Returning vets: medical care and other support

I'm attending the annual CME program of the Minnesota Academy of Family Practice, and I'm impressed. Regardless of the parlous state of American primary care in general, and family medicine in particular, this inexpensive [1] educational program just keeps getting better. The most memorable presentation thus far is unique enough, I think, to merit a post.

Colonel Basic LeBlanc, MD, of the 1BCT 34th ID "Red Bulls" (Minnesota) spoke on the medical care and global support of the returning soldier. Here are my quick notes. They are not his words, but even so I will try to separate my comments:

• Wounded to death ratio in Vietnam: 2.6/1. In Iraq: 16/1.
  [jf: If one adjusts for this, then the 3,000 American dead today would have been about 15,000 in the 1970s. That's a significant fraction of the 50,000 US soldiers who died over 20 years in Vietnam. Is this war more routinely violent than the Vietnam war?]
  
  
• 25-30% of returning soldiers will experience some form of emotional "disorder", usually transient.
  
  
• Driving behavior is a significant issue for many.
  [jf: My take home -- I'll strive to be sympathetic to aggressive and seemingly irrational drivers. They may be struggling with "transitioning the combat skill". Of course I always give "bad" drivers lots of room, but it will help me be more patient.]
  
  
• Questions to avoid asking vets: "Did you kill anyone?" [jf: apparently it does get asked], "How's it going over there?", and "When do you go back?".
  
  
• Question for caregiver to ask: "How are you and your family doing?"
  [jf: In general the returning vets are said to welcome comments of appreciation, presumably not including any personal opinions on the incompetence of the President.]
  
  
• Traumatic Brain Injury (TBI): LeBlanc spoke on this, but he didn't give numbers. I got the feeling this was a sensitive topic, but maybe I'm imagining things. If one speculates that there are 48,000 significantly wounded vets, and that half of them have moderate to severe TBI, that's a lot of eternal disability. That would make sensitivity understandable. Many of the care references LeBlanc provided were for Traumatic Brain Injury care.
  
  
• The VA will likely be swamped, much vet care will have to be done in coordination with the VA by non-VA staff. If you're providing medical care, the key to coordination with the VA is to learn the "soldier's VA representative".
  
  
• Military OneSource (1-800-342-9647) is the 24x7 coordinating site for many care related issues.
  

Additional resources:

1. Post deployment health evaluation and management
2. Craig hospital brain injury information
3. Defense and veterans brain injury center
4. Brain injury resource center
5. Book: Courage after Fire
   

[1] OK, so it's heavily subsidized by drug companies, none of whom are doing this from the goodness of their mercantile hearts.

Reality is not looking good: more QM experiments

It was thought, indeed hoped, that if we narrowed special relativity to 'meaning cannot travel faster than light', and allowed for instantaneous communication that did not allow meaning to be communicated, that we could preserve something called "realism". Not so.

Quantum Theory Fails Reality Checks: Scientific American

...Einstein was famously bugged by what are now well-established facts of quantum theory: the randomness of a particle's choices and the possibility of instantaneous linkages between far-flung light or matter. Experimenters now conclude that Einstein cannot even pick his poison, because allowing for instant links kills any simple notion of reality, too.

The team updated a classic 1982 experiment in which researchers measured the polarizations, or spatial orientations, of twin pairs of photons. In quantum theory, photons and other particles do not have definite values for properties such as location or polarization but rather acquire a specific property randomly when measured in an experiment.

... Researchers learned that they could test a related question using photons that are entangled, meaning they are instantaneously connected over any distance in such a way that the measured property of one depends on the other—like a pair of dice that always comes up doubles.

In the 1982 experiment, if the photons "rolled doubles" more than a certain fraction of the time, it meant that particles violated something called local realism: the idea that influences between particles ripple through spacetime like waves (locality) and that particles have hidden nonrandom properties (realism).

