Death of a Legend

Yesterday Dr. DeBakey died at age 99 leaving a larger than life legacy.  Our medical school class was the last to have Dr. DeBakey welcome it to Baylor College of Medicine (BCM) about a year ago. He gave rather strong admonition for us to study hard and excel in our chosen profession.  More recently, he also gave an interesting presentation on key accomplishments in his career this past Spring at our BCM research symposium.   It was amazing to have a 98 year-old physician lecture with such energy, passion, and dignity.  He told us how he became interested in sewing from watching his mother sew.  He also learned how to sew and appreciate good fabric.  This skill was obviously useful in preparing him in his career as a vascular and heart surgeon.  His innovative use of Dacron in aortic repairs was a major invention that he cherished to the end of his life.

How I did not want to spend my summer or How high efficiency and poor parts and construction create increase the actual cost of air conditioning

Well, it's nice to be off a little while in the summer to relax and take care of things that I don't have much time for during the year.  I have been spending most of my time with family and on pet research projects that are kind of like my hobbies now that I'm in medical school.  Unfortunately our fairly new home is having some problems that need attention as well.  Thank you Pulte (http://www.pulte.com/), for using "builder grade" junk to construct our home.   Pulte seems to use a lot of parts (faucets, A/C's, etc.) that fail in only a few years (we just replaced our main sink faucet ... we are not going to replace the inadqueate duct work, which would cost $8000).  I hope their "cutting corners" reputation / using parts that fail in 5 years catches up with them.   To their credit, our furnace is nice, as shown in the picture above left.  The air conditioning portion lacks an expansion valve and instead relies on an orifice.

One of the things needing attention is our central air conditioner, which is being replaced at a very young and tender 6 years of age.  Ours had some kind of leak or other problem that was causing it to freeze and fail about every 3 months, making us hot at the most inopportune times (usually a Holiday, like 4th of July when you can't find a A/C repair person).  We have had a Carrier 3.5 ton Model CK3BXA042021AAAA / 38BRC042330 (R-22 Refrigerant, which is being phased out) (see picture at left).  Needless to say, the Carrier central A/C should not be failing so soon and it really makes me think that Carrier parts quality is very poor (along with the Pulte unwise selection of parts and home construction of that unit).  Apparently I'm not the only one who thinks so (see another Carrier complaint).  The complaints.com link also allows searching by brand and "Carrier Air" turns up about 96 complaints compaired to 12 for Lennox and about 12 for Pulte.  Every A/C company is likely to get some complaints, but Carrier really stands out and Pulte does not reflect well on themselves for choosing that brand.  If Carrier wanted to improve, they might start with paint that doesn't fall off after a few years (note the Carrier label that is falling off the top of the unit in an attempt to hide the guilty).   However, that's what came with the house, so it wasn't really something we could do a lot about other than replace certain critical components, which is what we are doing.  I noticed our neighbors also had theirs serviced recently as well, and so I don't think the problem is limited to our home.   We are replacing the central A/C system with a 4 ton Lennox Ch23-41 / XC14048 (new R-410A refrigerant) unit for about $6400 from Central City Air here in Houston.  

We had a Lennox central A/C in one of our previous other homes, and it lasted 18 years, which is how long these air conditioners should be lasting.  We nursed that previous 18 year-old Lennox unit along near the end and found out that it's better to replace a failing unit early on after we had sunk a couple of thousand in repairs into it.  A few $200 bills here, and another $400 bill there, and pretty soon, you could have paid for a new unit.  Our outside condenser system just plain looks bad for its age and corroded and our A/C repair man raised a number of concerns about the construction and working parts of that system as well.  Our home is one of those "high efficiency" homes, which uses more insulation and an undersized heating and cooling system.  High efficiency with an undersized A/C also means that the air conditioner will work harder and longer to begin with; add poor parts quality from Carrier and poor construction from Pulte and you wind up with a problem in only a few years that we had to address.  Despite these little annoyances we have been enjoying living in the Houston area, however.  There is a lot to do for our children (local parks, beach, entertainment, etc.), traffic moves pretty well, and the cost of living here (including gas prices) is low compared to national averages ... we save money overall living here and it's quite nice.  I even like our neighborhood; it's attractive, safe, and people are friendly.  I should not complain too much.  However, I wasn't able to find a lot of information concerning the actual quality of air conditioning units on the web, so I thought I would write this up.

