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From our anonymous insider…

Dissection investigated the shoulder joint. Our upper limb is similar to our lower limb in bone and joint structure. However, while most of our weight is translated through bone in our lower limbs, most upper limb weight is translated through muscles, the most fascinating of which is serratus anterior. This muscle originates on the front of the upper ribs, wraps around the body, under the shoulder blade, to insert on the anterior side of the medial border of the scapula (shoulder blade). This “boxer” muscle pulls the shoulder blade against the thorax ensuring it slides along the back when other muscles act upon it.

Lectures continued the discussion of metabolic processes, including the role of lysosomes, the recycling centers of the cell. Extracellular debris, and cellular parts are trafficked to these small vesicles to be degraded by powerful enzymes. Our patient case was Hunter’s disease, a lysosomal storage disorder caused by a mutation or deletion in a lysosomal enzymes’ genetic code. There are only about 500 Americans afflicted with Hunter’s, which affects nearly every organ system and can result in heart valve malformation, respiratory problems, liver/spleen enlargement and severe neurodegeneration. Individuals suffering from Hunter’s, which typically manifests by age 2, frequently cannot speak or comprehend basic stimuli. Life expectancy varies from 10-20 years.

A pediatric geneticist described treating Hunter’s patients with Elaprase, a recombinant enzyme replacement therapy that replaces the mutated or absent lysosomal enzyme. This “orphan drug” costs over $300,000/year (see Forbes), but can’t get through the blood-brain barrier to enter the nervous system and improve neural development. The geneticist explained that orphan drug prices are passed on to private insurance companies at an undisclosed negotiated price, paid in full by Medicaid without negotiation, or are paid for by the manufacturer when the patient has no insurance. Shire reported worldwide 2015 Elaprase sales of $552 million (press release).

We were done every day before 5:00 pm. I studied 1.5-2 hours after class each day in preparation for the exams that are three weeks away. There is a medical school test prep industry that includes phone-based flashcard systems such as Anki and Firecracker ($300 for two years). I haven’t subscribed to any paid products yet because skimming through lecture slides and notes, then taking practice exam questions, is effective.

We got Labor Day off and our student affairs dean held a dinner party for those who stayed in town. We learned that for the past two years, approximately 20 percent of graduating students have gotten engaged to one another.

Statistics for the week… Study: 10-12 hours; Sleep: 6 hours/night; Fun: 3 nights out. Example fun: a Friday after-class soccer match followed by a BBQ with Jane’s family.

The Whole Book: http://tinyurl.com/MedicalSchool2020

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“A Decade Lived in the Dark” (New Yorker) is about a woman in England who believes that she is “sensitive to light” and has to live in the dark. The article is kind of interesting on its own account, especially given that the sufferer has written a successful book about her experience.

I wonder if this shows a good evolutionary adaption to a more crowded world. In the mid-20th century a middle class American could afford a standalone house within a reasonable commuting time of a job. The standalone house would have windows on all four sides and therefore there would be plenty of light inside the house from sunrise to sunset. As the U.S. population is headed toward a number previously associated with India or China more of us will have to live in apartments, which may get light from only one side (like a hotel room). Given that Americans spend a lot of time indoors, I wonder if our more crowded country means a generally darker experience for the average person.

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From our anonymous insider…

In anatomy, we dissected the anterior thigh, lower leg and foot. Before this week, I did not realize there were two bones between the knee and ankle: the tibia and fibula. (To feel your fibula, locate the protrusion on the lateral side slightly below your knee and follow it down to a protrusion on the lateral side of the ankle.) One of the most interesting parts of this three-hour dissection was the opening of the knee capsule, which requires ripping through tough layers of ligament on both lateral and medial sides to arrive at the treasures: the anterior and posterior cruciate ligament (ACL, PCL, respectively). These are named for the criss-cross structure they form in the interior knee. Once we cut the ACL, a beautiful bundle of fibers from the anterior side of the tibia to the lateral condyle of the femur, it is amazing how much we could move the tibia in relation to the femur.

