Criminal Behavior

Sep 14 2011 Published by under [Humanities&Social Science], [Science in Society]

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Office stocking has proceeded to the point where I can catch up on some reading. Science from August 19 includes a special section devoted to Investing in Early Education. The ten articles present compelling data regarding the efficacy of preschool. By the 1980s early education had enough documented benefits that randomized controlled trials were deemed impossible (because parents would refuse to be in the control group) or unethical (because effective "therapies" would be withheld), leading to a case-control design for the first large longitudinal study.

I encourage you to read the whole section; it's worth it, even if  you have to pay!

The first article in particular asks a major question: why isn't early education offered to all children who need it, given its documented benefits? Three long-running studies are reviewed, all of which demonstrate significant benefits well into adult life (see figure).

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HighScope/Perry first demonstrated the benefits of early learning in 123 students with a return on investment of $16 for every dollar spent. The intervention cost almost $18,000 per student for half-day attendance during the school year. Subsequently, the Abecedarian study also used a randomized control design from age 6 weeks to 5 years with full-day year round classes. Costs rose appreciably to just over $70,000 per subject; ROI dropped to $2.5 per dollar invested.

The Chicago study did not boast a randomized design, but did involve 1,539 students at a cost of only $8,224 per student for half-day, school year programs. Each dollar spent produced $10 of benefits over time. Sounds like this one hit a sweet spot in terms of "bang for the buck."

What benefits are we measuring? Graduating from high school, better employment, and lower incarceration rates. All of these factors also correlate with better health.

So why don't we have universal preschool, at least for high risk children? We have lots of data showing benefit and excellent ROI for society! A variety of issues come into play.

The nature of "at risk children" changes over time. At present, many more immigrant, English-as-second-language children are in the US than in these earlier studies. Will similar programs translate to these youth? Only time and tracking will tell. While I tend to err on the side of intervention (I mean, do we really think it would hurt?), those who control the funds often come out on the other end of the equation (we can do nothing till we know what works!). Now we also must contend with those who believe only stay-at-home-mommies are the answer. Which brings us to politics.

And that's the real issue. Children do not vote. These programs primarily help bridge the gap between advantaged and disadvantaged kids; those who fund political campaigns generally do not look for this sort of extremely long-term return on investment. Even though we would all be better off with better educated, skilled workers who stay out of jail (thus providing the labor force and tax base we need for our society and economy to thrive), many in the US consider this unnecessary spending.

If we withheld a treatment this effective in the practice of medicine, it would be criminal.

One could argue the same in this situation.

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Upright and Above Ground

Jul 17 2011 Published by under [Etc]

Today's post title is the flippant answer I occasionally (OK, more than occasionally) give when someone asks me, "How are you?". Some days, upright and above ground is all I can promise.

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In reality, the upright part is not accurate. I don't lie about at the office, but my ample posterior is often applied directly to a chair. Upright means head-above-feet, not on-my-feet. Since the start of 2011 I have read several posts about standing and treadmill desks (one very useful article can be accessed by clicking the image). Since my day job ended June 30 (and the new one starts in September), my life has been excessively sedentary. I decided to see if I could blog standing up.

Of course, I'm too cheap to plunge right in and buy an actual standing-height desk without knowing if I will tolerate it. I finally figured out that I could use my laptop at shopping-cart-handle height or 42 inches from the floor. My kitchen island is standard cabinet height at 36 inches, and a plastic storage tub of 5.5 inches raises it to a reasonable level.

Friday I ran a bunch of errands. In between, I spent about an hour writing my post after reading all the source material on the sofa, in a generally non-sitting position. After about 5 minutes of awkwardness, I got used to the position, and things worked well. My favorite Fit-Flops gave great padding, so no foot pain occurred, and I felt fine.

Yesterday I upped my time to just over 2 hours. Once again, no problems working in "the position." In addition to playing with Google+ and blogging it, I performed several moving-related tasks online. I felt fine, and stuff got done.

I even conversed via twitter with Karyn Traphagen (@ktraphagen) who made the switch earlier this year. She still works standing up, albeit with a real system made for the task: keyboard at arm level and monitor raised to eye level. Eventually, as I work longer stretches, my neck will appreciate that ergonomic treat.

So this morning I woke up, got out of bed, and realized that my core muscles felt like I had played the Wii Fit Hula Hoop game last night. Given that no other change in my daily activities occurred, I'm pretty certain my muscles hurt from the extra use just standing!

I'm not ready to order a desk yet. I have to stick with this a bit longer and feel like I am really committed. For something this easy and cheap to work would be great!

Anyone else out there doing it upright?

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Under the Sheet and Against the Clock

Feb 07 2011 Published by under General Health

Today dawned bright and early for me. Immediately after the SuperBowl festivities, I started fasting for my annual check-up. Scheduling this event the morning after a major binge of junk food and alcohol was not my smartest move.

I arrived and the usual ceremonies occurred: signing consent, scanning the insurance card, and determining the body weight and vital signs. My doctor entered, and we went through the usual history and physical stuff, and finally ended up at the favorite part for all we female types, the pelvic exam. My doctor asked an interesting question during the pap smear: why are they instructed to rotate the sampling brush counter clockwise? This topic led to discussions about cervical cell growth; perhaps the cells had a right-left asymmetry that made the rotation of the sample crucial. I decided to find out for myself!

Pap Smears

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This screening test for cancer bears the name of its inventor, Georgios Papanikolaou (detailed discussion here). The basic idea seems simple; a swab placed at the cervix of the uterus collects cells that are smeared on a slide, stained, and examined for (pre)-cancerous changes. Routine use of the test in developed countries led to earlier detection of cervical cancer and markedly reduced mortality from the disease. Over the years, improvements have been made.

When I went to medical school, the cell-sampling device was a wooden spatula (D in image at right). One slightly elongated end entered the center of the cervix, and the shorter portion circled the opening as you twirled it. No mention of direction of collection occurred in my instructions many years ago.

In the 1980's a better collection device emerged, namely a cervical brush (E in the image). These bristly devices had more surface area than the spatula, and collected more cells. The brushes also got placed into liquid storage medium. Companies wrestled with the design, and ultimately came up with the broom (see A in image at right).

Cervical Sampling Devices (Day et al. BMC Women's Health 2004 4:6 doi:10.1186/1472-6874-4-6)

The Cervix or the Broom

Ultimately every question should have an answer. In this case, the counter clockwise instructions either had something to do with the cells of the cervix or the character of the broom.

Before you dismiss the cervix as the answer, remember that our bodies demonstrate left-right asymmetry. The heart leans left. The liver normally resides on the right. The gut has a left to right to left kind of flow.

But you can dismiss the cervix now, because this answer is the broom.

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At left you see the largest image I could find of the SurePath broom. Turns out those bristles are not round but flattened on one side. Those precise counter-clockwise instructions (or whatever is specified by each manufacturer) allow the collecting side of the device to contact the cervical cells and pick the little suckers up.

So Now You Know

You now know what is happening under the sheet during a pelvic exam, and why it proceeds in a certain direction. Now, I plan to not think about Pap smears for another year or two.

Original sources may be viewed by clicking on the images.

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