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Kamis, 31 Maret 2016

Media blames Batman and cosplay for the behavior of a Mad Man

On Friday July, 20th the world woke up to the news that a crazed gun man walked into a midnight screening of the Warner Brothers film "Dark Knight Rises" and opened fire. Like many, I watched the report stunned at this horrific act of violence. I was angry that this had happened but my anger grew as the reporters claimed that it was a man in costume who committed this crime. One reporter suggested that he was dressed as Bane. The topic then shifted to the violence in the film and that it had somehow inspired James Eagan Holmes  to gun down movie goers even though no one in the theatre had seen the movie yet. Even after a survivor from the theatre called into the Today Show on NBC saying the man was not in costume but was wearing body armor and a gas mask to protect himself against the gas he ignited, the reporters remained ignorant and still pointed the finger at Batman and "passionate" people in costumes.



The media is no stranger to sensationalism (and reporting things that arent true yet failing to correct themselves) but in this case, many people in the comic and cosplay world were offended. Reports were essentially saying that it was one of us who went on a murderous rampage. A cosplayer took it too far. A comic fan wanted life to imitate art. It was Batmans fault. Its comic books fault. Its the cosplayers fault. Why was the blame shifted to us and not the lunatic who committed this crime? Why were they making excuses for him? Why were they bringing the art of comics, cosplay and movies into this? People have been committing violent acts since the dawn of time, before there were movies, comics or indoor plumbing. Jack the Ripper murdered prostitutes in London in 1888. Cain killed his brother Able in the Bible. In the Middle Ages acts of torture included limb and finger removal, bone breaking and boiling. There was no Batman to blame, only the perpetrator. Because of the Colorado shooting and the media spotlighting comics and cosplay, I wouldnt be surpried if Movie Theatres begin banning anyone in costume for Midnight Showings.





I have been a victim of the press and its sensationalism. A few years ago my grandfather was murdered in his own home. Because my Uncle is a Police Officer, the local news and media was all over the story, calling it "Father of a Police Officer Murdered In Home". Dealing with the death of a loved one is hard enough but its a million times worse when they are taken from you. The press kept hounding my mother who unwillingly became our family spokesperson to help get the word out to catch the murderer. The press was very insensitive. I broke down in hysterics when I saw my grandfathers body being carried out of his home in a body bag on television. When it was time for the funeral, the reporters and camera men had surrounded the church, snapping shots of anything they could get. They went into a frenzy when my Uncles Police District arrived to pay their respects along with the Special Crimes Unit. After the casket was loaded into the hearse, a camera man jumped in my face to snap a shot of me walking with my mother. She grabbed my hand. I turned my tear stained face away so he couldnt get the shot. They didnt care about me or my family and many of them reported things that werent true. But it didnt matter. They just wanted to get a story.



Safe to say, I dont like reporters very much and strive to be different from them when it comes to my own writing. I am going to be very clear in making my point: The shooting in Colorado was the fault of  James Eagan Holmes. Not Hollywood, not Batman and not the cosplay community. New reports from the police are saying that this was done with "calculation and deliberation". His apartment was rigged with explosives and he murdered 12 people and wounded 58 others. Unconfirmed reports stating that he was inspired by the Joker are irrelevant. He wanted to kill. Hes a murderer, just like Jack the Ripper and other madmen before him. I can tell you personally that you cannot reason with madness and chances are you will never get your answer as to why it happened. I still dont know why my 80 year old Grandfather was murdered; why he was chopped up in his own home. I can tell you that it wont change anything even if I knew the answer. In all honestly, I dont care. I dont want to hear the excuses of the man who took my Grandfather away.  NOTHING will justify that and NOTHING will justify the shooting in Colorado. Like Micheal Cane memorable said in "The Dark Knight:"

"Some men just want to watch the world burn."

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Money Fast With This Website PROOF MONEY

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If i were you , i wont let this go... i mean i understand you love adfly as much as me.. But this site will make you more money than adfly.. Im just saying..

SIGNUP HERE IF YOU READY TO MAKE MONEY!
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More photos of Ese Orurus abductor Yunusa in court today

Yunusa Dahiru in court today to answer to charges of abduction of a minor and impregnating her...



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Adfly VS Shortest

Adfly VS Shortest



Hello again well we all know that Shorte.st And Adf.ly are the most famous 2 shortening websites. Now We have to be honest here okay... 

Adf.ly is considered as the KING the most VISITED url of the world. And also it offers higher payout rate , low cashout limit and it is a renowned and TRUSTED network

Now Shorte.st is very new and it offers a decent payout rates and also low cashout limit and alo it offer some innovative ad formats that you can use to monotize your own links. Cool huh? 

Now we all know know about adfly but let me just talk a lil about adfly and then shorte.st Okay? 