But which assumption might be wrong? "It could still be possible," Aspelmeyer says, "that you maintain realism … and that you just relax this locality condition." So he, along with team leader Anton Zeilinger and colleagues, tested a proposed antiquantum model in which influences travel instantaneously but particles have real properties (no locality but realism).

They split red laser photons into entangled pairs and sent the twinned light particles along separate paths. They then measured the polarizations of the photon at different angles to see how often they scored "doubles," called correlations.

Aspelmeyer says the group's hunch was that "if you allow for nonlocal interactions, anything goes, [so] you can recover quantum physics completely" without losing a grip on reality. But, as in the older experiment, they once again saw more correlations than nonlocal realism allowed.

In other words, Aspelmeyer says, nonlocality is not enough to save realism from quantum theory...

So what is "realism"? Despite recently reading 1.5 modern books on QM, I don't know. I don't think the definition in the above article is complete, I suspect the study means that we can't dodge mind-boggling QM interpretations merely by surrendering to instantaneous correlation across the breadth of the universe. I didn't care for the flippant tone of the article, it's not just Einstein who was bugged by what QM means. Feynman, I think, once said something like "if it doesn't drive you batty you're not paying attention".

James Fallows has a blog

James Fallows has a blog. Doesn't anyone ever mention these things? Fallows is one of my favorite writers.

His archives are unusual, they go back to 1970! It looks like someone was playing with the blog and using it to archive old events, articles, books, etc. Sometime in late 2006 Fallows started writing for real.

Phil Carter summarizes five failed military strategies in Iraq

Phil "Intel Dump" Carter, writing in Salon, summarizes five failed military strategies used in Iraq. General Petraeus is executing the sixth strategy - "Plan F".

Phil is a fan of General Petraeus, and I can see why when I followed the link to the General's team. Alas, the incompetence of Cheney/Bush/Rumsfeld has left the A+ team an apparently impossible task ...

Time for Plan G in Iraq? - By Phillip Carter - Slate Magazine:

... Gen. Petraeus and his brain trust have devised the best possible Plan F, given the resources available to the Pentagon and declining patience for the war at home. But the Achilles heel of this latest effort is the Maliki government. It is becoming increasingly clear to all in Baghdad that its interests—seeking power and treasure for its Shiite backers—diverge sharply from those of the U.S.-led coalition. Even if Gen. Petraeus' plan succeeds on the streets of the city, it will fail in the gilded palaces of the Green Zone. Maliki and his supporters desire no rapprochement with the Sunnis and no meaningful power-sharing arrangement with the Sunnis and the Kurds. Indeed, Maliki can barely hold his own governing coalition together, as evidenced by the Sadr bloc's resignation from the government this week and the fighting in Basra over oil and power...

Pet food recall again expands, and now there's a motive

Another Chinese source with melanine contamination, this time in rice. Most interestingly, we now have a motive for melanin contamination.

Spiking food with melanine elevates measured protein levels, making the food worth more. This suggests the contamination was deliberate, but the intent was not to kill animals. Indeed, the renal toxicity of melanine appears to be a new discovery. The intent was mere fraud.

Pet food recall expanded; industrial chemical found in second ingredient - International Herald Tribune

WASHINGTON: An industrial chemical that led to the nationwide recall of more than 100 brands of cat and dog food has turned up in a second pet food ingredient imported from China.

The discovery expands the monthlong cascade of recalls to include more brands and varieties of pet foods and treats tainted by the chemical....

...The chemical, melamine, is believed to have contaminated rice protein concentrate used to make a variety of Natural Balance Pet Foods products for both dogs and cats, the Food and Drug Administration said Wednesday...

...Previously, the chemical was found to contaminate wheat gluten used by at least six other pet food and pet treat manufacturers.

Both ingredients were imported from China, though by different companies and from different manufacturers.

The FDA on Wednesday began reviewing and sampling all rice protein concentrate imported from China, much as the agency has been doing for wheat gluten, Rogers said.

A lawmaker said Wednesday the Chinese have refused to grant visas to FDA inspectors seeking to visit the plants where the ingredients were made. An FDA spokesman later said the visas were not refused, but the agency had not received the necessary invitation letter to get visas.

