Happy Halloween!

One of my co-workers is a Jedi of balloon art. She graciously allowed me to post one of her latest works:

I spend a lot of my work time looking at skeletons, and appreciate the extra details she put into the lumbar spine and sacroiliac joints (as seen from behind).

Grand Rounds - Vol 5, no. 5

This week's edition of Grand Rounds is up, hosted this week by Pallimed, a hospice and palliative medicine blog.

My contribution to this edition concerns the little-known Banjo Center of the Brain, and is listed in the comment section.  Look for "We need a banjo to OR 3 stat!"

Hoedown Throwdown

This short video was posted to YouTube about 10 days ago by mikehoye, who says:

I got off the subway at Bloor and Yonge last night, and this is what I saw; some buskers with a fiddle and a banjo were playing, and these four other guys just started to pop it and lock it, apparently just for the hell of it. It cheered me right up.

Cheered me up too.

Always a Doctor, Even in the Dying of the Light

Medical skill is not commonly associated with writing ability. For that reason, it's always great to find physicians who not only break that stereotype but smash it to pieces.

I'd like to recommend Always a Doctor, Even in the Dying of the Light by Kenneth Weinberg, M.D., an emergency room physician who just wrote about the death of his radiologist father in the New York Times.

I don’t know how he stayed alive so long with blood counts that I, as an emergency physician, associate only with patients at the edge of death; I don’t know why his blood felt cold; and most of all, I don’t know why his dying brought no tears to my eyes.

Was it because after his memorial service, determined to celebrate his life, my brothers and I bought Champagne — and then, at my mother’s request, went into his closet, tried on his old clothes and staged a spontaneous fashion show, causing the assembled wives and grandchildren, and my mother, to laugh for an uproarious hour?

Or was it because he died at home, surrounded by those he loved, in such stark contrast to what I experience so often at work: all of those patients circling the drain on trips between nursing home and emergency room, and then dying alone with no one to feel their blood turn cold?

Thank you for sharing this with us, Dr. Weinberg. Your account moved this radiologist to tears.

(via PalliMed)

The Blind Men and the Elephant and the Donkey

"Blind monks examining an elephant" by Itcho Hanabusa

Anyone doing medical research for more than 20 minutes soon learns that they can get wildly different results depending on just how they slice and dice their data. A wonderful example of this appeared a few days ago in the New York Times. Tommy McCall, former information graphics editor of Money Magazine, poses an intriguing question in his short op ed piece: Bulls, Bears, Donkeys and Elephants:

Since 1929, Republicans and Democrats have each controlled the presidency for nearly 40 years. So which party has been better for American pocketbooks and capitalism as a whole? Well, here’s an experiment: imagine that during these years you had to invest exclusively under either Democratic or Republican administrations. How would you have fared?

His conclusion, summarized in an impressive-looking graphic:

As of Friday, a $10,000 investment in the S.& P. stock market index would have grown to $11,733 if invested under Republican presidents only, although that would be $51,211 if we exclude Herbert Hoover’s presidency during the Great Depression. Invested under Democratic presidents only, $10,000 would have grown to $300,671 at a compound rate of 8.9 percent over nearly 40 years.

The implication is that the stock market has a very strong liberal bias. Your reaction to this is probably either "Oh, shit!!" or "Dude!!", depending on your political orientation. However, don't touch that dial.

An excellent follow-up post by Theodore Gray, co-founder of Mathematica, gives a quite different picture of this data. Gray created a wonderful interactive model to look at the same question, but using the Dow index (1897 - 2008) rather than the S & P. I downloaded it and had a ton of fun playing with it. Using the same assumptions as McCall, his initial model looks very similar:

However, what if one adds some very basic assumptions to the model? For example, many long term investors plow their stock dividends right back into buying more stock. If anything, this makes the Democrats look a lot better:

But wait, there's more.

What if we assume that it takes a while for a new president's policies to take effect? Not an unreasonable assumption, considering that one of the few things with a bigger turning radius than a Humvee or an aircraft carrier is the U.S. economy. What if we allow 12 months for this to happen? What if we also consider the effects of inflation and decide not to blame the whole darned Great Depression on the Republicans? The results now seem to vindicate the red staters:

But wait, there's still more!

