Thursday, May 26, 2005

meet george jetson....

the first FAA approved hovercraft (!) will be available in 2009


What's the point of making a comprimise to keep the filibuster in-tact if when it comes time to use the filibuster you decide not to filibuster and allow a nomination/bill to proceed in order to keep the filibuster in-tact?

Wednesday, May 25, 2005

Summer Fun

Summer plans have been shaping up pretty well and were basically finalized after a preliminary meeting with the Department of Health in Tampa yesterday.

1) The VRACS dataset originally discussed is simply not going to work for my dissertation for a number of reasons - starting with the fact that it only kinda belongs to TGH and mostly belongs to some Indian researchers. Furthermore, the sample surveys were half-heartedly designed without adquete sampling theory applied and things are a bit slopply with the data itself. Finally, the sample size is only about 400 people - kinda small for a population based question. Anyway, I wanted things to be clean at every step along the way so that I didn't run into trouble somewhere deep down the line and deep in the summer, thus causing me to pull out and start over again (which is EXACTLY what happened last summer with the NHANES III and NHANES 1999-present series).

2) #1 is okay because things are coming together.
There are 2 models for writing a dissertation with the Michigan Anthro department. One models is traditional - you pick a topic, question, place - you go there, you do field work, you collect data, you come back, analyze data, and write it up. Another model is that you can throw together a string of 3 related published papers regarding some theme/question over a period of time.
Given my plans this summer, and the access I have to other data sets and populations, I believe that the latter may be the model I opt for in completing my dissertation.

3)Apparently the City of Tampa Department of Heath (DOH) is part of Tampa General Hospital and works closely with the Infectious Disease group - which I did not know but now makes total since because they are both public places and both deal with a lot of STD patients. Well, I was excited to learn that my summer contract with Infectious Disease allows me to also work with the DOH - therefore, I have some access to their data, clinic, and populations as well under the direction of Dr. H.
Yesterday, I met with the director, Dr. H and an epidemiologist Dr. G, to discuss the possibility of using an STD dataset collected in Tampa throughout the various DOH clinics. They were agreeble to this plan and had no problem checking this out a little bit. More specifically, we are having a meeting next week with some of the other epidemiologists at DOH regarding the data.

So why is an STD dataset so valuable to me?

4)I will also be working with the Hernando County Health Department with a group of HIV+ and at-risk for HIV adult men in Brooksville. The idea is to meet with social workers and public health officials to develop an education/policy initiative aimed at reducing HIV incidence amongst this population. See a theme developing? I do - and its quite appropriate for an anthropolgy dissertation using this population and the Tampa STD data.

HIV risk factors, socioeconomic status, population of people using Florida DOH clinicis.....its coming together - slowly.

The nice part about this is that a 3 paper model dissertation will allow a focus on the policy/prevention aspect, clinical aspect, and the data analysis of risk factors as well - getting at the problem from both ends (real people and real numbers, population and individual health care). Almost sounds like the kind of dissertation an MD-PhD student interested in population health and clinical care is supposed to be doing!

Mae - 1 Year 11 Weeks

We got Mae 1 year ago - below is a photo taken at her first vet visit on May 19, 2004 and another photo taken on May 22, 2005.

Saturday, May 21, 2005

True Crime - UPDATE

Last week, I posted photos of Steven Lorenzo's home at 213 West Powhatten. If you remember, Lorenzo is the suspect in a series of kidnappings and murders of gay men. The police began searching the house again during the beginning of May but had been tight lipped about what they were looking for specfically and what they had found. However, in a St. Petersburg Times story today, Tampa Police elaborate on the case and the evidence recovered inside the home.

"They found rope, tape, plastic gloves and other "torture-type" items - along with printed pages about serial killers. They found an envelope containing newspaper articles about Galehouse, Wachholtz and "other missing or dead individuals."
They found pictures on Lorenzo's computer of a "lifeless" young man, blood on his face and on the floor beneath him, ligature marks on his wrists and ankles.
Tampa police and Hillsborough sheriff's detectives examined the pictures. So did two medical examiners and a DEA agent. They all agreed: The man was dead when the pictures were taken, in what appears to be Lorenzo's living room and bathroom."

It also looks like Lorenzo had an accomplice, Scott Schweickert, who helped plan and carry out the abductions and murders. Furthermore, there may have been previous attempts before the Galehouse/Wacholtz killings and there may have been victims after those two deaths.

