Archive for: February, 2012

Help Me Out: Black Women's History

Feb 27 2012 Published by under [Etc]

Last night's Academy Awards featured stars in glittery gowns and lint-free tuxedos. My husband has a low tolerance for the show, so after I got my fill of red-carpet gowns and shoes, we watched a best-picture nominee and followed the prizes via twitter. Yes, my husband wanted to watch The Help.

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I read it, loved it, and blogged it last summer. As the movie gained traction, I have heard more stories about my life in 1960's Houston, TX, including the day my mom  took me to the "colored" toilet in a shopping mall. She had a toddler who had to pee, and she saw a restroom marked for women. When she came out, apologetic store clerks told her the error of her ways. My own kids hear these stories and cannot believe that we ever allowed such stupidity.

I was really routing for both Octavia Spencer and Viola Davis to take home statuettes last night for their performances in the movie adaptation of this book (although Meryl Streep is fantastic in everything she does). Both women brought such depth and grace to these roles that even my husband was impressed by the movie. However, the twitter feed eventually lit up with complaints about these women playing maids in this day and age.

I wonder if these same folks bitch about those playing maids and footmen in Downton Abbey "in this day and age?"

My disclaimer follows:

If you have seen my photo, you know I am not African American; I have a proud insect ethnicity (WASP). I have felt like "the other" on occasion in my life. When I started out in medicine, everyone immediately assumed that any woman was a nurse. Now, when every medical show on television has multiple female physicians, this happens far less often. The nurses in these shows remain overwhelmingly women, though, reflecting the current reality. D00ds are still doctors till proven otherwise.

However, I may not be as sensitive to racial stereotypes since that has not been part of my experience.

The Help is a period piece, a story of a misguided time that we must not forget. It's the story of invisible women whose story becomes part of the record. I do not remember this sort of issue with Morgan Freeman playing a chauffeur in Driving Miss Daisy, another flick set in 1960's Mississippi (although that film came out during my fellowship when I had a two-year-old child and may have missed the controversy).

What do those who complain about these actresses playing maids want? Better roles for actresses of color? Hell, I would like to just say better roles for actresses in general (that could be another whole post).  Do they not want this story told? Because the world is better if we pretend this period never happened?

Or could this be another example of African American women being ignored? There's a museum for the men who waited on white people as Pullman porters and a book on the same. Should this work be adapted into a movie starring male actors, would they get put down for taking demeaning roles in a movie set in segregated US?

As I said in my original post:

The bottom line seems to be that housekeeping and childrearing remain undervalued. These chores require no specialized training, but they remain essential to our lives.

They are "women's work."

A male actor playing someone who takes on a demeaning job to support a family seems heroic. A woman playing a part where she cooks, scrubs floors, and raises others' children to achieve the same end...not so much. At least, for some. For me, the real value of The Help was making those women more than cardboard characters in the background. They were as brave and courageous as the men depicted during those same period dramas.

This week following the Oscars, we transition from Black History Month to Women's History Month. It's a great time to explore the contributions of black women to our world. And what a greater way to honor two amazing movie performances!

Even Meryl would approve as chair of the effort for the National Women's History Museum.

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What I Am Reading: Too Big To Know

Feb 23 2012 Published by under Uncategorized, What I'm Reading

Click to enlarge (Original image at http://bit.ly/zKZNml)

In 1988, Russell Ackoff first drew the pyramidal progression from data to wisdom shown in the figure. Data points or facts were gathered into knowledge by experts who certified and spread this understanding of data via books and other credentialed documents. Ultimately, with further probing and understanding, knowledge would lead to wisdom.

In the age of Google, anyone with an internet connection can access data directly. Data formerly isolated to one silo or another now can be linked among multiple disciplines. In general, this should lead to increased knowledge and wisdom. However, as the price of an online soapbox has dropped, the number of people providing interpretations of data has increased.

Our "Knowledge" no longer comes vetted by experts; how do we know what we find is climbing toward wisdom and not utter crap masquerading as "Information?"

