Blissful Life

Author: akshay

  • CME on dissertation and synopsis – a statistical view

    The Department of Community Medicine, MMC&RI organized a CME on statistics today in the P&SM lecture hall, which was being renovated all this week for just this occasion.

    The first talk was on the importance of statistics in medical research.
    I missed the second talk about synopsis.
    Then Dr Ganagaboraiah talked about which statistical tests are best for which methodology, the pitfalls in using different tests, the importance of correct sample size, avoiding bias, the importance of confidence interval, significance, power, etc.

    This was followed by my favourite session on R by Dr S Ravi. He showed R studio and gave some reasons to use R in a beautiful latex (beamer?) presentation.

    And ironically, systat (who was sponsoring the day?) gave a talk about the systat software in the end. The conversation revolved around how systat is at par with SPSS which highlighted the generalized apathy towards R. Makes me wonder if I should quit medicine and build a GUI for R and sell it.

  • The Wait While The Dosa is Baked

    Read how to make Dosa here

    I finished Ophthalmology postings.
    And I started Orthopaedics postings.

    These days are very rainy, very clam, very eventless.

    NIE has a quiz fest from today. I’m participating in all that I can. Because tomorrow I’m going to attend the Firefox Launch party. It’s unfortunate that “biz-sci-tech” quiz is on the same day.

    I have registered mbbshacker on quora too. I will put less personal stuff there.

    Downloaded all the videos in Duke University medical neuroscience course on coursera. On week 2 now. It is interesting. I might even skip neuroscience if I finish this course.

    The rain is quite heavy in South India. It’s 35 inches back home, says dad.

    There are two internals back to back next week. ENT on Tuesday. PSM on Wednesday. I am yet to start ENT.

    I’m living on my bed (literally) these days. Never get to wake up before 8, never goes for a jog, nobody plays football in the evenings.

    The fact that I could gulp down all the knowledge on earth if I wanted to is exhilarating! It leaves me confused about what course to take after MBBS. Clincial Neurology might be too “clinical”. Psychiatry is a very good option. Community Medicine is where my aptitude is (I believe). I am not sure I am research type. I might find practical research boring. Theoretical, maybe yes! But I don’t know if there’s theory in medicine. I might have to start my own research lab. Or I could join this guy:

    Whatever is my future, I’ll have to wait till the dosa is baked to eat it.

  • “Share” Button is the Biggest Threat to the Human Capacity to Think

    The ability to read and rationalize is unique to human beings. It could be the so called “fast paced environment” in the 21st century
    that caused it, but we do not read things
    carefully these days.

    In ancient past the only way for people to communicate was to talk to each other – in sign language, or through pictures, or through a proper language. Conditions improved when we discovered script and ways to write down words. Printing press made it absolutely easy to create multiple copies of what we had to say. But computers connected to the internet changed the scenario.

    With the ability to copy-paste and spread a word without spending a penny came a detestable habit – forgetting to read and analyse what is going through. While copy-pasting needed one to define one’s selection by dragging with their mouse around the right words, “Share” or “Forward” makes it a single-click affair, and much worse.

    Here is an audio (in Hindi) which tells us how this ease-of-use has actually made us lazy to think about even the consequences of a click. A radio jockey pretends to be a Facebook manager who is rewarding active users and calls up two guys – a Muslim and a Hindu – who had put status updates against each other on the preceding day. When asked about what they had posted, they are ashamed to answer.

    Notice that at the end of the audio the poor fellows accept their mistake and admit that they were “copy-pasting what someone else had posted”.

    This happens in chain forwards too. Most chain forwards begin with a claim of authority (“The Scientific Association of ABC warns that…”) which is directly followed by a false claim (“…eating XYZ is harmful for body as it contains UUU…”). Following this there is either an unscientific explanation of how this works, or a very emotional story of someone being affected by not following this advice. And at the end there is the quintessential “forward this to your friends and relatives”.

    The people who actually read this critically will focus on two things – the authority who is claiming it, and the explanation behind it. They proceed to verify that the authority has actually issued such a warning or that the purported harm is plausible according to the given explanation.

