Thursday, March 15, 2012

This Week in Review

Daylight Savings Time:

At 2 a.m. on, Sunday, March 11, 2012, most U.S. residents set their clocks ahead one hour for the beginning of Daylight Saving Time. However, not all states observed the time change. Residents of Arizona, Hawaii and U.S. territories Puerto Rico and the Virgin Islands remained on their normal schedules. About 75 countries and territories have at least one location that observes Daylight Saving Time, according to Alternately, 164 don't observe the change at all.

Benjamin Franklin has been credited with the idea of Daylight Saving Time, but Britain and Germany began using the concept in World War I to conserve energy, according to the Washington Post. The United States utilized Daylight Saving Time briefly during the war, but the concept was not widely accepted in the states until after the Second World War. In 1966, a piece of federal legislation called the Uniform Time Act stated that clocks should be set forward on the last Sunday in April and set back on the last Sunday in October. The law was amended in 1986 to start daylight saving time on the first Sunday in April, although the new system did not go into effect until 1987. The end date remained unchanged until 2006.

Today, Daylight Saving Time begins on the second Sunday in March and ends on the first Sunday in November. The time change precedes the first day of spring and the vernal equinox, which is set to take place at 1:14 a.m. EDT on Tuesday, March 20. Not a fan of Daylight Saving Time? Not to worry; you can resume your normal schedule come November 4.

Pi Day in America!!!

Why should anyone celebrate a mathematical constant that allows you to compute the area inside a circle? As unlikely as it may seem, the number pi has been paramount to the development of modern life. As far back as the ancient civilizations of Babylon and Egypt, people required approximations of pi to manage the flooding of the Tigris, Euphrates and Nile Rivers as well as for astronomy and for surveying and building ziggurats and pyramids. The ancient Greeks were the first to study pi for its pure mathematical value. Today pi is important in applied mathematics such as Fourier analysis and image reconstruction; it is used in engineering, science, and medicine and is also studied for its own value in number theory.

The first time a day was dedicated to pi was on March 14, 1989 at the Exploratorium, a museum of science, art, and human perception in San Francisco. The idea was the brainchild of Larry Shaw, a physicist at the center. Now 4,000 years after people first discovered how useful pi could be, we celebrate International Pi Day. The date is derived from the first 3 digits of pi--3.14--using the American dating system. 2015 will be a big year for pi since we will celebrate pi to 4 correct decimal places, 3.1415. Public interest in pi reached a zenith when in 2009 the U.S. House of Representatives formally declared March 14 National Pi Day, in House Resolution number 224. The Bill begins:

"Whereas the Greek letter (pi) is the symbol for the ratio of the circumference of a circle to its diameter..."

After many more "whereases," it resolves...

"That the House of Representatives supports the designation of a Pi Day and its celebration around the world."

Pi has been featured in popular culture such as in the title of a Kate Bush song, in the movies The Matrix, and Pi, and in the 2001 novel Life of Pi by Yann Martel. Pi has even inspired the invention of a new literary form called 'piems.' The challenge is to write a poem where the length of each word is the same as the number in the pie sequence. For example, the first eight decimal places of pi can be recalled with the phrase: "How I need a drink, alcoholic of course" (to represent 3.1415926). Many more can be found here: If you prefer numbers to words, try memorizing pi. The current Guinness World Record for remembering pi is well in excess of 60,000 digits. Memorizers typically add 10 or 15 digits a day to their totals.

Meanwhile, the "mathemagicians" of the world continue to outperform each other, calculating pi to ever more decimal and hexadecimal (base 16) places. The current world record is ten trillion (10,000,000,000,000) decimal digits. It was set in October of last year by Japanese systems engineer Shigeru Kondo, using an $18,000 homemade computer running software developed by American graduate student Alex Yee. Within the next ten years, a quadrillion digits will probably have been computed. While pi's wells never run dry, we cannot currently prove that the decimal expansion of pi has infinitely many eights, let alone that it is normal (has equally many ones, twos, threes, etc). Jonathan M. Borwein, a Scottish mathematician who holds an appointment as Laureate Professor of Mathematics at the University of Newcastle, Australia, has recently completed a research paper with his colleagues analyzing roughly 16 trillion bits (binary digits) and has concluded that it is almost certainly normal. Over the years, we may discover something startling about pi. That was part of the punch line in Carl Sagan's novel Contact, in which he suggested that alien life forms encoded messages to the human race in the numerical value of pi.

"Beware the Ides of March"

March 15 is a day of which to be weary. In Shakespeare's Julius Caesar, a soothsayer warns our protagonist of the Ides of March. Nevertheless, Caesar dismisses his words as well as a dream his wife has about his statue flowing with a fountain of flood, supplying a macabre bath for Roman citizens. He goes to work anyways and is subsequently murdered (stabbed 23 times) by members of the Roman Senate. Do literary characters ever heed good advice or pay attention to bad omens? Probably not; otherwise, we'd have no dramatic irony.