"It troubles me greatly the Chinese are making it more difficult to understand what led to this pet food crisis," Democratic Sen. Dick Durbin told The Associated Press after meeting with the FDA commissioner, Dr. Andrew von Eschenbach.

A message left Wednesday with the Chinese Embassy in Washington was not immediately returned.

Natural Balance said it was recalling all its Venison and Brown Rice canned and bagged dog foods, its Venison and Brown Rice dog treats and its Venison and Green Pea dry cat food.

The recalls now include products made by at least seven companies and sold under more than 100 brands.

The California company said recent laboratory tests showed its recalled products contain melamine. Natural Balance believes the source of the contaminant was rice protein concentrate, which the company recently added to the dry venison formulas.

A San Francisco company, Wilbur-Ellis Co., began importing the ingredient in July from a Chinese company, Futian Biology Technology Co. Ltd., according to Wilbur-Ellis president and chief executive John Thacher.

It resold the ingredient to five pet food manufacturers, including Diamond Pet Foods Inc. Diamond manufactured the dry dog and cat foods recalled by Natural Balance, Diamond Pet Foods spokesman Jim Fallon said....

...The source of the melamine remains unclear. It may have contaminated the rice protein through the reuse of dirty bags used to ship the products...

...The Las Vegas importer of the contaminated Chinese wheat gluten, ChemNutra Inc., that led to the original pet food recall has suggested that spiking a product with melamine can make it appear to be richer in protein during tests, thus increasing its value.

ChemNutra also imported rice protein concentrate from China, although from another source. Spokesman Steve Stern said the company is testing those shipments...

... A committee of the House of Representatives is holding a food safety hearing Tuesday and is expected to discuss the pet food recall.

Does anyone believe similar fraud would not be perpetrated on food consumed by humans? China has been remarkable uncooperative, and American consumers have been remarkably complacent.

String theory: a one page summary

CV tells us SEED magazine has pdf/gif (gif?! why not png?) single-page summaries of science and technology topics. The String Theory is the only one I'm interested in. CV says they need one for QM -- I second the notion! Also, General Relativity.

String Theory Cribsheet | Cosmic Variance

SEED has come out with it’s latest Cribsheet, this one on String Theory. The Cribsheets are very handy one-page summaries of some fascinating science issue....

Previous Cribsheets include:

1. Stem Cells
2. Climate Change
3. Avian Flu
4. Hybrid Cars
5. Nuclear Power
6. Hurricanes
7. Extinction
8. The Elements

tigers, lions, cars and the evolution of risk assessment

Emily and I were bemoaning the "new" uncertainties that afflict the middle-class American, but we had to admit that historic uncertainties were rather greater. After all, how can industrial acquisitions compare to the risk of being acquired by a saber-toothed tiger?

Surely our lives don't have risks like that? Or do they? What is a Suburban but a tiger on wheels? We drive about all the time, but at any moment that seemingly sated 18-wheeler might "decide" to take out my Subaru.

A hundred years from now, assuming our great-grandchildren are not again tiger-bait, they'll be appalled that we ever accepted the risk of human-controlled vehicles. Perhaps, Emily suggests, it's the lions and tigers. For eons before we were the apex of the apex predators, we fed the sharp-tooths. We had to develop faculties that allowed us to go about our lives despite the ever present risk of being munchies. It is those faculties, perhaps, that cause us to irrationally accept the risk of driving a car ... And, perhaps, other irrational risks ...

New world: Outsourcing Your Crowdsourcing

I couldn't improve on the title of this O'Reilly essay. I think it's a fascinating story.

dSLR camera sensors are ridiculously prone to dust contamination. Most of us ignore the dust, but it's a problem for stock photos. The specks can be digitally removed, but the work is tedious and slow. On the other hand, it's not hard to do an adequate job -- just slow. A perfect outsourcing solution, but most photographers prefer to do their own dust cleansing. If the image is worth a lot of money it's worth the labor.