That is one of the problems appropached in the book  Too Big to Know: Rethinking knowledge now that the facts aren't the facts, experts are everywhere, and the smartest person in the room is the room, by David Weinberger. This thoroughly-referenced book examines our brave new world of knowledge and concludes that the answer may simply be...more data.

Click for more info

For example, consider phylogeny, grouping and classifying related plants or animals or proteins or genes. In the "old days" experts in the field got together and came up with a classification system so that everyone would call stuff by the same name. If one person called a protein TGF-beta inducible gene H3 (BIG-H3) and another called it TGF-beta induced 68kda (TGFBI), they might not realize they were thinking about the same thing. Agreement was crucial. The modern solution has been metadata, data about the data. Both of these proteins can be referenced to the same entry in a table somewhere in a database. When you select TGFB-H3 for your literature search, the metadata knows that you also mean TGFBI.

Metadata may also assist in recognition of untruths or poor quality information. This process still relies on recognized experts to rate the quality of a given site or piece of data, as well as the wisdom of groups, the power of the hive-mind. There will still be people who will choose to ignore stuff that is rated "pants on fire" (see Politifact's Truth-o-Meter), but cranks have existed since the dawn of time. The internet cannot solve everything.

InterrelatedDataEtc

Relationship of Data, Information, and Knowledge Today

Too Big to Know captures a modern theme and runs with it. We are drowning in data and information, but sometimes it feels like we know less. We must learn how to deal with the potential and problems of this new reality. Instead of a progressive pyramid, we now swim in a sea of data (tiny red dots in figure at right) with bits from all over the place synthesized into knowledge (larger orange dots). Knowledge (yellow asterisks) is harder to find, as is wisdom (green stars). These bits all exist together, like a stew, rather than stacked like a sandwich (a pyramidal sandwich, if you please).

The old model was orderly, while chaos reigns in the new one. The discussions in the book give me hope that we can learn to live with the new model and harness its power. I feel like I cannot do the book justice here; perhaps the topic is too big to blog!

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Rules Amended

Feb 21 2012 Published by under Uncategorized

First, I must thank Kate Clancy for pointing me to First Year Comp, a great blog on writing. One of the posts I found discussed the use of quotations, especially big block quotations, versus paraphrasing. A quick survey of students showed that many do not read large quotation blocks in books. The rules for quotes:

  • Do not quote anything you can paraphrase in 1 sentence
  • A quote should "do" at least 2 things in your piece

I usually end up quoting based on the first point; I am unable to boil the thought down any further. Besides, it's so easy to cut-paste-link in a blog! Makes me wonder why any of us bother to do anything but quote online...

Then this post hit my twitterstream. Now, I could paraphrase these large block quotes in a sentence (Indiana representative links Girl Scouts to Planned Parenthood and left-wing subversion), but it just doesn't convey the actual sense of lunacy. One of the block quotes follows:

A Fort Wayne lawmaker has refused to sign on to a resolution celebrating the 100th anniversary of the Girl Scouts, calling the group a "radicalized organization" that supports abortion and promotes the homosexual lifestyle.

Rep. Bob Morris, R-Fort Wayne, sent a letter to his fellow House Republicans on Saturday explaining why he would be the only member in the House not to endorse the nonbinding resolution.

He said he did some web-based research and found allegations that the Girl Scouts are a tactical arm of Planned Parenthood, allows transgender females to join and encourages sex.

Morris also said the fact that First Lady Michelle Obama is honorary president "should give each of us reason to pause before our individual and collective endorsement of the organization."

Go read the whole post at Maddow.

So I guess we can add one more time to use the quote and not paraphrase:

  • When the readers need to hear the exact words to believe it
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A Solution for the Twitterverse!

Feb 20 2012 Published by under [Information&Communication]

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Last summer I succumbed to the buzz and got on Google+. Hey, all the cool kids were doing it; why not me?