Adfly like i said it is very popular url shortening website. And in my honest review it is also better than shorte.st in alot of aspect BUT EXCEPT THE TOOLS! i have to be honest. It is not a big problem though but still have to be honest 
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The minimum cashout is $5 so that is a good thing , you want to start doing shorte.st please SIGNUP HERE
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Photos Olajumoke Mo Abudu Nse Ikpe Etim Omawumi others at a special Intl Womens Day screening of Fifty

To mark the 2016 International Women’s day, EbonyLife Films on the 8th of March 2016 hosted about 200 women to a special private champagne screening of the film Fifty at the Genesis Deluxe Cinemas - Lekki, Lagos. The star-studded special screening had in attendance Ireti Doyle, Omoni Oboli, Nse Ikpe Etim, Kemi ‘Lala’ Akindoju and Uzor Osimkpa who were presented with bouquets of flowers in celebration of their roles. See more photos after the cut...



Also present were music sensations Omawunmi and Ruby Gyang, Hollywood actress Kehinde Bankole and ‘woman’ of the moment Olajumoke Orisaguna amongst many others. The women who worked behind the scenes of the movie FIFTY were not left out of the celebration as they were each presented with a gift by Mo Abudu.

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Latinas Cant Cosplay!

When I discovered the hobby of costuming back in 2006 and made the decision to try it, I was incredibly excited and told all of those closest to me. I had been reading comic books since I was 11 years old and was watching television shows like the Lynda Carter Wonder Woman series and the Superfriends. As I grew older I not only began collecting comics, but toys as well and watched super hero themed films religiously (mostly Superman I & II and Batman Returns. We had limited comic movies back then). When I reached my teen years, I began writing fan fiction and drawing fan art. Now that I was an adult, cosplay seemed like the natural next step in expressing my fandom. Surprisingly enough, one of my closest friends (at the time) flat out said something rather shocking; I couldnt cosplay because I had tan skin. Thats not something you expect to hear from one of your best friends and I was literally stunned to hear such a racist remark. But it turns out, he wasnt alone. Several people were telling me that I could not cosplay because I was a Latina.


Racism is nothing new and neither is hatred. I, like many, have dealt with both my whole life. Although things are better now than they were when I was growing up in the 80s and 90s (yes, Im that old) it still  exists. People judge you based on the color of your skin before you even open your mouth and speak. They hate on you, treat you bad, bully you, threaten you and try to do everything in their power to make you feel inferior. Nobody deserves to  be treated like that and I definitely did not deserve to be told that I wasnt allowed to express myself because of the color of my skin. I had a very rough time deciding what my first cosplay character would be because according to my friend, I could only dress as characters whose skin tone I matched. I had to stay away from the pale skin ones. I decided to push the prejudice aside and put together my first costume; Aerith Gainsborough from Final Fantasy VII. I wore it to a local con and upon seeing me, my "friend" said:


"Oh nice. You do look like Aerith. Except with tan skin." Needless to say, the friendship did not last due to this and many other reasons.


Apparently my skin color was a huge deal to him and it didnt stop there. Upon finding a photo of me on Flickr from the con, someone left a comment saying that the colors of my outfit clashed horribly with my skin tone and I should have never dressed that way. Only white people should dress as Aerith. On a video game forum, someone said my Aerith looked "dirty" because of my skin color. The moderator refused to take the comment down upon my request ( it was Game F.A.Q.s) Over the years I have read many hateful comments.  One person said  that I  did not deserve to wear Supergirls S crest because I was a "Sue Storm ruining Jessica Alba looking chick" (actress Jessica Alba is half Mexican and a proud Latina). My boyfriend actually stumbled upon a photo of my Catwoman posted on a message board and was enraged when he read the following statement: "She would be a good Catwoman if she were white." A MEME was made of me and several other cosplayers saying that all Latinas fail at dressing as Hatsune Miku.




Im going to be completely honest and human and say that it did get to me. The negativity and racism gave me moments of weakness and I wanted to give up. Every hero, every princess has that chapter in their story where they want to walk away but in the end, they pick themselves up and keep moving forward. Thats what I did. I wasnt going to allow racists cowards who hid behind their computers dictate what I should and should not do, who I should and should not dress as. The color of my skin is not a "problem". It is not a disability. I have every right to costume just as much as anyone else no matter their age, race, gender, religion or weight. And I costume for one person only; myself. This is about my self expression and my creativity.

It literally makes me laugh and shake my head when I think that people have told me that Latinas Cant Cosplay. Heres a big, fat middle finger to all the racists. Dont let anyone ever tell you, you cant cosplay  because of the color of your skin and know that even though we may not know each other or ever meet, you have my full support. This Latina proved that you can become whatever character you want to be.


                                    
                                                                Official Facebook Page


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Kylie Jenner shares half nude bathroom selfie

After the intense backlash big sister, Kim Ks nude photo received, Kylie decided to share her own semi-nude bathroom photo yesterday.
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Reaction to post on academia and social media

"Should social media accomplishments be recognized by academia?" a post of mine from October 4th, generated some lively discussion on Twitter.

Here are a few of the more interesting responses:

@ashishkjha Important question from @Skepticscalpel Should academia value impact on social media? Yes. And its coming. Slowly.

