Monday, July 26, 2010

Ounces of Caution, Pounds of Cure

When my car needs repairs for problems I can't identify, the strategy of starting off with the cheapest interventions makes sense. Why spend the money on the most costly intervention and risk unnecessary expenditures?

This approach to solving problems makes good sense, until you start talking about the car being your own body. Case in point, if you have a problem with your brain or heart whose origin you can't identify, do you want the doctor to throw the take-2-aspirins-and-call-me-in-the-morning strategy at the problem or the ER-stat-to-make-sure-it's-not-a-stroke-or-heart-attack strategy?

With the car problem, the main consideration reduces to the issue of cost-benefit. If the cheapest solution works, great, you haven't emptied your bank account to tackle it and the benefit is that your car continues to function. If your car is the most precious possession you own you may not choose to take the chance that the simple and cheap solution could end up doing long-term damage because it didn't address the underlying issues.

That's the kind of consideration that comes into play when your car is actually you and the problem is an unusual headache or atypical chest pain. No one wants to take the chance that the simple solution could overlook a serious problem. At least that's how modern health care thinks about it. Or so it seems.

Last Wednesday, I was in the instructional technology lab talking to the padawans when I became conscious of a dull pressure on the left side of my breast bone a couple ribs down, right over my heart. "Hm. A pain in my chest. That's strange."

Mentally I compared it to pain I developed 20 years ago when I was a graduate student in medical art. At that time—for the period of several months—whenever I sat slouched and then straightened up, my chest would feel tight in that same place. (Ignore the issue of slouching. I still do it.) If I arched my back, I could get the nitrogen that accumulated to release with a knuckle-cracking pop. But this felt different. I left a voicemail message for my wife and mentioned it to a colleague and the boss in case it should change too rapidly for me to mention later.

Sitting at the reference desk for an hour the discomfort seemed to disappear, but when I started walking around it seemed to return. After another 2 hours I decided to call my wife again and have someone drive me to the hospital. My wife works in benefits administration and urged me to call our primary care provider whom she was certain would have a walk-in EKG machine. As luck would have it, that afternoon was when the office, a teaching clinic, was off for rounds. The answering service operator insisted I go to the hospital. Off I went with my colleague driving.

The emergency room admitted me as soon as I walked in at 3:21 p.m. and hooked me up for an EKG. That and a blood test for enzymes that get released when the heart tissue dies that causes the pain of a heart attack both came back negative. Still, as a precaution, the attending physician admitted me for observation.

The question is if a car is running well and has always been well maintained, is comprehensive service justified? If I am a healthy male with low cholesterol and no history of heart trouble, was this course necessary? When your heart is potentially at risk, no one would recommend taking a chance; so in I went. My wife arrived to settle me into my room and said goodnight so she could get the kids home from our friend's house.

On hindsight, here is the kicker. The attending physician stopped in before the end of the evening. Chest pain that originates from the heart does not change with movement. Mine did. Likewise it cannot be replicated by manual pressure. Mine could. She speculated that my pain was musculoskeletal in origin. I must have strained my chest muscles or breastbone; although I could identify no specific, originating event. She said a stress test the next morning would likely confirm her hunch.

The stress test comprises an MRI scan with thallium dye in your coronary arteries—the arteries surrounding and feeding the heart. It’s done in 2 stages, the first after getting your heart rate elevated using a treadmill, then the second 2 hours later after resting. I did great. No evidence of narrowing of arteries that could have caused chest pain. I even impressed the cardiologist who observed that my heart rate at the same point on the treadmill as other patients was lower than average. That sounds pretty fit for someone who doesn’t do much exercising. Of course, you have to put that into perspective: I’m more fit than the average person being tested in the emergency room. Go ahead, laugh.

When all was said and done and my wife had picked me up to drive me home, I had a prescription for extra-strength Motrin to ease the ache and a full coronary workup at emergency room prices.

My question again: Was all that entirely necessary? With a few minutes of pre-screening by phone, a physician could easily have gauged my symptoms for the likelihood of a heart attack. I had no sweating connected with the pain. There was some dizziness, but not concurrent with the pain (plus this had already been happening for 2 weeks and seemed likely to be latent vertigo from a cruise I’d just returned from). The pain changed based on activity. I could recreate it by pressing on the spot where the pain originated. All of this was determinable through dialogue. In fact, apart from the EKG, the enzymes tests, and the stress test, the attending physician and cardiologist both determined this by talking to me, as obviated by their combined skepticism that my pain was heart-related, and 2 nurses, 1 physician assistant (educated at Arcadia University!), and 2 resident physicians surely also determined this though none of them actually articulated so.

