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I'm a 2009 graduate of Dartmouth College who loves Jesus, my wife and all things Northeast.

Tuesday, November 30, 2010

A rough weekend at the movies

Hollywood lost two icons this past weekend. Canadian actor Leslie Nielsen passed away on Sunday from complications of pneumonia while director Irvin Kershner died on Saturday from complications of cancer. Nielsen, who spent much of his career as a dramatic actor, will be best remembered for his comedic roles in movies like Airplane! and The Naked Gun. Kershner, on the other hand, may be best known as the director of The Empire Strikes Back, the second installment in the Star Wars series. He also directed Sean Connery as James Bond in Never Say Never Again.

The I-can't-believe-they-got-a-grant-to-study-this files are open yet again, this time coughing up a study by former Cornell University psychology professor Daryl Bern. According to an article in The Cornell Sun, Professor Bern has recently concluded a study that shows viewing erotic images may increase the ability of Cornell students to predict the future. Somehow I don't think I need erotic images to help me predict the psychology community's response.

Elsewhere in the Ivy League, the Dartmouth men's football team concluded the 2010 season with a resounding 31-0 win over basement-dwelling Princeton. This gives the Big Green a 6-4 overall record (4-3 Ivy). A solid performance after years of mediocrity, or worse. The future is looking up! And speaking of Dartmouth, my favorite Dartmouth alumna to whom I'm not married (that is, historian, National Book Award winner and MacArthur "Genius Grant" recipient Annette Gordon-Reed '81) was recently named a Trustee of the College.

In other news, the New England Nor'Easters downed the Miami Sharks in the finals of the U.S. Chess League on November 20. Not a bad first season for the expansion Nor'Easters. Congratulations!

Tuesday, November 23, 2010

On abdominal pain

For EMS personnel, abdominal pain calls are notoriously difficult. As an emergency physician in Buffalo once said, "The problem with abdominal pain is it can be so many different things." In a nutshell, this sums up the dilemma faced by EMS. Without the advanced diagnostic tools and imaging technology available in the hospital setting, it is extremely challenging to arrive at an accurate field impression/differential diagnosis. There are definitely clues that can point you in one direction or another, and a skilled provider performing a detailed assessment can make headway, but sometimes you just don't have the resources to pin it down.

This vagueness plays out in the treatment options available to providers. The only mention of abdominal pain in the 2009 edition of New Hampshire's patient care protocols is to instruct paramedics to withhold Nitronox, a 50% nitrous oxide-oxygen gas mixture used for pain relief, from any patient with this complaint. This is not to be cruel; if the patient turns out to have a bowel obstruction, the gas can get trapped in the folds of the obstructed bowel and potentially cause a rupture. In many cases, all you can do is assess the patient to the best of your ability, provide supportive care and rapidly transport him to the closest appropriate facility (other options for pain control exist as well).

The Health section of yesterday's New York Times had a fascinating article about abdominal pain in pediatric patients. The author, physician Perri Klass, related how as a resident she and her colleagues used to "smirk" at cases of functional abdominal pain. Functional abdominal pain, which is a term previously unfamiliar to me, is evidently a diagnosis arrived at when nothing else seems to fit. Children with persistent stomachaches that cannot be explained by the presence of any disorder are often said to have this condition.

The article discussed how functional abdominal pain had previously been a throw-away diagnosis, or as Dr. Klass puts it, "A code for a troublesome patient, dubious symptoms or an anxious family." Now, though, clinicians are recognizing it as a legitimate complaint that requires serious attention and treatment.

As difficult as abdominal pain calls can be, it's nice to know that sometimes the doctors get stumped too.

Testing

I took my National Registry practical exam on Sunday in Concord, NH. The exam, which was held in a dormitory at the New Hampshire Fire Academy, consisted of eleven stations ranging from intravenous and intraosseous access and drug therapy to patient assessment, advanced airway management and cardiology. There were also two rounds of oral boards. For such a large-scale production--eighty people showed up to either retest individual stations or take the entire thing--the logistics ran like clockwork. It took me just over four hours from start to finish, and there was a minimum of downtime between stations.

