Hey Hey HEY 26 year old!!!!!

One more

The olden days

Five minutes nostalgia - good live version of this classic

Psychology of being sick

We are learning that people who become ill/hospitalized frequently have similar psychological reactions to their conditions, all of which to some degree are helpful, but become maladaptive when they stray too far from the mean. I was surprised at how similar these defenses and personality traits were to the ones I noticed during my time in sales, its funny how simple we are. When I read this chapter I'm constantly reminded of different customers, I think we all should have to do sales at some time in our life, convincing someone that they need something is the best type of psychological education you can get, and if you're good, you can get paid to do it. So here are the defenses: regression, denial, anxiety, depression, and anger. Each must be dealt with differently, later then dominant personality traits.

Regression: where a patient reverts to a more childlike way of thinking, they can become excessively passive. Its important to explore the reasons for this behavior with the patient, try to alleviate their fears by information and reassurance.

Denial: unconscious repression of a frightening situation that wards off the anxiety that may come along with it, can lead to delays in treatment and refusal of necessary treatments/tests. Best dealt with by introducing new information to the patient and observe how the patient incorporates and retains. Its best not to confront the denial, unless there is an emergency.

Anxiety: anxiety is a natural and necessary psychological state as a result of being ill. Too much fear, worry, and rumination however is maladaptive. In this case, elicit the specific nature of the patients fear, provide them with accurate information regrading this, and be reassuring where you can be. "there are excellent treatments" etc... given that there actually are! Don't lie.

Depression: kind of like anxiety, except with a pinch of guilt, because the patient feels somehow responsible for the illness and experiences the loss of function. Major depressive episodes are not normal, and have higher rates of not cooperating with any treatments. In this situation, its best to clarify the nature of the depression, correct any distorted notions, and reassure where it is possible.

Anger: Many people are angry at being ill. They can become hostile, paranoid and accusatory. Check for neurological issues or substance abuse, a major contributor to anger/violence. Best practices for managing angry patients are: First, prevent them from hurting themselves. Second: minimize conflicts which helps patients retain a sense of control

Third: Acknowledge anger and concerns (this is customer service type stuff)

We are also learning about a whole host of personality traits that come out with illness:

Dependant personality: these patients have fears of abandonment, lookout for unrealistic expectations of unlimited care. They may be disappointed or frustrated when something inevitably falls short of their expectations, can be demanding.

Use:

Gentle limit setting

Token compensation - trade a "tip" for good behavior or more patience

Consistency - dependent patients do better with a consistent predictable hospital visit.

Controlled personality traits: these patients are highly orderly and conscientious, need to have as much information as possible, and are heavy on the minute details. Taken to a compulsive degree they can become oppositional.

Use:

Logical explanations, they respond well from being participatory in their care. These patients can be gratified by acknowledging their exact natures "I can see you are discerning and intelligent, how would you best prefer to be informed regarding the nature of your test results?"

Self-dramatizing: naturally magnetic, charming people, long on emotion, short on specific detail. Overly familiar, needing to feel "special". Patients tend to deny the severity of their conditions.

Use:

Tread the line between the familiar and reserved, make them feel special.

Long-suffering: usually have a lifelong history of suffering, self sacrificing relationships, feel as burdens to others, appear modest and humble, and want love and acceptance but feel they may not deserve it. They view their condition as much deserved, beneath the self-flagellation look for attempts at attention and control.

Use:

Acknowledge the suffering! Acknowledge the suffering! Place the suffering in the context of all they do for others.

Suspicious traits: distrustful of doctors/nurses, tests. Somewhere on the paranoid spectrum, fear becoming exploited. Being sick and vulnerable can be a crisis because it lowers their defenses. Openly suspicious and critical.

Use:

Detailed information, including risks and benefits. Do not try and dispel their paranoia, that will only reinforce it. They are looking the "gotcha", acknowledge their concerns!

Superior personality traits: Patients can be self-important, self-centered, condescending. Look for it to be cloaked with a "patronizing false humility". They demand the best specialists, frequently engage in splitting - idealize one person while castigating another

Use:

Realize the narcissism protects them from realizing their own fragility and dependence. Inquire about the accomplishments, emphasize your own expertise and demonstrate self confidence, they need to believe they are receiving the best.

Aloof personality: Unemotional, reserved, indifferent, distant, detached, unconcerned. Look for avoidance of eye contact. Can be odd, extraordinarily concerned with either dietary habits or hyper-religious.

Use:

Respect the need for privacy!! Mirror their detachment by displaying a tempered interest. Don't try and be friendly or you will be appear intrusive and the patient will withdraw further.

Its all sales, everywhere I go, I see the same thing- our motivations are suprisingly similar. Whether you're trying to sell cutlery, booze, personal training, ketchup, or medical opinions - people all want the same two things: to be loved and to have control.

I like this

This is the best brain buster I have ever heard...

There are 1,001 envelopes before you. All of them are filled with a harmless powder, except for one which is filled with deadly anthrax. You must locate this envelope. You have only ten live mice that can be used to sample the powder from the envelopes. However the anthrax toxin will take the whole night to kill any mouse that samples it, thus you must figure out a way to use the mice tonight, there is not enough time to wait for one to die before using another. There is enough powder in each envelope for any mouse to sample any number of envelopes. How can you find the envelope containing the anthrax by the morning? Think hard, the post office is counting on you.