To the comment that EVERYONE offered—it’s better to be safe than sorry—I must reply: That’s what medicine is about—risk assessment. I am low risk for heart attack and the verbalization of my symptoms plainly suggested I was not having one. Considering my risk, I could have gone into the doctor’s office to get a walk-in EKG. Yes, I have a family history of heart trouble (my dad had quadruple bypass surgery—at 81 years-of-age, non-emergency—and both parents have high blood pressure), but that’s information that’s already in my medical history. It would have been a fraction of the emergency room cost to have a preventive stress test done as part of routine screening.

Wiser medical, insurance, economic, political professionals will comment about my observations from a more informed perspective, but this event gave me a noteworthy personal connection to the health care debate.

Friday, May 21, 2010

Teaching How to Troubleshoot

Spring semester is over. I've turned in the grades for the graduate technology course I teach to school library certification students. The padawans are starting up summer project work.

There's one project we do annually for the Physical Therapy department. The PT students take 9 medical conditions for which quality of life can be improved with strength-building exercises. Here are some of the topics: End-stage Renal Disease, Cancer-related Fatigue, Fibromyalgia, Childhood Obesity, Down Syndrome, Juvenile Rheumatoid Arthritis. The PT students present current research and exercise strategies to 2 audiences respectively, professional and consumer.

The basic strategy is to videotape the speakers presenting off of paper notes. With accompanying PowerPoint slide durations timed simultaneously, we can then synchronize the slides to the speakers. Videotaping the speakers away from the project slide presentation allows us to avoid lighting problems. We then composite the videos together with the slide shows. I manage the instructional technology padawans from videotaping through to the video creation in Flash format. We post the videos for Arcadia University-affiliated clinical instructors to learn from and recommend to patients. We replace them every year with new presentations created by the next year's student class.

We just finished videotaping the presentations for 2010. We'll create the final 18 presentations throughout the summer. Every year we improve on the videos with more streamlined procedures, better quality, faster throughput. And every year we have to troubleshoot the new procedures.

In 2008, we composited the final presentations using QuickTime Pro. A related problem is that we had to use the videos with the exact original videotaped dimensions. QT Pro isn't flexible enough to zoom in or otherwise alter the video's appearance. For instance, if we didn't zoom in enough on presenters of smaller stature, we ended up with videos of mostly background. Also, if the video file sizes got too big, e.g., much larger than 1 Gb (or some 20 minutes of presentation), QT Pro was unable to process a final video image. We had to turn large .avi files into more modest .dv files or even smaller .mov files to be able to accomplish the compositing.

In 2009, we began using Final Cut Pro. Because our processing skills were so elementary, we synthesized clunky techniques through sophisticated software. More specifically, we turned PowerPoint presentations with timed slides into video files to composite with the speaker videos. Whenever we found timing errors, we had to program in the new slide durations in PowerPoint, create new slide videos, then composite them together again with the speaker videos. I won't go into how drop-frame time coding (a default setting in FCP that we didn't even learn about for another year) made those slide videos unpredictable in length thus further complicating the composition process.

This year, we finished videotaping on Monday and Wednesday and already had trouble that we didn't have last year simply downloading the video files from the digital camera's memory cards. The file formats are .mod. Last year we learned how to convert them to .mov files that FCP could handle. This year 25% of the files could not download without error messages.

Guessing that those files were unlikely to have been corrupted over the 2 days it took to bring them from the video site to computer lab, I guessed that the operating system on our iMac simply couldn't manage those few files. I wondered if Windows XP could do any better on a pc. And indeed it could; we downloaded the 4 troublesome files to a pc, transferred them to the server, then transferred those files to the iMac. No problem. Best of all, the downloads that took multiple hours to the iMac (alright, no doubt there are other issues with our OS) became file transfers lasting 15 minutes total. (Fine, if we worked at it, we could probably fix all the issues with the iMac, but why? This system worked fine and didn't make the process that much more difficult.)

My issue over these 3 years has been that I've been the sole person able to identify the problems and conceive of solutions. Sure I manage the lab, but I am not a computer superhero. I'm a reference librarian who has learned technology from padawans who have graduated and moved on, by experimentation, by googling effectively for solutions, and by standing back and considering the bigger issues. I suspected this year that the iMac's OS couldn't handle some otherwise perfectly decent video files. I considered another OS, albeit on a different platform. And then I tried out a hunch that worked out.