Friday, May 20, 2005

lost links

Other than Gary Payton, Reggie Miller was the last significant link to the era of basketball represented by the late 80s - mid 90s
Gary Payton, Shaquile O'Neal, and Grant Hill are the only remaining NBA players from the 1996 USA Men's Basketball Team, which lost another member to old age last night when Reggie Miller retired after the Pacer's game 6 loss to the Detroit Pistons - scoring 27 points on his way out the door while getting a chance to play one more time on his home court.

In the early 90s, Cliff Hall and I would have epic one-on-one battles in the backyard of his neighbor's home where there was a small, but well kept, basketball net, glass backboard and concrete drive. These battles usually took place during the spring and summer NBA playoffs - cliff was usually Michael Jordan or Scottie Pippen, but I was always Clyde Drexler, Patrick Ewing or Reggie Miller. Every shot was narrated by a pretend Marv Albert and scores were kept with great care in a never-ending Best of X series.

Thursday, May 19, 2005

UPDATE: Highland Avenue Structure

Thanks to the help of readers, I have more information regarding the odd structure on Highland Avenue that was discussed last Tuesday.

Apparently, Bert Wahl owns this building and at one point ran a business "rescuing" and selling big cats, including lions, tigers, and cougars. However, in 1997 the business, Wildlife Rescue Inc., was cited for violating the Animal Welfare Act by the USDA. The inspectors claimed that Mr. Wahl was leaving his cats in poor conditions (which are obvious by the photos I posted previously). Since this was the first offense of Wildlife Rescue and Mr. Wahl, the USDA let him off relatively easy with a $1000 fine and a cease and desist order.

But this wasn't enough for the animal abuser. Bert Wahl continued running an illegal and unlicensed business while keeping his animals (merchandise) in poor conditions and in 2000 he was again cited for violations of the Animal Welfare act by the USDA.

While there are no longer any animals, at least in view, at the premises, Mr. Wahl may still be around the area. After looking his name up on the HC Property Appraiser website, 2 properties were found to belong to him - both in very close proximity.
I walked by the first of these properties and quickly realized that they weren't simply in close proximity - they were directly next to each other!

This is the view from the street in front of the second property -

And this is the view from the side of the house

You can clearly see from these photos that the structure I posted previously is directly behind the other home. Therefore, I assume that Mr. Wahl used (or uses) the yellow home as his residence and once used the brown home to keep the cats and supplies. Now that he can no longer do that, at least in plain view, the structure sits abandoned, dilapidated and falling apart.

An anonymous comment included these links:

title change

i have retitled the blog "a living hominid" to reflect its url and my posting, this way i don't take everything from murakami

no post wednesday

The LCE large group presentation took place yesterday (as discussed here previously) and went off just fine (except for the fact that the neuropathologist was 30 minutes late and his USB drive didn't work - so he had no slides - no biggie though). Afterwards, it was time to rush down to south Tampa to see Alivia's graduation

Oddly enough, I still have fairly vivid memories of my preschool graduation - including the poems we read (polly, the doctor says), the songs we sung (my contry tis of thee was definitely one of them) and counting on stage with Mrs. Chambers. In some ways I have better memories of graduating preschool then high school and college...


Picasa is an excellent digital photo storage management software program complete with one-button photo editing capabilities. Best of all it is ASBSOLUTELY FREE - not shareware either, the full thing. I use it to quickly go through all of my digital camera photos after dumping them onto the computer -its faster and easier then photoshop for getting quick results for large volumes of pictures.
Anyway, it has some fun color temperature/saturation settings as well that allow you to take horrible photos and at least turn them into odd visual experiences.
Here are just a few examples of some bad photos that I salvaged.

Summer Readin'

1. Dream State: Eight Generations of Swamp Lawyers, Conquistadors, Confederate Daughters, Banana Republicans and Other Florida Wildlife. Diane Roberts 2005
2. Kafka on the Shore. Haruki Murakami 2005
3. The World is Flat. Thomas Friedman 2005.
4. Freakonomics: A Rogue Economist Explores the Hidden Side of Everything. 2005.
5. The Ancestor's Tale: A Pilgramage to the Dawn of Evolution. Richard Dawins 2005.
6. Cigar City Mafia. Scott Deitche 2005. (tampa mobsters!)
7. Food Politics: How the Food Industry Influences Nutrition and Health. 2005.
8. Everything Bad is Good For You: How Today's Popular Culture is Actually Making Us Smarter. Steven Johnson 2005.
9. Foreign Babes in Beijing: Behind the Scenes of a New China. Rachel DeWoskin
10. Why Not? 2004
11. Mountains beyond Mountains

I try to squeeze a few non, or only tangentially, medicine and anthropology books in to the summer. This is my self-created list of choices - anyone else have any suggestions for must reads?

