Sign up for Times Reader (New York Times Computer Based Reader)

The registration page for the beta test is here.

Times Reader runs on Microsoft's new Windows Presentation Foundation (WPF), which is built into the new Vista operating system and is included in the .Net 3.0 Framework service pack for Windows XP. If you are using Windows XP, the installer application will first install Net 3.0 Framework, a process that takes about ten minutes, and then install Times Reader, a process that takes about two minutes.

Technorati Tags: times reader, new york times

How to Get Doctors to Wash their Hands

From the Freakonomics Column of the New York Times:

They pressed their palms into the plates, and Murthy sent them to the lab to be cultured and photographed. The resulting images, Silka says, "were disgusting and striking, with gobs of colonies of bacteria." The administration then decided to harness the power of such a disgusting image. One photograph was made into a screen saver that haunted every computer in Cedars-Sinai...

Technorati Tags: new york times, handwashing, infectious disease

List of Favorite Podcasts

By request, here's a list of my favorite podcasts. You can subscribe to them all on iTunes.

Medical and Scientific Podcasts:

• ACC (American College of Cardiology) Conversations
• Brain Food
• Futures in Biotech
• IT Conversations
• JAMA: This Week's Audio Commentary
• John Hopkins Medicine Weekly Health News
• Listen to the Lancet
• Mayo Clinic - Medical Edge Radio
• National Institutes of Health (NIH) Podcast
• NEJM (New England Journal of Medicine) Interviews
• NEJM This week
• New York Times Health Update
• New York Times Science Times
• NPR: Your Health
• Science & the City
• Science Friday
• Science Talk: The Podcast of Scientific American
• Sound Medicine

Other Podcasts:

• 43 Folders
• APM: Future Tense
• APM: Marketplace Takeout
• Boing Boing
• KCRW's The Treatment
• Living on Earth
• New York Times - TimesTalks
• New York Times Book Review
• New York Times Front Page
• New York Times Most E-mailed Articles
• New York Times Movie Review
• New York Times Music Popcast
• New York Times Washington Report
• NPR: All Songs Considered
• NPR: Business Story of the Day
• NPR: Health & Science
• NPR: Most E-Mailed Stories
• NPR: Present at the Creation
• NPR: Shuffle
• NPR: Story of the Day
• NPR: Talk of the Nation Opinion Page
• NPR: Technology
• NPR: World Story fo the Day
• NYT Op-Ed Podcast
• NYT: David Pogue
• NYT: Modern Love
• NYT: Only in New York
• NYT: World View
• On the Media from NPR/WNYC
• Open Source
• Penn Radio Podcast
• PRI's Studio 360
• Slashdot Review
• Slate Explainer Podcasts
• Slate Magazine Daily Podcast
• Tech Nation
• The Economist
• The Onion Radio News
• To the Best of Our Knowledge

Technorati Tags: podcasts, medical podcasts

The Inner Life of the Cell: Extraordinary Animation

Via Information Aesthetics.

New HIV Recommendations: Test Everybody

From the CDC:

CDC's recommendations urge providers to include HIV testing as routine part of their patients’ health-care. Routine HIV testing ensures more people learn whether they are infected with HIV, allowing them to benefit from earlier access to treatment, and reduce the risk of infecting their partners.

Technorati Tags: cdc, hiv, aids

"Immune Attack" and the "Games for Health" Conference

Via EurekAlert:

Immune Attack is a new generation video game that engages students and teaches complex biology and immunology topics in a manner different from the traditional classroom approach. The goal is to immerse the student in immunology concepts to make learning fun and exciting. "Immunology is a complicated and difficult subject to learn, which is precisely why it makes such an interesting basis for a video game," said Eitan Glinert, FAS Project Coordinator of Immune Attack. "The challenges in Immune Attack give those who might not otherwise be interested in biology the chance to learn in a fun, hands-on manner they won't find in a text book."

More info about the Games for Health conference here.