I must admit I still prefer Twitter to the other social media services. If you cannot say it in 140 characters, get a blog! However, I am not alone on the internet, and I have friends that prefer Facebook and other sites (although I have not yet knowingly met a person who prefers G+).  I keep hoping someone will explain what makes Google's site "the one."

The bottom line is that any person or group that wants to communicate broadly must have a presence on all of the social media sites. Otherwise you will always be missing someone who prefers doing it another way. Solutions exist to connect Facebook, Twitter, LinkedIn, Foursquare, and others. Software became available within a few weeks of the G+ debut to allow your posts there to go out to Twitter et al.

I love Twitter. Was there no solution to let my tweets feed into my G+ stream? Otherwise, I only think to post there about once a month.

Today I found a solution via Quora (posted on 14 January 2012), the internet Q&A site. I am giving you a direct link to the instructions. You will want to keep them open in a separate window, on another device, or (gasp) print them out.

Google+ allows you to post via SMS. That’s the trick.

Who exposed this method online? A whippersnapper the same age as my son (Timmer, you're slacking). His bio follows:

My name is Salavat Khanov. I'm 19-years-old blogger & developer based in Ufa, Russia. I'm currently studying at Ufa State Aviation Technical University (Software Engineering student) and working on my own projects.

I take keen interest in programming and development of Mac and iOSapplications, also Web development. Currently I am very much interested in the process of learning and making Mac OS X applications and working on websites.

Since 2009 I have been actively working in the web industry. I have worked with many different people on various projects and as a result I gained some unique and strong experience in the IT, English language and generally - life.

It took 15-20 minutes for me to set up the system, and it works great! Thank you, Salavat - you made my day!

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These Social Networks: Personality and Preference

Feb 15 2012 Published by under Uncategorized, [Information&Communication]

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On Valentine's Day, an online friend tweeted a link to a Wall Street Journal article about a study of personality and social media network usage. The article consisted of 118 words, but I had to know more. I pulled the paper for detail:

A tale of two sites: Twitter vs. Facebook and the personality predictors of social media usage. Hughes et al. Computers in Human Behavior 28:561-69, 2012

The authors want to know if users of Twitter and Facebook differ in their personalities. First, what aspects of personality do they want to consider? They study the
Big-Five:

  • Neuroticism: Measure of affect and emotional control. Low levels suggest emotional stability, and higher levels reflect sensitivity and nervousness (Drama Queens, if you please).
  • Extraversion: Measure of engagement with others. Extraverts tend to be outgoing and talkative. Intraverts get their energy from within themselves.
  • Openness-to-Experience: Measure of desire for novelty. High scores indicate broad interests for new experiences, with low scorers preferring familiarity.
  • Agreeableness: Measure of "friendliness." High scores general found for people who are kind, warm, and sympathetic.
  • Conscientiousness: Measure of work ethic, orderliness, and thoroughness. High scores belong to those who get it done on time. Low scores can indicate proscratination tendencies.

In addition they also assessed two personality facets that may also influence online interactions:

  • Sociability: Measure of need to belong. No distinction between this score and that for extraversion/intraversion is presented.
  • Need for Cognition: Measure of disposition toward novel cognitive stimulation.

They combined validated survey instruments for each of these factors, along with some questions about Twitter and Facebook use and basic demographics, and made a single online instrument to test the following hypotheses:

  1. Neuroticism will be positively correlated with social use of both Facebook and Twitter
  2. Extraversion will be positively correlated with use of Facebook
  3. Extraversion will be negatively related to use of Twitter
  4. Openness will be correlated with both social and informational use of both Facebook and Twitter
  5. Agreeableness will be unrelated to social network use
  6. Conscientiousness will be negatively correlated with social use of both Facebook and Twitter
  7. Conscientiousness will be positively correlated with informational use of social network services
  8. Need for cognition will be positively correlated with informational use of Facebook and Twitter, but will be unrelated to social use
  9. Sociability will positively correlate with the social use of Facebook and Twitter, but will be unrelated to informational use

The investigators recruited participants through ads on both Twitter and Facebook; informed consent was obtained and a small donation made to charity on behalf of each person. No report is made on how many participants came from ads on which service. A total of 300 people (97 males, 207 females) completed the survey. Ages ranged from 18 to 63 (mean 27). Europeans accounted for 70%, 18% were from North America, 9% from Asia, and the remaining 3% from other continents. 55% of participants were employed, 41% were students, and only 4% had no job.