I couldn't get this, but when I found out the answer I started laughing aloud because it was so beautifully easy - that solution -whoever thought of it - that is the truest form of intelligence, I find the solution gorgeous. I just didn't have the perspective to see it - its funny about how perspective changes the experience. WHAT AM I NOT GETTING??!! :)

Types of pain

Just got back from a run, very tough really was able to push it today, had a funny thought about nature of pain. I learned in lecture that pain is divided into the actual physical stimulus and the emotional interpretation of that sensation. Also, that my body's opioid receptors primarily act to moderate the emotional aspect of pain, not so much the blunting of the negative physical sensation. How paradoxical that one could theoretically be in pain but not "feel it" because of the cortical emotional interpretation that says "this doesn't matter". This afternoon I experienced a beta-endorphin release after my run, and my body's natural receptors for these ligands were stimulated in response to the physiological stress of the cardiovascular demand from my run. My emotional experience was euphoric despite the fact that my body actually hurt which is interesting because its seemed the primary function was not to remove the physical pain of my lactic acidosis and and shortness of breath, but to alter my perception, and you know what? I felt flippin great despite being sore and tired. It could be that in the context of a painful stimulus, the cortex may interpret this as "necessary to survival" and so a more direct way of persevering despite pain generating actions (which is a bellwether for tissue damage) is not deadening nociception at the extremity but instead altering the conscious perception by creating a positive emotional reaction to it. Could be the basis for the old saying "hurt so good", but soon after experiencing joy while in pain because of the molecular shell game played by my opioid receptors it dawned on me the power an opioid addiction must have over its host. You take this exogenous substance (heroin, morphine, codeine, hydrocodone) and you start tapping those receptors and experiencing intense emotional highs (technically undeservedly because you haven't outrun any lions so to speak) meanwhile your life slowly goes to pot. But everytime you take the drug your body's receptors don't know that its being stimulated by something external, and those wise old opioid receptors that the brain trusts start whispering to your cortex, "its ok, its ok this pain is necessary for survival, your doing great. How can I be so sure? I know this because I'm being activated, if I wasn't, I wouldn't be able to tell you this... keep going the pain doesn't matter" And ultimately therein lies the rub with addiction and most other things in life - there is no free lunch! Not in physics, not in chemistry, not in economics, and not in biology. Ultimately, its not a real high (real meaning helpful to you and your cause) unless you bought it with blood sweat and tears (i.e. - just escaped with your life, real hard run, worked real hard, got the payoff). So I'm left wondering if you can override those false stimulations with a Zen like top down cortical mandate which would essentially be like saying, "no no - i know the pill is a lying - i didn't earn this high, it was brought to me falsely therefore I wont perceive it, its not helping me survive." But I don't think this is possible because that seems like a quite a cognitive circus trick - blocking the opioid action using some type of preemptive frontal cortex inhibition - I doubt if the wiring is even there for that.

P&S Rugby 2009

no time to write...

very busy,

but check it out>>>>!!!!

hot off the press

immunology is an exploding field right now because:

-much of pathology is traced back to improper immune function

-research protocols are clean, effective, and yield great results

-genetics are very much behind the etiology of automimmune

-rational drug development for the immune system has less hurdles than other systems because many treatments can be effected from the bloodstream without having to access difficult tissues and spaces

med school has picked up the pace, there is not time to both write and read...

Poem

I found a book of poetry on the mailroom floor. I opened it randomly and read the first poem as I rode up the elevator. It reached me, so here it is...

The happy ones are almost always also vulgar;

happiness has a way of thinking

that's rushed and has no time to look

but keeps on moving, compact and manic,

with contempt in passing for the dying:

Get on with your life, come on, buck up!

Those stilled by pain don't mix:

with the cheerful, self-assured runners

but with those who walk at the same slow pace.

If one wheel locks and the other's turning

the turning one doesn't stop turning

but goes as far as it can, dragging the other

in a poor, skewed race until the cart

either comes to a halt of falls apart

-Patrizia Cavalli

Officer v Gentleman

A prominent law professor was arrested the other day. He is black, the cop is white. The story has captivated many in the nation because it is so rich with content. I will add my opinion now (everyone else is doing it).

If you have been living under a rock for the last month- Here are the details

This story is interesting to me because it appears to be a modern day recapitulation of race relations during the civil rights era. But there is something inherently positive about this event (I'll explain) if we seek to understand each party and not find fault.

Gimme a...

White cop: Hard nosed blue collar white guy from the Boston area. Probably honest, but sees the world in binary (good/bad), and uses cognitive shortcuts in order to be a successful cop.

Black professor: Well educated, a professor of law at a world class institution. Highly prestigious and intellectual, nevertheless protected from most of the bad in this country by the ivory tower.

Here is my take. Both are at fault. Could the professor have acted in a way so as not to be arrested? Yes. Should he have been arrested despite his behavior? No. This encounter seems to have triggered the worst in both of these respectable people, both pillars of society, and I'm speculating here, but what got both of them heated was the fear of what each one of them represents to the other. Once they reacted to each others role in society- KA-BOOM!!!- national news

I'm going to take some creative liberty, but here are the characters' motivations.

White guy

First the white guy. Maybe he comes from a blue collar background. Many times I have seen people and communities in lower socioeconomic status area tending to be more segregated, whites keep with whites, blacks with blacks, latinos with latinos and so on. I experienced this growing up in my hometown and later on in the working world. And so maybe the cop comes from a police family, a modest background and he is used to being around mostly white people, probably he is exposed to bigots within his own race. Its not an easy world, and people don't go into law enforcement for the money so life gets stressful sometimes. Add to that, in Cambridge lies Harvard, an institution of great wealth, elitism, and status. In the minds of many Harvard = wealth, status, and power, things most will never have, himself included. So maybe there is some resentment between a civil servant and this huge institution that excludes his kind, and moreover he is conservative and the ivy league school is criticized by conservatives for being liberal, privileged, and insulated - read- entitled.

Black guy

Now the black guy. He's a bit older. Maybe his parents saw it through the worst of the civil rights movement. He's old enough to probably even remember some of the injustices personally. In fact he's experienced a lot of injustice in his life because he's black. Despite the racism, he rose above it, he soldiered on because he was smart and persevered. He's a law professor so he deals in arguments. He is facile with words and logic, and in time he is embraced by an institution that is relatively free of institutional racism (ivy league school). Despite having "arrived" at the top of his profession as it were, the memory remains, the memory of the civil rights movement, especially the memory of the negative role law enforcement played during that time. So even as far has he has risen, and though he can function in an unbiased way professionally (part of the reason law attracted him in the first place) he is still human. He still has an unconscious mistrust for law enforcement.

Scene:

At the house, they are looking at one another. It must have been a strange encounter. Two people who never would have otherwise crossed paths in life forced to interact with each other on what would soon become a national stage.

Remember playing with magnets as a kid? Did you ever try to find that distance between them where the force of attraction increases exponentially and overwhelms them both and snaps them together. Thats what I think happened. There were on the brink and parting company, it was almost a non-event. Then something happened. Only those two know what happened. It could have been a look, or word, or an intonation, so much of communication is nonverbal, I wonder what triggered it. But when it did you had both people acting out their scripts. The man of letters and argument - using his "power" against him, words and status as a weapon. Lashing him verbally, full of memories of the bad white cops of the past. This triggered the cop, I work all this hard, I actually protect you, and this is the thanks I get, thats it I'm using my "power" against you - I'm arresting you.