Firefox 2 and 3 freeze-ups

Internet Explorer has not serving me very well (it's slow, it sometimes doesn't close, etc.).  Internet Explorer is functional, but leaves some things to be desired.   So, I decided to use Firefox a few months ago (until now) until I was forced to confront the 100th encounter with an interesting feature of Firefox somehow freezing my entire Windows XP systems from time to time.  We are talking about the mouse no longer moving and no keyboard recognition; it happens on multiple systems with many different users.  It seems to be a common problem (check out this search:  http://support.mozilla.com/tiki-searchindex.php?words=firefox+system+freeze+Windows+XP&sa= ) .  It might be an issue with Windows XP but we see similar issues on Vista as well.  It might be the way that Firefox does business.  I have no idea exactly, but it seems to affect both Firefox 2 & 3.   Anyway, the "party line" from the Mozilla folks is that it can't possibly by Firefox and they send users chasing their tails with suggestions to update/change drivers, firewalls, and all that.  Nevermind that there is no other application that does this and that the problem only occurs with Firefox and is reproducible across numerous machines and users.  Even if it is something else, Firefox has the unique distinction of activating this terrible bug, so there should be a bit more sympathy, but no.  Anyway, I loaded Opera (www.opera.com) on three of my machines and my Blackberry (http://www.opera.com/products/mobile/) and I'll see how it goes.  Hopefully it doesn't freeze up the entire Windows XP system like Firefox did ... not even Internet Explorer had that problem.  Opera also seems to be faster as well.  Anyway, I hope it will be an uneventful permanent switch.

First year (MS1) is done

Wow, it's hard to believe I'm at this point.  I'm done with my first year of medical school and it feels great.  Ok, I realize this is supposed to be the easiest year, but, in any case, I feel a certain sense of accomplishment or at least relief that I have time to do something other than my medical school assignments.  We have gone swimming, to an amusement park, and I get to play with computers as much as I want.  I am also working on a couple of research projects including one that I'm writing an MS Access database for right now (I actually find that fun).

Hope for people with Locked-in Syndrome or ALS?

One of the worst things that can happen to a person is something called "Locked-In Syndrome" (see http://en.wikipedia.org/wiki/Locked-In_syndrome). The reason this is so bad is that the person can still think and is conscious but is unable to communicate with the outside world because that part of the nervous system has been destroyed. In a sense, the person is "buried alive" inside their own body. This might happen as a result of a stroke that takes out a significant part of the left hemisphere or part of the brainstem in the pons, for example. People with ALS suffer a similar fate in that they lose the ability to move their muscles and eventually even lose the ability to breathe or keep their airway open and suffocate.

One of the technologies that might offer some hope is something called a Brain-Computer Interface (http://en.wikipedia.org/wiki/Brain_computer_interface). Using such a tool, it might be possible for a person to manipulate a robot arm or computer interface to communicate or otherwise interact with the outside world. It sounds a little science fiction, but recently scientists were able to get a monkey to feed itself using a robot arm that interfaced with the monkey's brain (http://www.nytimes.com/2008/05/29/science/29brain.html). Obviously there must be some limits to this technology and it has not been tried in humans yet. However the monkey and human brain have many similarities that make trying this technology in humans seems very close and I'm sure it is being tried to some extent already using EEGs and fMRI interfaces.

Back from a Holiday weekend

I always like to talk to my classmates after a Holiday weekend (like this past Memorial day 3 day weekend). Everyone is so rested and happy. Even our lecturers seem to have a little extra spring in their step. Soon we will be in exam study mode and year 1 will be over and then we will get a 1 month break. One thing that is clearly helping me is daily workouts. It's been tough working that into my schedule for really no valid reason, but I'm there and I love it. We have learned time and time again how working out helps cardiovascular health, and, most recently, that it has actually been proven to be equivalent to a natural antidepressant and an inducer of brain cell growth development! How about that for motivation to work out. I need every brain cell I can get with all the memorization we need to do.