Types of Physicians' Practices

After one obtains an M.D. or a D.O., works as an intern, and completes resident specialty and subsequent fellow subspecialty work, he or she has several options as to which type of practice he or she would like to enter. One may enter private practice, become a hospitalist, join a corporate clinic, or join a government/military organization.

Private practice is a common option that can be further subdivided into solo and group practice. Solo practice is exactly as advertised, practicing without partners or employment affiliations with other practice organizations. This type of practice is becoming less common on the medical scene and is characterized by a small staff and use of family members as part of the staff. The greatest advantage of this type of practice is autonomy; your input and opinion will always be paramount, and your suggestions will never be ignored. The drawback is that limited staff makes for a heavy burden. The obligation of taking call when you need time off can affect the quality of your life. Furthermore, solo practices face the risks of financial setback due to lack of referrals and a small patient base as well as lost income due to illness or vacation.

Group practices are typically divided into single-specialty and multispecialty practices. Single-specialty practices are usually characterized by the presence of two or more physicians providing patients with one specific type of care. Advantages of single-specialty group practices include increased financial security and a controlled lifestyle. Decision-making is shared, which is a source of potential conflict, in comparison with solo practice. Multispecialty group practices offer various types of medical specialty care in one organization. Advantages to this system include the ability to provide multiple patient services at one location and the ability to offer attractive compensation packages (salary, benefits, vacation). Drawbacks include lower salaries that reflect fewer working hours as compared to single-specialty practices and decreased autonomy and decision-making ability as a result of a larger group.

Hospital-owned practices are becoming a more common option for established as well as new practices. Advantages of this system include the ability to assume more risk and a large referral network of practices. As with large multispecialty practices, physician autonomy is diminished. Nighttime hospitalists are often referred to as nocturnalists. In this system, many hospital specialists provide services but are not admitting physicians, such as anesthesiologists, radiologists, pathologists, and radiation oncologists. Corporate multispecialty clinics, such as Kaiser Permanente, are similar to large, multispecialty group practices. Financial risk is minimal, as is the paperwork burden typical of physician-owned groups. The biggest disadvantage is loss of autonomy is running the practice, compliance to rules and regulations created by other individuals, and small productivity incentives. Lastly, government/military occupations, such as those available through the Veterans Health Administration, are another alternative for practicing physicians. The Veterans Health Administration is involved in the operation of numerous VA outpatient clinics, hospitals, and medical centers.

Highlights from a Meeting with the Emory University School of Medicine

On Tuesday, February 28, 2012, a panel of members of the admissions committee and medical students from the Emory University School of Medicine presented a program to premedical students at the University of Georgia. The members who comprised the panel shared some valuable advice with the undergraduates who were in attendance.

Many panel members stressed the importance of doing what you love and what you are passionate about. They suggested shadowing physicians and gaining clinical experience in order to properly evaluate whether medicine is the right profession for us. Several people recommended taking advantage of study abroad opportunities, both medical related and otherwise. The importance of making personal connections and branching out was emphasized. A close relationship with a faculty mentor is especially crucial, for only this person will be able to know you on an intimate level and be able to vouch for your abilities in a way others will not be able to, which will make for exceptional recommendation letters instead of the usual letter which attests to a student’s academic abilities and good work ethic. Interviews should be enjoyable; it is important to be yourself and be genuine. Medical schools are looking for genuinely interested human beings with integrity. Make sure your personal statement sounds 100% like you do. Applicants will usually be expected to sufficiently respond to why you want to be a doctor. They will also be expected to adequately answer why they are interested in the school to which they are applying. Remember to demonstrate humility and know you are not always right, be friendly to everyone-patients and peers alike, and take everything in stride. Some medical students decide to pursue an M.D./Ph.D. in medical school. Others take a gap year to work for the CDC or intern at the National Institute of Health.

When choosing members for the incoming class, medical schools consider a variety of factors. The MCATs are viewed as the most egalitarian index of academic potential. Admissions committees seek to diversify the student body in terms of interests, cultures, ethnicities, geography, and other aspects. About 1/3 of Emory’s medical students are Georgia residents. For most medical schools, the application deadline falls around October 15. One woman on the admissions committee pointed out, however, that “deadlines are for people who really are not interested in medical school.” Most applications open June 1 and should be completed as soon as possible. Even after submitting an application, a 4-8 week verification process must take place before an applicant even exists to a medical school. For this reason, it is of paramount importance to submit applications as early as possible. Applicants should also remember to cast a wide net; the average successful medical student applicant applies to about 15 medical schools. When choosing the right medical school for you, it is important to choose with your heart.