The National Registry exam was different from the New York State paramedic practical exam in subtle but significant ways. Most obvious was the number and nature of the stations; both exams featured static and dynamic cardiology, IV access and bolus medications, adult airway management, patient assessment and one randomly selected "basic life support" skill. But where New York also tested IV med administration via drip and a second random BLS skill, the National Registry instead tested dual-lumen airway placement, pediatric airway management, pediatric intraosseous access and the oral boards.

More subtle were the differences when the stations overlapped between the two exams. A number of these were evident from examining the skills sheets on the National Registry website, but I also attended a "prep class" taught by an area instructor. She has been an evaluator for the National Registry for nearly twenty three years, and she has their permission to run this class the night before the exam outlining common pitfalls in the various stations. No actual exam scenarios are discussed, but she covers many of the ways in which this exam may vary from individual states' tests. It was more than worth the time and money!

Unfortunately, according to the test administrator's unofficial results, I did not pass my static cardiology station. I will have to retest that station another time (hopefully next month). It's a little disappointing, to say the least, but I'm glad to have most of the exam behind me. And since I have already passed the National Registry written exam, this is the last remaining hurdle to transferring my certification from New York to New Hampshire and Vermont.

Sunday was also our church's annual Thanksgiving Dinner, held in the town's community center. It was a great time of feasting, fellowship and, of course, thanksgiving. A lot of people spent a lot of time and energy making it the tremendous success that it was, and I know their efforts are deeply appreciated by all. (And to whoever brought the stuffing ... two enthusiastic thumbs up!)

Friday, November 19, 2010

In memoriam

Jeffrey A. Klein of Chappaqua, New York, my longtime friend, classmate and teammate, passed away last week at the age of twenty three. Jeff and I met in first grade when his father coached our tee-ball team, and we remained friends through high school, playing together on the basketball team for three years. Jeff was one of the most cheerful people I've ever known, and on and off the court he was the guy you could always depend on to pick you up when you were down. We're all going to miss you, man.

Sunday, November 7, 2010

World Champion(s)

While much of the country was focused on Red vs. Blue during last week's midterm congressional election, a select group of Americans donned the Red, White and Blue and brought home gold (or silver) at the World Youth Chess Championships and World Senior Chess Championships. Steven Zierk of California won clear first place in the Under 18 section, earning him the World U18 Champion title, the International Master title and a Grandmaster norm (three norms and a minimum rating of 2500 are required to achieve the title). In the U12 section, Kayden Troff of Utah took home the silver medal, as did Jeffrey Xiong of Texas in the U10 section.

Meanwhile, over in Greece, Grandmaster Larry Kaufman of Maryland tied for first place in the World Senior Championship. He took fourth place on tiebreaks, which meant he did not receive a medal, but it is nevertheless an impressive performance from the man who achieved the Grandmaster title by winning the World Senior back in 2008! Hearty congratulations to Zierk, Troff, Xiong, Kaufman and all the players who represented the United States with class and aplomb.

On the gridiron, the Dartmouth football team (5-3, 2-3 Ivy) put up a solid second-half showing to down the Cornell Big Red 28-10 on Saturday. With Brown (4-4, 3-2 Ivy) next week and Princeton (1-7, 0-5 Ivy) the week after, Dartmouth is in great position to make a strong finish to the season and secure a winning Ivy record. Go Big Green!

In other news, I went in for my seasonal flu shot today. The nurse asked me which arm I preferred for the injection, and I said my left, since it's my non-dominant arm. Then she saw my shirt, which prominently featured the New York Yankees' logo, and deadpanned, "Oh, you're a Yankees fan? Let me see your right arm ..."

Thursday, November 4, 2010

A case of bad taste

According to a report published on cnn.com, an alternate juror in the Connecticut murder trial of Steven Hayes sent a note to the court marshal at the end of the court session last Friday that, "Asked him to meet her Sunday at a restaurant." The trial is now in the sentencing phase, with the jurors considering whether or not to sentence Mr. Hayes to death for the murder of Hayley Petit, her sister and her mother. (Hayley was admitted to Dartmouth early-decision and would have been a member of the Class of 2011.)