But, what if the image isn't worth much money? What if you're dumping images quickly to an online photo service that depends on "crowdsourcing" (millions of monkeys typing) to produce cheap, good-enough, stock photos?

Outsourcing Your Crowdsourcing - O'Reilly Digital Media Blog

... I recently read an interesting post over at AUPN about a company based in New Delhi, India that is doing post-production work for photographers via FTP. The company is called Differential Technologies and you can check them out yourself at their website — http://www.worldofdt.com

... I went and checked out Diferential’s website anyway, because I was interested to see if they might be able to help me with submitting photos to a micro-stock agency. A while back I wrote about my experiences in trying out the Aperture plugin for the micro-payment stock agency iStockPhoto.com. In the end I found that I really liked the plugin, but just couldn’t justify the amount of time that was necessary to prepare my images for upload.

The trick to iStockPhoto seems to be that one needs to submit as many photos as possible, the photos need to be fairly unique and appealing to a variety of markets, and they need to be well key-worded, and adjusted. They don’t, on the other hand, need to be from big budget photo shoots, shot with ultra-expensive cameras, or have hours and hours of post-production work put into them.

... The team at Differential set me up with a personal FTP account and I sent them an exported JPEG of the original Master image. I used the new Ubermind FTP plugin for Aperture to transmit the image, and selected a full resolution JPEG with the color space set to sRGB as my Export Preset.

About half an hour later I received an email from Differential explaining to me that the job was done and I could download the image from the same FTP account. The result is below. Differential’s email also explained to me that the charge for such an image would normally be $2.00 (USD) due to the excessive amount of dust on the sensor. The price, they say, ranges from $0.50 to about $2.00, so I guess I hit the max on this one....

... After I looked over the image, I wrote back to Differential inquiring about key-wording services. They said they would be happy to work something out with me. I think this could be the start of really great relationship.

On the Aperture side of things, the whole experience got me thinking about how I could optimize the process so that I would have to do the least amount of work, and keep things nicely organized. I really like the option of just having an “iStock” keyword on hand, perhaps in one of my Keyword Control bars, and a Smart Album set up to search on this keyword. I could continue using the Ubermind FTP plugin to send the images to Differential, and when they were finished, I could just import them into Aperture, and send them to iStock using the plugin.

The only work I would have to do would be to set the iStock categories for each image. Later, I could even go as far as to connect them with their corresponding Masters using the Stack tool...

Of course now that we're seeing high-quality online photo editing solutions, we will see Amazon 'Amazing Turk' services for similar post-production services. Home video editing is another obvious example. I'd be glad to send copies of my home videos out for video editing, though that's an example of only the outsourcing part of the equation. The wonder of this story is the clever combination of outsourcing and crowdsourcing. It's a fascinating parable for our times.

Morford and the virtues of small things

Morford, a columnist for SF Gate, specializes in 'over the top' rhetoric. Sometimes it's tiresome, but often it's oddly agreeable. I liked this one...

You Cannot Save The Earth / Does buying that cute recycled organic lip balm really do any good? Your government snickers

... maybe all this good eco-vibration spurs you on even further, and you decide to green up the whole house, get into gray water and solar and reclaimed wood and non-VOC paints and all the rest, and fill the joint with organic cotton sheets and chem-free cleansers and passive heating systems...

...Just look around. It feels as though your heart is being eaten by angry capitalist cockroaches. Like your id is being munched by deranged zombie architects. And your eyes, oh God your eyes, they can't help but be burned like charcoal as they take in mile after mile, town after town, dreary suburban dystopia after dreary suburban dystopia of massive gluttonous eco-mauling overdevelopment, more Wal-Marts and SUV dealers and scabby strip malls and so many generic prison compounds that are apparently actually tract-home complexes it makes you want to rip out your soul with a pickax and feed it to the few remaining wild coyotes in Joshua Tree before someone shoots them all to make way for a new Home Depot...