The first analysis classified participants by social network usage. Four factors generated included Twitter Information, Facebook Social, Twitter Social, and Facebook Information. The strongest correlation identified was Sociability with both Twitter Information and Facebook Information, completely refuting hypothesis #9. The pattern of correlations with Twitter Information and Facebook information were diametrically opposed; they conclude that personality may help determine which service one uses to consume or deliver information. The strongest correlation with Twitter Social was Conscientiousness, while Sociability showed the strongest relationship to Facebook Social.

The investigators also asked each participant which network they preferred, with 197 picking Facebook. Users with this preference rated higher in Sociability, Extraversion, and Neuroticism than those preferring Twitter. The latter group scored higher in Need for Cognition.

The authors discuss a boatload of correlations in these data, for what they are worth. Correlations do not  prove causation, and this study population was small, self-selected, and not generalizable. Their findings provide support and lack-thereof for all nine of their hypotheses.

The bottom line for me is that most people who use social media have a preference for one site or another. For my personal interactions, I need to be where "my people" are. If I want to get the word out about a product or service or event or other news item, I need to be everywhere; otherwise I will miss people. Diversity issues also present themselves, not through the traditional race-gender-ethnicity lens but through a personality lens. When I restrict myself to one network, I may be preaching to a choir even more like myself than I imagined.

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Shhh! I Hear a Paradigm Shifting!

The February issue of the Journal of the American Society of Nephrology includes a science in renal medicine article that caught my eye:

It Is Chloride Depletion Alkalosis, Not Contraction Alkalosis. Luke and Galla. J Am Soc Nephrol 23:204-207, 2012. doi:   10.1681/ASN.2011070720

If I ever teach metabolic alkalosis again, I have to revise my lecture!

Ever since loop diuretics became available in the 1960s, they have been a recognized cause of metabolic alkalosis. These drugs cause the kidney to excrete excess volume (Na + Cl + water), which is very useful if you have swelling from heart failure or liver disease or kidney problems. If the volume loss goes too far, the patient could develop alkalosis (too little acid/too much base in the blood). The major base in the blood is bicarbonate (HCO3-). Our "old-school" explanation of the pathophysiology follows. Volume depletion turns on aldosterone which controls a number of transporters in the distal nephron. The net effect of these transporters is retention of Na+ with concurrent excretion of K+ or H+. The latter would help perpetuate the alkalosis, because excreted H+ (acid) does not consume any of the blood's buffering bicarbonate. Restoring the patient's volume turns off aldosterone and allows the alkalosis to resolve.

How simple! How elegant! How wrong!!!!!

A number of human and animal studies are reviewed in the article. The alkalosis formerly known as contraction can be induced with diuretics plus dietary maneuvers. If volume is expanded without chloride, using albumin or other solutes, the alkalosis remains. If chloride is replenished without volume repletion, the alkalosis resolves (even though the subject remains volume depleted).  Thus, this form of alkalosis is better described as chloride dependent (CDA).

Click for original source

The figure from the paper summarizes the new explanation. First note that unlike most tubular cartoons, the peritubular capillary is central in this one. Either side of the cells is a urinary space. The cortical collecting duct contains 3 cell types. Principal cells (middle of cellular column) reabsorb Na+ and excrete K+ to maintain electroneutrality in the luminal fluid. A-type intercalated cells (Acid secreting; top of cellular column) can transport H+ into the lumen. This activity during alkalosis with volume contraction may be driven against the H+ concentration gradient because of Na+ absorption by the principal cell, as in the old-school explanation above. Of more importance to the alkalosis, B-type intercalated cells (bicarbonate secreting; bottom of cellular column) express pendrin (Pn) on their luminal membranes. This protein transports bicarbonate into the luminal fluid while reabsorbing Cl-.