Tuesday, May 17, 2005

Highland Avenue Structure

Yesterday, I drug SAM on an extra long walk to check out the Powhatten place, but nothing much was going on over there.
So I decided to head north, past Hanna (an unusual direction for our normal walk) to check out a building that caught my eye a few days ago. Unfortunately, I did not consider the fact that as we are getting later and later into May and with the progression into summer comes late afternoon thunderstorms.
Luckily, with the sky darkening, I reached the odd house at the corner of Sligh and Highland after almost turning back.

The house is obviously abandoned which is odd in and of itself - not so much because no one lives there, but because the real estate market is quite competitive in Seminole Heights and empty houses usually don't stay empty long and they stay relatively well-kept during their time on the market. But this place doesn't even boast a for-sale sign.

However, it wasn't the fact that this place was abandoned that caught my attention - instead it was the backyard.

The place is filled with cages - and these cages contain little plastic igloo shelters.

What kind of animals were in these cages? What was going on at this place? These people must have been breeders or some serious hobbyists of some sort. I seem to have this odd childhood memory large cats being located behind a place like this in Seminole Heights. Maybe this is the original location of Wildlife on Easy Street or something similar. Does anyone out there have any clues?
Unfortunately, I forgot to jot down the address to lookup the property on the Property Appraiser site because Sam's tugging alerted me to the presence of rain drops beginning to feel a little harder than a light sprinkle. So, I hurried away without thinking about getting more information to help solve the puzzle. I guess a trip back is in order.

Monday, May 16, 2005

40 days and 39 nights?

The NBA schedule officials must have screwed up a bit - somehow I got three games yesterday and ZERO games tonight - this is the first night in over two weeks that I have been stuck without playoff basketball. Am I supposed to do all that work I've been shoving aside for the love of the Pistons? I couldn't even watch yesterday's western conference games - after the emotional game 3 on Friday in Indiana and the wonderful game 4 domination on Sundary afternoon, I actually needed a break from basketball.

True Crime

The past few weeks, our relatively quiet Seminole Heights neighborhood has periodically sounded more like a Bosnian warzone - with numerous helicopters circling overhead only blocks from my house. Why all the excitement?

Apparently, during the fall of 2003, Steven Lorenzo was committing some very serious crimes (drugging, kidnapping, and raping young men) at his home on 213 West Powhatten Avenue. On December 20, 2003 two young men left a gay bar and went missing. One of those men, Michael Wacholtz was found dead on January 6, 2004 - left wrapped in a blanket lying in his Jeep. Friends and bar-patrons remember the other man who went missing, Jason Galehouse, leaving the bar on December 20 with two other men, matching the description of Lorenzo and Wacholtz.

Galehouse is still considered missing since no body has been found and his mother, Pam Williams holds out hope (maybe delusional hope) that her son has amnesia from the drugs and is alive and well, shopping in the Ross in Sarasota (where he was supposedly sighted a few months back).

Steven Lorenzo has been in jail since December 2004 on federal drug charges. He is also a suspect in the kidnapping, drugging, and raping of 6 other men - however, he has not yet been charged in the case of Galehouse and Wachholtz.

Anyway, his empty house has been searched during recent weeks, bringing an influx of local news media into our neighborhood. If baynews9 was going to break the story, I figured it only appropriate that Hard Boiled Wonderland also get the "big scoop".

So, armed with SAM as my patsy, and camera in hand, I wandered over to 213 W. Powhatten yesterday afternoon to check things out for myself.

As you can see from this first photograph, the house has been kept up very well, considering that no one has lived there since November. Obviously, Mr. Lorenzo has arranged some type of landscaping/lawnmowing type service or a relative/friend is helping out in his absence.

There really isn't much to see from the street and this is clearly why the news outlets have resorted to using their helecopters for a better look at things behind the house. I have seen camera shots from the helecopters showing massive amounts of material being piled up and sorted through in the backyard of the home.

One of the main items of interest in news reports/rumors is the hot tub. I poked over to the side of the house, staying well within the public area of the sidewalk and observed that the hot tub had indeed been yanked out of the home or deck or wherever it normally goes and moved to an area for further investigation.

Oddly enough, there is no police presence/guard (at least in plain sight) and the house is not roped off with crime scene tape or a do not cross line. I would have thought that an empty house with an active search warrant might receive more protection.

If I here that the police are back to search the house again, I will take the ever-willing, crime-fighting companion, SAM, back for another walk on Powhatten and see if I can get a more interesting scoop while trying to stay relatively unnoticed and out of the way.