If I had left the file downloading to the padawans, they would never have completed the task. They might even have attempted to re-videotape the speakers with no guarantees the resultant files would have downloaded any more successfully.

If I have no fantastic technology skills, I often wonder whence comes any problem-solving abilities I have. Maybe fantastic technology skills come less from mastery of the technology and more from the ability simply to stand back and think, to see the picture from a little bigger perspective.

I talked through my entire thought process with the 2 padawans to help them think more. The challenge is to help them learn how to problem solve, too. Just.

Thursday, February 4, 2010

Common Creed

Hang with me here, I'm going some place after the opening paragraphs of ecclesiology.

I've attended a house of worship all my life, so like other longstanding activities in which people engage, it's possible to take it for granted. Not long ago, however, I was singing along with the rest of the members of the congregation at my church in Chinatown, Philadelphia, when I was struck by the oddness of this particular activity. The subject of the song was not the issue. (If you are committed to a church and its worship, you can speculate fairly accurately. If church is foreign to your everyday vocabulary, it may all be rampant fanaticism anyway.) The sense of oddness arose from the activity itself. I was standing in my usual spot singing with my usual sincerity and gusto when I became conscious of the fact that 130 other people were singing exactly the sang words, with the same melody, with approximately the same zest. For the non-cognoscenti this would have to appear profoundly bizarre. Is there a comparable activity anywhere outside the Church?

I devoted some idle little gray cells to the task of figuring out how to describe this ritual. Let's see, we uniformly believed what we were singing. It served the purpose of helping us to unite collectively behind the beliefs represented. It was getting our minds and spirits ready for the succeeding elements of worship. I had it.

We were creeding.

Oxford English Dictionary defines a creed as "acceptable or professed system of religious belief; the faith of a community or an individual, esp. as expressed or capable of expression in a definite formula." By transference it means "a system of belief in general; a set of opinions on any subject, e.g. politics or science." There are commonly accepted creeds in the Church that enter the liturgy at various timess. Singing as creeding is different, though. No denominational body bestowed creedal honors to any given song we sang. But we were professing what we communally believed through each song we sang that morning. And there was certainly formula in the way we sang it. It's all very interesting from a theological perspective.

What struck me so odd about this as I looked at it with an outsider's eye, was the near total foreignness of this activity to the secular world. The closest activities I could conjure were the recitation of the Pledge of Allegiance and the singing of the National Anthem. And even the latter is a bit of a stretch, because it professes no belief whatsoever, even if it does serve a communal purpose in a definite formula.

I happened to comment about these observations among some friends and received an amendment to my list--but one that will only have significance to those with a regional affinity. The words begin: Fly, Eagles, fly, on the road to victory!

As foreign as creeding is in secular society, it's even more so in the professional realm. Think about that for a moment.

You might argue that company slogans are creedal, but how many managers lead their team members in a regular, even irregular, recitation of the company slogan? I came across a newspaper article--of course I won't be able to give you any details, it always happens that way--that did provide a window into the Walmart experience. Apparently, managers Do lead their team members in recitations of company slogans. Fanaticism you may dysphemize it, but creeding produces solidarity, passion, identification.

For Technology for School Library Media Centers, a graduate course I teach in the Education Department of Arcadia University, I've been thinking about a slogan for us to use. The only award it might win is a Phlegmmy, and I haven't even yet worked up the gumption to promote it, but it goes like this: SLM-C (pronounce slam-c) and new technology, [clap, clap, pause] I can do that!

Yep, I'm feelin' it.

Monday, January 11, 2010

You say Wang and I say Wang

Let me set the record straight. Wang Laboratories, the computer company you remember from the 80s, did us Wangs wrong.

In Chinese, Wang is pronounced similarly to song. This is a function of the Pinyin method of transliteration. Tang is pronounced the same way as are Gang and Fang, though you don't see those surnames nearly as often. Wang is after all the 2nd most common surname among Chinese after Li according to Wikipedia and other sources.

Not surprisingly, I've had to correct people all my life. And I continue to wrestle with ways to address the pronunciation issue such as during introductions. I still have to remind myself occasionally that it's worth the effort. As a librarian now whose name gets mentioned a lot as the liaison to the Sciences, I've concluded without a doubt that it is.