In states of chloride depletion (left side of cartoon), Cl- is not available to exchange with bicarbonate, so the latter cannot be excreted. After Cl- repletion (right side) this exchange can occur. Bicarbonate can be excreted to correct the alkalosis, without any alteration in the functions of the aldosterone-dependent transporters in the other cells.

Medical students have always been frustrated that we classify volume status by urine Na during "pure" volume depletion, but with urine Cl during metabolic alkalosis. Various explanations have been offered along the way, the most reasonable being that in periods of excess bicarbonate filtration (like alkalosis) a cation has to accompany it in the urine. Thus, urine Na may be falsely elevated in this setting. Turns out, the urine chloride concentration really is the critical component.

Will any clinical changes result from this new nomenclature? For the most part, no - when patients lose chloride and become alkalotic, they generally suffer volume depletion. We treat this with Na + Cl + water, repleting volume and chloride together.  The paper summarizes a number of relatively recent studies and provides a great illustration of the shifting nature of established physiology.

There is always something new to discover.

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Value Added

Feb 13 2012 Published by under [Science in Society]

A few years back I decided I needed some business training to pursue my administrative goals. A big piece of this education included financial materials. One problem involved valuing a business.  Sure, you have the building and supplies and widgets, and usually some cash is on hand as well. However, businesses come with intangible assets. What is the name "Disney" worth, for example? How about "Enron," now versus 1998?

The only way to really find out the value of a business or other entity is to sell it. Like houses, they are worth whatever someone will pay.

In scientific publishing, someone has paid for the data before submission to the journal. What value does the journal add?

  • Peer-review - Yes, I realize most of this is done by volunteers, but there is infrastructure to maintain.
  • Editing - Do you put spaces on one or both sides of the "<" sign? Thanks to hired punctuation police, scientists do not have to think about this. Of course, most of us can get the message from the unedited manuscript (regardless of the quality of the grammar and kerning), so this function can be perceived as beautification with little true value.
  • Distribution - Costs are lower via the internet, but not yet zero. Even publishers have to buy servers and pay electric bills. We also expect the information to be maintained in perpetuity, no matter how few people access it.
  • Reputation - Each journal adds intangible value to the articles within, a value most difficult to quantify.

These are the things we pay for with subscriptions, page fees, and download prices. How do we judge what is fair? We can look to Open Access publications for an idea of the overall costs for the first three items. What we cannot learn as easily is the price of reputation. A publication in Nature may be worth $35 per download in perpetuity. Is a 5-year-old article in Pathophysiology (Impact Factor not available) really worth $22?

I am not certain what the solution will be. The internet has clearly disrupted publishing of all sorts, and scientific journals will not be exempt. Until that magical reputation factor drops lower in value, I doubt that the glamor rags will suffer.

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Sangry* About Healthcare

Feb 11 2012 Published by under Uncategorized, [Medicine&Pharma]

Many comfortably middle class folks I meet view the uninsured as a great mass of people making bad choices, ignoring their personal responsibilities. Many of them do not believe that anyone they know would be uninsured.

If you fit in that group that that assumes "people like me" have healthcare, you must read Kevin Zelnio's post about his son's recent bout of pneumonia. See, Kevin recently started his own business as a writer and consultant. We keep hearing about small business being the the lifeblood of our economy, and every business starts out as one person trying to make something happen. When you first begin, insurance is an insurmountable expense. You need to put bucks back into the business and (gasp) pay for food and shelter. You have no bargaining power for insurance rates. I have met several entrepreneurs over the years, and all of them have gone uninsured for at least a year (unless they had a spouse with employment-based insurance).

Image from Kevin's son (Click for original)

Kevin shares with the world the gut-wrenching fear of having a critically-ill child while recognizing that a hospital admission could wreak financial havoc for years. He also pulls in the statistics for the uninsured in the United States, illustrating what a wide-spread problem this is. Please read his post now, if you have not; I will wait.