Technorati Tags: immune attack, games for health, immunology

Flickr: Guilin - Longsheng

From Flickr. Uploaded by jackfrench on 17 Sep '06, 9.42am EDT PST.

Musings on "Vasculopath"

I don't like the word "vasculopath." Partially because it's dehumanizing. But also it implies a certain degree of therapeutic nihilism: this patient is going to lose their limbs, die of a myocardial infarction or a stroke, and there isn't much we can do about it. Since so many people have severe vascular disease and since there is actually a lot that can be done, the term "vasculopath" should be retired.

Xray of a Gun Concealed in the Vaginal Vault?

This is the best xray I've seen recently.

From Movin' Meat. the blog of an emergency physician:

Yes, that's a pistol completely stuffed into the vaginal vault. All of a sudden her agitation and thrashing about seemed a lot more important than it had a few minutes before. How the hell were we to get the gun out without the damn thing discharging?

(Thanks to Kevin.)

Technorati Tags: emergency medicine, radiology

Feedreader of Choice: Rojo

Rojo was just updated and is now my feedreader of choice.

Technorati Tags: rojo, feeds, rss, web2.0

"Virtual Reality Therapy for Psychological Victims of 9/11"

Via the New York Presbyterian Hospital Website:

Millions of New Yorkers witnessed the attacks on the World Trade Center of Sept. 11, 2001, whether from inside the buildings or from afar. A large number of these people -- as many as 65 percent by one account -- report experiencing resulting emotional problems, including post-traumatic stress disorder (PTSD)... The two new studies, which build on the established therapy, are the first to (1) employ a virtual-reality simulation of the interior of the World Trade Center buildings and (2) to offer virtual-reality therapy in conjunction with D-cycloserine, a drug that has been shown to enhance learning. In the virtual-reality therapy, patients wear a helmet that immediately immerses them in a three-dimensional environment -- when they look down or sideways, the scenery shifts. The patient experiences depictions of the World Trade Center before, during and after the attacks. Scenes range from a plane flying past the first tower, to a re-enactment of two planes hitting both towers and their collapses, accompanied by realistic sound effects. And for the first time, for those who were inside the World Trade Center when the attack occurred, a 3-D graphic re-enactment of the escape from the interior will be used. Patients progress through the scenes in a gradual fashion with supervision by the therapist, ensuring that they will not become overwhelmed.

Technorati Tags: new york presbyterian hospital, 9/11, virtual reality, psychiatry

Spinach from Earthbound Farm

Found this in the fridge yesterday. Fortunately, I appear to have not developed hemolytic uremic syndrome.

From Flickr. Uploaded by KidneyNotes on 17 Sep '06, 1.08pm EDT PST.

In iTunes 7, Podcasts no Longer Play Sequentially

I listen to 60 podcasts on my iPod Nano during my commute (mostly the New York Times and NPR). The old version of iTunes allowed you to play all podcasts as a group by choosing "genres: podcasts" -- this allowed you to easily skip ones that were uninteresting. However, in iTunes 7, podcasts can only be played one at a time, and switching podcasts requires laboriously selecting each from the menu.

I would suggest *not* switching from iTunes 6 to 7 if you listen to podcasts sequentially until this problem is fixed.

Does anyone have a workaround for this problem?

Update: The problem was fixed by going to the iPod Summary tab and clicking "Restore." ("If you are experiencing problems with your iPod, you can restore its original settings by clicking restore.") Thanks for everyone who offered suggestions.

Update: Setting the "shuffle" setting to "albums" or "songs" also appears to prevent podcasts from playing sequentially.

Technorati Tags: itunes 7, podcasts, ipod

The Girl With Error Message Eyes (from Second Life)

Via Warren Ellis:

Below, a random person I spotted in Transylvania two minutes after the grid went back up earlier today. In her eyes, you can make out part of an error message, denoting that a graphic or script from her customised “avatar” or representative form in Second Life is missing. It means that the system, that’s been crashing and hiccuping constantly since an upgrade on Wednesday, is failing to find and/or process the entirety of her body. Elsewhere, I’ve seen people wearing that message over swathes of their skin, projected there by the system.