Judge Jon Blue denied a motion by Mr. Hayes's attorneys to dismiss the juror, though he did chastise her, calling her date request a, "G------ dumb thing to do." I couldn't agree more, Judge. Regardless of whether or not it is appropriate for an alternate juror to date a court marshal during a trial, this woman's choice of timing and venue is abysmal. I would stop short of saying that this lapse in judgment automatically disqualifies her to serve in the trial if called upon, but one wonders about her suitability to weigh a matter of life and death if this is how seriously she is taking her current role.

Everybody makes mistakes, and no one exercises perfect judgment all the time. But how could you possibly think that the sentencing phase of a murder trial, with capital punishment on the table, was an appropriate time to ask out a court official? Or that enlisting another juror to pass a note to said official was the best way to go about it? At least she didn't put the date request on Twitter.

Also, the article did not mention whether or not the marshal showed up at the restaurant. I suspect he did not.

The Einstellung effect

I was overjoyed by the arrival in our mailbox of the November issue of Chess Life, the U.S. Chess Federation's monthly publication. I look forward each month to reading its chess news and tournament coverage, columnists and selections of games and problems. This month, I was particularly intrigued by Grandmaster Andy Soltis's column about the "Einstellung Effect." (The full text of the article is available at www.uschess.org, but I believe you have to be a USCF member to access it.)

Grandmaster Soltis normally writes about topics of interest in the chess world, but these are often related to positions that have occurred in various tournaments or other venues. This month, his topic is, "Why do the best players play second-best moves?" To summarize his two-page column, researchers have conducted studies in which chessplayers of varying strengths were shown two similar positions and asked to find the quickest win. The first position had a well-known checkmate-in-five combination while the second position, which had identically placed pieces save one, did not (due to the one relocated piece now covering the checkmate square).

The researchers found that strong players tended to immediately identify the mate-in-five but took a while longer to find a quicker but less well-known route to victory. Hence, the Einstellung effect, which according to Soltis, "Occurs when you try to solve a problem and are lured into a familiar but second-best approach." One study also found that there was no significant difference in the amount of time it took Class A players (shown only the second position) and International Masters (shown only the first position) to find the fastest win, which was the same combination in both cases. This is because the IMs were distracted by the more familiar yet longer combination. Soltis concludes, "They did no better than the A players when facing more or less the same position. The IMs' superior strength had been wiped out by the Einstellung effect."

This is a fascinating finding for anyone interested in psychology; the Einstellung effect is not confined to chess praxis but can be applied to mathematics and any number of other disciplines. I must question, however, GM Soltis's presentation of the entire question. It is true that the Einstellung effect may inhibit strong players from finding the fastest win, but what about finding a win the fastest? If I can find a mate-in-five instantly but have to spend a couple minutes finding a mate-in-three, is that really an efficient use of my time and energy? I doubt it.

All the same, kudos to GM Soltis and researchers Merim Bilalic, Peter McLeod and Fernand Gobet for giving me something to ponder on this rainy Thursday!

Monday, November 1, 2010

All Saints' Day

Martin Luther's "95 Theses" may be the most famous document ever posted on Halloween (in 1517), but the best headline I've seen in 2010 belongs to Saturday's edition of The New York Times. "World Series? Who Cares. Chess League Playoffs Are On," declared the legend atop Dylan Loeb McClain's weekly (chess) column. I enthusiastically echo and endorse this sentiment. And forget Monday Night Football: Tonight, my attention will be glued to the New England Nor'easters - New York Knights playoff match.

Yesterday was Halloween here in the Northeast (and everywhere else, I gather). Listening to the morning radio shows during the week, I learned that there were designated times for trick-or-treating. These times, which varied from one town to the next, ranged from late afternoon to early evening. It makes perfect sense to highlight certain hours of the day as "trick or treater friendly," for the purposes of controlling traffic, but I wonder what would happen to those nabbed asking for candy past approved hours?

The Dartmouth Homecoming was a mixed bag as far as sporting events go. There was one of the most impressive student and alumni turnouts I've ever seen for a Dartmouth football game ... if only the team had shown up too. The final score of Harvard 30, Dartmouth 14 reflected the occasionally stellar but mostly lackluster play by the Big Green. On the plus side, the men's and women's soccer teams downed their Harvard counterparts by scores of 2-1 and 3-2, respectively. The field hockey team also emerged on the winning end of a 1-0 decision against the Crimson.

Election Day is tomorrow. Make sure to vote!