He's a sensitive soul, but he does have a good, if obvious, comment about individual versus global action. Organic cotton sheets are an aesthetic choice, not a game changing action. The same thing applies to global poverty -- education and tariff reduction do much more to reduce poverty than coins in a box. Still, if a butterflies wings can trigger a storm, then perhaps organic lip balm can lead to a carbon tax..

Why now? Blacksburg and Montreal

Within the past 20 years, in my hometown of Montreal (Quebec), there have been three sets of shootings of college students. One took place at the Ecole Polytechnique in 1989 (affiliated with the University of Montreal), another (smaller) at Concordia University, and one recently at Dawson College. In the first attack 14 women died, in the last the toll was limited only by courage, good fortune and rapid medical care.

The Polytechnique massacre led to stricter gun control laws in Canada. I believe the weapon used in the Dawson shooting was illegal in Canada, but it is widely sold in the US.

In the US there is Columbine and now Blacksburg.

Has anything changed? If we look back at the last fifty years in North America, and we adjust for population growth, will we see intermittent episodes of these events?

I suspect modern hand held weaponry is lighter and smaller, easier to acquire (even where it is not legal), easier to operate, more affordable and more lethal than the weapons of twenty years ago. Is technology change alone responsible for any increased lethality of school shootings? Or perhaps there's no clear pattern at all.

I can't imagine any easy fixes. NPR had an excellent program on US gun control recently. The universal judgment was that the NRA has been utterly victorious. They have cleared the board and crushed the opposition. The NRA made Bush president in 2000, and America learned its lesson. No American politician will dare challenge the NRA for at least a generation. I would not encourage challengers, I know when a cause is lost. For now.

Update 4/18/07: I've been thinking about this, of course. Given Mr. Seung-hui's age, the prevalence of disease, and the history we're given, there's a reasonable chance he was schizophrenic. If so, then the most pragmatic preventive actions, given the impossibility of weapon's control in America, is to focus on the disorder of schizophrenia. Should every university professor and staff-person be required to complete a program of study in schizophrenia and major depression? Should universities focus on improved early recognition and treatment procedures, and techniques to manage the very difficult intersection of culture and psychiatric disease? Above all, we need far more knowledge of how to prevent and treat schizophrenia, and we need to know methods to divert the victims of the disease from violent paths.

Saletan and the organ trade

The growing organ trade first came to media attention around 2002 or so. Saletan has the 2006 update. Growth has been exponential ...

The worldwide market in human organs. - By William Saletan - Slate Magazine.

...The numbers on the maps add up to thousands. According to the World Health Organization, the annual tally of international kidney transactions alone is about 6,000. The evidence includes reports from brokers and physicians, accounts from Indian villages, surveys of hospitals in Japan, government records in Singapore, and scars in Egyptian slums. In Pakistan, 40 percent of people in some villages are turning up with only one kidney. Charts presented at the meetings show the number of "donations" from unrelated Pakistanis skyrocketing. Two-thirds of the people getting these organs are foreigners. Data from the Philippines show the same thing...

This is about taking life from the weak and giving life to the strong. Here's one more reason why this is not a good idea. Someday the friends and family of those who give up their organs will go looking for revenge ...

The botched security of banks: Schneier ignites a comment storm

Schneier has been too kind to the banks and their increasingly inane security procedures; he's mostly left them alone. Today he finally picks on a misguided credit union, though he should be chewing on Vanguard:

Schneier on Security: Bank Botches Two-Factor Authentication:

... Um, hello? Having a username and a password -- even if they're both secret -- does not count as two factors, two layers, or two of anything. You need to have two different authentication systems: a password and a biometric, a password and a token...

The interesting stuff, however, is in the comments. Schneier hit a nerve, and his audience responds. Some comments claim banks believe their regulators want "two factor authentication" and, in the interests of doing nothing of value, they interpret this as multiple passwords, intermittent security questions, anonymous user IDs, etc. They probably figure they can avert expensive mandates for physical tokens with a load of smoke and mirrors. Their probably right, but the increased complexity and illusory security measures will almost certainly increase consumer losses.

