Several supporters of Grand Rounds have contacted me about the Carnival study from Free Money Finance -- are there conclusions here that can help expose the writers and hosts of Grand Rounds to a larger audience?

In short, I don't think it has much bearing on our practice. Former GR hosts on the discussion board can learn why; I'm not interested in airing this publicly. In the meantime, I look forward to watching Carnival of the Colonoscopists and every other niche group try to manipulate Instapundit into greater traffic -- if that's not a zero-sum game, it's asymptotically approaching it.

But have no doubt: the writing in Grand Rounds is worthy of a wide audience. Go check out the latest edition, now up at Straightfromthedoc.com.

Next week's host is Healthy Concerns. It's worth noting that both these blogs feature a lot of advertising, and are, in fact, part of corporate ventures. I've been a part of another such enterprise for several months now.

Has sponsorship compromised these blogs, these writers? Is advertising something you're sad to see? Mull it over, because the path to boosting Grand Rounds traffic may lie in this direction.

Time and Place

I've been reading and writing about global positioning technology for a few years now, and still to partake in the occasional geocache hunt from time to time. But Wade Rousch has written something pretty insightful and novel on the subject:
Indeed, GPS is transforming geography in much the same way that mechanical clocks and watches regularized our once fluid experience of time. As soon as there were simple ways to measure time, we could organize our actions around specific moments; every school bell and factory whistle in the nation could sound at 8:30 A.M. The concept of synchrony set the stage for the 19th-century revolutions in industry and transportation.

Similarly, now that we can easily measure latitude and longitude, we can organize our actions around specific locations. Adventurers can navigate to the same remote spot at different times, as in geocaching; businesses, artists, or historians can share online information about any physical thing using its GPS-supplied coordinates rather than a Web-type Uniform Resource Locator (URL). Call it "synlocality."

The author thinks it's inevitable that cell phone companies turn on the GPS devices they've included in their phones. I think there will be some tentative steps in that direction, but there's potential for a huge backlash against location-tracking.

Maybe it's like broswer cookies: if the benefits outweigh the potential loss of privacy, and if people can opt-out if they want, then the technology will be adopted.


Circadiana is hosting the 47th Grand Rounds. Check out the latest from the medical blogosphere, and be sure to peruse this interesting sleep research blog.

Maybe somewhere in Bora's archives is the answer to why I'm awake right now.

Next week's host is Kevin Pho, M.D., coming to you straight from the doc. Email me if you're interested in hosting future editions of Grand Rounds.

Buried Treasures

Lileks was in rare form with today's Bleat -- disclosing the secret Amazon customer service number (800-201-7575), wandering around renovated malls, and musing about Shakespeare's role in Psalm 46:
Count 46 words from the start, and you get "Shake." Then count 46 words from the end. You get "Spear." The KJV was published in 1611; Shakespeare turned 46 in 1610.

Like that man a hundred years ago, who discovered the (potential) Easter egg in the King James Bible, the question is not so much "who put it there?" but -- "how was it ever discovered?" Then again, if you look at a typical science grad student's day, it's spent poring over data, looking for trends in excel spreadsheets.

I guess the difference now is we generate our own data, rather than analyzing and re-analyzing the masters.

I think about this sometimes when I'm quickly scanning through slices of a head CT, looking for gross blood. How many megabytes am I skimming through? How many head CTs will I order tonight? How many will be done in this ED, in this city, just tonight?

These are images of the seat of consciousness, and I spend about twenty seconds scanning for particular patches. When I don't see them, I close the window and move on. After the radiologist confirms, that data is consigned to the dustbin, maybe never to be viewed again.

I'm confident we (almost never) miss anything that could affect the patient's short-term health. But maybe we're missing something else.

Against the Tide

I remember riding the subway on Friday evening, heading to the first of three night shifts in the emergency department. I had slept poorly during the day, and didn't know what to expect from these first weekend overnights. Traumas? Procedures? Would I be able to handle the pressure?

I surveyed my fellow passengers. The subway seemed bouyant, full of laughter and the relief of people leaving the work week behind. I felt a pang knowing that, whatever happened these next few nights, I'd be missing the party.

But I was wrong -- the party, as it turned out, came to me.

Riding back on this morning, with my post-shift giddiness, I scanned the solemn Monday morning faces. Are they concerned about the same things I was? Could they possibly enjoy their jobs as much as I do mine?

A More Significant Diversion

My phone received a text message last night, from a friend who knew me back when:
"Olivier Dubois is the new Nick Genes!"
I didn't know what this cryptic phrase meant, until I picked up the Metro this morning and saw Dubois all over the front page, relating details from his airline adventure.

And as my texting friend noticed, there are some parallels in Dubois' account of a normal descent, no cautionary word from the cockpit, etc., and my tale from a few months back.

Except, you know, his plane crashed and caught fire, and he could have easily been killed, while my flight was just diverted for a few hours. Details.

Of all the passenger interviews, Dubois gives the best summary of what happened on Air France 358, and what it felt like, and wisely leaves the editorializing to passengers like Gwen Dunlop. So, kudos to him for keeping cool and remembering details after an unbelievably distressing experience.

But it remains to be seen, of course, where Dubois goes from here. A blog? Memoirs? Movie of the Week? Because his ceiling is sky-high, let me tell you.