Differential Diagnosis Mnemonic: VINDICATUM

There are a few mnemonics for possible differential diagnoses. I use VINDICATUM.

Vascular
Infectious / Inflammatory
Neoplastic
Drugs
Iatrogenic
Congenital
Autoimmune
Trauma
Unknown
Metabolic

For more lifehacks for healthcare, innovations, and best practices, see The Efficient MD.

(This post is for informational purposes only. Please see the disclaimer.)

Grand Rounds 2.51

Grand Rounds 2.51, this week's best posts of the medical blogosphere, is up at Diabetes Mine.

Novel Printed on a Poster: Down and Out in the Magic Kingdom by Cory Doctorow

Via Cory Doctorow:

Aki Kyozoku, a fan of my novel Down and Out in the Magic Kingdom, has converted the entire text of the book to a poster that depicts the type and graphics from the book’s cover. By shading the type and inserting spaces in it, Aki was able to use the type itself as pixels in a giant bitmap that you can print on your favorite large-format printer and stick on your wall. Man, that’s cool!

The PDF file is here.

"Planet Xena" To Be Named Eris. Illuminatus Fans Amused.

Via Slashdot:

"After over a year of hanging in maybe-planet limbo, newly-classified 2003 UB313, nicknamed Xena, now has a permanent name: Eris, goddess of strife. Its moon will be named Dysnomia, after the goddess of lawlessness — in Greek mythology, Eris's daughter — certainly not a reference there... I don't think I'm alone when I say, 'Hail Eris! All hail Discordia!'" In the same IAU announcement (PDF), Pluto was given its official minor planet number: 134340.

Technorati Tags: eris, planet xena, xena, slashdot, illuminatus

New England Journal of Medicine Audio Summary for September 14, 2006

From the NEJM:

This summary covers the issue of September 14, 2006. Featured are articles on sirolimus-eluting stents versus uncoated stents in acute myocardial infarction, paclitaxel-eluting versus uncoated stents in primary percutaneous coronary intervention, chemotherapy with preoperative radiotherapy in rectal cancer, oral fingolimod for relapsing multiple sclerosis, cost-effectiveness of HIV treatment in resource-poor settings, and gram-negative bacteria and secretion of toxins; a review article on echinocandins for candidemia in adults without neutropenia; a case report of a man with masses in both kidneys; and Perspective articles on the XVI International AIDS Conference, on Gates, Buffett, and global health, and on fingolimod and sphingosine-1-phosphate and lymphocyte migration.

Salt to be Reclassified as Food Additive and Regulated?

From the New York Times:

Now the nation’s largest doctors’ group, the American Medical Association, is going after the government and the food industry to reduce what it sees as a persistently high level of salt in many processed foods.

At its annual meeting in late June, the medical association recommended that the Food and Drug Administration limit the amount of salt that food companies are allowed to add to products.

Specifically, the medical association, which had never before called for regulation of a food ingredient, asked the F.D.A. to revoke salt’s long-time status as a substance that is “generally recognized as safe,” a classification that warrants little oversight. Instead, the F.D.A. should regulate salt as a food additive, the medical group said.

Related Link: Hypertension

Technorati Tags: salt, fda, american medical association, new york times

"Diet Coke + Mentos = Organ Donation" (Jen's YouTube Video)

The Well Placed Medical "?!"

Doctors write lots of question marks in medical charts. We don't write "?!" enough. I had the opportunity recently, after an elderly woman with pneumonia in the ICU was found to unexpectedly have a parasite on her blood smear.

"Malaria?!" I wrote.

Sometimes it's exactly the right punctuation mark.

"September 11, 2001: What We Saw"

Private footage from 36 floors up and 500 yards away, released today.

Flickr: Five Years On

From Flickr. Uploaded by gmonster25 on 11 Sep '06, 9.14pm EDT PST.

