It’s that time of year again. Maybe you’ve already heard of the “July Effect”? Here’s a post making the rounds again today illustrating the depths of sarcasm and irony with which this meme is sometimes considered in healthcare.
But this is an idea that goes back for years. The gist of the idea is that it’s dangerous to go to the doctor in July because the new interns start then.
Here are a few pieces presenting that perspective.
This idea has been around for decades, at least since the 1980s.
Dedra Buchwald, MD; Anthony L. Komaroff, MD; E. Francis Cook, ScD; Arnold M. Epstein, MD, MA. Indirect Costs for Medical Education: Is There a July Phenomenon? Arch Intern Med. 1989;149(4):765-768. doi:10.1001/archinte.1989.00390040007001. http://www.ncbi.nlm.nih.gov/pubmed/2495778
Of course, it’s not as simple as the popular press would like to make it sound, and there is far more research presenting the opposing (but less well known) view, or that it is a small effect and one which impacts only certain patients in specific circumstances. Basically, the idea is that The “July effect” is mostly not true, and has been well debunked.
“For the subset of patients with internal medicine diagnoses, the expected “July Phenomenon” was observed, with significant relative declines in diagnostic and pharmaceutical charges in teaching hospitals over the academic year. In contrast, surgery patients showed an increase in length of stay and various charges over the academic year in teaching hospitals. There were no meaningful effects of housestaff experience on mortality, operative complications, or nursing home discharge. These results indicate that housestaff training is significantly related to the use of hospital resources for inpatients, but that the degree and direction of the effects differ by specialty.” (Rich et al, 1993)
“Although this study finds no support for a “July Phenomenon” in terms of quality of clinical care, house officers were found to be more likely to have poor documentation practices earlier in the academic year.” (Shulkin, 1995)
“There was no evidence of an increase in negative outcomes early in the academic year compared with the end of the academic year. We believe that a systematic approach to the diagnosis, resuscitation, and treatment of trauma prevented a July phenomenon.” (Claridge et al, 2001)
“Although small differences in outcome exist with respect to the academic time of the year, the timing of these differences indicates that there is not a “July phenomenon” in obstetrics at our institution.” (Myles, 2003)
“We find that the annual house-staff turnover results in increased resource utilization (i.e., higher risk-adjusted length of hospital stay) for both minor and major teaching hospitals and decreased quality (i.e., higher risk-adjusted mortality rates) for major teaching hospitals. Further, these effects with respect to mortality are not monotonically increasing in a hospital’s reliance on residents for the provision of care. In fact, the most-intensive teaching hospitals manage to avoid significant effects on mortality following this turnover.” (Huckman & Barro, 2005)
“The data suggest a “July effect” on some outcomes related to shunt surgery, but the effect was small. Nonetheless, the potential morbidity of shunt failure, infection, and the cost of treatment indicate that continued vigilance and appropriate supervision of new staff by attending surgeons is warranted.” (Kestle et al, 2006)
“Conclusions: High-risk acute myocardial infarction patients experience similar mortality in teaching- and non-teaching-intensive hospitals in July, but lower mortality in teaching-intensive hospitals in May. Low-risk patients experience no such July effect in teaching-intensive hospitals.” (Jena et al, 2013)
“Particularly in major teaching hospitals, we find evidence of a gradual trend of decreasing performance that begins several months before the actual cohort turnover and may result from a transition of responsibilities at major teaching hospitals in anticipation of the cohort turnover.” (Huckman et al, 2014)
“Data from a single institution study did not show a “July Phenomenon” in the number of operating minutes, overutilized minutes, or the number of ORs working late in July.” (Sanford et al, 2016)
“These data, in combination with the findings of Shah et al,1 suggest that the July phenomenon can largely be debunked in the modern era of surgical education.” (Thiels et al, 2016)
Why is it safe? Because the new docs are well trained, and have experience in a variety of situations. This all made me very interested in the annual event on Twitter in which experienced docs share tips with new docs just starting out. The biggest and best hashtag is #TipsForNewDocs, but others included #DearIntern, #DearResident, and #DearPatient.