And, you can read it in the final paragraph of Gray's article. The ending conclusion is too good to spoil here. I will say that I found it really comforting, considering current market conditions.

I guess that the old Sufi/Jainist/Buddhist/Hindu story of the blind men and the elephant is still just as relevant as ever. I'll leave the last word to American poet John Godfrey Saxe (1816 - 1887), who penned one of the best known versions of this tale. The final stanza of his poem says it all...

So oft in theologic wars,
The disputants, I ween,
Rail on in utter ignorance
Of what each other mean,
And prate about an Elephant
Not one of them has seen!

(via TheZorg)

Grand Rounds - Vol 5, no. 4

Cost-saving automated external defibrillator storage. (A) Vending machine. (B) Advertising box. (figure used with permission)

This week's edition of Grand Rounds is up, hosted this week by the Anesthesioboist.

She groups this week's posts into a movie theme. My contribution, AED Lessons from Japan, appears under the heading of Educational Materials (our section's personal movie theme: Elf).

The Banjo Center of the Brain

I've used my banjo in a number of venues, but I've never brought it in to work. Looks like some Nashville neurosurgeons have beat me to it.

Bluegrass legend Eddie Adcock recently underwent brain surgery to treat a hand tremor. During this procedure, his surgeons placed electrodes deep into his brain to stimulate the thalamus at just the right spot to inhibit his tremor.

Alas, the banjo center of the brain is not an area well-known to neuroanatomists. To pick the optimal location for the electrodes, the surgery was performed under local anesthesia while Eddie played his banjo. He was thus able to update the surgeons in real-time as to whether the tremor was better or worse, letting them get the lead placement just right.


The BBC has posted some remarkable video and audio clips recorded during this surgery. The audio beginning at the 3:49 marker moved me the most. In this bit, the BBC interviewer asks Mr. Adcock to play the banjo with his stimulator on and off. The difference is pretty clear, even to the non-bluegrass ear.

Losing the ability to play is a special terror we musicians know, even for those of us who earn our living some other way. I went through this recently following a biceps tendon repair. The first few months were depressing for me because I couldn't bow my fiddle in my ginormous bionic elbow brace. However, once I was able to drape said brace over my guitar and play a few minutes every day, my spirits picked up considerably.

So, here's to the Vanderbilt neuro boys. There are a lot of musicians and music lovers out there who would happily line up to buy them a few drinks. If it would help us to play like Eddie Adcock, I know that several of us would also line up for our own set of electrodes.

(Hat tip to Anita Anderson)

Master of Understatement

Paul Krugman, economist, Princeton professor, and eloquent op-ed columnist for the New York Times, is also a master of understatement. In his first blog posting this morning, he wrote simply:

A funny thing happened to me this morning …

His initial reaction to the "funny thing":

My immediate conclusion was that was an obviously fake Swedish accent.

Bush's Last 100 Days

As of today, George Bush is down to his final 100 days in office. What will he do with this time? Here are some ideas from his predecessor...

A Gray Slate in '08

After careful consideration of the issues, I've decided which candidate I'm backing on November 4th. No red or blue party for me, I'm voting gray...

A Subprime Primer

If your economic training matches mine (single mandatory college economics course), you may find the following slideshow handy in understanding the current subprime mortgage fiasco.

Caveats:

1. you'll need to view this in "Full Screen" mode to read most of the text
   
2. some of the language is crude, though perhaps not crude enough

Subprime Primer

View SlideShare presentation or Upload your own. (tags: subprime mortgages)

(via Presentation Zen)

Radiologist Steps Down as Head of NIH

Elias A. Zerhouni, M.D. retires as director of the National Institutes of Health (NIH) at the end of this month.

Dr. Zerhouni stands out as being the first radiologist to lead this august organization, and has accomplished quite a bit during his tenure, despite lackluster presidential support. I'm especially proud of his standing up to Bush on stem-cell research.

As reported by Nature News, in his testimony to the Senate in March 2007,

...he said that US science would be better served with access to more stem cell lines. In a competitive world, he told senators, "it is important for us not to fight with one hand tied behind our back here."

