the alternative.

Share

8 responses so far

Papers "Not Meant To Be Factual"

Apr 21 2011 Published by under [Education&Careers], [Information&Communication], [Science in Society]

Unlike statements during political debate, scientific papers present facts. The discussion may include some speculation about the ultimate meaning of those facts, but papers generally tell a story of data and meaning.

Unless someone makes a big mistake or outright lies.

Each day seems to bring to light a new scandal and retraction (the blog Retraction Watch has plenty of material), events that seem to be accelerating over the course of my 20 years in academic medicine.

Retractions in the Medical Literature: Who is responsible for scientific integrity? by R. Grant Steen in the current issue of the American Medical Writers Association Journal caught my eye. The study examined the PubMed database for biomedical research papers retracted from 2000-2010. Almost 5 million publications resulted in 788 retractions over that decade. [Including 88 review articles - how does a review get retracted?]

 

Both the number of articles retracted and the time to retraction increased over the past decade as shown in the graph. The continuous line represents the number of subsequently retracted articles that were published in a given calendar year; more retracted articles were originally published in 2006 than in any other year. The data points in columns represent the number of months between publication and retraction, categorized by year of retraction.

In 2000, 4 articles were retracted and the longest time to retraction was 8 months; in 2004, 49 articles were retracted and the longest time to retraction was 50 months; in 2009, 184 articles were retracted and the longest time to retraction was 117 months. A total of 788 retracted articles are represented as data points in this figure (many points overlap).

So which journals suffered the most retractions? The table shows glamor mags take the prize:

Steen focuses on the role co-authors can play in assuring integrity of the literature. He does address the reasons for the increasing rate of retractions:

One could argue that authors are more dishonest now than in the recent past. This interpretation is consistent with the finding that the number of article retractions has increased significantly in recent years. However, it seems unlikely that a cultural change in the past decade has prompted this increase. Instead, journal editors may have become more aware of misconduct after the publicity about Schön, leading them to set a lower threshold for retraction when an article comes under question. These reasons may also explain why the time to retraction has increased in recent years: Journals are making a more aggressive effort to weed out questionable articles, even if they were published long ago.

One could also argue that the importance of high-impact publications for grant funding and career advancement may make the risk of fabrication or falsification of data more acceptable to researchers.

So ultimately, who is to blame when retraction occurs? Obviously, the authors must bear most of the burden, but Steen argues that the editors of the "repeat offender" journals should also hold responsibility:

Editors are gatekeepers for their journals, and if a journal does not offer a trusted brand, what does it offer? Some scientists have already blamed journal editors for failing to provide a rigorous review for papers before accepting them for publication.

Rigorous peer review may help uncover fraud or fabrication, but, as the editor of Science wrote, "It is asking too much of peer review to expect it to immunize us against clever fraud."

Ultimately, we all must retain a degree of skepticism about anything published in the literature. Even a brilliant series of experiments, performed and published in good faith, can be undone by one negative study with a new technique or tool. Authors, reviewers, and editors all must do their jobs to insure the integrity of the scientific literature.

 

Share

12 responses so far

More Games We Must Play

Apr 20 2011 Published by under [Medicine&Pharma]

It's enough to make me muss my 'do!11! {Click for Source}

So 3 days back at work, and I still have not received a form to fill out for that patient's medication. I called the insurance company today, and had just a lovely time.

First question: What is my name? I explain that I am the doctor and give them my name. The call center guy proceeds to reverse my first and last names for the next 5 minutes. I finally get that straight.

Next question: What is my fax number? I give that to him. He then explains the procedure once the form arrives by the end of business hours today:

Have the doctor fill out the form. If no time concerns are checked, medical review will be completed in up to 2 weeks. If the urgent box is checked, our doctors will review the request in 3 to 5 days.

Hmmm... I did mention that I am the doctor. I never considered my voice masculine, but whatever. So my patient has to go without medications for a week while I have been waiting for this form and for your doctors to review the request?

We can turn it around in 24 hours if, after faxing back the form, you have the doctor call. He can call us at this number."

Sigh.

Last night I received a robo-call from Huckabee's people asking to use my name on a petition to repeal healthcare reform because it threatens our freedom and everything that makes this nation great. I keep hearing conservatives yelling about a government take-over of medicine. Based on the last week, third party insurers run the show right now, and they do not have our best interests at heart.

Rant over now. Tomorrow I promise I will move on to other things.

Share

No responses yet

Dear Insurance Company

Apr 18 2011 Published by under [Medicine&Pharma]

A long-term patient recently moved to your state. Establishing medical care with a new specialty practice can take time, so I sent brand-new written prescriptions for all of the drugs the patient required.

The patient attempted to fill these medications. You have been kind enough to reject them pending me faxing back a form to make sure all cheaper alternatives have been given adequate trials. The kid has been on these drugs for four years. FOUR YEARS! The only reason he seems new to you is the move to another state. Now he will miss medications because I have been out of town, and your form is sitting in my office inbox gathering dust.


Could they have been filled for a week while awaiting the form? Could you notify newly covered patients that new prescriptions may take two weeks to fill because of your cost-saving tools? Could you come up with something that allows patients to continue their medications? Could you develop something that does not piss everybody off?

Sincerely,
Pascale H Lane, MD

- Posted using BlogPress from my iPad

Share

4 responses so far

The Carnal Carnival: PEE!

Apr 15 2011 Published by under [Medicine&Pharma]


Click image for original source

This month, the Carnal Carnival feature pee! May I present a collection of recent blogs about kidneys and the golden fluid they produce.

First up, Uremic Frost presents an obituary for Edith Helm, the first female kidney transplant recipient. A 20-year-old newly-wed when she found out she had months to live, she underwent the transplant and ultimately became the first transplant recipient to give birth. She died at 76 in her home state of Oklahoma.

Next, we had an unusual event this week, documented by the Renal Fellows Network. The event was presentation of a new predictive equation for patients who have lost at least 40% of normal kidney function, and it predicts the two year risk of end-stage kidney failure with at least 90% accuracy. As the equation was presented at the World Congress of Nephrology, it also got published in JAMA and an app including the equation was released for all major mobile platforms. Very Media 2.0.

University of the Kidney presents a cool video on the dream of organ regeneration. Over at Nephron Power an excellent slide show on cystic kidney diseases can be viewed.

Precious Bodily Fluids considers how fast your creatinine level would rise if someone really removed both kidneys and left you in a bathtub of ice.

Finally, I have to give my Scientific American guest blog another shot-out. Who wouldn't want to reminisce about Paradoxical Polyuria? Ah...good times.

So enjoy learning a bit more about the golden fluid, and try not to pee your pants in the liquor store!

- Posted using BlogPress from my iPad

Share

11 responses so far

Scientists May Act Like Children

Apr 13 2011 Published by under Uncategorized

Yesterday I had the pleasure of hearing Gerald P. Koocher, PhD, deliver the Walter C. Randall Lecture in Biomedical Ethics at Experimental Biology 2011.


First, how could you not want to listen to a guy who looks that much like Pee Wee Herman?

Don't fear if you were not among those in the room. Dr. Koocher has made his PowerPoint slides available. I will hit the highlights here.

The powers that be define bad science as fabrication, falsification, and plagiarism, although their survey also identified authorship issues, uncomfortable work environments, and "The Bozo Factor" as other issues. What is the latter? Incompetency and inadequate supervision of others, for the most part.

So why do people cheat? Most folks can come up with a rationale for cheating, and often a reward figures in the equation. If the likelihood of discovery seems low enough, people may cut corners or outright lie. So the same thought process that drive a 5-year-old to deny taking the forbidden cookies may also lead to data fabrication in the laboratory.

His research showed that intervening was scary, but in most cases the whistleblower did not suffer horrible consequences. Dr. Koocher suggests that we develop alternatives to whistle blowing with our colleague. Offering help and expressing concern about something irregular can be one way to intervene and allow someone to change course while saving face. He also recommends the Bullwinkle approach. This cartoon character often stated "I am so confused." A nonthreatening approach can work best.


He also believes that scientific ethics need to learn from hospitals and report "near miss" behavior. When something almost gets done wrong, we need to learn from it.

I will let you explore the slides, including his Gallery of Ethical Rogues.

- Posted using BlogPress from my iPad

Share

2 responses so far

Older posts »

Bad Behavior has blocked 363 access attempts in the last 7 days.