I’ve collected a bunch of these awesome tips for all those new docs that started today, and you can find them here.
This morning I took pictures of UM Diag, where a PRIDE Flag has been chalked in support of the survivors of the Orlando massacre. The candles had burned to the ground, and melted away, leaving wax in the cracks between the bricks.
Last night I was one of a some hundreds of people at the Candlelight Vigil for Peace sponsored by the /aut/ Bar, also in support of Orlando.
Yesterday afternoon, I sang with the Out Loud Chorus at Motor City Pride in Detroit.
A week before that, I was riding the train home, curled up in a seat by the baggage, away from the other passengers, with tears streaming down my face, grieving for the loss of a dear-to-me friend who was a transgender woman.
Two days before that, I’d walked 22,464 steps, because I couldn’t find a cab to get me to the memorial of Robin, one of my BFFs (best friends forever), married-with-children, who had died of cervical cancer.
Two weeks before that, the breast cancer community, the healthcare social media community, the WORLD lost Jody Schroger, who I also considered a friend, even though we never met in person, because of the sweetness and richness of our six years of conversations on Twitter. Jody was a breast cancer survivor and advocate, until she wasn’t anymore.
These things are all connected, and not just through my recent life or experience. They have in common issues of community, loss, love, health, and more. They have in common issues of how to feel safe, how to be safe, how to be heard.
Jody was a hugely influential breast cancer advocate, one of the founders of the famous and successful #BCSM Twitter chat. Jody started out fighting for herself, but that just wasn’t the kind of person she was, so after her diagnosis, she basically spent the rest of her life fighting for everyone else. Yes, especially for breast cancer patients, but it wasn’t long before that became a very gracious and determined effort to encourage equality, access, information, and empowerment for ALL patients.
Robin had cervical cancer, one of the cancers for which healthcare has done a pretty good job of prevention, or at least really reduced the incidence. Here’s a line from the American Cancer Society about this: “Most invasive cervical cancers are found in women who have not had regular screening.” Now, right up front, I want to say that I don’t really know anything about Robin’s own personal medical history with this, and I wouldn’t share it if I did. What I can share is that sense of hurt and betrayal that comes with the death of a loved one that is perceived as preventable, except for … fill in the blank. While I know that Robin and her family were incredible people, joyful, kind, funny, and generous to a fault, there were times when they had to make tough choices about financial stuff. I’ve had to do the same, but I’ve always had the failsafe of employer health insurance. Not everyone does. I imagine that because there were times when one or another of them worked multiple part-time jobs without insurance, or were self-employed, that perhaps there were a few times when routine screenings for perfectly health people seemed unnecessary. But, as things turn out, the screenings were needed. Is this something that happened because we didn’t yet have Obamacare? Because the insurance people have doesn’t cover what they really need? Is it a question of access or information or health literacy or trust in the healthcare system? I don’t know. But I know that ALL of those issues play a part in the pain and suffering and losses experienced around us every day. And whatever we’re doing to fix them is too little too late for Robin, and I will miss her for the rest of my life.
I’ll tell you that while coming home from one memorial is a rough raw time to get the news about another friend’s death. When I got the news, I was no expert, but knew enough about the context of trans* lives to know what you ask when a transgender person dies unexpectedly: suicide or murder? Those are the two questions that leap into your mind, and which you try not to ask. When I hear about a sudden loss of other friends, I’ll ask was it an accident or cancer or some other illness. But not for trans* friends. As friends talked with me about my grief, I was surprised how many had no idea about this.