The timing of his retirement is interesting, as it takes place about 4 days before the upcoming presidential election. Again from Nature News:

Zerhouni, 57, said that he was leaving before national elections on 4 November so that there would be no question of his lingering into a future administration.

"I felt that it was very important, for the sake of NIH, to not just stay and have the [next president's] transition team think: NIH is taken care of. They have a decent director. Let's focus on other things," he told reporters on a conference call.

I hope that the next president does indeed put a high priority on medical research, and in finding a worthy successor to Dr. Zerhouni.

Easy as Pi

XKCD presents a sextet of intriguing sex positions.

In this context, at least, a natural log is not as natural as one might think...

We See Right Through Your Crap

As a big fan of the Bizarro cartoon and blog, I was pleased to see radiology featured in a recent panel.

This Bizarro cartoon is brought to you by Painful Truth Imaging Company. "We see right through your crap."

Will We Get a Bailout Too?

Great news! A solution has been found to the U.S. healthcare crisis. At least it has according to John McCain:

Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.

Crikey.

I'm going out on a limb here, but I'm guessing that that will work just as well for healthcare as it has for banking lately. And "subprime" healthcare is an innovation I'm not eager to see...

(via Bad Astronomy)

Temper Fugit

"The queen had only one way of settling all difficulties, great or small. 'Off with his head!' she said without even looking around."

-- "Alice's Adventures in Wonderland"

There are certainly interesting political waters roiling around the U.S. these days. Since we're talking about politics, it can be hard to swim clear of the usual boatloads of punditry, rhetoric and demagoguery. However, amongst this noise and turbulence, it's nice to find occasional conservative and liberal islands of calm and rationality. It's especially interesting when some of them seem to be in agreement for a change.

In McCain Loses His Head, George Will recently likened John McCain and his temper to that of the Queen of Hearts, and opines:

Under the pressure of the financial crisis, one presidential candidate is behaving like a flustered rookie playing in a league too high. It is not Barack Obama...

...It is arguable that, because of his inexperience, Obama is not ready for the presidency. It is arguable that McCain, because of his boiling moralism and bottomless reservoir of certitudes, is not suited to the presidency. Unreadiness can be corrected, although perhaps at great cost, by experience. Can a dismaying temperament be fixed?

Another good read is The Choice, an equally thoughtful editorial by the editors of The New Yorker:

...The longer the campaign goes on, the more the issues of personality and character have reflected badly on McCain. Unless appearances are very deceiving, he is impulsive, impatient, self-dramatizing, erratic, and a compulsive risk-taker. These qualities may have contributed to his usefulness as a “maverick” senator. But in a President they would be a menace...

...Although his opponents have tried to attack him as a man of “mere” words, Obama has returned eloquence to its essential place in American politics. The choice between experience and eloquence is a false one––something that Lincoln, out of office after a single term in Congress, proved in his own campaign of political and national renewal...

This sort of bipartisan congruence of opinions is something that I have fantasized about ever since seeing "The Supremes", one of the best episodes ever of The West Wing. The story line therein revolves around an upcoming presidential nomination to the U. S. Supreme Court. The heart of the episode is when an arch-liberal (Glenn Close) and an arch-conservative candidate (William Fichtner) for the nomination meet unexpectedly in the White House. The wonderful conversation that ensues is one of my favorite moments ever on television.

IMHO, it's worth buying the whole 5th season of West Wing just for this one episode. The following YouTube clip captures a tiny bit of the flavor of that episode, albeit with distracting commentary.



This sort of meeting of the minds between smart conservatives and liberals is something the U. S. needs badly. Alas, unlike the TV version, the real U. S. continues to be hampered by the lack of an Emmy award-winning screenwriter to make it all come out right in the end.

Call me Pollyanna, but when George Will and The New Yorker start seeing eye to eye on something, it gives me hope for the coming election. Maybe this time we'll get it right, and get the screenplay, director and cast that the country deserves.

Volvosaurus Rex

Hot car stories usually leave me cold. My own auto needs are fairly utilitarian and pretty well covered by a Subaru Forester, which carries us ably through all kinds of weather and terrain. However, a hot car story involving Paul Newman, David Letterman and Jon Stewart piqued my curiosity enough to make an exception.