Recent Documentaries

Apparently there is a new "documentary" in production titled SUPERSLIM ME, in which the narrator sets out to "prove" Morgan Spurlock wrong (SUPER SIZE ME, 2004). If you haven't seen Super Size Me, I suggest you do. The basic premis is that Spurlock lives on McDonald's products alone for a couple of months and monitors the health consequences to his body. Obviously this is an extreme diet, probably not something a person would actually do, and meant to make a point (duh). In addition, there are some really funny scenes with numerous lawyers, professors, and food industry execs.

Following the success of Supersize Me and similar style documentaries (such as Farenheit 911), people have spent time debating whether the movies were factual and objective. To do this, anti-documentary documentaries have been produced to "discredit" the original movies. Therefore, some people do not feel that they can "trust" documentaries anymore. This where SUPERSLIM ME comes in - the author (auteur?) claims that Supersize Me is biased because Spurlock simply consumed large amounts of Mickey-Ds and didn't exercise.

But Supersize me is a movie that is meant to make a point. Most americans do not exercise, therefore, its isn't biased that Spurlock didn't exercise. Also, If you follow the obesity public advocacy literature at all, you will realize that Supersize Me had all the "big Names" in the field - David Katz, Lisa Young, John Banzhaf - therfore, at least hearing what they have to say (which makes up at least 30-40% of the movie) is worth the time by itself - not too mention the scene where Spurlock and Banzhaf go to McDonald's together (Banzhaf is a lawyer who has been a pioneer in suing fast-food companies and was the first lawyer to sucessfully sue a tobacco company in the 90s). Most importantly, Spurlock's movie and the sucess of Super Size Me worked! McDonald's, while still very unhealthy, has been making significant changes to their menu since the movie was released last summer. Maybe what we are beginning to see is an alternative way to use the media in a sort of guerilla style assault on powerful organizations that would otherwise not have to really answer to consumer concerns. I think this was the greatest contribution Michael Moore's early work provided in TV Nation and Roger and Me.

Furthermore, a documentary doesn't have to be "objective" to be "real", it can certainly have a point or an agenda and still document something. Instead of looking at these movies as trying to "prove" something to you, look at them as trying to make you think about something you might not normally consider.

In addition, there is so much competition in a society of content-delivered media, that a documentary has to be very entertaining to appeal to a broad audience and be seen by someone other than "the choir" of already converted. The past 5 years have witnessed amazing sucess of documentaries as they blended into a more entertaining movie-product.

The only movies I have enjoyed seeing in an actual theater over the past 2 or 3 years, excluding Spiderman, have been the popular documentaries including Michael Moore's material, as well as Supersize Me and the movie about Al-Jazeera. Whether there is an agenda in these movies is besides the point for me, instead, I am able to see interviews with major players presented in a fun/entertaining way and I am given a starting point or someone's reference point as to what debates surround an important issue.

I do not rely on movies, whether they be called documentaries or not, to "prove" something to me. Nor do I rely on published books, peer-published literature, or first hand observation to make an ultimate decision. Instead, these movies, literature, and observations/experiences are all pieces of the puzzle in using my own critical thought process of evaluating available data and "proving" or disproving things to myself.

Saturday, May 14, 2005

Roof Dogs

In March, Seminole Heights suffered a "microburst" which appeared to be a tornado but apparently did not form the typical funnel cloud and therefore was given another wind formation name.

After the storm, there were numerous downed powerlines, some roof damage, and a couple of trees on top of cars. Many of these images were captured by the local news media and played repeatedly over the next couple of days. One of the most interesting images caught by the Tampa Tribune featured TWO DOGS on TOP OF A ROOF. While the reporter never said so, the implication was that somehow these dogs got on the roof because of the strong wind.

Well, as many Seminole Heights residents know, the ROOF DOGS were not a microburst phenomenon - they are an everyday part of life.

Typically, the Roof Dogs will happily run up and down the roof when Sam and I walk by - somehow knowing exactly when to stop short of plummeting into the side yard from the second story.

I have never seen a person at the Roof Dog house - just a couple of older cars in the yard - but I would love to know why they decided to opt for roof dogs instead of indoor dogs, porch dogs, backyard dogs, etc. Not that it's a problem - the Roof Dogs seem genuinely happy and don't appear to be in too much danger of falling.