End scene.

The media reports the story, and the flood gates are opened. Is there racism in America? Yes, of course. Ironically, probably not in this instance. I don't believe the learned professor was arrested because he was black, I believe he was arrested because his words rightly or wrongly injured the cop, and the cop retaliated.

I believe this event presents us with the a great opportunity to move race relations forward. Enter Obama. See, this is what I like about Obama, he's canny. I think by virtue of being biracial he's equipped to psychologically undertake both perspectives. Whatever identity struggles he went through as a biracial youth have paid massive dividends, he is a race relations C3PO, fluent in both black and white perspectives. He invites both guys to the White House to have a beer and bury the hatchet. Awesome! This is how problems should be solved, open and honest communication. Not endless lawsuits and arrests. What do you think the two guys could learn about each other? This "beer at the White House" should be the slogan for learning about our differences. I hope both sit down and honestly say what was in their hearts that day. It would take a lot of courage but it would help us all to know, and it would forward the country. This country is changing so rapidly that who knows where we'll be in 20 years, but if we jump on these opportunities to learn about each other on level ground, we make the world a better place for our children, which is the only population available for the future. The opportunity to set an example of forgiveness and understanding is right on the table, it could be an historical event. This incident, as incendiary at it seems on face value, could actually metamorphose into a blessing. I hope it does.

P.S. - you know what i've observed that is good for race relations? education and solid homes. i have observed that people of different races are more likely to be actual friends (that means call you up and hang out outside of school/work/locker room/etc) when both parties are more educated or have solid family structures, stable home, money, food etc... Not exactly a groundbreaking observation, but isn't it funny how our backgrounds sometimes give us away??

Blind taste test.

It seems the more things change, the more they stay the same.

Check this out. Here is a new drug up for approval. It is called tesofensine, and it is seeking FDA approval by a Danish pharmaceutical concern NeuroSearch (NEUSF). The drug initially began as a potential Alzheimer's or Parkinson's treatment. Soon it came to light that tesofensine wasn't doing much for these diseases, but oddly enough resulted in significant weight loss and elevated mood. NeuroSearch next changed the application and sought approval for tesofensine as an anti-obesity, possibly anti-depressant treatment. The mechanism of action of this molecule is a CNS biogenic amine reuptake inhibitor (serotonin, norepinephrine, dopamine). 5 bucks to anyone who can name the most famous biogenic amine reuptake inhbitor of all time?

Say hello to my little friend:

Get it yet?

Here is tesofensine:

It seems tesofensine bears an uncanny resemblance to its more infamous South American cousin, cocaine, aka, snow, blow, yeyo!, aka Bolivian marching powder, aka candy cane, or Bernie's gold dust, that renowned alkaloid of the coca plant. Look at the similarity in these two molecules, they are basically the same, the functional groups are the same, with the exception of tesofensine being maybe a little more lipid soluble w/o the ester linkages in the R groups coming off the ring, so I'd be willing to bet it crosses the BBB and has greater CNS availability.

Isn't it funny that a "legitimate" pharmaceutical concern is seeking approval of an analogue of the most famous weight loss anti-depressant molecule of all time?? People lost weight on tesofensine? I don't believe it!! Jeez, why don't we just legalize and regulate cocaine already?

1. more tax $$

2. less prison time for everyone, (save $$)

3. demystify it for the youth so they can see it for what it is

4. put cartels out of business saving $$$ from drug war

$

$$$

$$$$$$

$$$$$$$$

get it? thats what its apparently all about

$$$$

Epilogue

A quick web search uncovered the tesofensine direct consumer marketing campaign:

UPS worker shot in cold blood

UPS shooting

This is a tragedy, the delivery man shot in cold blood, during work, at 10 AM. The incident is the next heart-breaking installment of what has been an ultra violent summer here in northern Illinois. As the article indicates, they have one suspect in custody, and are looking for the second. This story troubled me because it brought out a side of myself that I normally don't experience. I thought, what if this had happened to one of my loved ones??? Would I be consumed with anger? Thoughts of revenge? Would I be occupied with thoughts about getting my own justice?? The answer was an overwhelming yes.

I know the old adage an eye for an eye, tooth for a tooth, leaves everyone blind and toothless, and I'm read up on the reasons for/against the death penalty - but when the rubber hits the road of a human tragedy, I don't care, I totally understand why families of victims go for the death penalty. If someone intentionally, and in cold blood critically maimed/killed one of my family members - I think I just might find the needed release in dispatching the killer into the next world myself. Strong words I know, especially since I'm a medical student, oh well, at least I'm not in it for the $$$. Lets see, maybe the killer expresses remorse, thats one thing, remorse if forgivable. But what if the killer doesn't express remorse? What is right? What's the ultimate utility of taking another life? Aside from possible benefits to society by deterrence, reduction in the tax burden yada yada. What is the utility to the victim for taking the life of the killer? Thats the question I would try to answer.

State tax info

The following states have no state income tax for individuals:

Alaska - no sales tax either- the state is completely run on petroleum industry revenues

Florida - the state sales tax is between 6.5 - 7.0% depending on your county, no tax on food or prescription drugs (Rx)

Nevada - sales tax between 6.5 - 7.75% depending on your county, no tax on food, Rx

South Dakota - state sales tax 4% everywhere you go! No tax on food/Rx

Texas - state sales tax is 6.25%, no tax on food/Rx

Washington - state sales tax, 6.25%, no food, Rx taxes!

Wyoming - state sales tax is 4%, except if you're buying food, Rx- then there is no tax.

Special mentions go to:

Arizona - 4.54% for incomes >150K

Colorado - 4.63% of Federal taxable income

Connecticut - 5.0% I was surprised by this, compared to its northeast neighbors, its a steal.

Illinois at 3%, but I happen to know that its being raised to 5% next year, there is a huge budget deficit in my home state.

New Mexico - 4.9%

North Dakota - 3.81%>82K, 4.42%>171K, 4.86%>372K

Pennsylvania - 3% flat, not bad.