After the anatomy lab, orthopedic surgeons taught us how to conduct a lower leg exam. We learned to isolate specific axes of rotation to evaluate ligament integrity and range of motion. Tragically ironic, a classmate’s boyfriend injured his knee the next day. She conducted the exam and felt an increase in medial rotation of the knee and offered the diagnosis of a loose lateral collateral ligament. When asked what he should do, she responded, “I don’t know, ask me in three years. Your LCL is messed up.”

Our patient case had type 2 diabetes, which includes two distinct phases. The first involves the desensitization of target cells to the action of insulin. Insulin acts as a “signal of construction” by stimulating target cells to uptake available energy and molecular building blocks such as blood glucose. As blood glucose remains high, pancreatic cells that secrete insulin become overworked and die. As pancreatic islet function is degraded, the patient transitions to the second phase, a severe, irreversible form of type 2 diabetes that mirrors type 1 diabetes. Importantly, patients who manage their diabetes before entering this second phase can reverse the entire disease. The lecturers, an internist and a PhD researcher, agreed that determining the mechanism of insulin resistance would win a Nobel prize.

One common drug class used to manage type 2 diabetes and to depress blood glucose is sulfonylureas. Sulfonylureas function by increasing beta-cell release of insulin. One of my classmates asked, “Isn’t treating type 2 diabetes with these drugs accelerating the degradation of beta cell function?” The internist responded “Yes, but sometimes we have to use them. When a patient’s glucose levels are off the chart, you have to use every option. Second, sulfonylureas are much cheaper than alternatives such as insulin injections. Many of my patients cannot afford anything else.”

With exams in a month, a few classmates are already freaking out. We aren’t being given the graded homework assignments to which they are accustomed and from which they could gauge their progress. We are supposed to determine what style of independent learning works for us. Instead of concentrating on learning, these classmates are worrying about exactly what is going to be on the Week 9 exam. Our drama for the week is that they apparently brought their uncertainty up with the Office of Student Affairs. I would have hoped that they’d have more faith in the system with which they are entrusting four years and more than $300,000 (tuition, room, and board).

Statistics for the week… Study: 8 hours (6 hours devoted to anatomy); Sleep: 6 hours/night; Fun: 4 nights out. Example fun: Friday night about 15 of us had a “jam session” dinner party. After spaghetti and homemade meatballs, we broke out the beer and instruments. The group included a classically trained cellist, two pianists who would have been welcome in most jazz clubs, and a harmonium(!) player. I was glad that I had brought my guitar, but I’m not sure that these real musicians were similarly glad.

The Whole Book: http://tinyurl.com/MedicalSchool2020

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“Bariatric Surgery: The Solution to Obesity?” (New Yorker) shamelessly cheerleads for surgical modification of the human body to deal with changed environmental conditions:

“We are meant to fast and feast, like the other carnivores,” I once overheard a flight attendant say to another on an overnight plane. “But there’s always a feast around.”

Given enough time is it possible that the human body would evolve to avoid weight gain even in the presence of unlimited food? Do thin people have more children than fat people, for example?

In the meantime the author claims that we can actually save money on healthcare by cutting into the abdomens of anyone who shows signs of gaining weight:

Bariatric surgeries, which can cost as much as thirty thousand dollars, are covered by many major insurance companies. (Most studies suggest that the expenses are recouped within two to three years, because the surgeries avert future obesity-related medical expenses.)

What do readers think? Can this be right? Maybe we do need to speed up evolution because we aren’t adapting fast enough to the continuous casino and cruise ship buffets. But is surgery the answer? Why not wait a few years for CRISPR to be perfected? Modify our genes so that donuts don’t taste good anymore.

Related:

• Obesity, population growth, global warming, and the role of veterinarians
• Whales, Technology, and Obesity
• American Economic Association Meeting in Boston (scroll down to the article on free school breakfast)
• Expanding preschool = expanding waistlines?

 

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I didn’t catch the vice presidential debate. What happened? The transcript suggests that mostly the VP candidates talked about the presidential candidates rather than about what each might do personally. Is this conventional?