Friday, May 13, 2005

Detroit Obesity Tax

According to the CDC

  • 62% of Michigan adults are overweight (BMI > 25) or obese (BMI > 30). (CDC BRFSS, 2002)
  • 24% of non-Hispanic white adults, 35% of non-Hispanic black adults, and 31% of Hispanic adults in Michigan are obese. (CDC BRFSS, 2002)
  • The obesity rate among Michigan adults increased by 80% from 1990 to 2002. (CDC BRFSS, 2002)
  • 24% of Michigan high school students are overweight or at risk of becoming overweight. (CDC YRBSS, 2001)
  • 28% of low-income children aged 2–5 years in Michigan are overweight or at risk of becoming overweight. (CDC PedNSS, 2002)

Michigan is not the only state in the country getting fat, as you can see comparing data from 1990 and 2003

U.S. Obesity Prevalence 1990

U.S. Obesity Prevalence 2003

While Michigan may not be the only fat state, and maybe not even the fattest (down to the third spot overall in 2005 after being ranked #1 fattest state by Men's Health in 2003), Michigan combines their fatness with a collapsed infrastructure, economically depressed cities, and questionable city leaders (more on that some other time).

Given this combination of poor health indicators, it is not suprising that the Mayor of Detroit is considering passing a "fast-food tax" within the city.

I am a strong advocate of using public policy to improve public health outcomes. For example, neighborhood variables and therefore zip code are an excellent predictor for cardiovascular disease. Therefore, neighborhood analysis is ideal for allocating city resources, such as parks and clean-up programs, which are positively correlated to lowering CVD risk. Furthermore, I am not opposed to a carefully thought out use/luxury tax being applied to high-fat food items and fast foods. But the proposal in Detroit is myopic, greedy, poorly timed, and biased. In addition, the tax could end up taking money out of the city instead of bring in additional funds.

Currently, there is a 6% state sales tax in Michigan. If the Mayor's proposal passes, there will be an additional 2% imposed on sales of fast-food, namely places like McDonald's, Burger King, etc. These businesses SHOULD be regulated. They provide a product which strongly contributes to one of the three highest public health threats facing our country (obesity), along with the comorbidities associated with the disease (atherosclerosis, myocardial infarction, diabetes mellitus, etc). However, this tax is not the proper regulation - it will lead to absoultely no decline in obesity prevelance.

Detroit is over 80% African-American, 31% of Detroit children live in poverty, and the median household income in the poorest zipcode is under $8000 (national average = $43,000). The literature is still out on whether fast-food industries differentially target low-income populations, but either way, this 2% tax will certainly differentially affect some of the lowest income populations in Michigan. However, a 2% tax is not a significant deterent to poor individual dietary choices. People within Detroit will still go to McDonald's but will also be forced to carry a large share of the economic burden for the city's past and future bad decisions.

In order to really affect dietary choices, and to shift the economic burden more fairly, the tax should be shifted away from consumers at the local level and towards distributors and corporations. Without the choice-infrastructure in place to make other food choices, it is unfair to burden consumers. Until high quality foods are made affordable, many consumers have no choice but to eat low-quality foods in order match their economic and calric budgets. Subsidies must be made available to encourage companies to offer healthy choices and to make those choices affordable to low-income families. In addition, changes must be made at a larger level than the city municipality - otherwise consumers or businesses will leave those areas for more favorable locations. In order to make a real impact in the obesity-epidemic the infrastructure must be in place to fully support significant dietary changes that will be difficult for many families.

The legislature is one way to make changes, but to fully affect change within corporations, the judicial system is another avenue that must be explored. Public health and policy makers were able to make significant headway against tobacco companies during the 1990s by linking tobacoo companies directly to negative health outcomes of smokers. Tobacco prevalence has declined significantly and tobacco companies have had to change their marketing strategies and tactis. The fear of large jury settlements is one way to change corporate behavior. Professor John Banzhaf at GWU School of Law is the major advocate of using the judicial system to change the landscape of dietary choices and the public perception of the obesity epidemic.

There is absolutely no quantitative data in place to measure the success of the Mayor's proposed tax. How will we know if the tax leads to decreaded prevelance of negative health outcomes associated with obesity? Who will be doing that data collection and who will pay for it? The likely answer is that none of this has been considered because it is not part of the plan. The only thing that will decrease is the poorly managed Detroit budget deficit, allowing Kwame and his crew to roll around in expensive SUVs while his constituents struggle to make ends meet.

Detroit Mayor's Tax Proposal
Detroit News
Another from Detroit News
Detroit Free Press
John Banzhaf

Thursday, May 12, 2005

A dog in your back

This is a Scottish Terrier

He lives in your back

Any questions?

Wednesday, May 11, 2005

Real ID Act

The senate has UNANIMOUSLY passed a bill that adds 82 billion in funding for the Iraq war. Wrapped up in this bill was the "real ID act" giving states 3 years to implement a federally-regulated drivers license.