“A staggering 41% of respondents reported attempting suicide compared to 1.6% of the general population,ii with rates rising for those who lost a job due to bias (55%), were harassed/bullied in school (51%), had low household income, or were the victim of physical assault (61%) or sexual assault (64%).” http://endtransdiscrimination.org/PDFs/NTDS_Exec_Summary.pdf
“The Trans Murder Monitoring (TMM) project systematically monitors, collects and analyses reports of homicides of trans people worldwide. … The name lists present the names and some details about the deaths of the otherwise anonymously reported trans murder victims. These lists are specially compiled for the annual International Transgender Day of Remembrance. The tables present statistics on the world region, country, date of death, location and cause of death, and the age and profession of the victims. The maps illustrate the worldwide scale of the reports of murdered trans persons.” http://tgeu.org/tmm/
If you are one of the good hearted people who is surprised by this, you are probably asking, “Why?” Basically, it comes down to fear as one of the primary motivators of hatred. I could go on a long time, but you are smart folk. Just look in Google for “transphobia” and you will find plenty. For the heartbreak of suicide, I’m a big fan of the Social Media for Suicide Prevention (#SPSM) group who meet on Twitter at 9pm Eastern Time on Sunday evenings. I don’t know of a similar regular chat for transgender life, but there are a lot of Twitter hashtags that might be relevant. Here are just a few: #Transgender / #Trans / #Transpeak / #StopTransMurders / #TwoSpirit. The lesson I take away from these awful statistics, and from the death of my friend, is that love doesn’t always win, at least not at the level of individuals, but that we can keep working toward a world in which love does win. You know, my trans friend who died last week? The events in Orlando would have infuriated her so much. We had a memorial for her tonight, and someone said it was almost like she was one of the victims of Orlando, what with the two coming so close together.
At Motor City Pride, I was singing with Out Loud Chorus, which is one of the choirs I sing in. Why do we sing in choirs? For a lot of reasons, but right up there at the top is for friendship, community, creativity, and challenge. (There are a lot of health benefits, too, by the way. 1 | 2 | 3 | 4) Why do LGBT communities have PRIDE events like Motor City Pride? Some of the same reasons (community, friendship, creativity), and some different (it’s a safe space is probably one of the top). “Safe space” is a concept that has been mentioned an awful lot since the Orlando Massacre. Where I’ve seen it, it’s been mentioned as part of a larger explanation of why and how LGBT folk are not and do not feel safe or included as members of our broader culture.
I remember vividly the first time I felt attracted to another woman. It was in high school. She was an upperclassman — lean, olive-skinned, wearing shorts and a man’s sleeveless undershirt. I felt like someone had zapped me with electricity, skin prickling, mouth hot and dry. And I had absolutely no idea what had just happened, because nothing like this had ever happened to me before. I eventually figured it out, years later. In the meantime, yes, I’d been dating guys, been married and divorced, had a kid. By the time I was divorced, a safe space was the number one thing I wanted most in the world. After I had a kid, I wanted the safest place possible for BOTH of us. Attraction to women was something I felt sometimes, but not very often, and frankly, it wasn’t something I sought out or looked for, and never acted on. A big part of “never acted on” was feeling distinctly unsafe. I’d heard the stories, knew about the things that happened to people who were gay. Some of them were pretty horrible stories. Of course, the decision wasn’t as simple (or as reasoned or conscious or aware), as I’m making it sound here.
When I joined Out Loud Chorus (OLC), decades later, I was firmly wearing my rainbow ALLY button. Quite a number of people in the choir are LGBT allies, so I didn’t feel strange about that. I recently sang in my first concert with OLC, selections from which were what we sang for the crowd at Motor City Pride. The title of the concert was “Destination: Me.” It was about transitions in our lives, how we change, how we choose to change (or not). Parts of it were about transitions experienced by the transgendered. As we prepared for the concert, what I kept noticing over and over was how incredible the people are in the choir. The bravery they take into their everyday lives, almost as if they don’t even think about it, it just IS. The determination and laughter. The unquestioning honesty and acceptance of people the way they are. There was a man at the concert in May who stopped the choir in the hall while we were lining up, and said a bunch of hurtful, almost vaguely threatening things to the “queer choir” as we lined up to go perform. I was taken aback. I’m accustomed to being the ally on the side who intervenes when things like this happen. It’s different when you stand there as one of the people with the invisible target on your chest. There is a very distinct “straight” privilege that belongs right there beside white privilege.