Utah - 5%

And the most tax oppressive states in the union? Check this out:

Hawaii State income tax: Income >150K 10-11%!!!!!!!!!

Think life will be better in Oregon? Income>175K, Oregon state income tax a whopping 11%!!!!!!!!

30 years old

Its my thirtieth birthday, and I had this big plan to write about my life so far. To take some time to engage in guided reflection because turning thirty is a supposed to be a milestone or something like that. To tell you the truth, there are a hundred other things I'd rather be doing right now... (studying micro/pharm/path for next year, going over my flight plan and practicing touch and goes, reading the PDLI quarterly report, shooting free throws, doing the xhtml tutorial, exercise, cleaning up my garden, sending the water sample to the lab, planning my orientation group or the rugby schedule, shadowing physicians, calling my girlfriend, reading that folder of articles on cognitive enhancement, playing with my friends' kids, playing piano/guitar, planning a trip on the cheap, thinking of how to start a new business, chatting with loved ones about their lives, laughing, learning, understanding!!!) so I guess thats the message at this point- the most rewarding feeling is productive activity, to be doing something -living. I'm so thankful for my thirty years of life and health. Moreover, I realize that you can't fit it all in, you have to sacrifice good things, there's only so much time, get busy living, use it wisely.

Gotta run!

Adventures in medical malpractice...

FYI - EMTALA the emergency medical treatment active labor act - passed in 1986 is essentially says:

"Any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination" to determine if he is suffering from an "emergency medical condition". If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute's directives." - regardless of ability to pay/insurance. 

Here are EMTALA ramifications for individual physician liability. The following are a couple of cases that have set precedents that have guided practice protocols.

If the patient is erroneously diagnosed, and the physician mistakenly believes that he does not have an "emergency medical condition", when in fact he does, several courts have held that [EMTALA] does not apply to that case. Urban v. King, 834 F Supp 1328 (1993). There could, of course, be a claim for professional negligence for failure to make a diagnosis under State malpractice law in this situation.

The court in Jones v. Wake County Hospital System, Inc., 786 F.Supp. 538 (E.D.N.C. 1991) stated that EMTALA requires only that a medical screening procedure be established and that it be followed in every case, without regard to ability to pay, and that EMTALA is not violated even if the screening procedure is insufficient under state malpractice law.

Some of the cases have suggested otherwise, however. There was a brief mention in Deberry v. Sherman Hospital Association, 741 F. Supp. 1302 (N.D. Ill.1990), to the effect that a hospital could be found to be in violation of EMTALA for failure to diagnose an emergency medical condition through an inadequate screening procedure. This principle is at least implicitly recognized in other cases as well. See, for example, Power v. Arlington Hospital, 42 F3d 851 (4th Cir 1994) (failure to order CBC, leading to missed diagnosis of sepsis).

The most prominent case on this point is Summers v. Baptist Medical Center of Arkadelphia, 69 F.3d 902 (8th Cir. 1995), rev on reh en banc 91 F.3d 1132 (1996). In that case, an examination of a patient who had fallen from a tree stand while hunting was allegedly incomplete because a chest x-ray had not been included when a set of spinal x-rays was ordered. The physician did not believe that the patient had any fractures, and discharged him home, with instructions. There was no transfer to another facility involved. The patient presented at another hospital two days later, and he was diagnosed with an acute comminuted vertebral fracture, a sternal fracture, and bilateral hemopneumothoraces secondary to untreated rib fractures.

This is a great video!!!!!

Thanks keonepax!!

Tchaikovsky = ridiculously good

I don't know what it is about classical music, it just hits me in a way that says- anything is possible.

Just dream it, and figure it out. It makes me feel incredibly small on one hand (true) but paradoxically;

Free to try whatever, you know just because something has always been a certain way, it doesn't mean

that it always will. A pioneer knows this implicitly,

There has to be a vision, who ever thought of anything thats in existence, just do it already right?

Big Mac, combustion engine, PCR, foam hands, MBA's, Batman, just think of something and do it already!!!

Can you imagine how the time passes? We sit around unaware, heaven forbid watching television, when

its right there, these guys figured it out. I'll bet they only cared about music and maybe

one other thing! How nice, these were real McCoys, not given to materialism or greed, or

fame (maybe I'm romanticizing) but my schema of who these people are as interpreted

through their music fits my philosophy- when you put out quality, its not with $$$ in mind,

its above that

Take Bach, Jesu, joy of man's desirin, my current favorite, who do you think he was

talking to with this one? The big kahuna on the next floor up? I'll bet he didn't write it with the charts

in mind. Thats why 400 hundred years later he lives on and his spirit (as conveyed by

his choice of notes) reaches people in the future and who knows where, long after we're 

dead and gone?

he couldn't have possibly foreseen his music playing in little magic boxes called PC's and ipods

on the "internet", known to pretty much everyone.

do you think he would have cared how he would be viewed today? i don't,

hence he tapped that paradox of getting only when you no longer want, succeeding

when you're TRULY ready to fail, feel pain; freedom when you accept the truth, he tapped those 

timeless wisdom mcnuggets rather nicely

bach, beethoven, mozart

i hear you loud and clear, find that higher calling, that thing that makes the world a

beautiful place (depsite mexican gangland decapitations, wars in iran, cancer, fear etc...),

tchaikovsky- i hear you man - just give me time to do the work, where did you find the strength

to get up every morning and really truly say, i don't care what happens, this is all i can do.

i've done all i can do.

i'm telling you i'm getting it, i'm starting to understand, i'm starting to 'get it'

and if nothing excites me??? than i'm just a big

softy in my latter day couch potato culture, taking my chances, blowing in the wind

fattened for the...

what is with this formatting

Learning insight

Here

Activity in the right frontal cortex prior to the "aha" sensation.

Gamma wave mainly from the right hemisphere.

This is where its at, i love this topic

Learning Photoshop

In my effort to learn photoshop I present my first try; a tribute one of my favorite chemists, and my favorite quote of his. I'm ok on the rainbow gradients.

ahem - after further review he could not have possibly been my favorite chemist because he was not a chemist. hahahaha!

I don't remember hearin about this?