The argument is that a federal license is basically a national ID card. I'm not sure I fully buy the arguments that a national ID card is inherently a violation of privacy and civil liberties. However, I certainly feel that it is a violation of state rights. Furthermore, why is a homeland security/immigration measure getting stuck to a bill for national security/war funding? Because the republicans put it there knowing that there were no democratic senators with the balls to vote no to "money for our troops". If they would have voted no, they would face the same commercials during their reelection campaigns that John Kerry had to deal with because of a similar add-on to a previous troop-funding measure.
But the democrats continue to come off as platformless cowards on this one. Many democrats gave speeches about how wrong this bill was before voting YES to it out of fear. There are 2 major problems here and yet another failed opportunity to strategically capitalize on republican actions.
1. Should we be giving more money to troops in Iraq? Well, let's sidestep this debate and basically agree that public sentiment is that you must give money to the troops IF they are there already UNTIL they come back - any other action would be politically devastating. I can buy that, even if I don't buy why such a large amount of U.S troops are still in Iraq. Therefore, I can excuse democrats for voting YES to funding, at least until they come up with a CLEAR exit scenario (something which Kerry failed to do in the last election).
2. Here is the important error by the democrats - a party that constantly misses ways to market themselves and seize on errors by republicans. Instead of democratic senators giving speeches detailing why they WANTED to vote NO on the bill because of RealID being added on by the republicans, the senators should have given a speech detailing why they WANTED to vote YES on the bill but couldn't because the Republicans stuck a totally unrelated, poorly thought out, measure on an importnat national security vote. If a strong majority of democrats would have done this, what would have happened? The Republicans would obviously be forced to take the stupid RealID measure off of the table. Clearly if the democrats strategize a little bit, they still retain SOME power in the senate (john bolten confirmation?).

During the 2004 presidential elections - and Florida Senate election for that matter - there were numerous times that the democratic party failed to market themselves properly or capitalize on republican missteps. I am convinced that a strong PR firm, branding agency would do wonders for their platform and create tangible changes at the polling booth.

You can listen to this story on NPR at the following link
Or read about it at the ACLU site

Tuesday, May 10, 2005

LCE Large Group Presentation

On Wednesday, May 18, I will be doing the large group presentation during LCE.
This basically works like the New England Journal of Medicine's clinical case discussion.
The idea is that I pick out a case that has a good differential and bring it in for presentation. You start with the Chief Complaint (young adult male presents with Vomiting) and allow responses from the students to guide your from there - meaning, they would ask for physical exam findings, come up with a differential, ask for the positive/negative indicators, lab values, images, etc and come up with a more refined differnential. The attending physician usually comes in as well and it makes for a fairly entertaining hour and a decent little thought exercise - granted we don't really know any of the pathology right now so the logic behind our guesses at the differential is kinda shaky at best.

Anyway, Dr. B will be coming in and he is bring a cadre of people with him including Dr. M, a radiologist, and Dr. N, a neuroanatomist. So this means I probably won't have to say too much -fine by me.
It is advantagous to volunteer for these because you are then allowed to pick your next LCE preceptor - which allows me to ensure I get someone in Tampa (driving to Sarasota, Spring Hill, Lakeland, etc doesn't sound too fun) and hopefully someone in ID or EM.

Dr. B agreed to assist and allowed me to select the case - however, he made a push for a recent gunshot wound to the neck which would have allowed us to discuss trauma and stroke. However, we did a stroke in February and trauma doesn't allow for as much consideration in the differential.
Since we are currently in our neuro block, and I'm rotating with a neurosurgeon, I thought it would only be appropriate to do something with all the classic neuro exam signs.

We saw this patient on hospital rounds - a 25 year old male with persistent vomiting, nausea and headache. Apparenty, the bouts of nausea had been occuring for approximately 8 months, however, in the last few months, frequency and severity were increased and accompanied by a number of other symptoms, including headaches and transient confusion (described by his wife). The patient presented to hospital when the nausea began to occur with headaches during the middle of the night.

It is important to note that vomiting presented first. This led initial diagnoses to focus on the GI system. However, lab data came back negative and the presence of headaches with vomiting led to a neuro consult.

On exam, there were a number of important signs. Muscle tone was reduced on the left side, an ataxic gait was present (stumbling), and nystagmus was noted (eyes don't catch up to tracking an object). There was rebound phenomenon in the left upper limb (left arm bounces after lifted and dropped) but no Hoffman's sign or clonus (both tests for upper motor neuron lesions).

These findings are quite significant with a neoplasm (brain tumor), specifically in the posterior cranial fossa. While the majority of brain tumors occur in cerebrum (astrocytomas), the presence of coordination problems and nystagmus leads one to suspect that the tumor may be in the cerebellum.