    But the people who forward it mercilessly focus on different things – the claim, the emotional story, and the “harmless” opportunity to help a lot of unsuspecting people. I wonder if they even read the claims. They gloss over the long piece of text and then think “Uh, oh! What if this is true? This affects a lot of people, I suppose. After all there is no harm in just sharing it.” Click. Shared.

    The people in the above audio clip might also have done the same. They would have superficially understood the emotions being conveyed in a message. And then they would have taken it for granted that the claims in it are actually true. And, worst of all, they would have shared the message with best intentions.

    It is when we forget to slow down and think that mistakes tend to happen.

    When in doubt, do not share. When you are compelled to share, “say something about it”. Add your opinion, or doubts about it along with what you share. And never share something that you have not read fully.

  • Holidays and working days

    General election is definitely making a wave. I did my first vote on April 10 standing in queue for just over an hour in Maruthayi LP school. I resisted the urge to rub the indelible ink right after the officer put it on my index finger. I wanted the mark to stay, at least till the first day after holidays.

    The polling day was April 17 in Karnataka. The finger was thumb.

    On Vishu I went to Nagarahole National Park with my family for the third time. It was also the third time we returned without being able to go for the wild safari. This time it was none of our mistakes, it was the summer rain the evening before.

    r/getDisciplined is my new hope to get better at academics.

    On the way back to college I had two great ideas – upgrade Ubuntu to trusty tahr, and advertise a one on one, home workshop for website creation/Linux basics/Python for students. The former was done. Latter needs a website.

    Classes are going as slow as it ever have been after 6th term began. I could have failed a subject in second year, there is enough free time to learn a subject. Or to watch House of Cards.

  • MAA grant

    The medical education unit room in the first floor of Platinum Jubilee Hall is a neat place.

    There is a projector with a flexible base that stays where you put it.
    There are excellent rotating chairs and static cushioned chairs with nice tables that go along.

    And last Thursday the room hosted the MAA grant interview of candidates.

    There were 17 projects which sought the 10×10000 and 2×5000 grants by 1961 batch and 1984 batch respectively.

    Dr Manjunath had already informed everyone how their presentations should be outlined.
    Dr Shekar, Dr Balu, and a few elders from 1961 batch was present to discuss the presentations.

    It went in alphabetical order except for a few changes.

    I was second to present my “Study on the Respiratory Effects in Road Construction Workers”.
    Somehow the title had to include the word “prevalence”. Also, unlike what Dr Sumanth, my guide, and me thought, there is some problem with smokers and non-smokers being included in the study.

    The inclusion criteria should not be one year. It should be more considering how chronic bronchitis is defined to be two years.

    And peak flow meter can measure only obstructive diseases.

    Totally, I was apparently “just coming and doing research” which is “not the way research should be done”.

    To be frank, I felt like I am going to be better off not wanting to do any research. After all, I’m not going to be patient enough to do data collection. I should rather switch to statistical analysis (my opinion). That’s where all the fun is. And that won’t have to go through all these trouble of convincing people about ethicality and practicality of stuff.

    Others presented projects about tobacco, birth asphyxia, and stuff.

    From today, I’m a research analyst :p

  • Workshop on Coercion

    What could be called the 2nd Indo-European symposium on coercion, started today morning at 9 in the first floor of Platinum Jubilee Auditorium, JK Grounds, Mysore.

    Checkout their website here: mysorecoercion.com

    First, Prof. Tom Palmstierna talked about various forms of coercion used in Europe. Belts, net beds, clothes, so on. The interesting thing is, these practices are not the same in different regions. Some countries practise seclusion, some countries practise restraint, and mental health workers in different regions consider their own methods as good, and others’ method as terrible.

    He went on to point out cochrane reviews which said that there is no evidence to show that coercion is useful. By which he only meant that coercion per se is not helpful. And this point was clarified in questions, when Dr S said that coercion or physical restraint is the first step to treatment.

    Although it was argued that coercion and restraint are not the same, Prof Palmstierna said that coercion is a spectrum which goes from restraint to strong advice.

    The discussion about CTOs will happen later.

    The second session – about the definition of coercion in the Indian setting, was made into a discussion session because Dr Murali Krishna was unable to reach.