Irish pork crisis of 2008

A real lottery ticket

The latest candidate for Werner Sombart's creative destruction

Scene, cut to: Neighborhood grocer

Last night the groceries came to this many dollars and $.04 - "hold on let me see if I have four cents I said..." Nope, take it out of the twenty." Oh darn, I hate when this happens - now I carry around 96 cents. What can I do with this? Well, I could buy a share and a half of GM now. I'm all for second chances and reinventing the self etc which is exactly what GM has to do if it wants to survive. Why not take a chance its cheap and the change was just going to sit in my pocket. Imagine that you can purchase shares in an American institution now for pocket change... What does that say? How the mighty have fallen, we are truly witnessing history. Times will be tough for GM during their day of reckoning - and they have been humbled, but that doesn't mean its over... 

ps- i forgot, there's just one more thing. the taxpayer bailed out GM to the tune of $20 billion. the government is not in the private equity business and really has no place doing distressed buyouts- now GM is bankrupt - i wonder where all that money went, physically- where is it? just the latest example of government passing on the losses to the taxpayer

Right rudder

I am beginning to enjoy my preflight inspection. It has become a true ritual; a slow methodical pouring over of every inch of the aircraft. It is satisfying to get to know your plane, cataloguing every little scuff, flap actuator pin, rudder cable etc... On the third day I practiced liftoffs. Clean (no flaps) liftoff speed for the Cessna 172 is around 60 knots. Basically after you announce your takeoff intentions, you firewall the throttle (take about three seconds to go from open an 1/8" to full), and head down the runway. Pull back on the yoke to rotate (means pull nose up). You have to use a firm pressure on the yoke at the initial liftoff, shortly into the ascent the pressure breaks on the yoke and you can let it forward a bit. I learned that you have to jam the right rudder basically the whole time during the takeoff. "Why?" I asked. American made propellors turn clockwise from the perspective of the cockpit. The downswing of the propellor produces more thrust than the upswing which pulls the aircraft to the right. In order to keep a straight course you have to balance your thrust so having the right rudder out creates a yawing force to the opposite side  equalizing the increased thrust. Interestingly, British aircraft have propellors that turn in the opposite direction, so if you step on the right rudder during takeoff in one of these planes you will taxi off the runway.

I practiced takeoffs, straight and level flight, ascent, ascent while turning, constant speed descents and descents while turning. I have a tendency to watch the gauges (heading and vertical speed indicator) a little too much, and should use the horizon and engine noise to determine my power, pitch, and attitude. I'm just trying to get the feel of what happens to the gauges when I do pull back throttle, decrease angle of attack etc... 

After takeoff or when you want to land you have to fly the pattern. This consists flying in a circle composed of roughly of four legs. Depending on the winds all traffic usually goes through the runway with a particular directional orientation. Poplar grove has two runways 27 and 30 for 270 and 300 degrees (orientation of the runway). Airport runways are laid out so that the most frequent winds are head-on to the runway. This is determined by a wind rose. Check it out, here is the wind rose for  One always wants to takeoff and and land into the wind, but cruise with a tailwind. 

This shows the strength and frequency of the winds on an annual basis, so it makes sense for airports to consult this when picking an orientation for the runways. Anyway you can google this for the details but basically the faster winds are toward the ends of the radials, and the larger the bar the more frequently the winds are out of that direction (a southernly wind means that its coming from the south, NOT heading south). 

So back to the pattern- you takeoff into the headwind and turn left (normally most patterns are left turning, it is easier for the pilot to see when turning to the side that he's sitting on). After you turn left you are on the crosswind leg, then turn left again and you are parallel with the runway but heading downwind (meaning you have a tailwind). Next you make a left and this the base leg. If you make another left you've come full circle and are now on the approach leg heading upwind toward the runway. It is customary to enter the pattern on the downwind leg, and depart the pattern from the upwind. You have to enter the pattern at the proper altitude as well because you don't want to come in on top of someone, pattern altitude at Poplar Grove is a thousand feet above ground. Or 1,858 feet on the altimeter, because poplar grove is at an altitude of 858' above sea level. Announce you entry and final approach. 

Finally, there are different types of aviation gasoline (AVGAS). They are normally color coded by octane. You can go up in performance but never put a lower rated fuel into your engine because lower rated fuels combust at lower pressures and this could cause inefficient combustion and excessive engine heating. The C-172 takes 100LL (low lead). As of this entry, the cost of fuel is $3.85 a gallon, and we go through about 6 gallons during an hour of flight. 

Takeoff is cool, but for me I will not be happy until I can land the thing myself. Because from my current vantage point I can see that anyone can takeoff but landing is the proper closure, is more of an art and requires skill.  

 

Can you feel the g's?

Let me ask you something. When is the last time you operated a car that was built in 1968? Would you depend on that 40 year old transmission to take you to where you need to go on a road trip? I guess I would have to now answer yes. Because in a similar way, I depended on the wings of a 40 year old Cessna 172 to not fall off in the middle of my first flight as a student pilot. My father, doubling as my flight instructor, saying "Oh they make planes much better than they make cars, don't worry." It was my first real lesson about flight. After you have done your pre-flight check and have diligently assessed the avionics, ailerons, and elevator trim and have lifted off the ground, it is of no real use to then start questioning the structural integrity of the aircraft. I confess that for the first half hour I was doing this. But eventually previous experience kicked in, and I decided to submit to the notion that those things were out of my control and no longer worried about the propellor snapping off. What a metaphor for life! 

Interesting thing about the propellors not working, we were at 5,000 feet level flight. My father reaches for the throttle and pulls it back (off), the propellor stops turning. I look at him and ask, why would you do that? It was the best way to prove to someone that if you lose power you wont just fall out of the sky (we had debated this fact earlier). Actually it was quite nice without the engine, we just sat there both staring forward, cruising quietly through the earth's gorgeous atmosphere, two descendants of the great apes in a metal box impersonating a bird thousands of feet above the ground sailing into the great blue yonder. So if it ever happens don't flip out. The glide ratio is how far you can get as you lose altitude. 20/1 glide ratio for perfect conditions in the 172 means that if I'm 5,280 ft (statute mile), I could technically get 20 miles for an emergency landing. However wind changes this dramatically. 80 knots is the glide speed that maxes out the glide ratio so adjust the yoke and trim accordingly, AFTER first completing the emergency checklist.