@MartinSGaynor Science comes 1st, 2nd, 3rd.. MT @ashishkjha Important Q: @Skepticscalpel Shld academia value impact on social media?

@ashishkjha agree how to measure impact a key question. Eye balls cant be enough. But too important a question to ignore.

?@DoctorTennyson Yes-I think social media has a role for #publichealth, #education, and fosters collaboration. More than obscure journals

@NirajGusani still you add value to your dept -how do/should they measure it?

?@gorskon Heck, at @ScienceBasedMed, we get 1M page views a month, but I get no credit.

@gorskon I agree though. For the most part, social media harms, not helps, academic career.

@gorskon Cranks complaining to my chair & cancer center director dont help.

@gorskon If I ever want to change jobs, Google searches will likely harm, not help, prospects

@Nadia_EMPharmD We actually asked this very question in a study we published this past year:

?@JBMatthews Academic tracks have been modernized in many places including ours; beyond # of publcns.

@JBMatthews As a journal editor and department chair, I believe its starting to "count"

?@nataliestavas We should study what has more meaningful impact, # of twitter followers or an article in the @NEJM

Most agreed that social media activity should count for something, but quantifying that something may be difficult. A certain number of followers or page views would not necessarily signify value.

Via email, Dr. Jeffrey B. Matthews, Dallas B. Phemister Professor and Chairman of the Department of Surgery at the University of Chicago, said his school of medicine created a new track for faculty that does not require traditional scholarship for academic promotion. It is non-tenure (tenure still requires traditional discovery and traditional measures of impact and importance), but there is otherwise no distinction of title.

To advance to professor requires evidence that the faculty member is outstanding. The chair and faculty committee must define what "outstanding" means, whether it is distinction in clinical practice like a high-volume, high-complexity specialty or a national draw of patients, in educational leadership such as a program director with leadership roles at APDS, ABS, RRC, or "other."

He added, "I would have ZERO trouble convincing our promotions committee that a high visibility blog with high traffic views that had evidence of thought leadership in the public domain would qualify as high impact and outstanding. And that is at the University of Chicago."

What do you think of the University of Chicagos progressive stance?

Have any other schools taken such steps?
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A Better Way to Buy Video Games by Marc Charles

7:27 PM

Greetings:

A friend of mine launched a site recently.

And I think its a much better way to buy video games......

Check it out:


http://www.gamelock.com

Marc
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Rabu, 30 Maret 2016

Patients vs doctors

A JAMA Viewpoint article suggests that doctors should be aware that patients may be surreptitiously recording their conversations. The author, a neurosurgeon, takes a very benign view of this issue and recommends that if a doctor suspects that patient is recording a conversation, "the physician can express assent, note constructive uses of such recordings, and educate the patient about the privacy rights of other patients so as to avoid any violations."

He also says this would show that the physician was open and strengthen the relationship between the doctor and the patient. Im not so sure.

Heres a different perspective. If a patient is secretly recording a conversation, the relationship between him and the doctor is already in serious trouble. What I would do is to tell that patient to find another doctor.

If a patient asked me if it was OK to record our conversation, I would agree, but I would also want to record it to preserve a complete copy.

This comes on the heels of another privacy and trust question—should doctors google their patients? There is no consensus on this, but having read several discussions on the topic, most writers feel that googling patients should only be done for certain narrow reasons which you can read here.

Most medical societies have not weighed in on the subject, but I would guess when guidelines are published, they will discourage the practice. But of course, patients may google physicians at will.

Taking it to another level, Dr. Jeremy Brown, Director of the Office of Emergency Care Research at the National Institutes of Health, recently proposed that emergency physicians should be equipped with body cameras to record audio and video of patient encounters.

Leaving aside such questions as who owns the videos, how to store the vast amount of data, and what impact this would have on the performance of the individual physicians, body cameras would establish an adversarial relationship that is unnecessary for the overwhelming majority of doctors and patients.

A physician interaction with a patient begins on terms quite different from those of a police officer interacting with a suspect in which the adversarial relationship is already established. The increasing number of controversial and highly publicized cases involving police and suspects has resulted in a need to protect both parties. This need seems much less pressing in medicine.

Where does this end? Should all patients be equipped with body cameras too in case the physician copy "gets lost"?

It is sad to realize how far we have sunk as a profession.
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Appendicitis and shared decision making

Staying with the current theme of appendicitis on my blog, here is a summary of recent developments. A JAMA Surgery Viewpoint suggested that because of the findings of a Finnish randomized trial, surgeons now should give patients with appendicitis a choice between an appendectomy or treatment with antibiotics.

The paper acknowledged my criticisms of the Finnish study which found that simple appendicitis could be treated successfully with antibiotics in almost 75% of patients.

I respect the authors of the JAMA Surgery article and am happy they referenced the blog post noting my concerns about that Finnish trial: the trial compared antibiotics to open appendectomy—an operation with more complications than the more commonly performed laparoscopic appendectomy; the antibiotic used in the Finnish trial is not a first line choice in the United States; patients were followed for only one year.