In library research instruction sessions for various courses, I make a bit of a joke out of it for mnemonic purposes. (Credit goes to my younger brother, Daniel.) "Just remember, Wang is wrong, but Wang is right." Hint: It's much funnier if you pronounce it incorrectly the first time then correctly the second. Depending on the crowd, I may follow that up with the reminder that only people of the same ethnicity can make fun of ethnic names. Don't be like the clueless (but forgiven) professor who responded in one class, "Every time you wing, you get the Wang number." That's an old joke that does nothing to advance the pronunciation cause and would be offensive if we Wangs chose to let it be.

Spinning off of my AU email ID, I've toyed with the idea of a library wangc moniker, but precious few would have an inkling. When I get more celebrated as a librarian, I'll surely be able to pull it off. If Mike Krzyzewski can do it, so can I.

Aside from native Chinese speakers (and sometimes not even then!), in the rare situation when a person is going to pronounce it correctly without initial input from me, that person is likely to be African-American or Latin-American. I have not yet divined why that is so, but it happens so infrequently anyway.

Perhaps for obvious reasons, I care about the native pronunciation of names. The name of a co-worker that sounded like Joli didn't make sense when her given name turned out to be Yolanda. It did when I thought about her Latin-American heritage. In some languages, y can come out so that it sounds almost like a zh. Yoli becomes Zholi which goes into American ears and comes out American lips as Joli.

I was never able to do complete justice to a high school friend's surname, Nguyen. It uses the ng from sing followed by a long u and yen. Or something like that. After some practice, my friend kindly assured me I was improving. A dentist in the practice where I go uses Winn as the closest Americanization that doesn't completely offend his Vietnamese sensibilities.

The problem is that non-native language speakers don't have the oral, lingual, glossal proficiency to create sounds that native language speakers use regularly. After the early language development period of a person's life, proficiency only comes with considerable practice--and perhaps luck. It can be done, though, as in the case of a tongue-tied college classmate who I took first-year Chinese with me who then finished the course with admirable pronunciation.

I've been working on Polish names since that same period of time. My college advisor's surname was Grzywinski. Her husband's name, she told me. She chose the American pronunciation for everyday use, Grizwinsky, but--as a non-native Polish speaker--she said it should be pronounced zhavinsky.

Working at Arcadia University years later, I met a graduate assistant who's surname was Przybylski. Her family also chose the American pronunciation of Prizbillsky. But she told me her father pronounced it--guess what--zhabillsky! I was willing to wrap my head all those years around the idea of a silent Gr in Grzywinski, but a silent Pr, also, defied logic even to my subtly enhanced American language sensibilities.

Happily, the acting director of our MBA program a few years ago was a native Polish speaker. We often crossed paths in the faculty dining room; so one day over lunch, I asked him about the silent Polish consonants. His own pronunciation immediately revealed that, though not silent, they were so neutral that to the non-native speaker the zh could easily sound dominant to the point of exclusion. So Grzywinski is better said ger-Zhavinsky. And Przybylski, ber-Zhabillsky. I now educate people at every socially appropriate opportunity.

Incidentally, then, Krzyzewski isn't so accurate as shashefky as it is ker-Zhazhevsky. Google: pronounce Krzyzewski. I'm not the only one who's trying to reason these things out.

Then came Grzimek. Grzimek's Animal Life Encyclopedia is a classic reference work in the field. Landman Library recently updated its print copy and I've been considering Gale's new database. I had no problem speculating on the correct pronunciation. It looked Polish, it had to be ger-Zhimek. The first time I discussed the work with our conservation biology professor then though, she politely corrected me: "We call it Chimeck."

Uh, okay. The MBA director hadn't prepped me for that one.

According to Wikipedia, it turns out Bernhard Klemens Maria Grzimek was from Upper Silesia, a region of Europe that was variously under Polish and German rule in the 20th century. So to the Poles, my guess of the pronunciation is probably a good approximation. To the Germans, according to the head of our Modern Languages Department, Zeemeck is correct. To the publisher of the animal life encyclopedia, Chimek, is correct.

Let's call the whole thing off.

Friday, January 1, 2010

Listen, Do You Want to Know a Secret?