I stopped wearing my rainbow ALLY button recently. Today, I started giving away the rainbow ally buttons I have, because, for me, right now, it feels like a lie, and one that, after Orlando, I can’t bear to live with.
At the Candlelight Vigil for Peace, one of the phrases that was repeated over and over by speaker after speaker was, “knows what it’s like to be afraid to hold hands in public.” You know, there are health benefits to holding hands, too, of course. Rumor has it that this is maximized when holding hands with a romantic partner. Think about that for a moment. Holding hands makes people feel healthier and happier. But if you are gay, you are probably afraid to, or have been. It was strange for me to listen to this over and over. I’ve held hands with people. Usually, just people who are friends. There was one romantic partner with whom I enjoyed holding hands. I’ve held hands strategically when a man was threatening me or endangering me, and it calmed him to hold hands. I’ve held hands with people when my hands were hot and theirs were cold (or the reverse). I’ve held hands with my kids probably more than any other human beings. But I have never held hands with a woman who had romantic potential for me. And even so, I knew what they were talking about, about being afraid to hold hands, about being afraid to even want to hold hands.
My favorite speaker of the night was Amanda Edmonds, the Ypsilanti mayor, who spoke of putting her wife on a plane to Orlando just a few hours after the shootings. Of worrying. Of crying, and not being able to stop. Of not being able to help the way she longed to help. And of finding different ways to help, but starting here, with the people and places where we already are. There were other great speakers, so many of them. It was so special when Jim Toy said we need to remember not only the victims of Orlando, but all the victims, and to stand in solidarity with not only the gay communities, but other marginalized communities who suffer from isolation and exclusion, and when he explicitly stated the need for us to befriend the Muslim community, the crowd practically roared with support and applause.
There was music. This little light of mine, which is probably sung at many candlelight vigils. We shall overcome. The small choir sang a thoughtful piece, with this wonderful phrase: “There is no map for where we go. There is no map for where we go. We’re not lost, we’re here.”
Some folk have focused on the why of the Orlando massacre pretty heavily. Was it ISIS? Was it homophobia? Was it self-hatred? Was it planned? Was it mental illness? I’m not sure if it really matters at this point. Or perhaps there is value in both sides, working from a multiplicity of perspectives toward a variety of solutions? Personally, I think there is significant value in taking a nuanced or multifaceted view, in considering aspects of all of the proposed causes. I’m not sure that it really matters to find a single cause to blame for this. The potential causes proposed are all reasonable considerations, they are all ongoing problems. We should be working to correct and improve all of them, as potential causes of future incidents, at the same time that we work to improve safety and provide healing for the families and communities involved in this and other tragedy.
You see, what happened in Orlando is terrible, but it isn’t just about Orlando. There’s a post going viral on Facebook about all the places you can’t go or can’t be unless you are willing to be murdered. It starts with your home and your office. There are similar posts about getting raped. And if there isn’t one, there should be one about who you aren’t allowed to be if you want to be safe in America, with LGBT, Muslim, disabled right at the top of the list, complete with “a different color” and “from a different place,” ending with just plain “different.” You want to be safe? Find a hole and crawl in, and never come out. You want to be safe? Don’t be different, don’t get sick, don’t get injured, don’t be born to the ‘wrong’ parents or have the ‘wrong’ friends or family. Don’t love, because that’s dangerous.