The JAMA surgery paper answered three questions I posed in a previous post. One, the Viewpoint authors consider antibiotic therapy for appendicitis mainstream. Two, surgeons must assume that patients might opt for antibiotics despite at least a 25-30% chance of suffering a recurrence of appendicitis. Three, an informed consent discussion now should include a mention of antibiotics as an option.

I disagree with the Viewpoint authors’ assertion that antibiotics are as safe and effective as surgery for treating appendicitis. Based on one flawed study, antibiotic therapy cannot yet compare to the many years of excellent results of laparoscopic appendectomy.

Here are some other problems.

Let’s talk about shared decision-making. After hearing all the options, some patients will want to guide their own care. However, most patients would rather not. A 2011 Journal of Medical Ethics study of over 8000 patients found that 97% “of respondents wanted doctors to offer them choices and to consider their opinions. However, two out of three (67%) preferred to leave medical decisions to the doctor.”

What about the medicolegal implications of antibiotic therapy for appendicitis? Right now, the “standard of care” for appendicitis is appendectomy. Suppose a surgeon, in the interest of shared decision-making, explains the Finnish study to a patient and neglects to mention that it only involved patients with simple appendicitis. Or suppose that patient’s CT scan is read as simple appendicitis but is not accurate, and the patient actually had complicated appendicitis that went on to perforate despite antibiotic therapy.

If that patient becomes septic and requires a laparotomy and suffers a subsequent wound infection and massive hernia or dies, who is going to be held responsible for not recommending an appendectomy? Certainly not the patient.

In the era of shared decision-making and patient autonomy, maybe patients should be required to carry malpractice insurance so they can sue themselves if the decisions they make turn out badly.

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Slave Revolt

What started out as a joke with the Slave Leia Public Service Announcement (starring Kaley Cuoco) has turned into a massive online bashing targeting Slave Leia cosplayers everywhere.




For those of you visiting my Blog for the first time, my name is Victoria Centeno. I work as a full time preschool teacher and part time model. I have been cosplaying for five years and am known as the "Cosplay Girl". My website (Cosplay Girl http://www.victoriacosplay.com/) has received over one million hits. I was recently named "The Queen of Cosplay" by Axiom Magazine ( http://www.axiommagazine.jp/2011/08/15/the-queen-of-cosplay-victoria/) and was the subject of the Entertainment Weekly story "Slave Leia: Some Assembly Required" ( http://www.ew.com/ew/gallery/0,,20399642_20511850_20991188,00.html ). I have also been featured in Latina Magazine, The Hollywood Reporter and Rolling Stone just to name a few. Ive been reading comics since I was 9 years old and am partial to DC Comics.



I first tried on the metal bikini (actually it was the rubber version made by Rubies) in 2009 at the request of a local radio station I was doing camera work for. While I had the costume on loan I took advantage of the opportunity and took some photos and posted them online. My pictures caught the attention of the right people and I was offered a job as an official Slave Leia model for the 2010 San Diego Comic Con and Star Wars Celebration (which sadly, I had to decline). Return of the Jedi was the only Star Wars film my family owned growing up and my siblings and I watched the VHS on a daily basis. I never thought I would grow up and literally be Princess Leia.  I was more than thrilled to become an official model for Gentle Giant Studios.





Since the Slave Leia PSA there has been a number of articles and Blogs (written mostly by women) crucifying anyone who has worn the metal bikini, labeling it a "problem" and "concern" at conventions. True there are times where there appears to be crowds of Slave Leias but its simply because those women were hired to be there. Things like the Slave Gathering, which takes place every year at the San Diego Comic Con (and have become legendary in addition to being a crowd pleasing event) have lured such celebrities as Olivia Munn and Adrianne Curry. It also receives massive press. One might complain that the metal bikini is too revealing when in fact, it shows as much as a two piece swimsuit at the beach. Ive seen women wear far less in cosplay even going as far as applying nothing but pasties over their bare breasts. Wheres the public outcry to ban those particular costumes at shows? Some may argue that were actually promoting slavery or sex slavery and that Leia was a victim who was sexually abused by Jabba the Hut. Unless theres a version of Return of the Jedi with a deleted rape scene that I missed, those theories and assumptions are best described as laughable. Stick with the facts; yes Leia was a prisoner and forced to wear that outfit as she watched her friends and allies suffer but did she sit there and play victim? No.



This princess waited until the time was right and turned the tables on her captor, killed him and won her freedom. Its convenient that critics fail to recognize Leias accomplishment and bravery because of what shes wearing. Its no different than one women judging another because of the clothes she has on. Im often told by associates that they are surprised at how "nice" or "intelligent" I am for a model. Once again this is an example of stereotyping. People are accusing Leia cosplayers of not being "real" geeks without knowing that womans story or reason for putting the metal bikini on. Fingers are being pointed with accusations of us demeaning ourselves when in fact, we chose to wear it. No one forced us. Heres a life lesson for those who say were offensive; just dont look. To those who say the naysayers deserve to be heard, my response is that I dont deserve to be attacked and judged for the costume I choose to wear. Its just as easy for me to accuse someone of being jealous as it is for someone to accuse me of being an attention whore. We can play the blame game all night people.