9/11 and the Birth of the Blog (From Wired)

From Wired:

When the world changed on Sept. 11, 2001, the web changed with it.

While phone networks and big news sites struggled to cope with heavy traffic, many survivors and spectators turned to online journals to share feelings, get information or detail their whereabouts. It was raw, emotional and new -- and many commentators now remember it as a key moment in the birth of the blog.

Technorati Tags: blogs, 9/11, wired

New York Times Front Page for 9/11

Linked from the New York Times Website.

Related Links: 9/11, World Trade Center, Terrorism

7 Days In September

With material from almost 30 filmmakers, director Steven Rosenbaum turns the tragic events of September 11, 2001 -- the memories of which are forever jarred in our psyches -- into a moving portrait of emotion, loss and even kindness. Although the film uses footage of the horrific attacks on the World Trade Center and the resulting catastrophic loss, it also hones in on New York City's tremendous ability to rebuild, through will and compassion.

How to Survive an EMP or Superworm Attack

Via Slate Magazine:

Bill Gates and Steve Jobs could probably tell you terrific stories about where they were and what they were doing when they realized the true implications of the electronic age. But you'd get a somewhat more interesting account from any aging electrician in Hawaii: That's because one evening there in July 1962, 100 burglar alarms suddenly sounded and 300 street lights suddenly blinked out for no apparent reason. All over the region, phones, radios, and televisions went dead without warning.

The cause, it turned out, was 800 miles due west and 250 miles up in the air: A 1.4 megaton nuclear weapon had been detonated some 1.32 million feet above tiny Johnston Island in the Pacific.

Nurse, 51, kills intruder with bare hands

Via CNN:

A nurse returning from work discovered an intruder armed with a hammer in her home and strangled him with her bare hands, police said...

"She's an emergency room nurse. She's used to dealing with crisis."

Flickr: Smoke

From Flickr. Uploaded by strobe_flash on 9 Sep '06, 2.54am EDT PST.

The World Trade Center Disaster and the Health of Workers: Five-Year Assessment of a Unique Medical Screening Program

The full report is here.

Background. Approximately 40,000 rescue and recovery workers were exposed to caustic dust and toxic pollutants following the September 11, 2001 attacks on the World Trade Center (WTC). These workers included traditional first responders such as firefighters and police and a diverse population of construction, utility, and public sector workers...
Results. Sixty-nine percent of 9,442 responders examined between July 2002 and April 2004 reported new or worsened respiratory symptoms while performing WTC work. Symptoms persisted to the time of examination in 59%. Among those who had been asymptomatic before 9/11, 61% developed respiratory symptoms while performing WTC work. Twenty-eight percent had abnormal spirometry. FVC was low in 21% of our population. Obstruction was present in 5%. Among non-smokers, 27% had abnormal spirometry vs. 13% in the general U.S. population. Prevalence of low FVC among nonsmokers was five-fold greater than in the U.S. population (20% vs. 4%). Respiratory symptoms and spirometry abnormalities were significantly associated with early arrival at the site.
Conclusion. WTC responders had exposure-related increases in respiratory symptoms and PFT abnormalities that persisted up to 2.5 years after the attacks. Long-term medical monitoring is required to track persistence of these abnormalities and identify late effects, including possible malignancies. Lessons learned should guide future responses to civil disasters.

FDA Warning on Taking Aspirin and Ibuprofen (Motrin, Advil) Together

From the FDA:

FDA notified consumers and healthcare professionals that taking Ibuprofen for pain relief and aspirin at the same time may interfere with the benefits of aspirin taken for the heart. Ibuprofen can interfere with the anti-platelet effect of low dose aspirin (81 mg per day), that may render aspirin less effective when used for cardioprotection and stroke prevention. Although it is all right to use Ibuprofen and aspirin together, FDA recommends that consumers contact their healthcare professional for more information on the timing of when to take these two medicines, so that both medicines can be effective.

Information for health care professionals is here.