Chicago's Museum of Science and Industry
Visiting Chicago, the city where I did my undergraduate and graduate studies (the latter being before my library science degree), I visited the Museum of Science and Industry for the first time in some 25 years. My family and I didn't have a lot of time to stay so we devoted our attention to the new U-505 submarine exhibit, completed in 2005 (

Visiting the new exhibit was, succinctly, phenomenal. I started off rushing as I proceeded through the wending, twilit walkway, then began to slow down to take in the whole experience. Eager to get to the submarine, I must have been doing what every visitor did; flying through to the next exhibit. I saw the first station in a blur, but not without noting its import. It spoke of the strategic significance of the German u-boat in the context of WWII. Well, that's important; people need to understand U-505 in time, place, and circumstance.

With each station leading the visitor to a deeper understanding of what they were about to see, I started slowing down to pay attention. Each emphasized a diorama or a video screen surrounded by printed panels providing more information about the value to the Allied effort of capturing a submarine, the challenges, and the genesis of a plan to surmount the challenges.

Proceeding more leisurely, I started taking in more details. I paused at a diorama behind backlit glass and satin curtain which dramatically opened and closed on electronic cue to see a scene which now portrayed the effort to sight the targeted German submarine. I anticipated what was sure to be, in my assessment of traditional museum exhibits, quasi-professional acting and noted with surprise that it was quite passable. I studied the faces of the actors and guessed from the physiognomies that they were contemporary. The production must have been filmed recently, not 20 or 30 years ago like museum productions I've seen always seemed to be.

I noticed an increasing sense of eager anticipation as I progressed. It was fueled by orchestration piped in from speakers positioned through the walkway. The music reminded me of a 21st century drama movie soundtrack. The fact that it was continuous was typical of so many movies today that use music integrally to establish mood and utilize silence only occasionally but with deliberation as its own distinct sound element.

The next station was a period style black and white video imagining the scene inside the vessels of the anti-sub task force dropping depth charges. The cameras captured closeup after closeup of the seamen. But these weren't the stiff, immaculate faces of reenactors of the past. These were the emotive visages of contemporary actors adorned with perspiration and grit, rumpled and sweat-stained. The background music continued to reinforce the drama.

With the stage set, I entered the hall housing the vessel itself and reeled at the unfolding view of the stern back to the keel that neither permitted it to overwhelm the space nor the space to overwhelm it. Descending the circumferential ramp, I continued to read more and more details about the submarine and the supplemental artifacts and educational stations.

A Biology major at the University of Chicago in the 80s, I remember the submarine as a museum piece that stood outside the museum where you could observe it while driving along Lake Shore Drive. I'm not sure I ever even went into it during the couple of times I visited the MSI in those days. Whatever the exhibit was then, the museum had moved leagues beyond the sensibilities of the day and thoroughly embraced a revolutionary approach to exhibition design.

The best of museum exhibitions I've seen have been floor-to-ceiling displays filled to visual and informational overflowing with printed and illustrated details. True they were typographical and layout extravaganzas designed to emphasize main themes and minimize information overload while telling a story, but the rare intrepid visitor was the primary beneficiary. (Yes, I generally read everything. It pains my family.) This exhibit was true storytelling carefully conceived to unfold the account sequentially and experientially. Participants had time to absorb the unfolding details as they proceeded to each station at a measured pace. It was difficult to imagine many people missing the main themes the way they surely would confronted by Info-wall.

How could the Museum of Science and Industry afford such an exhibit? Someone had clearly consolidated years of observation and made striking conclusions about the inadequacy of older designs. And the recommendation clearly to me couldn't have come cheaply. Museums in recent decades stopped depending solely upon admission dollars and had already been soliciting major corporate and private donors to underwrite its operations and development. This exhibit would have demanded a substantial budget simply to generate the concept accoutrements necessary to secure the donors for its development.

As I exited the hall, I paused to read about the making of the exhibit; a final nod to contemporary movie-making.

This blog could end here. But I'm a librarian—who's blogging i-candy.

As a big picture person, I see solutions across boundaries. And there are some here, I believe. One is to pay attention to the trends in the entertainment industry. So the industry uses music and visuals to create suspense and anticipation. Why not use a soundtrack and striking images on the library's website? The museum created a successful storytelling technique by unfolding the details through the exhibit. Can a website about learning database searching techniques capitalize on this technique? It's worth an experiment. Will it cost an arm and a leg to execute? It could, but doesn't need to even if it does take time. How do the entertainment industry and even museums keep people coming back? By keeping content fresh. Libraries can emulate that.

What else will come out of this mind-expanding experience? I don't know yet, but I'm not going to stop considering what I saw.