How is it that a princess who fought for her friends, beliefs and freedom offends the eye but not the dozens of cosplayers walking around dressed as murderers, thieves and rapists? Are you enraged at the sight of the Green Goblin because he murdered a helpless blonde atop a bridge? Do Joker cosplayers upset you because hes murdered children and paralyzed others? And what about Dr. Light? He raped Enlongated Mans wife on the Watch Tower. With incidents occurring at conventions such as raised ticket prices, the stealing of badges and assaults (such as last years pen stabbing incident at the San Diego Comic Con), youre biggest concern is a woman dressed as Slave Leia? Its time to get your priorities straight, let go of the hate and work on your self esteem.
?
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How Can I Make A Living With Adfly Is It Possible

How Can I Make A Living With Adfly? Is It Possible?

Do you believe in yourself? If so , then yes it is possible.
Let me tell you something.. I always tell everyone that if they want something they can always get it , it is up to you really. So if you do want to make a living doing adfly what is holding you? I can give you some tips, but it is up to you to keep it up and make the money!

I can show you so many ways for you to make a living with adfly (yes it is possible) and you still wont make it to work. So should i start then?

First: Lets take a look at my referrals



As you can see, i have 230 to be honest to make a living here in adfly i would have to need at least 500 to 600 referrals is it possible? Well let me tell you "YES!!!" i have a friend , he has 1,439 referrals and he is making alot of money monthly. 

I am not going to lie i do receive an amount every single month from adfly but the thing is , is not an amount that i would want to receive so what should i do ? 

I have to work hard to make that 230 to at least 330 can i do it? YES!

How can i make a living with adfly? 

You going to need a blog... Yes make a blog it is for free a blog like this that gives you alot of information a blog that will help people!! You have to be consistent with the blog and update it at least once a day.!

Why? So your  blog can be on google ALOT! so once you put "how to make money with adfly" my blog should pop up , why? Because i am consistent with this blog. I have more but i am going to work harder on this one.!

The best thing about all this is that i am making money with this FREE blog!! And i am proud about that... Make a website a blog for free about something that you wont have alot of competetion! Go to google and search.

Make a website about something you would love to talk every single day and would enjoy to write on your blog like i am doing right now. Is is possible? it is up to you!

Once you have that blog, put adfly around your blog, even put the banner around! Make a subject sometimes about let me introduce you to adfly this and that.! You get the point!

Everything is UP TO YOU! make it happen!!!
Godbless.

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Lactated ringers and hyperkalemia A blog post meriting academic credit

In a recent post, I suggested that physicians should receive academic recognition for certain social media activities. "Myth-busting: Lactated Ringers is safe in hyperkalemia, and is superior to NS," written by Dr. Josh Farkas (@PulmCrit), is a great example of why that is true.

Using only about 1250 words and 6 references, he explains that infusing lactated ringers not only does not cause harm, it is actually superior to normal saline in patients with hyperkalemia, metabolic acidosis, and renal failure.

I highly recommend reading the post which should take you only a few minutes. If youre too lazy to do that, heres a summary.

Dr. Farkas found no evidence that lactated ringers cause or worsens hyperkalemia. In fact, he presents some solid evidence to the contrary.

If the serum potassium is 6 mEq/L, a liter of lactated ringers, which contains 4 mEq/L of potassium, will actually lower the potassium level.

Because almost all potassium (~98%) in the body is intracellular, the infusion of any fluid with a normal potassium content will result in prompt redistribution of potassium into the cells negating any of the almost negligible effect of the potassium infusion.

A normal saline infusion is acidic, resulting in potassium shifting out of cells and increasing the serum potassium level. Lactated ringers, containing the equivalent of 28 mEq/L of bicarbonate, does not cause acidosis.

Theres a lot more in the post. Read it.

This issue is arguably the most misunderstood fluid and electrolyte concept in all of medicine.

In my opinion, the post should be displayed on the bulletin boards of intensive care units, emergency departments, and inpatient floors of every hospital in the world and should be read by every resident or attending physician who writes orders for IV fluids.

Disclosure: Ive never been a fan of normal saline. Two years ago I wrote a post that discussed two papers showing that because of its negative effects on renal function, normal saline was inferior to lactated ringers in critically ill patients.
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Is student test performance impaired by distracting electronic devices

After listening to a lecture, third-year students at the Harvard School of Dental Medicine were surveyed about distractions by electronic devices and given a 12-question quiz. Although 65% of the students admitted to having been distracted by emails, Facebook, and/or texting during the lecture, distracted students had an average score of 9.85 correct compared to 10.444 students who said they werent distracted. The difference was not significant, p = 0.652.

In their conclusion they authors said, "Those who were distracted during the lecture performed similarly in the post-lecture test to the non-distracted group."

The full text of the paper is available online. As an exercise, you may want to take a look at the paper and critique it yourself before reading my review. It will only take you a few minutes.