An ependymoma would be the most likely type of glioma to consider. Ependymomas occur in the ependymal cells within the 4th ventricle. This can push on the ventricle wall, causing vomiting and block the pathway for cerebrospinal fluid to flow out of the ventricle, thus causing increased cranial pressure leading to heaches.

An MRI was obtained to confirm this diagnosis, however, the tumor was, suprisingly, not in the ventricle at all. As a matter of fact the tumor appeared to be a medulloblastoma - which are congenital tumors that often appear in the cerebellum during childhood. They do have a similar presentation - but headache usually comes before vomiting with these types of growths.

So here was a 25 year old male, too old for a medulloblastoma and presenting symptoms more likely to be an ependymoma. However, it is possible that 25 year old males can get medulloblastomas, and this is the case here.

Upon surgery, a portion of the occipital bone was removed and the tumor was excised. A number of weeks later, the patient received a lumbar puncture. It is important to do a lumbar puncture to check for drop metastases where cancer cells metastasize via CSF pathways into the spinal cord.

Unfortunately, in this case, the lumbar puncture was positive meaning that the cells had indeed spread into the spinal sac. At some point a tumor will occur along the spinal cord and can also reoccur in the cerebellum and will most likely lead to death.


There may be some issue in terms of access to the VRACS dataset. However, the owner/collector of the data has okayed for me to teach a SAS seminar and to do a paper using that data. Therefore, it doesn't seem to be an ownership issue - but who knows.

Apparently the person who collected the data just doesn't think there is enough in the data set for a full dissertation. I am supposed to call to discuss the issue further this week (tomorrow). There are multiple data sets on HIV risk factors in India that have been recently collected and are lying around the Infectious Disease unit waiting for analyses. Therefore, if VRACS is too small, I can turn to these other sources. I am thinking the 3 paper dissertation model may be ideal for me using HIV risk in India as the uniting theme (with a broad question to link these paper to be determined).

In other news, I am thinking about backing out of an additional summer committment which would only take time away from the dissertation project. The other comitmment is a health-education activity where I would work with an interdisciplinary team in a community setting (e.g. AIDS men in Tampa, overweight kids in hernando county, diabetetic hispanics in ruskin, etc) to develop an education model and to assess basic epi stats in that population. It's a useful project in that it deals with health ed/policy and pays well, however, it takes time away from dissertation related activities and potential learning/interesting opportunities at TGH (rounding, etc). The main pros at this point for keeping the second summer position is that the extra money would be fun, its only 24 hours a week, Kryste is going to be quite busy anyway, and I have already agreed to do it (granted it doesn't start until June and they would certainly be able to find someone to fill the open slot - however, I don't really want to piss off AHEC in my first professional encounter with the group). Anyway, something to mull over for a couple of days.

Thursday, May 05, 2005

Dissertation Progress

In order to make myself think about my dissertation project regularly and to force myself to construct tangible ideas, I have decided to use this space for updates on my thesis.

When I left Michigan for medical school last summer, I took a data set and a dissertation question along with me. The ideas was to simply finish up the analysis of that data on my own, write up and send in chapters via email to my advisor/committee.

Coming off months of thurough training in SAS, SUDAAN, and SPSS throgh coursework and summer seminars at the UM-School of Public Health, I felt fairly confident about the statistical analyses that would be needed to answer my questions regarding cultral variation in diet and obesity and its link to the Glycemic Index within the United States.

The only caveat was that the dataset (NHANES) did not actually include Glycemic Index values. But, the February 2004 publication by Brand-Miller (Journal of Clinical Nutrition) listed the values for thousands of food items, using the USDA food codes which are also used in the NHANES diet survey. Therefore, I didn't think it would be a big deal to have the computer calculate the glycemic index values for the food entries in NHANES, providing me with the necessary data.

Well, it didn't take long for me to figure out that this was simply not going to work, at least I wasn't going to get it to work. Therefore, I began exploring the next option - hiring a software engineer to go through the data set and perform the necessary conversions, etc. While thinking about pursuing this option, however, the Willet group and others, continued publishing on the irrelevance of single-food glycemic index values since foods were eaten in combination with other foods providing a mixed-meal glycemic value. In other words, the glycemic values for each individual food that is part of a meal are not necessarily additive. Willet demonstrated this by publishing the average values for a number of mixed meals. However, the almost infinite combinations of mixed meals in NHANES makes it virtually impossible (and fully impossible at this time because the data doesn't exist) to calculate the mixed-meal values for each dietary entry for every sample.

In other words, the glycemic index question had become all but irrelevant by Fall of 2004 and the calculations and management of the data set had become much more difficult then originally envisaged.