    The crowd was asked about different forms of coercive practices followed in India. It was said that people are tied up, that it is mostly the family that does it rather than the doctor, that religious leaders and institutions have a role in how psychiatric patients are managed. That sometimes there is nobody to coerce the large population of India – people who walk on streets, talking to imaginary friends. Chain cannot be used after Erwadi incidence. There are physical, mechanical, covert medication, etc. Covert is common. Seclusion is not so used. Coercion is a necessary evil, it needs to have a law. Different opinions will always exist.
    Family’s concern, patient’s concern. Autonomy of patient vs freedom of society. Coercion is not a punishment. Role of BOV in MHA 1987 is not explained. Non-Indian citizens have to be considered. Is coercion always in the best interest of patients? Mental Health Care Review Board has only a role in supervision.
    Shouldn’t we be bothered about treatment more rather than the right of the patient?

    We should try to achieve general good clinical practice. There should be no difference in hospital or community. Legislation will delegate the powers to execution.

    Mysore Declaration on Coercion
     Last year, in the Indo-European symposium, a small step towards setting up guidelines about coercion was made.
    In India, covert medication, etc is common place. But we do not have data about the use of coercive measures and other forms of leverage. This makes international comparison difficult.
    There is a need for recognizing the rights of the mentally ill.
    Disproportionate, unsafe or prolonged coercion or violence against persons with mental illness is a violation of human rights.
    There are barriers like lack of awareness about the treatment and outcomes expected, the assumption that mental illness is always accompanied by mental incapacity, lack of provision for advanced planning in the event of future incapacity and compulsory admissions; lack of resources, lack of training.

    Long term goals would be to involve patients in decisions made about them. To develop strategic plans, benchmarking, regular analysis of data, regional and national and international comparisons and transparency.

    And so on

  • Time to Fly

    It has already been half a month since I turned 21.

    The sedentary life was giving me a heart attack. So I started jogging. Three days later replaced that with football in the evening. Only “Campnow stadium” (or hostel ground) is so full of dust that playing there is equivalent to smoking 2 cigarettes.

    Postings in community medicine is proving useful. Though I have not taken any case seriously in the wards, I have been reading about parallel stuff – like the story of tuberculosis (that led me to the understanding that tuberculosis has a very important role in the history of medicine) and the Indian national programmes for children.

    Here is a beautiful quote:

    2000 B.C.—Here, eat this root.

    1000 A.D.—That root is heathen. Here, say this prayer.

    1850 A.D.—That prayer is superstition. Here, drink this potion.

    1920 A.D.—That potion is snake oil. Here, swallow this pill.

    1945 A.D.—That pill is ineffective. Here, take this penicillin.

    1955 A.D.—Oops . . . bugs mutated. Here, take this tetracycline.

    1960–1999—39 more “oops.” Here, take this more powerful antibiotic.

    2000 A.D.—The bugs have won! Here, eat this root.

    —Anonymous

     Classes are still going slow. OBG is the only subject that is proving interesting.

    Outside the classes, things are going faster.

    Last Monday Dr Dharav Shah, a psychiatrist from NIMHANS took a beautiful session on how doctors can stop the alcohol epidemic.

    The Kreida 2014 team is beginning to rev up. All teams have been decided. I am doing sports quiz, one of the new items in this year’s kreida.

    Academic society will also kick up some dust soon with its activities.

    Fest: To hold, or not to hold – that is the question. Because October is too close to the exam. May is too close to today (which prevents fund collection) and to rain (which prevents outdoor fest)

    Trip: To go to Goa, the best time is November to March. Due to Kreida, March is blocked. I am sure I will have to walk without clothes if we go in this month itself.

  • 3rd year

    Community medicine  department became the first to suggest reading a textbook that was written for a different subject when the HoD asked us to read Harrison’s, Davidson’s and Hutchinson’s , McLeod’s instead of community medicine textbooks like Park.

    He also suggested one important thing – to stop getting involved in college activities, politics, etc and to start pouring in hours after hours reading those standard textbooks and others. Genuine. Why should students be spending any time doing things that are not useful for them, but probably harmful, in the long run?

    Thus, my resolutions to disregard anything that isn’t directly related to my career henceforth, got some cementing.

    He also said of the need to stop depending on parents. And that gave me some more reasons why I should start earning some bucks on my own.

    Technically, I’m motivated.