As you consider any research paper, you should ask yourself a number of questions such as are the journal and authors credible, were the methods appropriate, were there enough subjects, were the conclusions supported by the data, and do I believe the study?

Of course, many more questions could be included. Google "how to critique an article," and you will find numerous lengthy treatises on the subject.

The paper appears in PeerJ, a fairly new open access journal with a different format. Authors have to pay to have papers published, but they can opt for a reasonably priced plan for lifetime memberships with variable numbers of papers included.

It’s too new to have an impact factor but stats on the website state that the paper has had over 2,700 views and been downloaded 76 times.

The authors are from Harvard so they must be credible.

The study is described as quasi-experimental, meaning not randomized. That is not necessarily bad especially because it is said to be a pilot study too.

The main problem with the paper is that it was underpowered to detect a difference because there were only 26 subjects, 17 distracted and 9 not. The null hypothesis—that distractions do not affect test scores—was accepted as true, which is called a "Type II" error by statisticians.

Other issues with the paper are that distracting behaviors may have been underreported by the students, the test questions may have been too easy, and the two groups may have differed in their baseline knowledge of the material. Harvard dental students may not be representative of students or people in general. A couple of my colleagues on Twitter suggested that the lecture could have been either so good, or so bad, that paying total attention was unnecessary. PeerJ has a 70% acceptance rate for submissions.

Did I mention that one of the two authors of the paper is an "Academic Editor" for the journal?

Bottom line: This paper should not convince you that distractions by electronic devices are not harmful to learners.


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Selasa, 29 Maret 2016

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Code Black is still on TV Did it get any better

Despite some recent ratings problems, the TV show "Code Black" somehow remains on the air. It has lost viewers after five of the last seven episodes including a whopping 23.8% drop in the all-important 18-49 year-old demographic after the 2/17/16 installment.

Its still viable because of fans like Sharon who said on the ratings website: "The best medical show on. I have been in the medical profession 30 years and it depicts the most true to life situations of any of the medical shows I have watched. Love the show." Sharon must work on the psych floor.

I decided to take another look at it. Having seen the 2/17/16 episode, my opinion hasnt changed. Heres why.

A van full of people dressed as zombies with full makeup was in a crash. You may recall from my last review of this program that I had predicted something similar when I wrote, "Stay tuned for the next episode featuring a bus that tumbles off a narrow mountain road while carrying non-compliant hemophiliacs."

For a while, the docs couldnt tell the real injuries from the ones created by moulage. Very clever.

Two victims from the zombie van crash underwent major surgery—a man who had his ruptured diaphragm repaired and his son who failed conservative management of his injured spleen and required a splenectomy. Father and son spent their entire hospitalizations in the emergency department, and they looked remarkably well postoperatively.

Thanks to some timely counseling by the ED head nurse who got the child to overcome his dislike of the fathers fiancée, the man married her in his spacious ED room. Both were in full zombie regalia. The wedding was attended by the son and a number of ED staff including one of the attending physicians who performed the ceremony.

A woman had abdominal pain a few weeks after in-vitro fertilization. She was the wife of a VIP who donated a floor to the hospital. Of course, higher-ups in the organization became involved, and the patient was treated differently than the average patient [at least that was realistic]. She crashed while waiting to have a CT scan and needed emergency surgery for an ectopic pregnancy.

But the piece de resistance for this episode occurred when the surgeon performing the splenectomy on the child asked for a suture [type unspecified]. The camera took a close shot of his hand while the scrub nurse handed him … a scalpel. My research staff captured that moment.


When I was a resident, we had some great scrub nurses. We used to say to them, "Give me what I need, not what I ask for." Maybe thats the case at Angels Memorial too.

Thanks to a sharp-eyed anonymous commenter on a previous post for letting me know about the scalpel incident.
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Cautionary tales about the matching process

Within the next two weeks, anxious fourth-year medical students will submit their residency choices to the National Residency Matching Program. I have written many posts about how to investigate residency programs and the workings of the match.

Here are a couple of stories about deception and disappointment. The first appeared as an anonymous comment on a post I wrote about how to rank surgical residency programs.

I am the spouse of a surgical resident halfway through their residency. When I hear of the idea of "vetting" the residency program as med school graduate, it makes me laugh and cringe. Its not really possible.

We were extremely concerned about not getting stuck in a malignant or toxic program. But these people must have been aware of how bad the program was, we thought the place had the happiest, friendliest people. What a facade.


So now what? We struggle. If it gets too bad I suppose we will try to switch to a new surgical program. Maybe the switch is to a different discipline altogether. Time will tell.

The take-away is perhaps make sure you are lucky, because if you are not, life is hard, and options to fix it are even harder.
[I wish I could tell you how to make sure you are lucky.]

In the mean time we will show up at each and every required recruitment dinner. We will smile, we will follow the script and lie our asses off. Why? Because if we dont we will be labeled a "problem" resident and never get a recommendation from the PD to another program. So the cycle continues. Does the program kick out good surgeons, perhaps, but how many do they lose or worse ruin?

Vetting...no. Luck of the draw.


