I still don't get it. First the Twatlight series and now Vampire Diaries. What's with the all new vampire frenzy. There must be a huge deficit in our society that the vampire passion fullfills but I am not sure what that is. What is it with vampire romantic stories that makes them more appealing than regular shows. I have no clue. And as I am writing this my wife just changed the tv to Vampire Diarrhees...aarghhh
12.14.2009
5.09.2009
Twatlight
This post is way overdue. My wife (we are both in our mid-late twenties) had me watch the movie when she got the DVD. She had previously seen the flick in the theater and went nuts over it.
I have to say, I don't get it. The story is mediocre, the acting is among the worst I have ever seen and the parades of teenies that cry over Special Ed, make this even more of a turnoff for me. Thank god I am not the only one.
I do have to admit that I really like the soundtrack of the movie and some of the cinematography was pretty good, so it made a good audiovisual experience in some parts.
What is there about vampires (Twilight, Buffy, True Blood) that makes teenies and women crazy?
I have to say, I don't get it. The story is mediocre, the acting is among the worst I have ever seen and the parades of teenies that cry over Special Ed, make this even more of a turnoff for me. Thank god I am not the only one.
I do have to admit that I really like the soundtrack of the movie and some of the cinematography was pretty good, so it made a good audiovisual experience in some parts.
What is there about vampires (Twilight, Buffy, True Blood) that makes teenies and women crazy?
12.24.2008
IOM Report from Dec 2008
The Institute of Medicine (IOM) recently published a report on residency duty hours regulations. Basically, the report states that residents are still fatigued and that action is needed to guard patient safety. This report is a very serious document, and a response from ACGME was immediate. The next Annual Educational Conference of ACGME will take place in March, and it is expected that a lot of discussions and decisions on this matter will dominate the conference.
Here are a few comments on this new report (and on the survey that ACGME asked all residents to take):
1. Currently, there are no work-hour regulations that apply to attending physicians, who can therefore work an unlimited amount of time. An that choice is not always theirs to make; it can be imposed to them by their Division Chief or Chairman, just like my work hours can sometimes be imposed by my chief resident. Does this mean that current residents grow and develop their work mentality into a fake bubble of work-hour protection that has no application to real life? If I will have to work 100 hours as an attending, then learning to be a physician with a limit of 80 hours per week, is probably bad training. Is the public going to realize that attendings can also be over-worked and fatigued and demand work-hour limitations for them as well?
2. All the literature so far (see review in JACS, Nov 2008) demonstrates that the 80-hour work week regulations have decreased fatigue (at least chronic fatigue). However, there is no concensus on the effect of the regulations on the quality of training. The IOM 08 recoomendations seem that they will further decrease fatigue (maybe even have an effect of acute fatigue). However, only a few of the recommendations ("limit non learning time" etc) are designed to enhance education. If we keep cutting down the hours, without paying extreme attention to the methods of training and making changes to that domain as well, we risk "cutting down on education".
3. If the new IOM recommendations are approved and applied, there will be many duty-calls that will be uncovered by residents. This would mean that more residents need to be hired or more physician extenders need to be hired. The first solution costs money and also raises the concern that education opportunities will be divided to more people (this is mostly true for surgical residents, as the same number of total cases will be divided to more residents). The second solution is at least 4 times more expensive than the first solution. So, to the minimum these recommendations are very very expensive. Who will be asked to pay for this? Most hospitals (especially in today's economy) will refuse to put money into this; they will likely shut down their programs; and this is not limited to "small community hospitals". And I am sure that DoD and Medicare will be very excited to pour money into residencies. Money makes our world go round, so I think this will be the reason why the recommendations cannot be applied.
To conclude, I think that the ACGME will eventually adopt many of the new IOM recommendations, because the public wants at all cost to protect the patient safety. To the minimum, the new regulations will involve more strict and frequent monitoring of residency programs, less flexibility with violations and higher penalties for violating programs. The extend to which the recommendations will be adopted will be determined by the funding agencies. I do believe that these changes will improve residents' fatigue. On the other hand, I am very skeptical about the effect on training. I believe that in our era of expanding technology, endless paperwork in the hospitals and the transformation of patients into clients-customers, the way residents are being trained seems archaic. Changes are imminent and, I believe, necessary.
Here are a few comments on this new report (and on the survey that ACGME asked all residents to take):
1. Currently, there are no work-hour regulations that apply to attending physicians, who can therefore work an unlimited amount of time. An that choice is not always theirs to make; it can be imposed to them by their Division Chief or Chairman, just like my work hours can sometimes be imposed by my chief resident. Does this mean that current residents grow and develop their work mentality into a fake bubble of work-hour protection that has no application to real life? If I will have to work 100 hours as an attending, then learning to be a physician with a limit of 80 hours per week, is probably bad training. Is the public going to realize that attendings can also be over-worked and fatigued and demand work-hour limitations for them as well?