Neulaw Conference Summary

http://neuro.bcm.edu/eagleman/neurolaw/Home.html

" Baylor College of Medicine’s Initiative on Neuroscience and Law addresses how new discoveries in neuroscience should navigate the way we make laws, punish criminals, and develop rehabilitation. The project brings together a unique collaboration of neurobiologists, legal scholars, ethicists, medical humanists, and policy makers, with the goal of running experiments that will result in modern, evidence-based policy."

Dr. Eagleman in his introduction of Neuroscience and law gave a broad overview of the many ways that neuroscience can explain criminal and other legally interesting behavior. Dr. Eagleman focused mostly on results from science as he explained how Charles Whitman and Phineas Gage were not consciously able to influence their behavior. He gave the example of a man who became interested in sex with children as a result of a tumor and was treated twice and with each surgery was able to regain normal sexuality.

After this, Dr. Hays explained key rulings and issues related to the admissibility of expert testimony (FRE 702. He showed that expert testimony related to neuroscience could be admitted in court if it met a four part test outlined in Daubert v. Merrell Dow 509 U.S.579 if the technique / theory was tested, peer review and published, had a known error rate, and had widespread acceptance within the relevant scientific community. He indicated that actually polygraph tests did very well in determining whether subject were being dishonest and that traditional juries are not well characterized in terms of their ability to assess truthfulness.

Dr. McGuire is very interested in the implications of neuroscience on ethics and law as in the case of participation in imaging research study leading to unexpected discovery of a large tumor by scientists who are not clinicians. She highlighted the many ways in which neuroscience is giving beneficial insights but that results can have uncomfortable implications for patients and research subjects. For example, some of the questions we would really like answers to cannot really be funded for ethical reasons. During the panel discussion she elaborated on this point by explaining that if we studied predictive factors for future criminal behavior based on fMRI imaging of school children, one would be worried about the stigma for children with these predictive factors for criminal behavior and this would outweigh the benefits of perhaps early intervention.

As a neurologist, Dr. Kass was able to go into more detail about how neuroscience can be used to assess individuals. He spoke about how differences in human frontal lobes lead to differences in emotional regulation such as the processing of risk, reward, and ambiguity as well as individual information thresholds for decision making. He spoke about variability in human self-regulatory styles; for example, some people are driven by gain and this leads to eagerness. Others are driven by loss prevention, and this leads to vigilance.

Mr. Dan Goldberg provided an important legal perspective by warning about how application of neuroimaging and related science can be used to mislead juries. In addition to Daubert 509, lawyers can sometimes apply Federal Evidence Rule 403 to neuroimaging because the value of such evidence may not be sufficient compared to the potential undue prejudice that can be caused. For example, in studies, juries that were given a fallacious narrative backed up with a brain imaging study overlooked the errors in the story whereas juries that did not have imaging studies as part of the presentation saw the problems.

Dr. Amir Halevy gave an engaging presentation of the factors in determining brain death and explained that dying is not an event, but rather a process in which a body becomes a corpse. He walked the audience through the history of how death is determined and explained how the coincidental development of technology such as ventilators and organ transplant capabilities led to ethical worries that organ donation might precede death, if not in actual fact, then possibly in a legal sense. He carefully outlined important considerations such as whether the body was at normal body temperature when a determination of death was made as one example to ensure that every appropriate attempt had been made to resuscitate the patient.

Finally Dr. Winslade wrapped up the formal presentation portion of the conference with a careful analysis of voluntary surgical castration for three sex offenders under Texas Law, as for certain non-violent pedophiles . It is important to recognize that this castration procedure is part of a comprehensive therapy that includes intensive counseling and education. Dr. Winslade discussed three cases that showed that it is possible to treat pedophiles so that they can have better control over their impulsivity and other behavior problems even if there is no proven cure for pedophilia.