After 9/11, the local Buddhist temple painted an MLK quote on their walls that resonates with me today: “Hate cannot drive out hate: only love can do that.” The messages written around the chalked flag on the UM Diag today focused largely on similar messages, of love, and its power to heal. There was one in particular that seemed to describe an ideal vision for all the underserved, excluded, wounded, isolated, underprivileged people; be they gay or straight or genderfluid; be they patients or survivors or family or providers. The gist of it was that when all our children love themselves, this won’t happen anymore. For our children to love themselves, we first have to love them, and love each other, and set a good example for how to love. You know what? That may be the hardest thing any of us ever do.
This is a pretty interesting happening, and particularly interesting in the context of the maker movement, #DIYability, #InventHealth, #MakerNurse, and #MakeHealth. These are all concepts or movements driving the improvement of health and healthcare through engagement with the general public. This is where a lot of patients and the general public use creativity, insight, experience, and often various technologies such as 3D printing in order to craft custom solutions to interesting health challenges.
So, will the FDA guidance impact on people trying to make stuff at home, at work, in the hospital? Possibly. Actually, according to the strict interpretation of the current definitions, it sounds pretty likely. (Please, note, I am not a lawyer!) Here is one section on that aspect.
“Point-of-care device manufacturing may raise additional technical considerations. The recommendations in this guidance should supplement any device-specific recommendations outlined in existing guidance documents or applicable FDA-recognized consensus standards.”
So, this is talking about point-of-care, which would include pretty much all the maker communities I was mentioning above, but it’s really really vague. I’m not the only person who thinks so.
“Although the draft guidance is a start, there are still many unresolved regulatory issues that need to be addressed, especially as the technology continues to evolve and more innovative products are brought to market. One still-pressing, unanswered regulatory issue associated with 3D printing is how the FDA intends to approach non-traditional device manufacturers. As background, under the existing FDA regulatory framework, a manufacturer is defined broadly to include “any person who designs, manufactures, fabricates, assembles, or processes a finished device.” As 3D printers become increasingly accessible, a person (or entity) with a 3D printer does not need the financial capital, infrastructure, or resources historically associated with traditional manufacturing operations. While the draft guidance acknowledges point-of-care manufacturing, it does not provide much discussion on non-traditional entities, such as healthcare providers and suppliers becoming “manufacturers” of medical devices. … We also do not know how the FDA intends to resolve the legal and regulatory issues associated with point-of-care manufacturing.”
Matt Jackson, Kevin Madagan. FDA’S 3D Printing Draft Guidance Leaves Much Unresolved, Even More Unknown http://www.meddeviceonline.com/doc/fda-s-d-printing-draft-guidance-leaves-much-unresolved-even-more-unknown-0001
The next thing they mention, in the same paragraph, is biofabrication (which technically is less about making devices and more about 3d printing with biological “ink,” living cells, biomaterials, and such).
“In addition, this guidance does not address the use or incorporation of biological, cellular, or tissue-based products in AM. Biological, cellular or tissue-based products manufactured using AM technology may necessitate additional regulatory and manufacturing process considerations and/or different regulatory pathways. Therefore, all AM questions pertaining to products containing biologics, cells or tissues should be directed to the Center for Biologics Evaluation and Research (CBER).”
I’m actually relieved that they are leaving biofabrication alone for now, but it is not going to go away forever (nor should it). For people working at the intersectional spaces of 3D printing, where it combines with biologics, electronics, programmables, smart materials, and other materials with interactive potential, there is a possibility that content from this guidance may interact in unexpected ways with the other side of the work they are trying to do.
Here’s the good news.
“This draft guidance is a leap-frog guidance; leap frog guidances are intended to serve as a mechanism by which the Agency can share initial thoughts regarding emerging technologies that are likely to be of public health importance early in product development. This leap-frog guidance represents the Agency’s initial thinking, and our recommendations may change as more information becomes available.”
AND
“FDA’s guidance documents, including this guidance, do not establish legally enforceable responsibilities. Instead, guidances describe the Agency’s current thinking on a topic and should be viewed only as recommendations, unless specific regulatory or statutory requirements are cited. The use of the word should in Agency guidance means that something is suggested or recommended, but not required.”