I hope Schneier starts piling on to the banks ...

Corzine didn't wear a seatbelt - does your dog have one?

Corzine didn't wear a seatbelt. It's a characteristic of humans, they confuse power over people with power over physics. Kudos to McDonald for an excellent post, and for the valuable reference to Princess Di the seatbelt-less. In Minnesota Corzine would have gotten a ticket, but New Jersey's mandatory seatbelt law isn't due yet ($20 fine).

I wonder if Corzine will consider appearing in public service messages supporting the new law?

Despite my commie credentials, I have sympathy for the libertarian perspective. I think adults should be allowed to ride a motorcycle without a helmet, or a car without a seatbelt -- as long they then forfeit ownership of their organs in the event of brain death. The benefits to organ recipients will outweigh the costs of care for the seatbelt-less who survive.

BTW, your dog needs a seatbelt too. They need it because they're not sentient decision makers, and because a flying 80 lb dog can break your child's neck. Our dog wears a sled dog harness and appears fond of it; I think she likes the feeling of security it gives her. The harness was used for skijoring back when we had snow, and it works for high speed inline skate action too.

Accusation and injustice: Duke and Lacrosse

The accusation has been shown to be unfounded, and the DA will pay a price for what seems now to have been a politically inspired prosecution. Once again we are reminded of what happens when the law is used to further a political agenda, in this case the reelection campaign of a North Carolina district attorney. Of course, on a vastly larger scale, we are have recently seen how the GOP subverted the law to attack their political opponents, including putting one Wisconsin official in jail.

Will the media also pay a price? There's a long list of people who need to reexamine their readiness to mine this story and sell papers. I checked, and it appears that I'm not among the guilty. I recall thinking that the emotion had far outstripped the available data. The NYT had to pay out for prematurely assigning guilt to a Chinese-American physicist a few years back, I expect there will be some well-deserved payments this time as well.

Apple's OS delay: iLife, iWork, NetInfo, remote control -> it's bad

Mac Geeks are mostly fairly complacent about Apple's five month schedule slip to OS X desktop (vs. OS X TV, OS X iPhone, and OS X video iPod). The most knowledgeable, however, are quietly cautious. Gruber isn't saying this is bad, but my read is that he's starting to worry about Apple's priorities.

I'm also unhappy. It's not just OS X. I expected an Apple replacement for AppleWorks over a year ago. Microsoft still owns the only mass market spreadsheet solution on the Mac [1], and it's tied to buying into their entire suite of file formats. iPhoto hasn't had a major update in over a year, and it needs some serious help (such as importing Libraries). We don't have any adequate remote control solution for the Mac -- that's several years behind Windows. Apple's NetInfo based home and corporate network solutions are a mix of state-of-the-art and vintage 1978 unix. Aperture 1.5 is far slower than it should be, and the best explanations point to weaknesses in OS X data services. We all know the OS X Finder is very weak, and that OS X hasn't not yet equaled MacOS Classic file management. Simple Finder is a farce and OS usability leaves much to be desired. Not to mention the Dock ...

Oh, yes, and Safari. The browser that's stuck in 2004. The range of web sites that Safari supports shrinks every month. Google barely supports Safari; anyone who uses Blogger or Gmail with Firefox or IE can't tolerate Safari on Google. Hmm. Safari barely works on Google? Might as well say it doesn't work at all. There is a far better version of Safari in Apple's labs, but it's waiting on 10.5.

Speaking of core OS X applications, don't users deserve a version of Mail.app that loses massive email repositories less often?

Apple clearly has issues with their computing solutions that go beyond OS X. The saving grace for Apple is that XP is ailing and Vista is about as appealing as a root canal. Even so, there's no room for complacency. They're failing in more than one domain and OS X still has a vast amount of unrealized potential.

[1] Time for me to again test OpenOffice. The last time I tried it wasn't ready for my wife. Happily Nisus Writer Express is quite good.

Update: I almost forgot about Safari and Mail. app.