I noticed that it is better to be aware of heading, airspeed, weather, and most importantly where you are on the sectional chart! Because when you have to land, you not only have to remember in which direction the airport is, but you have to find it! 

The elevator trim is my friend and makes life much easier, it does away with the need of keeping constant force on the yoke. After setting a climb angle use it to set the yoke. 

I also learned to read the weather reports called METARs, meteorological report. Use this weather service

It will give you a report like this:

KRFD 272254Z 33008KT 8SM OVC008 14/13 A2971 RMK AO2 CIG 005V010 SLP058 T01440133

The first piece:

KRFD

K stands for contiguous United States, I have no idea why the K. RFD is the airport identifier (not code) We actually fly out of poplar grove airport C77, it is uncontrolled (no tower), but we use the Rockford forecasts.

272254Z

The date and time. 27 is the 27th of May at 22:54 zulu (Greenwich mean-time), minus five hours for CST during daylight savings, the time is 5:54 pm the time of the last update. 

33008KT

Winds. 0/360 degrees is north, 90 degrees is east, 180 is south, 270 is west. So here winds are out of 330 or 30 degrees West of North at 8 knots (nautical miles per hour). A nautical mile is 6,075 feet as opposed to 5,280 (statute mile). A nautical mile is one minute of latitude (the distance between north and south pole being 180 degrees). If one degree of latitude has 60 minutes or 60 nautical miles, what is the circumference of the earth?

8SM OVC008

Visibility is 8 statute miles or 8SM. Clouds are overcast at 800 feet or OVC008. If it were 8000 it would have been 080. 80,000 ft is represented as 800, just drop the last two zeroes. 

14/13 A2971

Temperature, dew point, and pressure. 14 degrees celsius, dew point 13 degrees. Set the altimeter to 29.71, thats inches of mercury, one atmosphere being 29.92 inches. As you can tell we are dealing with slightly high pressure. 

RMK AO2 CIG 005V010 SLP058 T01440133

Remarks - AO2 means automatic machine did the reading that can discriminate precipitation (AO1 can't).  CIG variable ceiling from 500 to 1,000 feet. SLP - sea level pressure 058, its in milibars or Pascals 1013.25mbar is one atm, 058 means you dropped the 1-0-1, so pressure is 1010.58. The last is measure is the exact temp and dew point - 14.40 degrees C, and 13.3 degrees C.

You can check the weather anywhere at anytime, it really is a modern marvel. Can you imagine how much riskier things were before this weather service? We are panzies compared to older times.

One time during a turn we banked at 45 degrees, it was a two g turn, it was pretty cool. He looked over and asked, "can you feel the g's?". I wanted to say, "maybe we should ask the wings..."

That was the first day.

On the second day, it was a bit windy. We drove out to the airport anyway, it was such a beautiful day, the only cloud cover was broken at 10,000 feet. The sun was glaring and bright. It was just a little too windy, 16 knots gusting to 21 knots. We called it, not today. We walked back to the car, I was staring at the sky. My father says to me, this is good that this happened, many times you will be tempted to ignore reasons that ground you. But remember, "it is better to be on the ground wishing you were in the sky, than in the sky wishing you were on the ground."  It was a good lesson.

Here is what medical school is like to me.

Here is a montage I made of things you learn in the first year of medical school. The are selected power point slides and lecture excerpts. I think its cute, please enjoy...

Oh its there trust me, cAMP is everywhere, you just can't see it.

cAMP is a VERY important molecule. Here it is: 

This thing is arguably as important as ATP its more hot-headed relative - but look at the trans-phosphodiester bond between C3 and C4, that thing creates significant instability. And so we learned that cAMP binds PKA (protein kinase A) and other intracellular proteins activating them motivating them regulating them. If ATP is your rich uncle that pays for everything, cAMP is the unstable motivational speaker of the subcellular world, it binds inactive enzymes and "animates" them. If you are like me and drink coffee, you would care about all this because the psychostimulant caffeine inhibits phosphodiesterase, the enzyme that breaks the 4' phosphoester bond in cAMP. Thus caffeine indirectly raises cAMP inside the cell, something called disinhibition. 

Here is a new paper out this month.

There was no way to visualize intracellular cAMP for all of time until someone figured out how to show the molecule bound to PKA. The problem with this technique is that it is slow, takes forever, and cannot capture the momentary changes in cAMP that happen during normal physiology. Until now...

Epac is a cAMP exchange factor, like GAPs and GEFs. This is what they did. They took an adeno virus and added Epac-1 (protein holds cAMP), and also tagged it with YFP (yellow fluorescent protein). Then took specific parts of the brainstem known as pre-Botzinger complex neurons that are very sensitive to cAMP (the mediate respiration). They changed the cellular environment a whole bunch of time with different conditions and captured with on a microscope. 

Here is intracellular cAMP 

Here there is the medulla on slice! How nice! NTS - nucleus of the solitary tract, yup there is CNXII hypoglossal right where is should be. I love neuroanatomy. Pretty neat finding, I bet this will be a lab technique that gets a lot of use.

L. Ron Hubbard

Went to the Scientology Church in times square Friday, they play the orientation film every 15 minutes.

                                                 Enjoy!

I have other things to do right now, but the analysis of this film is pretty straightforward-

establish credibility, reveal no dogma only technical and organizational details replete with jargon, overcome objections, promise guaranteed results, personal testimony from people like you and me (plus Kirstie Alley, Jon Travolta, and Isaac Hayes), and confrontational hard sell at the end. BUY our books- all to the backdrop of high romance cinematic soundscapes.

Pay careful attention to the placement of the actors, dressing and stereotyping, as well as the similarity with Christian imagery (cruciform symbol, church, etc...)  

I can see why this would work they're pretty good, and if you're lonely or suggestable you could be headed to the next org for an audit, not that its a bad thing - if it provides community and support, but  I cant comment on whether thats possible with Scientology... it is easy to be cynical about man made religions being for profit. Also - I love self help gurus, I think there enthusiasm is contagious, but it crosses the line at religion.

ps- i didn't film this

Cover Girl

I'm cooking breakfast and this commercial comes on. Its the latest cover girl commerical, and this time Ellen Degeneres is the model... she looks into the camera and says...

"inner beauty is important, but not nearly as important as outer beauty..."

