The Haptics of Writing

When we took our daughter to law school last summer, we made a pilgrimmage to an Apple Store to purchase a new Macbook to replace her five-year old Powerbook. Surely many of you have made similar pilgrimmages on behalf of your own children.

During one of our conversations last fall I asked our daughter if she were using the laptop to take notes in class. No, she was not. She preferred to take notes by hand and transcribe them to the computer later. Perhaps she was also being somewhat smug by not joining all the students who used their computers during lectures to checkout Facebook pages, read e-mail, or tweet their opinion on the latest trends. A recent Doonesbury touched on this aspect of life in the contemporary college lecture hall.

When the fall semester was ending, I asked our daughter if she could use her computer for her final exams. Yes, she could. You had to install software from the college that blocked access to the Internet and did not allow the student to write outside the alloted time. However, our daughter chose to handwrite her exams. Only two students chose to handwrite, and they met in a room of their own. Our daughter acknowledged that handwriting was slower than typing, but thought it gave her time to better formulate her ideas. With only two students in the room, it was a quiet location for thinking.

Today, I read a news item about a paper in the Advances of Haptics: "Digitizing literacy: reflections on the haptics of writing". The authors, Anne Mangen and Jean-Luc Velay, look at the relationship between how we write with cognitive development. They are primarily interested in handwriting versus word processing. The study draws on evolutionary biology, biopsychology, and neuroscience to explore how handwriting – the manual formation of letters in the process of writing – affects our reading which thereby influences our whole process of learning.

My simplified synopsis of the two modalities is that handwriting is a unimanual activity with a focus on a single physical point - where the pen or pencils meets the paper. Word processing is a bimanual activity that has two separated spaces: the keyboard and the display. Plus the writer does not form the letters in word processing, but does in handwriting.

Even if you do not have a child leaving their newest laptop at home during lectures and exams, you might enjoy reading this article.

0 comments - Posted by Steve Rauch at 11:50 AM - Categories:

C25K

If you are one of the 2011 resolutionaries who vowed to become more active and fit in new year, you might want to visit c25k.com which is both the URL for web site and the acronym for the Couch to 5K program.

Although this program has been around since 1996, I was not aware of it until seeing it mentioned on an NHS web site this week. The nine-week approach uses three training sessions a week to get the participant from alternating walking and running to being able to run for an entire 30 minute stretch.

The program's web site includes a plethora of useful information:

• Written instructions in more than 20 languages
• A version for treadmill users
• Podcasts to put on your favorite MP3 to accompany your sessions
• C25K apps for iPhone and Android
• Inspirational stories
• What to do beyond 5K

Before beginning any exercise program, especially if you were the ultimate couch potato in 2010, you should check-in with your healthcare provdier.

If that New Year's Resolution feels old, and you did make it last year, you might want to check out C25K and find our how others have gone from the living room to 3.1 miles in nine weeks. And that treadmill version might come in handy until the snowpack and ice have melted from the streets.

0 comments - Posted by Steve Rauch at 2:55 PM - Categories:

The Long and Short of It

Whenever I participate in the New Hire Clinical Orientation, I bring a recent news item on medical research. In preparation for the orientation on December 2, I checked my usual online sources. A story on the NHS Behind the News site caught my eye.

Finger Length Predicts Prostate Cancer. This web site evaluates recent medical research that has attracted media attention. They do a first-rate job summarizing the research, stating what conclusions are possible from the type of research done, and give their own appraisal of the study and often comment on the media headlines and clamor.

This research compared the ratio of the length of a man's index finger to ring finger and compared that to the incidence of prostate cancer to see if this ratio would work as a low-cost marker for prostate cancer. In the study, over half of the men had a shorter index finger than ring finger. Statistically, more men whose index finger is shorter than their ring finger had prostate cancer. This length ratio is linked to the testosterone exposure as the fetus develops in utero.This exposure to the hormone is thought to influence the later likelihood of developing prostate cancer.