If you are likewise intrigued by this cast of characters:

1. Read the following transcript of David Letterman telling the story to Jon Stewart in 1995 (via alt.fan.letterman).
   
   
2. Then watch the YouTube video at the end of the post, in which Letterman adds further juicy details, during a recent Late Show final tribute to Paul Newman.
   
   
3. Finally, check out pictures of the cars themselves on DaddyTypes

Transcript:

STEWART: -- what has been the coolest thing that's happened to you while you've done your show?

LETTERMAN: Well, you know, you'd think being in show business, or as close to it as I've come, you ought to have a lot of cool things happen to you.

STEWART: Sure.

LETTERMAN: And I've thought about this and thought about this, and currently I've distilled it now down to the persona of Paul Newman. I have been lucky enough to meet Paul Newman, and I just want to tell you, this guy is the real deal.

STEWART: Really?

LETTERMAN: He is solid gold, he's a great actor, he's a wonderful guy, and just an interesting fellow. I met him, I don't know, five or six years ago. Some friends introduced me. It was at a race in Phoenix. It was Bobby Rahal, who is a race driver, and his wife Debbie, and now, of course, I sound like Dick Cavett. "Gregory Peck was there as well and Jimmie Stewart," and on and on.

STEWART: And Groucho and all the rest.

LETTERMAN: Yes, sir. And so they introduced me to Paul Newman, and you're carrying on a conversation. "How do you do? I enjoy your popcorn and Cool Hand Luke." That's what you're saying to Paul Newman.

STEWART: Right.

LETTERMAN: In your head all you can hear is this huge voice screaming, "Oh, my God, it's Paul Newman. Oh, my God, it's Paul Newman." So I've been lucky enough to kind of have -- I guess it's a friendship. I won't say we're really good friends, but we have kind of a relationship, and he's called me from time to time. About six months ago -- and this is where it starts to get cool --

STEWART: All right.

LETTERMAN: -- Paul Newman calls up and he says, "Dave," he says, "I'm thinking about getting me a Volvo station wagon, and I'm gonna stuff a Ford 302 V-8 engine into it."

STEWART: Sure.

LETTERMAN: "This engine is about the size of a small piano, so we're going to have to push back the fire wall. Do you want one?" So, you know, I'm thinking a Volvo station wagon looks like something you'd make in metal shop, and if you want something really sporty you get a bakery truck, and every time you see a Volvo station wagon in the back it's three kids getting car sick on a golden retriever, and I'm thinking these cars are so safe because in traffic other motorists slow down to check out how ugly they are.

STEWART: Right, the tank.

LETTERMAN: So intellectually I don't want a Volvo station wagon, but, of course, internally it's Paul Newman, I say, "Yes, I'd like one."

STEWART: "Bring it on."

LETTERMAN: "Paul, let me have that Volvo station wagon."

STEWART: Sure. Me too.

LETTERMAN: So I'm aware of the fact in talking to Paul, he's far more excited about this than I am. He calls up from time to time and he says, "Have you picked out the interior yet?" And I said, "No, I haven't." He said, "Well, you better hurry. The dollar's falling." And I don't know what that means.

STEWART: No, he's very concerned about the world economics.

LETTERMAN: And then he calls up after that and he says, "Good news. Pirelli's gonna give us free tires." "Wow, that's great, Paul." It's Paul Newman. We're getting free tires. I don't know. So he calls two weeks ago, and he says, "Dave, the cars are ready. We got two, one for me, one for you." He says, "Everything is ready to go. I've got to ask you a question. Do you want a puffer on yours?" You know, and I'm thinking, well, is that like a special inflatable seat? I don't know. Like sails on this Volvo? And I said, "Well, Paul, are you getting a puffer on yours?" And Paul says, "Yeah, yeah, I'm getting a puffer on mine." And I said, "You know, I have no idea." And he says, "It's a supercharger. I said, "A supercharger?" He says, "Now you have to be very careful, because with this supercharger this thing will turn about 400 horsepower, so if you pop the clutch you're gonna tear up the rear end." By comparison, a stock showroom Corvette, 300 horsepower.