The transcript shows a long discussion about police, which seemed odd because running police departments is mostly done by states and cities, no? Most interesting to me was Pence’s comment: “Police officers are the best of us.” Can that be true? Pence implies that it is because they risk being killed: “African-American, Asian, Latino, Hispanic, they put their lives on the line every single day.” But the risk of death for a police officer is negligible compared to the risk incurred by a front-line combat soldier. Why wouldn’t it be “Combat infantry second lieutenants are the best of us” if the standard is risking one’s life for fellow citizens?

Kaine presents himself as the defender of women: “Donald Trump [should apologize] for calling women slobs, pigs, dogs, disgusting.” A scholar told me that in the old days we presented our enemies as subhuman, e.g., portraying the Japanese during World War II as monkeys. Now we point to their treatment of women and say that we are going to rush in with our military to defend those women. Kaine seems to be doing the same thing domestically.

Pandering to voters by telling them that they are going to get great stuff from the government but won’t have to pay for it with taxes seems to still be in style. The moderator: “According to the nonpartisan Committee for a Responsible Federal Budget, neither of your economic plans will reduce the growing $19 trillion gross national debt. In fact, your plans would add even more to it.” Pence seems to think that Americans are going to get off their sofas, put down the Xbox controllers, and return to the labor force: “when you get the economy growing, Elaine, that’s when you can deal with the national debt. When we get back to 3.5 percent to 4 percent growth with Donald Trump’s plan will do, then we’re going to have the resources to meet our nation’s needs at home and abroad, and we’re going to have the ability to bring down the national debt.” But he doesn’t say that he will scale back the programs listed in Book Review: The Redistribution Recession that make it irrational for Americans to work (or encourage states to adjust child support guidelines so that it becomes less profitable to have sex with a dermatologist than to go to college and work).

Kaine promises a Soviet-style planned economy for achieving economic growth: “First thing we do is we invest in manufacturing, infrastructure, and research in the clean energy jobs of tomorrow. Second thing is we invest in our workforce, from pre-K education to great teachers to debt-free college and tuition-free college for families that make less than $125,000 a year.” The “we” here seems to be the government’s central planners. “Third, we promote fairness by raising the minimum wage, so you can’t work full-time and be under the poverty level, and by paying women equal pay for equal work.” The central planners will decide how much each American should get paid, just as was done in the Soviet system. As the Democrats are solidly in the lead I would say that this demonstrates the continuing desire of Americans to enjoy a planned economy (see “Citizens for a Planned Economy”).

It seemed as though mostly the candidates talked about stuff that is too complex and technical for the average voter to know or care about. Was there an obvious winner?

[Meanwhile my Facebook feed continues to be filled with hatred of Donald Trump and celebration of Hillary’s wisdom. Hillary supporters have come to the conclusion that all Trump supporters are either stupid or sexist/racist or both. This makes some statistical sense because less than half of the voting population supports Trump and roughly half of Americans are less intelligent than average. I wonder if anyone has followed up by administering an IQ test to voters to determine if in fact IQ can be used to predict voting behavior.]

 

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A friend took the same photos with his Samsung Note 7 (with latest battery!) and my iPhone 6 Plus. It was close to high noon on an overcast day. Most of the iPhone images were unusable due to motion blur (both cameras were in fully automatic mode; the iPhone selected ISO 32 and a shutter speed of 1/60th of a second while the Samsung picked ISO 64 and a shutter speed of 1/120th to 1/150th). Here are the results:

• from the iPhone 6 Plus
• from the Samsung Note 7

And just today DxOMark declared that the Google Pixel delivers better performance than any other smartphone camera. I do like the idea of a normal perspective lens on a phone (iPhone 7 Plus), but I wonder if Apple spent too much time on Social Justice Wars (and avoiding corporate income taxes) and not enough on squeezing in a bigger sensor.