So, don’t worry TOO MUCH just yet, but do please read this, consider how it might impact on work happening in your community, and consider replying to the draft guidance or filing comments. You may submit comments on the Technical Considerations for Additive Manufactured Devices Draft Guidance until August 8, 2016.
Wow, wow, wow! What an AMAZING day! I’m at the Medical Library Association Annual Meeting, and trying to get to as many of the systematic review events as I can. Today is the first full day of the conference, and it was a jackpot — PRISMA for searches, a session on EBM/EBHC training, and a session on systematic review services. Lots of posters, too, but I haven’t had a chance to go look at those yet.
I tweeted a screenshot of the special session on systematic reviews this afternoon.
I saw an event in the program, something about PRISMA standards, so I thought I’d poke my head in. When I poked my head back out later, I could not stop talking about it. The gist of it is that PRISMA, whom most medical librarians and journal editors know of as providing standards and guidelines for how systematic review data should be reported, are branching out. Me, I’ve been watching with excitement the various PRISMA extensions that have been being added recently. Thsee include standards for reporting protocols, meta-analyses, patient data, abstracts, and more. Well, it turns out there is a pretty substantial team working on developing PRISMA guidelines for reporting search strategies. This is pretty exciting for me! And somehow, I had missed it until today. The group today was opening the results from the original team to a broader audience and asking for reactions. They had come up with 123 guidelines, which they narrowed down to 53, and then we broke into four subgroups (search strategy, grey literature, documenting results, database characteristics) brainstorming about how to narrow down even further, into truly actionable points. I tell you, this is a group to watch.
Some of my favorite lines:
“I did this review according to PRISMA standards.” “You can’t. PRISMA is a ‘reporting’ standard, not a ‘doing.'” (Margaret Foster)
“The faculty are asking individual students to do something that is essentially a team sport.” (Ana Patricia Ayala)
“Cochrane says, ‘You will not limit by language.’ PRISMA says, ‘You will report any limits.'” (Margaret Sampson)
Here is just one of the flip boards from the conversation to whet the appetite of the systematic review methods nerds.
SYSTEMATIC REVIEW SERVICES
Later in the day, there was a complete session devoted to systematic review services in medical libraries. Yes, this is the same one from the tweet earlier in this post. I was dashing in late from the poster session, so I missed the beginning of the presentation on training needs by Catherine Boden and Hellsten. I was disappointed, because they were citing many wonderful articles I wanted to look into later. I’m sure glad the slides are in the online MLA system, because I’ll have to go find them! Being late also means I didn’t get any photos from their talk. The most provocative concept I pulled from their talk was the idea that systematic reviews are actually “a constellation of related methods rather than a single methodology.” So elegantly put, and so true. It’s a helpful way to reframe how we think about what we do, and is supported by the same drive that is motivating the various PRISMA extensions mentioned above.
Sarah Vistinini presented for her team on scoping reviews, their similarities to and differences from systematic reviews, and the value of being included in the ENTIRE process (which she cleverly described as giving a “better appreciation of all the moving parts.”). Sarah showed some very cool evidence mapping (see pic above), dot prioritization, and more. There were glowing recommendations of the 2005 Arksey and O’Malley article on scoping review methodologies and a wonderful link to all the references: bit.ly/visin-2016.