Ellen, shame on you for selling out, you're whole career was built on the fact that you had very little outer beauty but your wit and humor prevailed. If outer beauty is so important, why don't you show us more of your body? Why are you in a black full pant suit in the commercial? Huh? If outer beauty is so important, lets see some legs honey... You were once a role model in full support of the notion that a women could be successful based on her intellect and observation (inner beauty) without having outer beauty, you were even on TV, an evironment notorious for selecting physical beauty.

What kind of message are you sending to all the girls and women in our culture that are already pathologically obsessed with their physical appearance? How much money did they give you?

Idea

What about a children's book series on basic science laws - physics, biochem, cell? They would be very simple and colorfully illustrated and get across major themes in science - I would personify molecules and even try to interweave life lessons into the subcellular plot - e.g. - take ATP a neurotic type A, always doing something, phosphatases are classically depressed - hence blue, always shutting down cell function, just an idea - but the illustrations and visual representations (colors) would be far more important.

Personify but not anthropomorphize, no faces on the molecule, but suggest personality to,

or completely blend them - the nucleus is an infinitely repeating library, it would remind me of Borges Library of Babel

The nuclear transcription factors might be meek and silent librarians, keepers of the maze. It would be a fun project.

Learning II

Eric Kandel gave the final lecture in our neuroscience course on the topic of learning and memory. In the lecture he described some molecular mechanisms behind the development of long term potentiation.

Here is a very important slide from the lecture. This slide depicts the current leading thought behind how long-term potentiation takes place (LTP). I remember that one time from my childhood, I remember my first plane ride, or the kid who bullied me all thanks to long term potentiation. LTP makes me who I am today. It is responsible for my conscious recall of facts, places, names, etc... Explicit memory. 

Quickly, in the bottom left corner a depolarizing excitatory stimulus activates NMDA receptors. Post synaptic intracellular calcium levels rise, and calcium dependent kinases are activated leading to increased levels of cAMP. The residual calcium makes the neuron more excitable for the time being, but in a short while the unbound intracellular calcium is either pumped out or sequestered, this is short term memory. But how do the big events get registered, the ones I will never forget, first kiss, first football season, first day of high school, college, work etc? Its not too different... Back in the neuron lets say instead of having all that calcium sequestered, the calcium containing neuron is repeatedly stimulated. Now the levels of calcium become so high that the levels of cAMP become elevated. Next in line in this molecular mousetrap is that protein kinase A which finally has the strength to fully dissociate from its regulatory subunit and remain activated. PKA in turn activates MAPK pathway, and the both of them make their merry way into the nucleus. Inside the nucleus (from Latin, nux, kernel, nut or inner part), cAMP response element binding protein or CREB for short is altered by these newly entered enzymes. CREB1 increases transcription and CREB2 decreases transcription of certain genes. CREB2 is silenced, CREB1 is freed and the initiation new protein synthesis can now occur. What are these new "memory" proteins?  New receptors, neuroligins, neurexins, etc... essentially things that make the connection between the two neurons more substantial. 

So Dr. Kandel brought up the interesting point that with new protein synthesis, there are physical changes in the brain when LTP occurs. If for some reason I remembered his talk, his words would have affected my memory, or ultimately the structure of my brain. Yes, the physical structure of my brain is altered, however insignificant, my brain would have weaker or stronger connectivities. Life has taught me that certain instances where my brain has been restructured have been more significant than others if you catch my drift.

Its interesting to speculate on the ramifications of his point because I believe personality is a very subtle and sensitive biological phenomenon. To the extent that aspects of my personality are learned, I have the responsibility to guard and culture my brain's connections in a responsible fashion. Which brings up another interesting point that was made in lecture. Here's another slide:

The slide proposes a mechanism for behavior disorders. I can not tell you how relieved I am that there is a molecular mechanism (pysch needs it badly, talk for another day). In the top row, labeled A, we have schizophrenia. Many are hard at work developing the pathogenesis of this disorder, there is a dopamine, serotonin, glutamate, and now a gene regulation hypothesis. Probably multifactorial, its a way to explain the behavior associated with this disorder. But take in row B there is normal behavior contrasted with that of a behavior associated with PTSD. This would be the first look into a molecular explanation of how a negative behavior is learned, reinforcing on a molecular scale. I'm just spitballing here, but it could be a justification for CBT. 

After lecture I had some questions, I asked:

What about CREB2 -/-?

How do you believe memory and creativity or intelligence overlap?

Why is learning in the critical period (time when a child where everything is easy) different than learning as an adult?

Answers:

CREB2 knockouts display quicker learning but reach a ceiling in their capacity. I gathered that there are too many other moving parts to look for a silver bullet. 

Memory does not map intelligence or creativity very well. He cited an anecdote of an artist who could not add six and six, yet was capable of creating stimulating visual art. I'm beginning to understand that intelligence, and most importantly creativity, is probably some sort of meta-cognitive function. I can't understand how I remember my name, so I'll save explaining why Chopin choose C# minor for another day. 

Learning language, music, mathematics, basically anything, is far easier as a child because the synaptic connections are looser, more susceptible to influence. What a double edged sword! 

Is there a way back? My belief is that there is, it just hasn't been found. The more I listen and learn the more it becomes apparent that we need to increase our appetite for risk. What a pleasure it is to learn of others labors and discoveries, but it is also wonderful to suppose what a breakthrough in that field could do for humanity. Research into subtle phenomena that make us human are poorly represented in animal models. In the name of science we decerebrate cats, inject poison into the veins of primates, and quite literally play God with the genome of mice. All for good reason I'm sure, but are we so much removed? Responsible but experimental and exploratory research should take place on willing and consenting humans. Our understanding of biology will necessitate a greater confrontation of the certain unavoidable truth that we are as much animal as human.