The notion of completing my dissertation was being pushed to a backburner - a very far back back burner - as the daily business of medical school took over, coupled with the questionable value of a PhD for a physician. Meaning, now that my data and project had fallen through, did it really matter? Would there be any affect of this on my career as a physician?

Well, the basic answer to this question is that if I was going to do family practice in some South Tampa group or emergency medicine in a busy urban hospital ,then, no, of course it would not matter. However, if I was going to continue exploring my interests in epidemiology, infectious disease, and preventive medicine, then a PhD (particulary from a "brand" name university like Michigan) would be quite valuable on the policy/research side of life.

I let these ideas stew in my head as I continued through Winter and Spring coursework of my first year in medical school, growing more distant from anthropology due to the clinically oriented environment of my everyday routines. However, the past few weeks have allowed me to refocus and reexplore the possibility and value of completing my dissertation due to some fortunate events.

First of all, the heavy coursework period has ended and we have a little more time in this block to make plans for a 2 month summer break beginning in June. This has given me the chance to read up on some anthro journals, look back at some of my ideas and talk with some graduate school colleagues.

Secondly, I have been able to put the past 9 months into perspective thanks to the help of Sumaiya. These past 9 months have been the first period in my life for the past 5 years where I didn't DO anthropology everyday, where I didn't feel like an anthropologist - whether that be teaching, research, courses, etc. The lack of contact with anthropology and anthropologists makes the 9 month period seem longer than it is. I had started feeling too far away from my time at Michigan to finish my dissertation. However, some time for reflection and some conversations with Sumaiya remind me that this 9 months is no big deal for a number of reasons:
1. I left with the encouragement of my advisor as part of a bigger plan
2. I am only in my 5th year of the PhD program - well below the average of 9 years to completion
3. Many bio-anthro students have been in the "field" for long periods (1-2 years, or more) or simply taken time to be in other places doing other things. Granted my "field" work is a little different, it doesn't really change things too much if my plans remain the same.
4. Rackham policy gives a doctoral candidate up to three years to complete the thesis

Finally, I have accepted a research position with Dr. John Sinnott who heads up the Infectious Disease unit at Tampa General Hospital, and is a clinical professor. This position, ultimately, may be the thing that allows me to realistically complete my thesis. Sinnott is a clinician, academic, and researcher, allowing allowing him to understand my unique circumstances (MD/PhD student at two different places in a program I created). In addition, and just as important, Dr. Sinnott has access to valuable data sets that are of clinical and anthropological interest. For example, the VRACS dataset is a large sample survey collected in India in order to assess risk factors for HIV. The group working on this dataset has produced papers previously with an anthropological question (SEE ABSTRACT) and there are many great questions stilil waiting to be answered. Fortunately for me, Dr. Sinnott has agreed to let me spend the summer using this data to complete my dissertation (!). I don't think I could have imagined a better opportunity.

For completing my PhD to be a reality, I set up a couple of regulations that had to met. These regulation appear IN ORDER - from most difficult to fulfill, to easiest to fulfill.
1. I needed to find a dataset that was already available (e.g. no fieldwork)
2. I needed to be able to do analysis and writing while in Tampa
3. I needed to find someone here who could act as a committee member/co-advisor
4. I needed to get approval from Frisancho

I think have definitely met requirements 1-3. Currently, I am in discussion with Frisancho to meet #4. Basically, he just wants to know my question - to know if its relevant to anthropology, to him, etc. I am not concerned about this - if anything I am concerned about his advancing age and desire to retire in the near-future. In order to get some insight into all of this, I have contacted Susan Tanner (a Frisancho student very near completion). Hopefully she can shed some light on things as she tends to be very down to earth and observant.

I am currently awaiting the VRACS data set, which is probably going to be a huge cumbersome EXCEL file that I will need to convert to SAS. The plan is that I will get to know the VRACS data set by teaching a little mini-SAS course to the residents and fellows at TGH (um, I hope I remember how to use SAS!). This will allow me to develop my question a bit while reading up on the literature and 2 previous papers that were presented at conferences from this data. Oh, speaking of literature - apparently my life is going to be one step easier - 2 high school aged volunteers with the infectious disease groups will be able to help me do literature searches, editing, etc. Let's get this thing moving fast before the data falls apart or HIV, India, or something else becomes irrelevant (ha).

Sunday, May 01, 2005

old federal courthouse

the old federal courthouse is likely to become the new tampa museum of art
this will allow the classy building to stick around a bit longer
furthermore, the building witnessed trials of a number of significant figures
Tampa Tribune has a short article about some of those folks in today's edition