  • How To Never Lose Your Contacts or Data on Your Smartphone

    This post will tell you everything you need to know about:

    1. Having to never lose any of your contacts
    2. Having to never lose any of your chats/messages/whatsapp conversations, etc.

    Required: An android phone (though the concepts presented in this post will apply to other smartphones like iPhone, and Blackberry too)

    What you need to know
    Your smartphone has two kinds of memory – the system memory (the internal memory) and the user memory (SD card, external storage)

    Memory Consisting Analogy What it means Things stored
    Internal Phone memory Brain When your phone dies, the memories die too Contacts, accounts, settings, application data
    External SD Card Notebook The memories are not tied to your phone, they can travel from phone to phone, state to state Images, videos, application backups

    So what?
    So, when you inadvertently burn your phone’s motherboard, or decide to format your phone, you’ll lose everything on the internal memory and nothing on the SD card. *

    How to utilize this knowledge and save your ass
    Now that we know what kind of memory is vulnerable to being lost, we can think of backing up things stored on it – contacts, accounts, settings, application data, etc.

    There are two places you can back your data up at:

    1. SD card
    2. Cloud (that is servers of google, apple, etc)

    Contacts
    Easy way: When adding a new contact, an often neglected option asks you “Create contact in: Google Account, Phone, or SIM?”

    If you choose “Google” as the answer to the above (instead of “Phone”), you’re done. Over. That contact will be synced to your google account the next time you’re connected to internet, and voila! You’ll never lose it.

    Note: Contrary to what some people think, choosing that the contact be saved in Google doesn’t mean that the contact won’t show up on your phone. A Google contact acts just like a phone contact, only that it will also be synced to the google server.

    What about existing contacts on phone?
    Moving the contacts you’ve already saved to your phone from your phone to Google is also going to be a piece of cake.

    See if in your Contacts –> Menu or Contacts –> Menu –> Settings there is an option meaning “Move contacts”. If it exists,
    Step 1: simply click “from: phone” and “to: google”.

    Most phones I’ve come across does not have the above “move” option. For these, we’re going to take a scary approach.
    Step 1: Contacts –> Menu –> Export Contacts
    Choose “phone” and it will save all your phone contacts to your SD card.
    Step 2: Contacts –> Menu –> Export Contacts
    Choose “sim” if you also have some contacts on your sim card.
    Step 3: (Scary step) Contacts –> Menu –> Delete all contacts! (Don’t worry, we have exported all your contacts to SD card in step 1 & 2)
    Step 4: Contacts –> Menu –> Import Contacts
    Choose “Google account” when you’re prompted where to import contacts to.

    Alternate way
    If you do not ever connect to internet, an alternate way to back up your contacts is to follow steps 1 and 2 above, and then step 4 when you need to restore your contacts. The disadvantage of this approach is that this is manual.

    Alternate way with software download
    Just download Contact Backup apps and these will do the above alternative automatically.

    SMS Messages
    The SMSes are unfortunately never backed up to the cloud by default. If you still use SMS for communication after all the TRAI regulations, I have the following app recommendation

    SMS Backup+
    It is free, and it works charmingly well, backing up all your SMS conversations to gmail thus allowing you to use gmail’s search to search even your SMS conversations.
    Advantages:

    • Backs up SMS, Call Log, and even Whatsapp conversations (excluding group messages)
    • Backs these up to GMail!
    • Free!

    Whatsapp Conversations
    Whatsapp has a built-in backup feature. By default it is on, and runs at 4 AM every day. It creates a backup of all your chats to the “Whatsapp” folder of your SD card. You can also trigger a manual backup, in case you know you’re going to break your phone.

    To-do:

    • Never “Delete and exit group”
    • Never “Clear all conversations”

    Restoring data after crash:

    • After you install whatsapp again, it automatically detects the backup inside “Whatsapp” folder on your phone’s SD card, and offers to restore conversations for you.
    • Do NOT choose to continue without restoring. Once you do this, you’ll potentially fork your message history thus leaving you with no chance to have a “total” history of your whatsapp messages.

    Advanced restore: (If you buy a new phone or something)

    •  In your new phone, and new SD card, there’s no “Whatsapp” folder. So, when whatsapp runs it won’t detect the backup (because there is no backup)
    • Just copy the “Whatsapp” folder and paste it in your SD card BEFORE installing whatsapp. Now, whatsapp automatically detects your backup and restores messages from it.