Physician Shortage

The new federal health-care law has raised the stakes for hospitals and medical schools that are already scrambling to train more doctors. Experts speculate that there won't be enough doctors to treat the millions of people newly insured under the law. According to the Association of American Medical Colleges, at current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years. That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000. The greatest demand will be for primary-care physicians. The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.

I agree that this problem of a physician shortage must be addressed in a manner that is both economically feasible and efficient. I think the new health-care law’s 10% Medicare pay boost for primary-care doctors will incentivize people to enter the medical field. Additionally, a number of new medical schools have opened around the country. This step will also help address the current crisis. Furthermore, medical schools should aim to increase their acceptance rates. Medical colleges and hospitals will also face the problem of the shortage of medical resident positions. The residency is the minimum three-year period when medical-school graduates train in hospitals and clinics. According to the AAMC, there are about 110,000 resident positions in the U.S., and hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions. Doctors' groups and medical schools had hoped that the new health-care law, passed in March, would increase the number of funded residency slots, but such a provision didn't make it into the final bill. Including such a provision will allow more vacancies for residency positions, further ameliorating the situation. All these measures will collectively increase the number of people entering the medical field, helping to relieve the stress on the current health system, which is experiencing a shortage of physicians.

Stem Cell Research

I believe that stem cell research has a lot of life-saving potential. Stem cells are unspecialized cells capable of renewing themselves through cell division, oftentimes after long periods of inactivity. Furthermore, they may be induced to become tissue- or organ-specific cells with special functions. In some organs, such as the gut and bone marrow, stem cells divide regularly in order to repair and replace worn out or damaged tissues. In other organs, such as the heart and pancreas, stem cells only divide under certain conditions. Until recently, scientists primarily worked with two kinds of stem cells from animals and humans: embryonic stem cells and somatic, or adult, stem cells.

The study of the biology of mouse stem cells in 1988 led to the discovery of a way to derive stem cells from human embryos and grow cells in the laboratory. These cells became known as human embryonic stem cells. The embryos used in these studies were created for reproductive purposes through in vitro fertilization procedures. When they were no longer needed for that purpose, they were donated for research with the informed consent of the donor. Since these cells were used for research with the donors’ informed consent, I do not believe that it was unethical to use those cells in that manner. In 2006, researchers made another breakthrough by finding conditions that would allow specialized adult cells to be “reprogrammed” genetically to assume the status of a stem cell. This new type of stem cell, called an induced pluripotent stem cell, is derived from an adult somatic cell rather than an embryo. These cells can be used for the purpose of treating Shwachman Diamond Syndrome, a rare inherited disorder characterized by pancreatic insufficiency, skeletal abnormalities, and bone marrow dysfunction. Hematopoietic stem cells, or blood-forming cells in the bone marrow, can help treat this autosomal recessive disorder.

Given their unique regenerative abilities, stem cells offer potentials for treating diseases such as diabetes and heart disease. Additionally, laboratory studies of stem cells allow scientists to learn about the cells’ properties and what differentiates them from specialized cells. Stem cells are already used to screen new drugs and develop models to study normal growth and identify the root causes of birth defects. Stem cell research continually advances knowledge about how an organism develops from a single cell and how healthy cells replaced damaged cells in adults. For all these reasons, I support stem cell research and the application of stem cells to treat various diseases.

Health Care Reform Act

The health care bill, formally known as the Patient Protection and Affordable Care Act, is around 1,000 pages in length even in tiny print. Personally, I support the provisions of this bill, as many problems inherent with the status quo will be amended with this piece of legislation. One problem with our current system is the cost of everything. Most people agree that health insurance policies are too expensive; for a family, the average premium is almost $14,000 dollars a year and growing. Since more people are aging, health care costs are the fastest growing part of the federal budget. Another problem is the loopholes inherent in the system. As of now, people buying insurance may be turned down as the result of having a pre-existing health condition, meaning some of the people least likely to have coverage are the ones who need it most. Due to high costs and holes in our system, more than one in seven of us have no health insurance.

The health care reform bill addresses these issues. To address the issue of high costs, insurers will be limited in how they spend premium dollars; if insurance corporations use too much money for administrative costs or profits, they will have to give some of it back through rebates. Preventive care, such as screenings and vaccinations, will become free in all new private insurance policies and in Medicare. Furthermore, it will be illegal to turn children down for having a pre-existing health condition like asthma or diabetes. The health care reform bill will make health care more affordable for those who need it most, and discrimination on the basis of pre-existing conditions will be illegal. For these reasons, I support the contents of the health care reform bill.