The second, also by an anonymous writer, appeared on the KevinMD website. At over 1700 words, it is too long to reproduce here. But it echoes the theme. Here are a few excerpts.

Within only a few days of starting my residency, I was called “retarded” and referred to with homophobic slurs. Women were commonly referred to with misogynistic labels.

After one semester of training, I was told that I had not been studying enough because I didn’t do well on the national in-service examination, a test given nationally used to measure your performance versus residents at other programs. I was threatened with academic probation and warned that I needed to read more.
[Do you think the writer might be a surgical resident?]

He describes his increasing despair at the lack of teaching and respect. He failed to obtain a fellowship and speculates about possible reasons.

Today I remain discouraged, jobless, and deeply regretful of the decision I made as a medical student to choose the residency program that I did. I try to remain hopeful that someone will give me a chance and renew my interest in practicing medicine the right way, but it is hard to remain optimistic.

My goal in writing is that as this year’s match day approaches, I plead with the newly graduating doctors out there to please do your homework. Do ask about board passage trends, do try to find out why questionable programs don’t always fill with applicants in the NRMP, and do not assume that an appropriate educational plan is being offered at a program simply because it is accredited. The ACGME and the NRMP publish listings of programs that are on notice, so avail yourself of these listings. Your residency program is a place where you will work very closely with what may amount to be only a small number of supervising doctors, and you only really get one chance to make the right decision.

In my case, there were red flags that I did not pay close enough attention to. During my interview, the residents gave very short and incomplete answers to my questions, and several of them seemed downright unhappy. I had just assumed that the faculty were part of a medical school which was never the case, and I failed to do any research with respect to the effect that program size might have on education. Don’t make the same mistakes that I did, and best of luck to all of the new docs out there. 


I don’t think the match depends on luck, nor do I think that the size of a program makes a difference.

There are two sides to every story, and we will never hear the other sides of these.

However, do not completely discount these anecdotes just because the writers are anonymous. You can understand why the writers did not reveal their names.

I hope all of you did your due diligence, but as these stories show, sometimes it is not enough.
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a,friends,new,artist,promotion,service
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How To Make Money With Adfly And Forums 2014 Trick

How To Make Money With Adfly And Forums 2014 Trick


I do not know if you knew this but having an Adf.ly or a Shorte.st account on forum will give you TONS of traffic and remember that Traffic means Money.

Well you know i found out about this awesome way to make traffic online and also money online because i always mess around to found ways to make my life easier lol does that makes sense? 


How to make money with adfly and forum is the best trick ever and i know for sure you are going to love this trick because i havent seen anyone else saying this trick , so i think i am the first one i do not know?

First you need to register to this FAMOUS forum called WarriorForum click there to signup now 
Now you probably saying what in the world is WarriorFoum , well it is a forum that is all about money making online you will find ALOT of ways to make money online and i am always there you probably will see me around asking questions or buying other ways people offer to make money online.!

I am telling you this forum is THE BEST right now on the internet , you can even search for it just go to google and put WarriorForum or just click HERE and just signup right away.!

Now , how can i make money with this website? Well you are going to put your affiliate link of adfly with shorten url , that means you will get your link affiliate link referral link and short it on adfly also and then put it on you SIGNATURE on WARRIORFORUM , now why on your signature? Because you can , and because that is not SPAMMING you can put your links there.!

Also if you see someone needs help , please if you know the answer you can always help them and put the adfly link there and they will clik your link or even GUESTS who are not member of WarriorForum ,

Now check it out and please do not spam and be gentle.!

GodBless
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Duke Docs Who Attached Intestine to Vagina Must Stand Trial

Catchy headline, isnt it?

That headline appeared two years ago on the Outpatient Surgery website. Too bad it wasnt accurate.

This case has been a topic on the Internet off and on for a few years. Although the patients surgery took place in 2008, the malpractice trial did not occur until earlier this month.

Like nearly every news media article about malpractice incidents, details were sketchy and sensationalism was featured.

Also common in cases like this that although many stories appeared about the case before the trial, but few reported the verdict. That is because after deliberations lasting less than one day, the doctors were not found guilty of negligence.

According to a story on the only media outlet reporting the verdict—Courtroom View Network, heres what happened.

The patient underwent surgery for debilitating chronic constipation at Duke University Medical Center in 2008. Postoperatively, she developed a recto-vaginal fistula [a tract or tunnel from the rectum to the vagina] due to a portion of vaginal wall being caught in the surgical staple line when the intestine was reconnected. The problem was corrected by a second operative procedure.

Prior to the first case, the patient had been informed that secondary procedures might be necessary if complications arose.

The malpractice suit was originally denied by a lower court because the plaintiff could not find an expert witness to testify that negligence had occurred, but an appeals court ruled that an expert was not necessary because "even a layperson would be able to determine whether or not negligence occurred," and "It is common knowledge and experience that intestines are meant to connect with the anus, not the vagina, even following a surgical procedure to correct a bowel problem."