2. All the literature so far (see review in JACS, Nov 2008) demonstrates that the 80-hour work week regulations have decreased fatigue (at least chronic fatigue). However, there is no concensus on the effect of the regulations on the quality of training. The IOM 08 recoomendations seem that they will further decrease fatigue (maybe even have an effect of acute fatigue). However, only a few of the recommendations ("limit non learning time" etc) are designed to enhance education. If we keep cutting down the hours, without paying extreme attention to the methods of training and making changes to that domain as well, we risk "cutting down on education".
3. If the new IOM recommendations are approved and applied, there will be many duty-calls that will be uncovered by residents. This would mean that more residents need to be hired or more physician extenders need to be hired. The first solution costs money and also raises the concern that education opportunities will be divided to more people (this is mostly true for surgical residents, as the same number of total cases will be divided to more residents). The second solution is at least 4 times more expensive than the first solution. So, to the minimum these recommendations are very very expensive. Who will be asked to pay for this? Most hospitals (especially in today's economy) will refuse to put money into this; they will likely shut down their programs; and this is not limited to "small community hospitals". And I am sure that DoD and Medicare will be very excited to pour money into residencies. Money makes our world go round, so I think this will be the reason why the recommendations cannot be applied.
To conclude, I think that the ACGME will eventually adopt many of the new IOM recommendations, because the public wants at all cost to protect the patient safety. To the minimum, the new regulations will involve more strict and frequent monitoring of residency programs, less flexibility with violations and higher penalties for violating programs. The extend to which the recommendations will be adopted will be determined by the funding agencies. I do believe that these changes will improve residents' fatigue. On the other hand, I am very skeptical about the effect on training. I believe that in our era of expanding technology, endless paperwork in the hospitals and the transformation of patients into clients-customers, the way residents are being trained seems archaic. Changes are imminent and, I believe, necessary.
12.10.2008
Magnolia's Cafe
My wife recently introduced me to this place where we often meet to have lunch together when I am off or post call. Park Av is famous for the nice little delis, but this one is now my favorite. Good environment, good food (try the soups as well) and a good variety of local beers. Give it a try if you are in Rochester, NY.
12.09.2008
rTorrent 0.8.4
I have been using rtorrent for the past few years almost exclusively for all my downloads. It is the lightest client, very reliable and loaded with features. My configuration file allowed rtorrent to watch for new torrents in a specific folder, seed it until a 2:1 ratio is achieved and then stop the torrent. Also, it self-managed bandwidth in a way that internet speeds were good during the day, and maximum downloads/uploads were achieved at night. For my setup, I had it installed initially on my debian box and now on my basement old iMac through macports. My main machine is the latest iBook that Apple released, and all the computers are connected to each other with afp, using this amazing guide. I also use mostly ssh and occasionally vnc (JollysFastVNC) to control and configure everything.
Last night, I was updating my basement iMac and rtorrent was updated to version 0.8.2. This resulted to failure of rtorrent to start due to some incompatibility with the version of libtorrent that was provided with the update. In order to make rtorrent usable again, I had to uninstall rtorrent and install rtorrent-devel, which provided me with the latest unstable version 0.8.4. However, it seems that the ratio handling for this version has changed. Now, my rtorrent.rc configuration file that I have been using for 2 boxes for almost 2 years (with some editing) is not really usable. This means that rtorrent works full on all the time, making internet crawl for the rest of my applications!
I really like rtorrent but until somebody looks into the new configuration rules more, I switched to Transmission for MacOSX. I still have rtorrent on my debian box which I don't really use for downloads any more, and I hope I can switch back to rtorrent on the iMac, since checking the torrent progress through screen over ssh on my iPhone was uber cool.
UPDATE 12.14.08
I tried Transmission and it worked ok; it would watch a folder and download anything I threw in. However, it would not follow my settings for download folder, and clutter the tiny drive of the old iMac. Also, the download speeds were very slow, approx 20-40 KB/s. So, I switched back to rTorrent once and for all. Hopefully I will figure out the whole config problem...
Last night, I was updating my basement iMac and rtorrent was updated to version 0.8.2. This resulted to failure of rtorrent to start due to some incompatibility with the version of libtorrent that was provided with the update. In order to make rtorrent usable again, I had to uninstall rtorrent and install rtorrent-devel, which provided me with the latest unstable version 0.8.4. However, it seems that the ratio handling for this version has changed. Now, my rtorrent.rc configuration file that I have been using for 2 boxes for almost 2 years (with some editing) is not really usable. This means that rtorrent works full on all the time, making internet crawl for the rest of my applications!
I really like rtorrent but until somebody looks into the new configuration rules more, I switched to Transmission for MacOSX. I still have rtorrent on my debian box which I don't really use for downloads any more, and I hope I can switch back to rtorrent on the iMac, since checking the torrent progress through screen over ssh on my iPhone was uber cool.
UPDATE 12.14.08
I tried Transmission and it worked ok; it would watch a folder and download anything I threw in. However, it would not follow my settings for download folder, and clutter the tiny drive of the old iMac. Also, the download speeds were very slow, approx 20-40 KB/s. So, I switched back to rTorrent once and for all. Hopefully I will figure out the whole config problem...
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