Heart Versus Kidney (From a Cardiologist)

Emailed to me by a cardiologist friend:

Let me explain how the heart pumps blood. It squeezes. Let me explain how you know if it is working. You palpate the radial pulse.

One day we are going to need to sit down and discuss how the kidney works, because it is not all that clear to me.

Flickr: Eclipse Airlines

From Flickr. Uploaded by vlad259 on 7 Sep '06, 6.54pm EDT PST.

New Sexually Transmitted Diseases Treatment Guidelines (2006) from the CDC

From the CDC:

These guidelines for the treatment of persons who have sexually transmitted diseases (STDs) were developed by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta, Georgia, during April 19–21, 2005. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2002.

Technorati Tags: cdc, sexually transmitted diseases, guidelines, infectious diseases

Flomax and Coumadin Interaction

Flomax can cause unexpected elevations in the INR for patients on coumadin. I wasn't previously aware of this. Alfuzosin, an alternate medication, does not have this interaction with coumadin.

Quote of the Day

"That's so twentieth century."

New England Journal of Medicine Audio Summary for September 7, 2006

From the NEJM:

This summary covers the issue of September 7, 2006. Featured are articles on DNA repair by ERCC1 in non–small-cell lung cancer and adjuvant chemotherapy, soluble endoglin and other circulating antiangiogenic factors in preeclampsia, enoxaparin versus unfractionated heparin in elective PCI, cytokine storm in a phase 1 trial of the anti-CD28 monoclonal antibody TGN1412; review articles on social anxiety disorder and on oncogene-induced cell senescence; a clinical problem-solving article describing more than meets the eye; and Perspective articles on T-cell costimulation, on going beyond disease to address disability, and on learning clinical judgment as a medical student.

Dr. Rangel Reviews Stingray Attacks

Via RangelMD.com:

The toxins are mostly made up of 5-nucleotidase and phosphodiesterase which are cytotoxins (they kill cells/tissue) and result in local necrosis (tissue death). This can lead to secondary bacterial infection and severe wounds may take months to heal. Stingray toxin also contains serotonin, which causes severe localized pain lasting up to 48 hours.

Technorati Tags: stingrays, steve irwin, pathophysiology

Google News Archive Search -- this is Fascinating.

This service allows you to search news archives and constructs a timeline of articles going back to the 1880s...

From the Google News Archive Search Website:

News archive search provides an easy way to search and explore historical archives. In addition to helping you search, News archive search can automatically create timelines which show selected results from relevant time periods.

Technorati Tags: google news archive search, google, news

Orange Juice Might be More Beneficial Than Lemonade for the Prevention of Kidney Stones

More at Medpage Today.

Comparative Value of Orange Juice versus Lemonade in Reducing Stone-Forming Risk -- Odvina, 10.2215/CJN.00800306 -- Clinical Journal of the American Society of Nephrology:

Foods that are high in citrate content generally are assumed to deliver alkali load when consumed irrespective of the accompanying cation. The object of this randomized, crossover study was to compare the effects of orange juice with those of lemonade on acid-base profile and urinary stone risks under controlled metabolic conditions. Thirteen volunteers (nine healthy subjects and four stone formers) sequentially received distilled water, orange juice, or lemonade while on constant metabolic diet. Twenty-four-hour urine samples were collected for acid-base parameters and stone risk analysis. Orange juice but not lemonade provided alkali as evidenced by higher net gastrointestinal alkali absorption and higher urinary pH and citrate compared with control. Urinary calcium was not significantly different, but urinary oxalate was higher during the orange juice phase. The calculated supersaturation of calcium oxalate was lower in the orange juice phase compared with control. Calculated undissociated uric acid was lower in the orange juice phase compared with both control and lemonade phases. The calculated supersaturation of brushite was significantly higher in the orange juice phase compared with both control and lemonade phases. Despite comparable citrate content, this study showed that orange juice has greater alkalinizing and citraturic effects than lemonade. Consumption of orange juice was associated with lower calculated calcium oxalate supersaturation and lower calculated undissociated uric acid. This short-term study suggests that orange juice consumption could result in biochemical modification of stone risk factors; however, additional studies are needed to evaluate its role in long-term prevention of recurrent nephrolithiasis.