Related

• Samsung Galaxy S7 review
• Falling out of love with the Samsung Galaxy S7

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“China To Build 66 New Airports Over The Next Five Years” describes the Chinese commitment to expanding commercial aviation infrastructure. “China Embraces General Aviation” talks about an additional 300 airports being built for business jets and piston-powered airplanes (this complements Chinese purchases of manufacturers of personal aircraft and components for those aircraft, e.g., Cirrus and Continental). Meanwhile, Californians are working to shut down the Santa Monica airport despite Federal government orders to keep it open (based on the fact that Federal tax dollars were used to pave the current runways and taxiways). The Airnav page for KSMO says that the to-be-closed airport handles 452 operations per day or 165,000 per year.

Related:

• High-speed Rail in California versus China
• U.S. versus German infrastructure spending and results

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Those of you who are approaching 100 may recall that I started photo.net back in 1993. It started out as a place for people to learn from tutorials (example: Making Photographs) and engage in a text-based discussion of technique- and gear-related issues (there was no Trump v. Hillary campaign at the time to consume 100 percent of Internet users’ attention). In the late 1990s we added a photo sharing system that let people show off their best work and/or get feedback on attempted great work. I spun off the site in late 1999 to some grad school friends who had a plan to surf the dotcom wave with photo.net as a base, but instead they were pounded into the sand when the market collapsed.

Continuing the occasional theme of this blog of “What is the point of the Internet if we have Facebook?” I am wondering if there is still a place for online communities for photographers and, if so, what the main purpose would be. Gearheads seem to post a lot of comments on the articles at dpreview.com. Is this sustainable, though? If you care about photo quality a little you would presumably buy either the latest iPhone or the latest Samsung, If you care a little more you buy a Sony mirrorless such as the A6300 and leave it on green idiot mode or maybe kick it into “sports” mode as the occasion requires. How many people are there for whom anything further is required these days?

How about showing off one’s best work? If the audience is on Facebook, why display photos anywhere else? Admittedly most people have only 500 or so Facebook friends, but isn’t it possible to mark a posting as available to the public and then a great photo can get more widely shared on Facebook?

Discovering the best work of other photographers? That seems like something that is hard to do on Facebook.

What do folks think? The things that people accomplished with photo.net in the 1990s… what’s the most popular way of accomplishing those things now? And is there a long-term place for niche online communities such as photo.net and, in particular, niche online communities for photography enthusiasts? (If the answer to the latter is “yes”, to what extent is it required to tie in with Facebook, e.g., for user authentication and maybe to users’ public content from Facebook?)

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Icon, whose amphibious seaplane has been the biggest news in the light aircraft world for about six years (during all of which the plane was 1-2 years away from first deliveries), is setting up a factory in Mexico (Avweb).

The FAA approval process for a factory is painful. However, given the labor-intensive production processes used to build airplanes (many unchanged since the 1930s), I continue to be surprised that more work isn’t done in Mexico. Stripping and repainting an airplane is particularly labor-intensive and painful yet most planes operated in the U.S. are repainted in the U.S. (cost range for a private plane: $20,000 to $200,000, depending on size).

One good thing: Airplanes can fly over Donald Trump’s proposed wall! (or the 580 miles of existing border “fence”)

Related:

• Cessna setting up airplane component production in Mexico (2010)
• Icon A5 limps into production surrounded by a phalanx of lawyers
• Icon A5 update from NBAA 2015
• Icon A5 Seaplane follow-up (2012)
• Icon A5 review with shopping video (2010)

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Photo nerds: Who is sick of having electronic flash units destroyed by leaking alkaline batteries? But who is also sick of paying big $$ for lithium AA batteries? You can buy 8 batteries on Amazon for $13.75. That’s $1.72 per battery, about half the price compared to 15 years ago? A 24-pack of same-brand alkaline batteries, however, is just $9.59, or 40 cents per battery.

I think that rechargeable lithium batteries have gotten cheaper much faster. If we can have a Tesla (3) in every driveway why haven’t leak-prone not-very-power-dense alkaline batteries disappeared in favor of sub-$1 lithium disposables?

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