The synopses on Behind the News are done by Bazian (their name is a delightful play on "Bayesian" analysis). They have written a case study of their NHS work. I rather expected them to take the finger length study to task. Really, finger length being predictive of cancer?

Instead, they were much more accepting of key parts of the analysis. They accepted the type of study, liked the size of the study. But they had questions about some other aspects of the research. While the percentage of men with indexed fingers shorter than ring fingers in this study is over 50%, fewer than half the men had prostate cancer. Bazian suggests that there is some other cause at work here that likely affects finger length as well as a propensity to develop prostate cancer. They even mention that this study looked only at men's right hands, but some studies looking at both hands don't find a straightforward relationship between finger length and hormone exposure.

Whenever a medical research items makes a big splash, head on over to Behind the Headlines to see what Bazian has to say about it. Besides, it is a fun way to learn about the different study types and improve your evidence-based practice appraisal skills.

0 comments - Posted by Steve Rauch at 4:12 PM - Categories:

NCBI's Images Database

The National Center for Biotechnology Information (NCBI) has released an image database built from the full-text articles in the PubMed Central repository. When the database went online in October, it held more than 2.5 million images. For more background, read the NIH Press Release.

The images can be graphs, line drawings, illustrations, radiography, or photographs. To see some of the range of resources, view the results of this search on chorea.

While I find that quick word searches have worked well for my uses, there is an extensive help page explaining other ways to search as well as dissecting the images results page.

The database includes extensive holdings of genomic images, but I can see the database being useful in a community hospital setting. Perhaps you have just attended an in-service on wound vacs and wondered what types of wounds these devices are used to treat. The results aren't pretty, but here they are.

Please do keep in mind that while viewing these images to open to anyone, use of the images must comply with their copyright status.

0 comments - Posted by Steve Rauch at 12:11 PM - Categories:

On Become a "Branch Campus"

Subject examinations, aka shelf exams, are administered to medical students as they complete their clinical rotations or clerkships. This morning, a third year student from Rocky Vista University College of Osteopathic Medicine took his examination here at Community Hospital.

Several RVUCOM students are spending the year in Grand Junction and are doing most of their clinical rotations with local physicians. Being able to take their examinations here saves them from making the winter drive across I-70. (View the current road conditions across the state thanks to the Colorado Department of Transportation.)

This step comes as we completed the requirements from the National Board of Medical Examiners to be a "branch campus" of Rocky Vista for testing purposes. We had to be located at least two hours from the college - no problem meeting that requirement, we needed to have the appropriate facilities, and we needed to have an Associate Executive Chief Proctor.

Heather Gray agreed to be our initial AECP; now Dan Thomas has taken over that position. Heather and Dan, along with Connie, Erica, and myself are the proctors who can administer the examinations. We surely have one of the highest proctor-to-student ratios of any NBME site, but feel this is a valuable service to offer the medical students.

0 comments - Posted by Steve Rauch at 3:44 PM - Categories:

Legionnaire's Disease

I have always enjoyed reading mysteries, the complete Sherlock Holmes was the first hardcover book I bought. I equally enjoy doing puzzles: crossword, acrostic, Sudoku, and jig-saw. These two interests seem to come together whenever I read about public health outbreaks. Two recent studies on Legionnaire's Disease help to illustrate how epidemiologists work to to discover the missing pieces from the facts they need to solve an outbreak.

When cases of Legionnaire's disease cropped up last year in Alcoi, Spain, molecular analysis linked the cases to one another, and to a series of cases that occurred earlier in the decade. However, the cases occurred in two different parts of the city, and at two different periods of time.

Legionnaire's disease is associated with exposure to atomized water that is contaminated by the bacteria causing the disease. Usual sources are stationary. The CDC guidelines have investigators ask specifically about exposure to these potential sources: showers, decorative fountains, humidifiers, hot tubs, wet saunas, cooling towers, respiratory therapy equipment, and evaporative condensors. During the earlier outbreak, investigators had tested the usual locations. With the new outbreak, they knew they had to find a water source that fit the time and location parameters.