The details and names and locations change, but I hear this same story a lot. In some ways, Kevin is lucky; his son suffered a single acute illness. Most of the families I see must deal with a chronic disease, one that will be ongoing, perhaps forever. In a few weeks or months, Kevin will receive a final bill and know his debt. The number may be astronomical, but it will be finite. If the diagnosis is cancer or asthma or kidney failure, the expenses keep piling up.

Some politicians suggest that charitable impulses will take care of these issues. As a pediatric subspecialist I have donated my care before. However, even if all the doctors and nurses and technicians involved with a patient agree to donate their services, there are still enormous expenses. The hospital must pay for supplies and utilities and documentation. Part of your stay pays for the custodian in the hallway and the folks who change the lightbulbs. They may not touch the patient, and their part cannot be assigned to any particular patient, but without them the hospital could not function. If one patient cannot pay, then those costs must be borne by those who do. Part of the inflated cost of care in this country comes from spreading out uncovered costs this way.

One of the big triumphs of Obamacare thus far is a mandate for dependent child coverage, with no exclusions for preexisting conditions. Before that, I saw families who wanted to buy insurance but could not. One child with a chronic illness excluded them from family coverage; the company would not create a package for two parents and all-but-one-child. See, children are supposed to be cheap for the insurance company. Yes, they get shots and have some illnesses, but major pediatric health problems are pretty damn rare. Create special family plans that exclude one child? "We can't do that."

So what's a family to do? In the current insurance climate, major illnesses cause most personal bankruptcy in the US (at least before the housing bubble burst).  Some families divorce, because the mother and children then become eligible for Medicaid if mom doesn't work - and yes, I have seen mothers quit jobs to get coverage for their children.

The US really does not have a system of healthcare or coverage. We have a patchwork of solutions that have popped up over time, much as our electric grid grew. Obamacare (I do not consider this a derogatory term) provides a step in the right direction; by making all healthy people buy coverage, we spread the costs out and make insurance less expensive. Exchanges should grant collective bargaining clout to the self-employed, so they can negotiate the better rates of larger businesses.

We have a long way to go, but it's a journey we must take. No one should have to break up a marriage to get healthcare for their child. No one should have to choose between bankruptcy or their child's life.

*Sangry = Sad + Angry

If you wish to contribute to a fund for Kevin's son's hospitalization, please click here.

Also, as Scicurious writes, contact your congresscritter about this issue.

 

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Personal Branding: Some New Thoughts from the Net

Feb 10 2012 Published by under [LifeTrajectories]

Over a year ago I moderated a session for Science Online 2011 about personal branding. In an era of shrinking budgets for everything, even those of us in academia need to pay attention to our reputation. No job lasts forever. Leading up to the meeting I reviewed two books on the topic.

This week I received information about an upcoming seminar from Expert Visibility. The even will be run by Lorrie Marrero, an organization expert who has achieved fame and fortune. She presents a brief video that introduces the levels of audience and expertise in an interesting way. We all start out as students, with no authority or audience. Eventually we learn to implement our knowledge, with attendant increases in authority and audience. If we proceed further, we become educators.

Click for source (discussion of pet jellyfish)

At this point, we cross a line and enter "The Fishbowl." We become a Visible Authority with a much larger audience. If we push further, the result would be fame and celebrity.

The books I reviewed included Career Distinction: Stand Out by Building Your Brand. This one targets folks from the Implementer to Visible Authority level in Marrero's schema. The other book, Fame 101: Powerful Personal Branding & Publicity for Amazing Success, clearly aims for those wanting to enter the Fishbowl and swim to Fame.

This brief video provides a framework to help people identify their branding goals. I wish I could attend her cut-price first conference, but, alas, I have to see patients that weekend.

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Wednesday Wisdom

Feb 08 2012 Published by under [Medicine&Pharma]

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You own a hammer. Does that make you a carpenter?

You own a hemofiltration machine. Does that make you a nephrologist?

 

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