Related Link: Preventing Kidney Stones with Lemonade, Types of Kidney Disease

Technorati Tags: nephrology, kidney stones, urology, journal of the american society of nephrology

Grand Rounds 2.50

Grand Rounds 2.50, this week's best posts of the medical blogosphere, is up at Clinical Cases and Images.

Nephrology Cases #11: Refractory Orthostatic Hypotension

A 72 year old man presented with severe, disabling, refractory orthostatic hypotension (low blood pressure) of two years duration. His blood pressure on standing was 74/40 despite treatment with midodrine 10 mg three times daily and florinef 0.1 mg once daily. His physical exam and neurologic exam were otherwise unremarkable.

He had a partial gastrectomy (removal of the stomach) for an ulcer twenty years ago. His kidney function was normal. He was slightly anemic (hemoglobin 10.9). His vitamin B12 level was within the normal range (297).

A diagnostic test was performed.

After a month of treatment with an oral medication, his systolic blood pressure improved to 140s on standing and he was weaned from florinef and midodrine.

What was the test, and what was the treatment? (Answers in comments.)

Related Link: Nephrology Cases

NIH Research Radio Podcast

The NIH Research Radio podcast (for both patients and health care providers) is excellent. The podcast is here.

FLICKR: rip steve irwin

From Flickr. Uploaded by johnnyb4 on 4 Sep '06, 6.42am EDT PST.

Hilarious Journal Articles #62: Tattoos and Body Piercings in the United States: A National Data Set

From the Journal of the American Academy of Dermatology:

Background Little is known about the prevalence and consequences of body art application. Objective Our aim was to provide US tattooing and body piercing prevalence, societal distribution, and medical and social consequence data... Results Of our respondents, 24% had tattoos and 14% had body piercings. Tattooing was equally common in both sexes, but body piercing was more common among women. Other associations were a lack of religious affiliation, extended jail time, previous drinking, and recreational drug use. Local medical complications, including broken teeth, were present in one third of those with body piercings. The prevalence of jewelry allergy increased with the number of piercings. Of those with tattoos, 17% were considering removal but none had had a tattoo removed... Conclusion Tattooing and body piercing are associated with risk-taking activities. Body piercing has a high incidence of medical complications.

Technorati Tags: dermatology, tattoos, body art, hilarious journal articles

Review of the New England Journal of Medicine's Email Newsletter, "Physician's First Watch"

Enoch Choi of Medmusings reviews First Watch.

Jacob Reider of Docnotes is on their editorial board.

Technorati Tags: new england journal of medicine, first watch, physician's first watch, enoch choi, jacob reider

Clinical Guidelines for Adults Exposed to the World Trade Center Attacks

Via RedOrbit:

New York City health officials issued long-awaited guidelines Thursday to help doctors detect and treat 9/11-related illnesses -- medical advice considered crucial for hundreds of ground zero workers now scattered across the United States.

The guidelines, from the New York City Department of Health and Mental Hygiene, are here.

Technorati Tags: 9/11, world trade center, new york city

The HydraCoach Intelligent Water Bottle

Might be particularly useful for kidney stone patients, who never drink quite as much fluid as they should...

From the Website:

Sportline ... today unveiled the HydraCoach -- a revolutionary new water bottle that calculates an individual's daily hydration needs and coaches proper water consumption to ensure optimal hydration. This is the first product developed that actually helps people adhere to the expert's recommendations for drinking the right amount of water on a daily basis.

Known as the world's first interactive water bottle, the HydraCoach may appear similar to other water bottles, but there is one noticeable difference - the HydraCoach Hydration Monitor. This patented technology enables users to program in their personal hydration needs, track their daily water consumption sip by sip, and be coached throughout the day to achieve optimal hydration.

Technorati Tags: nephrology, hydration, kidney stones, hydracoach