Although the second operation solved the patients problem, she claimed that she had suffered a conversion disorder causing slurred speech, tremors, and weakness. However, subsequent treating physicians felt that her symptoms were inconsistent and that she was "trying to appear disabled."

This case illustrates several important principles about medical malpractice cases.

They often take a long time—an average of 4 to 5 years—to be resolved.

Every less-than-perfect outcome is not necessarily due to negligence. Recto-vaginal fistula is a known complication of this type of surgery.

Stories from 2013, when the appeals court said the case could go to trial and from this year just before the trial started, implied that the surgeons had mistakenly attached the intestine to the vagina which many of us found hard to believe. But without knowing the details, we could only speculate.

The jury did not believe the alleged damage—a conversion reaction—was real.

This lawsuit, which cost both the plaintiffs attorney and the defendants insurance company a lot of money and dragged two highly competent and respected surgeons through the mud for 7 years, should never have gotten off the ground.

There was a reason that plaintiff couldnt find an expert to testify that negligence occurred. The intestine was never mistakenly "attached to the vagina."
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Pain is not the 5th vital sign

No, contrary to what you may  have heard, pain is not the 5th vital sign. Its not a sign at all.

Vital signs are the following: heart rate; blood pressure; respiratory rate; temperature.

What do those four signs have in common?

They can be measured.

A sign is defined as something that can be measured. On the other hand, pain is subjective. It can be felt by a patient. Despite efforts to quantify it with numbers and scales using smiley and frown faces, it is highly subjective. Pain is a symptom. Pain is not a vital sign, nor is it a disease.

How did pain come to be known as the 5th vital sign?

The concept originated in the VA hospital system in the late 1990s and became a Joint Commission standard in 2001 because pain was allegedly being undertreated. Hospitals were forced to emphasize the assessment of pain for all patients on every shift with the (mistaken) idea that all pain must be closely monitored and treated .

This is based on the (mistaken) idea that pain medication is capable of rendering patients completely pain free. This has now become an expectation of many patients who are incredulous and disappointed when that expectation is not met.

Talk about unintended consequences. The emphasis on pain, pain, pain has resulted in the following.

Diseases have been discovered that have no signs with pain as the only symptom.

Pain management clinics have sprung up all over the place.

People are dying. In 2010, 16,665 people died from opioid-related overdoses, a four-fold increase from 1999 when only 4,030 such deaths occurred. And the number of opioid prescriptions written has doubled from 109 million in 1998 to 219 million in 2011.

Meanwhile in the 10 years from 2000 to 2010, the population of the US increased by less than 10% from 281 million to 308 million.

Doctors are caught in the middle. If we dont alleviate pain, we are criticized. If we believe what patients tell us—that they are having uncontrolled severe pain—and we prescribe opioids, we can be sanctioned by a state medical board or even arrested and tried.

Some states now have websites where a doctor can search to see if a patient has been "doctor shopping." I once saw a patient with abdominal pain in an emergency room. After looking up her history on the prescription drug website, I noted that she had received 240 Vicodin tablets from various doctors in the four weeks preceding her visit.

Thats a lot of Vicodin, not to mention a toxic amount of acetaminophen if she had taken them all herself during that month.

What is the solution to this problem?

I dont know, but as long as pain is touted as the fifth vital sign, I do not see it getting any better.
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Medicine like air travel once was fun

A Wall Street Journal blog about a reunion of employees of American Airlines lamented the good old days of air travel. Heres an excerpt:

"They came together to celebrate the days when flight attendants in white gloves hustled to serve you, gate agents doled out upgrades and arranged seating so families could be together, and managers worked flights with the single mission of ensuring excellent customer service."

The employees told tales of the fun they had and the camaraderie they shared. The passengers had fun too.

One retiree said of todays airline employees, "They dont look like they are having any fun at all."

Certainly the same can be said of todays passengers.

Im usually not a fan of the airline-medicine analogy, but Im going to make an exception here.

Back in the day, those of us in medicine had fun too. Dont get me wrong. It wasnt at the expense of the patients.

We always approached our patients with a proper attitude of respect. But it was OK to enjoy those encounters and also the fellowship of colleagues. We helped each other out, and we did it with spirit and camaraderie.

Not anymore.

All we read about now is how doctors are burned out, stressed, depressed. We battle with electronic records, hospital administrators, clipboard carriers, third-party payers, the government and just about everyone else.

What happened to the fun? Its all about the money.

David Shaywitz in Forbes: "The view from the front lines suggests that hospitals and care delivery systems are obsessing like never before on doing whatever they possibly can to maximize their revenue. They are consumed, utterly consumed, by this objective."

He added: "Many (I’d say most) providers and provider groups feel that they are locked in a deadly battle with payors (and increasingly, other providers) for their livelihoods; many feel they are having to work harder and harder to bring in the same (or less) money then doctors a generation ago. Many feel that the profession has lost the autonomy and respect it used to enjoy, and that providers are now viewed as mechanized assembly line workers, held to strict quantitative “quality” metrics that rarely capture the complexity, or essence, of the patient experience."

I believe what Shaywitz said is true. Can anything be done or is it hopeless?
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