There is no such thing as an overnight success, just a lot of behind the scenes most never saw. I was thinking about this as I walked out the door to class this morning. All the people I pass everyday from the building, security, maintenance etc... if they are savvy, they could easily know so much about a person just by the simple act of observation. They tend to be older so they have experience, they have been here much longer than the students, so they know the type. They see you when you get home on the weekends, or what time you get up in the morning. They see when you come and go, what hours you keep. They can hear your conversations and they know who you keep as friends, or who your dating. They know your study habits, and when you go home or on vacation, they can see if you pack a lot or a little. They could (if they had to) probably make accurate guesses as to your background and how you live, not that they care... Anyway, back to the original point, being that there are no overnight successes, a good life is built brick by brick, right act by right act. So I use these watchful eyes to motivate myself to conduct right act after right act. Thus when I come down to study in the morning, or come back on a weekend sober and walk past them, our eye contact is like a little checkpoint charlie; we both log in each other's memories the characteristics we associate with each other.

the staggering consequences of pride...

i was chatting earlier with some ladies in the nurse practitioner program here at the university... i had been aware for awhile that the np (nurse practioner) program gets you out the door and into the clinic in a third of the time with a little less than half of the debt, none of the liability and hooks you up with a union to boot. not too shabby. you take a small hit on your income, but if you are in it for money please get out because you are ruining the profession. so to all candidate md's interested in primary care on upto anesthesia, why why why do you want to be doctors? tell the truth - is it because of the md? those two letters come at a hefty cost. believe me, i'm stained thoroughly with this sin, i like the thought of being the final authority, of being an md, doing the sign off, stopping the buck etc... but truth be told, deep down in places i don't talk about, its power - i know myself and i know the world enough to know its true. will i actually be the only final authority? the answer is simply, no. even with my md i won't. because increasingly np's are taking over primary care and advancing on other specialties, e.g. - my physical to matriculate into med school was completed by an np.

it makes perfect sense why primary care residencies have dropped off precipitously and will continue to do so, who in their right mind would ever go into primary care with an md when you can do it with an np? four years med school plus three years residency plus a negative $200,000 versus 2.5 years of school no residency and 100K max tuition (fyi np students after attaining their nursing degree pay by credit, go ahead and ask a med student and see if they know that) the only thing that doesn't make sense is why anybody would be surprised by this.

i have observed:

1. first year med students get up later than anyone i have ever met, its atrocious. i see everybody in the house leave in the morning and at what time because i sit right by the front door to my dorm and study every morning starting at 6:30 a.m. where i meet the guard coming on shift and exchange pleasantries and wouldn't you know its the p.t. and nursing students who are normally out by 7:30? a small cadre of md students do the early run, but you can't convince me with the argument that we study late because i've been privy to one of these 1 am study sessions and it can be described by many words but definitely not efficient. plus everybody knows nmda and ampa upregulation (keys to long term potentiation) happens while sleeping - consolidate those memories (on a side note my seven and a half hours of sleep a night in tandem with my tenacious yet seasoned optimism is my proven method for devouring this curriculum)  

2. the cost of med school will easily surpass $200,000, easily. actually tuition alone is $195,000, can i get a troubled med student relief program? as ashamed as i am to admit this i'm almost happy that the government is spending like carter because it probably means carter era inflation, which will discount my exorbitant tuition retrospectively

3. everyone - by this i mean from dean down to fellow first year has indicated that the first year of med school is a wash and fourth year is a vacation - that is the truth, whether you want to hear it or not is up to you. med school should be 3 years and residents should get a raise by about 20%. how much would that cost? medicare pays the bulk of resident salaries - there are 2x10^5 residents in the US today, lets give everyone a 20K raise - total cost 4 billion - a miniscule fraction of the cost of the iraq war, tarp, obama stimulus, bush's stimulus (remember that one), and finally drum roll please... it would be roughly one one-thousandth of the total annual cost in health care in the US, remember health care spending is like 15% of gdp (13 trillion). yes, giving those tired overworked house officers and residents (that keep the hospital going too) across the country a flat 20K raise would be one one-thousandth of the annual spending. and do you know what i would do with it? pay back loans faster, its a joke, so don't worry i couldn't actually "use" it. unless of course we are in a carter ahem i mean obama hyper inflationary phase in which case i would use it to buy food.

4. gross curricular inadequacy (where is nutrition?, where is micro? parasitology? patho? not till second year, if it all, and only briefly, how do i master this in a three/four week block. why is it that n.p.'s do it first year? where is pharm? where is intro to the dealing with the business of pharm? why is there a summer break? we don't need it a summer break. life is to cozy.

5 pervasiveness haughtiness - i have had several conversations with fellow classmates who shall remain nameless that have indicated gross deficit in health economics awareness to the point where i wonder if basic accounting or health economics should be in the curriculum. 

6. the moral hazard of pass/fail system: before the md students here skewer me, i know many have fought and died to bring us this wonderful system, and i know it is the reason i am friends with my fellow classmates as opposed to foes - but the short truth is that its being abused. we all know the universal truth that you get what you pay for in life, and if something is given to you for free you will not respect it, with every right comes a responsibility yada yada, so i am witnessing academic slippage, "i can still pass with a 70", "do we have to know that?", "hey, i still passed" it goes on. the the nonclinical years of med school culminate in usmle step one -thus every nonclinical experience in the first two years should be geared towards that exam, here the tell us not to even worry about it until three months prior-  the slippery slope of the pass/fail system that was initally and mercifully designed to depressurize the hyper competitive type a neurotic, but the cost is apparent - we are losing respect for the material. most want to do well - and most are silent - but the ground beginning to shake.

recommendations

1. md's unionize, i don't care if its illegal - everybody knows justice is for sale in this country, so get the law passed somehow, everyone else in the healthcare sector with the exception of the hospital volunteer is unionized. there needs to be a consolidation in physician leadership and the ama is not cutting it.

2. med school needs to be three years only, the time wasted here in first year is unimaginable, the motivated, cost sensitive should not be punished for the maintenance of an archaic system. it saves money, and would expiditously advance our career.

3. med students wake up! we are losing ground on all fronts. our own self discipline is wanting. our rights are being impinged to greater and greater extent. 

4. residents get a raise and a thank you. i know old timer they didn't have it as bad as you, but guess what they have different problems in this age that are worse than anything you ever went up against - you hours may have been bad, you may have gotten screamed at on a daily basis by the attending - but you may never have practiced defensive medicine, paid outrageous malpractice, sued multiple times, worked for an hmo, were buried in paperwork, or buried in a quarter million dollar education debt. life today is harder because there are a lot more people, more drain on resources, less trust in the world (especially for md's), revolving door of daily appointments, cost of living increases outpacing wages for decades

but despite all that, i still think i got it so good, i love what i'm doing

haaha