    PRO-TIP:
    The whatsapp backup file is saved in your SD card. So, if you lose your phone, and lose the SD card along with it, you could end up losing whatsapp backups too. But there’s a way to sync those backups to the cloud. Checkout Dropsync, or Auto Backup for Whatsapp
     
    Settings
    In newer android phones, there is a setting “backup & restore” that allows backup of all settings. But otherwise you’ll need different apps. Just search “backup settings” in play store.

    Other apps
    The way android is structured, the data of apps cannot be accessed by other apps (unless you’re rooted). So, if the app (whose data you’re trying to backup) doesn’t have a backup option, you are out of luck. (If you’re really into it, you can root your phone. Although this might lead to countless sleepless nights)

    *Some phones have an external storage that is built-in, or comes with the phone. I haven’t played around with this a lot, but chances are that this acts like an SD card.

  • Pathology Practical Examination

    After revision on 4th (coming back from a quick visit to home) and 2 days of not studying anything related to pathology, today on 7th I took the Pathology practical exam.

    As usual, it started with the spotters. I remember fatty liver, and peptic ulcer; WBC Pipette, bone marrow aspiration needle, Wilm’s tumor, CLL. And the rest of the histopathology slides were too confusing – what I thought emphysema was probably CVC lung, and I don’t even remember if I wrote the others right.

    Then, I got to sit down at my chair where a chart, a peripheral smear, a discussion slide and a urine sample was waiting.

    Peripheral smear was probably dimorphic anemia. I got really confused till I adjusted the condenser for the high power. (Always remember. High power, high condenser). Nevertheless I was asked the causes of eosinophilia, microcytic anemia, macrocytic anemia.

    Urine – my question was a sore-throat kid with burning micturition. Proteins present, Blood absent. Had to explain how phosphate coagulum gets dissolved in acetic acid, while protein doesn’t. Messed up by pouring nitric acid over urine in Heller’s test, instead of adding urine to nitric acid.

    (I remember the other side were being asked reducing sugar (diabetic neuritis), and ketone bodies)

    The discussion slide I got was that of a 56 year old man with burning micturition. BPH was an easy find, but I didn’t know about the serum markers of Prostatic cancer (which I answered in the evening – Prostate Specific Antigen, and Prostatic Acid Phosphate) or about the grading PIN-1,PIN-2.

    The chart was of CSF examination with cobweb formation, increased protein, presence of lymphocytes. Straightaway TB meningitis. Had to say other inflammatory conditions in the brain.

    With blood grouping, I got my answer paper soiled. The slide was kept right next to my microscope, right above the answer paper. And after I finished answering some other examiner, the slide was nowhere to be seen. 😛 The front page, where “RGUHS” was printed was very nicely coloured red and blue, red and yellow and red and colourless 😀 I almost did the same with the second slide I received too. Put the Rh on the backside of my answer paper. But luckily, by then I had found out that the group was B-ve. Had to tell the examiner about the minor blood grouping systems too.

    With the morning session done, I was too stressed out having a headache, just wanted to sleep. Came back to hostel. Had lunch, and went back to college so that I don’t sleep in my room.

    At 2 o’clock the viva-voce started and it was very quick for everyone.

    First room: Specimens on the table – Fatty liver, squamous cell carcinoma, lobar pneumonia, TB lymph node. But the questions were causes of fatty liver, define shock, types of shock, define necrosis, types of necrosis.

    Second room: Specimens – Osteoclastoma, Polyp intestine, hydronephrosis etc. Questions were PIN (which I forgot earlier), describing osteoclastoma, describing polyp, classifying polyps, cause of hydronephrosis, describing the specimen.

    Third room: Specimens – TB Lung, seminoma, Breast cancer, and so on. Questions – describe TB, describe seminoma, describe breast cancer. The important thing was to describe only what was visible. 😀

    Fourth room: Instruments. Wintrobe’s, Westergren’s. Had to tell the anticoagulant used. Pasteur’s pipette (I never knew it was called that. My “dropper/pipette” answer didn’t work)

    And in about 10 minutes I was finished.