The likely suspect turned out to be an asphalt milling machine - a device that scrapes asphalt from a street so that the new paving remains at the same level. Water is sprayed during the process to control dust. This particular device was filled from a spring, not from the city water supply, which likely allowed for the original contamination. The machine was removed from service, cleaned, and renovated to use dripping water rather than spraying water. No further cases turned up. Read all about it in Emerging Infectious Diseases.

Sporadic cases of Legionnaire's Disease often occur with no source ever being determined. In England and Wales, studies found that professional drivers were five times more likely than normal to contract the disease. This was not an ongoing outbreak that could be molecularly analyzed, but did provide investigators a population to survey. Drivers who had contracted Legionnaire's were contacted and asked to participate in a survey as a case group. The same survey was given to individuals of the same age, gender, and geographic location to provide a control group.

One of the interesting results came from a question about using screenwash - either prediluted or concentrate. Whereas 50 of 51 members of the control group used it, only 34 of 49 cases used it. The case group also drove more with their windows down, and drove through industrial locations (another possible source of exposure). Public health officials conjecture that the windscreen washer reservoir is in a warm location (the engine compartment), the water is atomized by the windscreen sprayer, and the drivers are exposed to the contaminated spray through the open window.

This case control study cannot prove causation; but it seems to be well-done and has led to a public health effort to have drivers use screenwash in their windscreen wiper system. After a few years, we might well see a follow-up study to compare the rate of Legionnaire's Disease compared to the rate of use of screenwash by British drivers. This study was written up in the European Journal of Epidemiology.

0 comments - Posted by Steve Rauch at 1:26 PM - Categories:

Encountering Negative Comments

Our daughter recently made the decision to go to graduate school. Once she chose a school, the real work began: getting her moved to and settled into Salem, Oregon

It was interesting to see how many pieces of information about the move we could obtain over the Internet. In some cases we arrived fully informed, and in others decisions were made before we started.

• Possible apartments (including the one she selected)
• Health Insurance possibilities
• Medical and dental care providers
• Closest Apple Store on our drive there (a MacBook Pro was in her future)
• List and location of reputable mechanics
• How to title and register her car
• How to get a driver's license
• Banking that provided a safe deposit box, nearby ATMs
• Renter's and car insurance

The one service that remained elusive was Internet access. The phone company required the additional expense of an ISP. The cable company wanted to bundle services she did not need. The third option was a wireless provider that covers many parts of the Pacific Northwest. But searches turned up many negative comments on their coverage, their contract, and their customer service. I asked the college IT folks, but received no clear direction.

Once we were in town, I decided to go with the wireless solution but not opt for the two-year contract. That evening, my daughter easily got online, and has not had any problems these few weeks getting a much more robust connection that I get from my own home. I was puzzled comparing all the negative comments to her actual experience.

One of the emails in my INBOX when I got back to work was the announcement of a new HeartBeat issue from Wendy Leebov. I have long been familiar with her works and had subscribed to this free newsletter on patient satisfaction. The lead story in August was how much faster and farther negative comments spread in today's world of social networking. The old rule of thumb was that a happy customer told 4 others, and an unhappy customer told 20 others. Leebov cites a new book that updates the ratio to 3 to 3,000.

I wondered if this is what I ran into with my search for Internet service providers? Surely some people were genuinely disappointed by the performance of this wireless Internet service and said so. But others were likely taking advantage of anonymity and the ease of posting comments to overstate the situation. Were some even working for competing services?

In choosing the wireless Internet service, I was willing to challenge the negative comments because I was not risking a great deal - one month of service and a wireless modem. But can we in health care expect our customers to take a risk with their next elective surgery? Fortunately for us, Wendy Leebov goes on to outline steps we can take to forge positive messages and how to take on negative ones. Her steps include:

• We can LISTEN
• We can INVITE feedback
• We can respond to feedback, quickly, honestly, and openly
• We can plant seeds

Read all of her comments on page 2 of the August HeartBeat. If you'd like to read the other HeartBeat articles, all issues are archived online.

0 comments - Posted by Steve Rauch at 12:00 PM - Categories: