EBM and Clinical Support Librarians@UCHC

A blog for medical students, faculty and librarians about their use of evidence based medicine, clinical literature, Web 2.0, sources and search strategies

Category Archives: Web 2.0 and Geek Stuff

News, Medicine, Librarians, Blogosphere: Participate in Medlib’s Blog Carnival – June 2010

Image/Photo Credit: http://blogcarnival.com/ – All rights reserved – Copyright 2010

Big News!

EBM and Clinical Support Librarians@UCHC has been invited to host Medlib’s Round Blog Carnival for the month of  June 2010. How does this work?  Here is an excerpt from the Blog Carnival FAQ page:

Welcome to the Blog Carnival page! We love the idea of blog carnivals where someone takes the time to find really good blog posts on a given topic, and then puts all those posts together in a blog post called a “carnival”… Carnivals are an edited (and usually annotated) collection of links that lets them serve as “magazines” within the blogosphere…

Since blog carnivals include lots of posts on specific topics, they also serve as a place to connect with those who are expert (or at least highly opinionated!) and those who are interested in that field. Blog Carnival simplifies carnivals for two kinds of people:  People who read and contribute to blog carnivals, and  people who organize and publish blog carnivals.

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What is the subject for Medlib’s Round Blog Carnival?

As a reference and public services librarian, over the years I have assembled a group of classic questions or library patrons in my mind that could be summarized as:  Questions (or People) I’ll Always Remember at the Health Science Library“.

This intent of this collaboration is learn more about the unique experiences of others librarians worldwide, or from those who work with health science librarians to teach, train and find medical information.  

Who should submit to the Medlib’s Round?

Bloggers from around the world

Medical/reference  librarians, folks who blog about clinical reasoning, evidence-based medicine, teaching and learning medicine (or practicing medicine).  I would appreciate hearing from physician- or scientist-bloggers who collaborate with health science librarians, medical students and others as they use digital library collections.

What should I write about?

Funny, sad, poignant, teachable moments (or people) encountered in your health science library.

  • Librarians: Please share some positive “memorable” encounters that took place in a public service/reference desk setting, over your career.
  • Clinicians, researchers,  pharmacists, graduate students, nurses: If your clinical or educational work as a scientist or care-provider has been positively enhanced by working with a librarian or librarian-instructors in health science library settings, please share your stories with us.

Is there a deadline to submit an entry?

Yes – please write your article, post it to your blog and send it to BlogCarnival.com no later than Tuesday, June 8th.

OK – I have an article to share.  Now what do I do?

First, go this link at BlogCarnival.com and paste the URL of your blog post using their online form.  You’ll need to also type in your name and email address.  (See screenshot below).  BlogCarnival will manage it from there.

Image/Photo Credit: http://blogcarnival.com/ – All rights reserved – Copyright 2010

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Questions – I have Questions. Who do I ask? Send an email message to ebmblog@gmail.com.  Thanks in advance!

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The (Good) Friday Post #49: Easter Greetings, Volcanoes, Helen Mirren and A Nerd Test

Here’s the (Good) Friday Post #49 for Apr 2 2010

First:  Anyone want to take a stab at pronouncing the name of this city in Iceland, where a volcano erupted this week…  ??

Image credit/source:  http://www.youtube.com/user/AssociatedPress – All rights reserved – Copyright 2010

Hello! to those folks from Connecticut who are currently vacationing in Iceland.   Sure hope you got to witness this volcanic event which took place on Mar 31, 2010:

Image credit/source:  http://www.youtube.com/user/AssociatedPress – All rights reserved – Copyright 2010.

I enjoy watching Helen Mirren as an actress…  from Prime Suspect to The Queen.  She is so convincing.

In the 1980 film, The Long Good Friday, she plays the role of girlfriend to sullen gangster Bob Hoskins; it is a tough movie full of bad guys set in downscale London.  It would be a fine movie to watch on a Good Friday.

Image credit/source:  http://tinyurl.com/yfx9cv3 – All rights reserved – Copyright 2010

Would it surprise anyone to learn that a librarian got a test score of “Nerd” on the Geek? Nerd? or Dork? Test? (No!)

There’s also a Personality Defects Test on this website but, my friends, those results won’t be discussed on this blog.

That’s the Friday Post for Apr 2 2010, folks!

Let the Good Times roll

Photo credit/source: http://tinyurl.com/yjnvbku – All rights reserved – Copyright 2009
All Easter borders – Image credit/source: http://tinyurl.com/yhkp28u – All rights reserved – Copyright 2010

Academic Medicine, Teaching & Learning in Medicine: Announcing a New Series called Learning Medicine

It’s looking more like spring each morning in the Northeast, after a nasty late winter. There are daffodils poking out of the ground. The days are growing longer. This morning I saw a green bagel in the cafeteria because tomorrow is St. Patrick’s Day*.

This makes it a good time to try something new on the blog. Today marks the first post in a series which I have titled Learning Medicine: Ten Questions.

The series is intended as an open dialog between current and former medical students, educators, clinical researchers, PBL facilitators, librarians (and anyone else I can rope into answering 10+ questions!). The content or questions in the interview may vary, depending on the background and professional experience of the interviewee.

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Today, please welcome esteemed veteran blogger and physician Graham Walker!

A Background Question – Who Are You?

Graham Walker describes himself in this way:

I’m a second-year Emergency Medicine resident at St. Luke’s-Roosevelt Hospital System in New York City. I was originally a medical school blogger (at the now-defunct Over  My Med Body! ) blog. Recently I’ve returned to blogging as a contributor to The Central Line, the official blog of the American College of Emergency Physicians.

My interests include: surviving residency, technology and web design, simulation medicine, informatics, health policy and caffeine highs.  I’m originally from Kansas, went to undergrad at Northwestern in Chicago, studying social policy/health policy, then went to Stanford for med school with a concentration in Community Health.

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Making the transition from undergraduate/or pre-med to graduate medical student

Can you name 4 or 5 key things that (in retrospect) you wished you had known before you began your first day of medical school?

Oh boy. Hopefully I can still remember anything about being a premed!  Here goes:

1) Know how you study, and develop good study skills in undergrad. Medical school is tough — they say it is like trying to drink water out of a firehose — so make sure that you’ve got a system in place to organize information in your head and commit it to memory.

For some people that’s flashcards, for others it’s study groups; for me, I *still* find I have to write things down in a notebook to get them to stick.

2) Know how you relax, and don’t give up doing that. For some people, that’s going to the gym. For others, that’s playing the guitar. Or doing a hobby. Or keeping in touch with your family. Medical school (and residency even more-so) requires copious coping mechanisms so have yours ready.

3) Get by with a little help from your friends. Don’t be a gunner in medical school. You’re in — You get to be a doctor — Yay!  Med school will be much easier if you work together with your classmates rather than view them as competition — *especially* once clinics start.

4) It is normal to feel overwhelmed. Accept it and embrace it, and it won’t be so stressful. There are parts of it that you’re going to hate, that are not going to be intuitive. But it will get better!

5) Try to get yourself all figured out. Know yourself by the time medical school starts, because while you’re in the thick of things, it’s easier to have as many of your own internal issues worked out before trying to ascend Mt. Medical School. “

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Being a Person AND a Medical Student

Please tell us about some moments in medical school or clerkship that:

Made You Angry: I remember two instances that made me upset: one was the way some OB-Gyn residents were talking disrespectfully about a terminal cancer patient. (I actually kind of understand their perspective as a resident now, but still don’t agree with it.)

The other was a grossly abnormal physical finding in a patient that I found that a group of residents chose to ignore, because I was a medical student. As the medical student, you are — more than anyone — your patient’s advocate. Know when to speak up.”

Made you wish you had Studied More: “ The Boards. But you always wish you could memorize more. Do your best, and move on “.

Brought Tears to your Eyes:  “ I remember it like it was yesterday. It was on my medicine rotation, one of the first patients that I really felt was “mine.” My residents let me “be in charge” as much as I could, and I fought for him to get a much-needed foot amputation. I was off or post-call one day, and I remember coming back the next morning and finding out he had died.

I wrote up the experience: Wonderful, Just Wonderful, Dr. Walker at: http://www.grahamazon.com/over/2006/02/wonderful-just-wonderful-dr-walker/ “.

Made you Roll on the Floor Laughing:  “ Slap-happy post-call. I’m known for being a little hyper and a bit of a morning person, which usually drives people crazy. Also any shift in the Emergency Department “.

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Learning Medicine, Becoming a Doctor. Empathy, gravitas, demeanor, honesty

Part A:  How does one learn to “act like a physician”?   (It’s not really in a textbook.)

I certainly steal bits and pieces from different mentors and heroes of mine. A phrase from this attending, a style from that one. Tips and tricks along the way.

There’s no one way to “act like a physician,” and often it changes for the situation and the patient. I’m a different type of doctor when I’m seeing an infant compared to when I’m evaluating a trauma patient or interviewing a 95 year-old. Being able to adapt and change: maybe that’s the ticket. ”

One area the third-year medical students are concerned with is effective communications with patients and their families when managing someone with a terminal illness, in palliative care or especially when attending unexpected deaths due to accidents, homicide, military, etc.

Part B:  How does a physician learn to “deliver bad news” to a patient or their family members?

Get at or below the patient or loved one’s level. Empathize. Speak in private. Speak their language, if you can. (Learn as many languages as you can.) Make eye contact. Be direct, calm, and compassionate. Tell them however they’re feeling or reacting is normal and okay: everyone reacts differently.

Be present in the moment.  This is one of the hardest things for me to do now, and I have to remind myself of it, especially in a busy emergency department. Don’t worry about what’s happening to the rest of the team, or the other patients, or the rest of the department. Just be there, if only for a few minutes.   Apply the Golden Rule “.

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Congratulations – You are now a resident!  Choosing a specialty.

Match Day is Thursday, March 18, 2010. Can you describe the process that allowed you to select a medical specialty (Emergency Medicine) and why?

Man, it’s hard to remember, because my view of the specialty has changed so much as a resident. I remember really connecting with the type of attendings and residents who went into Emergency Medicine.  My type of people, I guess.

They say it’s much easier to rule out specialties than rule any in, and that’s very true. I was the type of medical student who enjoyed most of my clerkships, but in the end, I chose the one that I thought I’d enjoy, be challenged by, and excel at. ”

What advice would you give fourth-year students as they learn their Match and prepare for residency?

Get excited, relax, and get scared. Residency is not anything like a harder version of medical school, like I imagined it to be.  Enjoy your last few free months. Travel. Get married. Spend time with the people who are important to you.

Do. NOT. Study. And most of all: learn Spanish “.

Do you ever get enough sleep?

Yes, I do. My program is pretty resident-friendly in that regard, and I think it makes us all better, happier, more efficient, and more compassionate doctors. It’s hard to go the extra mile (which is what you realize you have to do as a resident) when you’re exhausted and cranky. ”

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Since this blog is written to inform readers about health science literature, trends in medical or scholarly communications, effective search strategies and sources, the next question focuses on your experience in learning to effectively use health science literature, sources for evidence-based practice or anything digital.

Have your information needs and/or searching behavior(s) changed between medical school and residency?  Are mobile computing resources and technologies important to you?

Definitely.  In medical school it’s all about learning about the basics, and the basics of how you treat X.

In residency, it’s much more about management, when to use what, finesse, and pattern recognition. I think it’s different for every specialty, too.

Regarding searching for clinical evidence, which sources, journals or databases have you found most-useful in answering clinical or patient care questions over time?

Great question. If I’m going to anything, it’s usually either UpToDate or E-Medicine or straight to actual papers, via Pubmed.

I really like JAMA’s Rational Clinical Examination series, as well as BestBets, The TRIP Database, Cochrane Reviews, and often just… Google.  I also keep a private little blog of things I’ve learned and journal articles I want to hold onto for future reference.”

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What aspect of medicine/science digital communication and/or particular use of the Web for medicine or patient care interests you the most? (This is a completely open-ended question.)

I love Podcasts, Videos, Image Banks and clinically-useful blogs. It’s a whole other style of learning that helps you learn more when you’re tired of reading journal articles, review articles, or textbooks. ”

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Bonus Question: What question would you like to ask the readers? – or – What do you want medical students who read the EBM and Clinical Support Librarians@UCHC blog to learn from our interview?

I’d love to know how the students think medicine is going to change in their lifetime.

What do they think of the blurring of private/public life through [social media sites such as] Facebook?  Should we as doctors hide our private lives — that is, is it inappropriate for a patient to see a doctor, say, smoking or drinking on a site like Facebook?

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And that’s the first interview for Learning Medicine: Ten Questions series.  Special thanks again to Graham Walker for sharing his time, expertise, advice and experiences.

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Happy St. Patrick’s Day!

The Friday Post #46: That old Cardiac Rythmn, Medical Fiction and Jude Law

This is the Friday Post #46 for Feb 5 2010.  Let’s consider matters of the human heart because St. Valentine’s Day will be here soon, and because this is National Wear Red Day, a public service campaign aimed toward women which promotes awareness of cardiovascular health and fitness, sponsored by the American Heart Association.

Systole/Diastole Song

…. Ha ha ~  It’s a bit repetitious

Video Source/Credit: YouTube.com – All rights reserved – Copyright 2010

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The Mad Professor does the ECG Dance

What a way to learn Normal Sinus Rhythm!

Video Source/Credit: YouTube.com – All rights reserved – Copyright 2010

My goodness, don’t his arms get tired?

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Finally:  It’s no secret that this blogger needs some good strong coffee in the morning in order to get moving, wake up and be productive.  It snowed on Wednesday morning here in the Northeast, making for an ugly, accident-ridden commute.  Getting to work a bit late, and getting a cup of French Roast, I sat down to my computer to check my email and the latest medical news online.

Then I checked my blog statistics, which linked to an item on the Health Blog from Wall Street Journal, which led me to a news item on Digg advertising something called “The Union“.

(Disclaimer:  This is about medical fiction, Hollywood style, folks!)

Image Source: http://Digg.com – All rights reserved – Copyright 2010

It gets weirder: The link opens a website named UnionCares.com, a glossy page with sincere video testimonials, lush graphics and a catalog of high-tech mechanical human organs for sale, at high-cost and extreme profit to the ruthless company that created them.  And payment plans.

The fictional items “for sale” look like they were manufactured by the same industrial designers who created the Terminator.

Image Credit: http://www.theunioncares.com/ – All rights reserved – Copyright 2010

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This site gave me a nasty shock… did I miss hearing about something really big having to do with trends in transplantation?!  Was this a French Roast-coffee-deprivation thing clouding my reasoning abilities at 930am?

Thank God they’re not real.  The whole site is a promotion for a film (whew) due to be released in March 2010, called Repo Men.

This is not the same movie as the classic 1984 film, Repo Man, or the 2008 musical.  And Jude Law is in this film… !

However, seeing that artificial liver left me feeling a bit sick… so I finished the coffee, skipped the donut.

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That’s the Friday Post #46 for Feb 5 2010, folks.  Have a great weekend and good luck on exams next week!

News, Blogs I Like, Eye Candy: Collecting Library Blogs

Dave Pattern, Library Systems Manager at University of Huddersfield (UK) and technologist, created an automatic blog called Hot Stuff 2.0, which he describes as an:

automated WordPress blog that tracks around 800 library related blogs, looking for the latest trends and hot topics.   The purpose of the site is to track content in the biblioblogosphere and the harvested blog posts are indexed to provide word clouds, emotional content, geographical data, etc.”

A daily blog post is generated using a single word that has seen a marked increase in usage over the last few days. A “Word Wheel” image shows the strength of the links between that word and other words that have also recently seen an increase in usage. “

As Mr. Pattern writes:  “This can sometimes help to put to the words into context, but mostly it’s just an excuse for some eye candy.”

Text Source: http://www.daveyp.com/ and http://www.daveyp.com/hotstuff/ – All rights reserved-  Copyright 2010

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The Word Wheel is, indeed, an elegant piece of code. 

Eye Candy is the good way to describe these luscious images:

Image Credit/Source: http://161.112.232.18/hotstuff/14635.png – All rights reserved – Copyright 2010

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A post about Haiti found on this blog was collected by the Word Wheel on Jan 26 2010, when the Word of the Day was “Earning” (shown above).

It is an interesting list of library-related blogs he has aggregated for the Word Wheel; you can take at look at the collection here:  Dave Pattern’s Hot or Not List.

Finally: Take a look at the word cloud, and blog-hits, found recently for a search on the term “EBM“.

Clinical Reasoning, Mobile Computing, Point of Care Tools: Medical Knowledge in Your Pocket

This month, the second-year medical students at UCHC are in the process of selecting and purchasing their mobile computing devices (PDAs or SmartPhones) in preparation for the beginning of their clinical clerkship year when they’ll be using them to keep a log of patient encounters, check for drug interactions, calculate laboratory test results, look up point-of-care medical/reference facts or other essential activities like checking email and sharing files.

I’ve noticed that quite a few of the first-year medical students are already using PDAs, Blackberries and iPhones, thus getting ahead of the learning curve.  Several are already using EpocratesRX, a basic mobile drug reference resource available at no cost from Epocrates.com.

Other free downloads popular with medical students are Diagnosaurus 2.0, a differential diagnosis tool from McGraw-Hill, and Archimedes, a medical calculator, provided by Skyscape.

A desirable feature when evaluating potential new library subscription products is the availability of a mobile computing version.  Examples of highly-useful clinical resources which come with a mobile version are DynaMed, Essential Evidence Plus, Lexi-Comp, Micromedex, MD-Consult/First Consult, and two integrative-complementary-alternative medicines resources, Natural Medicines and Natural Standard.

These last two resources are especially important when clinicians need to determine potentially hazardous drug interactions between “over-the-counter” homeopathic or dietary supplements and allopathic prescription medicines.

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It is a rapidly changing world of devices, products, access, cost (and choices).  To review more of what is available in hand-helds for medical applications, visit a few pages* written for UCHC students by library staff :

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Wikipedia.org has a page about Open Source Healthcare Software.

Recently I came across a free clinical calculator site which anyone can use: MD+Calc.  Thanks to Graham Walker for putting this site up. Below is a screenshot of the topic page “Endocrine/Metabolic“:

Image/Source credit: http://www.mdcalc.com/ – All rights reserved – Copyright 2010
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Finally, here is a brief list of other free clinically-oriented sites**:

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* Note: Access to the clinical subscription databases described here is limited to UCHC students, staff and faculty.

** These links are provided for educational use only – not for clinical decision-making in the care of actual patients.



The Friday Post #45: Hapless Medical Student, StoryBird and Moonbows

This is the Friday Post #45 for Jan 22 2010.

First, thanks to Educational Origami (a favorite blog/wikis for educational and instructional ideas) for the link to StoryBird where you can sign up to create your own story, or collaborate with others to create a shared story.  The artwork is fabulous!

http://storybird.com/create/

Very cool

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Next: A Day in the Life of a 3rd Year Medical Student who essentially can’t do much of anything right.

Source Credit:  Youtube.com – All rights reserved – Copyright 2009

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Finally:  Take a moment and watch this amazing Time-Elapsed Moonbow

Source Credit:  Youtube.com – All rights reserved – Copyright 2009
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That’s the Friday Post #45, folks.  Enjoy your weekend!

News, EBM, Library Resources: JAMA Evidence now available

For those interested in learning strategies for practicing evidence-based medicine, check out the latest digital subscription from UCHC Library:

JAMA Evidence

JAMAEvidence
Image Credit: http://www.jamaevidence.com/ – All rights reserved – Copyright 2009

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Produced by American Medical Association editors and publisher McGraw Hill, content from the digital textbook is also available for mobile applications.

I particularly liked the JAMA Evidence glossary.

If off-campus, connect via your UCHC library proxy account.

Visualization, PBL: Visit with Wordle Occasionally

One aspect of participating in problem-based learning is that by the end of the semester, every student in the group has taken their turn at the group tasks involved, which are:

  • The Reader narrates the case as it is made available online. The written case with any supporting visual materials such as radiology or histology about the patient are posted on Blackboard and are no longer distributed in paper handouts.
  • The Scribe is the person with the marker who listens to the groups’ discussion and synthesis of the pertinent data about the patient such as chief complaint, presentation, past medical history, current labs values, medications, tests to be ordered, treatments to begin, etc.  They are writing down the data, hypotheses, learning issues as they become available.
  • Before every student in the room brought a computer to class — which sounds like the olden days but it was less than 6 years ago — the Scribe may or may not have been the one creating hand-drawn concept maps of that week’s PBL work.  Nowadays, concept maps are created not by drawing on the whiteboard but by using CMap, a free software program from IHMC (Institute for Human and Machine Cognition).  This brings on a new role in the group: Concept Mapper.
  • The Facilitators mostly listen, occasionally asking clinically-oriented questions or providing a bit of background or narrative about a patient, a procedure or a disease without being “teacherly”.
  • Each week, one person bakes and brings in goodies for 9 people.  That is an important function, too.

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On a basic science or biomolecular level, concept maps can get pretty complicated.

Recently I wrote down some of the medical terms, processes or conclusions which were heard during PBL, and made a Wordle map out of them.   Here is what it looks like:

WordleNPC1

Image credit: http://www.wordle.net – All rights reserved – Copyright 2009

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This week I learned more about the function of Purkinje fibers (oh my duh – I’d never make it through medical school!).

Here are two other Wordles.

This one is based on words found on the EBM and Clinical Support Librarians@UCHC blog:

WordleEBMBlog

Image credit: http://www.wordle.net – All rights reserved – Copyright 2009

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The last one is formed from words taken from my Delicious account called Onc2009, a set of bookmarks about cancer, that was created for Mechanisms of Disease-Oncology:

WordleOnc2009

Image credit: http://www.wordle.net – All rights reserved – Copyright 2009

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Wordle, an elegant piece of software, was created by Jonathan Feinberg.

The Friday Post #38: Strange Posts, Sleepy Chickens and Strange Sports

This is the Friday Post #38 for October 2 2009.

Strange?  Define Strange.

As a blog-administrator I get to filter all comments to the page before they are displayed publically.  The majority of the spam is deleted by myself or caught by Askimet, the utility in WordPress that takes care of that function.

On Tuesday, Sept 29 there was a link in my Comments section referring to a post I’d written earlier this week about LigerCat, a new PubMed search tool.  The in-coming link looked like this (screenshot shown below):

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StrangePost#3

Image credit: http://www.wordpress.com – All rights reserved – Copyright 2009

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Intrigued, I clicked on the address of the referring page and below is a screenshot of their synopsis of what I wrote:


StrangePost

PubMed Poke Apparatus grown in 2009?  Heaven help us all

Image credit: http://tiny.cc/I78dS – All rights reserved – Copyright 2009

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Cartoonist Doug Savage writes a blog called Savage Chickens and invented the term “sleepworking” with this post from Aug 28 2008:

SleepworkingSavageChickens

Photo credit: http://www.savagechickens.com/2008/08 – All rights reserved – Copyright 2009

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These videos come with a couple of caveats: Don’t try this at home. Some activities could result in serious bodily injury. Never jump off a roof, no matter what your friends say to you.  In questionable taste.

Getting hit in the eye by a pair of flying sunglasses would be no laughing matter.  These videos should remind us that there is, and will always be, a need for a new generation of Emergency Medicine physicians due in part to the poor coordination (or questionable judgment) of young people when it comes to acting like daredevils on (or with) sports equipment.

However, the young men in question have obviously practiced their sports often, are well-trained in them, and (admit it) it is creepily fascinating to observe their accuracy.

.First:  Sunglasses Catching

Video credit: http://www.youtube.com/watch?v=-prfAENSh2k All rights reserved – Copyright 2009

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Second:  Pants Jumping

Video credit: http://www.youtube.com/watch?v=pShf2VuAu_Q All rights reserved – Copyright 2009

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Last:  Laptop Catching is so out of the scope of this blog, I’m not even going to post the URL for it.  You can find it on your own.

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And that’s the Friday Post #38 for Oct 2 2009, folks.  Have a restful, enjoyable weekend!