STEWART: Ouch.

LETTERMAN: I say to Paul, "Now wait a minute. Paul, I have a Volvo station wagon, 400 horsepower?" And he says, "Oh, yeah," he says, "from 20 to a hundred you can chew anybody's ass." And I'm thinking to myself, what circumstance would Paul find himself in driving around in a Volvo station wagon where he feels like he's gotta chew somebody's ass?

(Hoots and applause)

STEWART: I don't know. I can see that's very nice though.

LETTERMAN: A 400 horsepower Volvo station wagon.

STEWART: But when Paul Newman offers you a puffer, I mean, you take it. You don't turn down Paul Newman.

LETTERMAN: You'd be a fool to pass on the puffer.

(via DaddyTypes and Daring Fireball)

AED Lessons from Japan

For some years now, automated external defibrillators (AED) have greatly increased the likelihood of surviving a cardiac arrest in the U.S. In Japan, however, lay usage of AEDs was not authorized until July 2004.

Hideo Mitamura (2008). Public access defibrillation: advances from Japan. Nature Clinical Practice Cardiovascular Medicine DOI:10.1038/ncpcardio1330

This recent article by Hideo Mitamura details some of the societal, legal and attitudinal changes in Japanese society since 2000 that led to this change. The U.S. Federal Aviation Administration seems to have gotten the ball rolling there in 2001, by making AEDs mandatory on all US domestic and international flights (including those of Japan Airlines). The well-publicized 2002 squash court death of Prince Takamodo of the Imperial family probably also played a role. After lay-use AED legalization in 2004, Japan adopted the devices avidly, and is now the second largest market for AEDs after the U.S.

The Japanese AED deployment has included several innovative approaches that would be quite swell to import back to the U.S. My favorite: siting AEDs inside vending machines. Assuming that vending machine users there are just as fanatical as Americans, I'll bet that every Japanese over the age of 6 now knows where to find an AED in a hurry.


Cost-saving automated external defibrillator storage. (A) Vending machine. (B) Advertising box. (figure used with permission)

Another Japanese innovation is to put AED locations on lots of internet maps. Better yet, GPS-equipped cell phones there can now lead their users right to the nearest AED.


(A) Each red dot represents an AED location in Aichi Prefecture. (B) A magnified view showing AEDs (red hearts) within buildings. (C) Display of AED location on the screen of a cellular phone. (figure used with permission)

So, hats off to the Japanese for a fine job in AED adoption. After learning a lot from the early U.S. experiments in AED usage and deployment, they now have a few things to teach us.

200 Years of Electoral Maps

I'm probably as tired as anyone of the flood of red-state / blue-state maps that are currently rising in the pre-election news crescendo. Even so, the fascinating set of interactive maps at 270t0Win.com grabbed my brain for about an hour today.

The site designers have linked a considerable amount of historical information to interactive U.S. maps, which allow one to follow the political fortunes of different parties for the entire presidential history of the U.S. No matter what one's political bent, it's both troubling and comforting to see how quickly this map can change. For example, view this chart, which shows currently blue state of Washington cycling between blue and red every 3 - 5 elections.

Some of these maps are very soothing to eyes weary of red and blue only. It's nice to see a parade from yesteryear of Anti-Federalists, Whigs, National Republicans, Anti-Masonics, and the oxymoronically-named Democratic-Republicans. Then there are all of those troublesome gray staters in the 1864 election...

Although the 2008 election is still a month away, it hasn't been left out. The site includes a very slick election simulator, which will run a Monte Carlo simulation for you while you wait, using the latest polling data. Of the last 1,000 simulations, about 96.2 % of them currently look really good for Obama.

(via Daring Fireball)

Hoist On Their Own Petard

I've always found racial stereotyping rather repugnant. Growing up in the U.S. South, I got plenty of chances to see it in action. Since then, I've learned that the South has no monopoly on this -- I've seen it in every other part of the U.S., and in every other country I've visited.

It's therefore rather delicious to watch a Jedi master of satire like Bill Maher point this type of demagoguery right back the other way at some very deserving targets...



(via BizarroBlog)