Kate Krause presented for a team primarily from the Texas Medical Center Library about their efforts to launch a new systematic review service, and the resulting “opportunities” (wink, wink, nudge, nudge, we all know what THAT means). The moderator described their presentation as a “collective therapy session,” which generated considerable amusement among the audience. The most important parts of her talk were, of course, the solutions! They require systematic review requests to come through an online request form, which gives them solid statistics and allows them to manage workflow better. They are using a memorandum of understanding (MOU) with faculty to facilitate a discussion of the duties, timeline, and expectations. They are providing different levels of service, with some interesting requirements for the highest level of service (like, if I understood correctly, mandatory five face-to-face meetings with the project lead). One curious nugget for which they are seeking the citation was heard at a prior MLA meeting — the more face-to-face meetings you have with a systematic review researcher, the more likely they are to actually publish on the project. They have a wonderful-sounding information packet given to new SR researchers, but I didn’t catch everything in it. I did catch bits (Cochrane timeline? list of other review types?) that make me want to know more!
Lynn Kysh and Robert E. Johnson presented a talk with the awesome title: “Blinded Ambition, misperceptions & misconceptions of systematic reviews.” They discussed some of the challenges to co-authorship and publication being assumed as an automatic good for librarians working on systematic review teams. Lynn described constraints to completing publication, and described times when librarians there removed their name from articles being submitted for publication because of methodological concerns. Very very interesting content. Well, and then there were the forest plot kittenz.
Last but not least, Maylene Kefeng Qiu represented a team that did the bulk of the work for a rapid review in … three weeks. Intense! Much of the challenge centered around timing, expertise available, staffing, workflow, and management coordination. The librarians on this team actually did the critical appraisal of the articles before giving the final dataset to the faculty member writing the review. My favorite line from her talk was, “Stick to your inclusion/exclusion criteria.” Their slide deck had so many wonderful images illustrating parallels and differences between systematic reviews and rapid reviews. I hope it’s ok if I share just one.
Basically, libraries and museums all around the world are making coloring pages and books from public domain content in their collections. Pretty awesome stuff! Some of the images are beautiful, some horrifying, some fascinating. Many fit right in with the sort of things people are already seeking out as part of the Adult Coloring movement, which I’ve been working on in other areas of my job. And some are funny or quirky and amusing.
Most of the image providers also give a citation to the original work in their collection catalog. Many of the images raise all sorts of questions. Why did they choose THAT image? Why was that image famous in the first place? Who was the original audience of the image? What was the creator trying to communicate? There are so many stories that the images hint at, leaving a faint clue to lead the curious deeper into a story forgotten by most.
I don’t know if the University of Michigan is participating in #ColorOurCollections officially or not (and this is NOT an officially sanctioned offering from them), but I have in my own files images I’ve collected from some of the wondrous items available in our campus rare and special collections. I’e selected just a few of my favorites that inspire in me the kinds of questions and whisper of stories that I’m observing in so many of the other images being shared. Most of these are selected from an anatomy exhibit curated here some years ago by Barbara Shipman. I’m afraid I’m not certain of which book which image came from, so I will have to check with Barbara. For now, I am hazarding a fair guess for those I’m unsure of and noting that uncertainty.
COMMENTS: I fell in love with the romance and beauty of this book the first time I saw it. The books is exquisitely crafted, beautifully illustrated, and filled with the philosophical and thoughtful poems of Tennyson’s exploration of the King Arthur mythos. He tells the story through the tales of four women who are relatively minor characters in most of the tellings of the myth, and most of whom die tragically in Tennyson’s retelling. I’m assuming that some enterprising graduate student has already studied the gender bias implications of the stories. The images are so lovely it is worth exploring the entire book, and luckily for you, it is available as a free public domain download from the Hathi Trust for those at partner institutions like UofM. This particular image illustrates the scene where the Lady of the Lake has stolen the infant Lancelot away from his birth mother to raise as her own. Why would she do that? How did it effect him? Does that original betrayal set the stage for later events in the story. I thought the Lady of the Lake was bound to the lake by magic. So how and why is she floating and flying above it in this image? So many questions.
COMMENTS: Vesalius is very likely the most famous name in the history of anatomy, kind of the Shakespeare of medicine with early rare editions of his work that scholars attempt to reconcile and interpret. This image is a macro excerpted from a large image of a crowd witnessing a dissection in a crowded theater. I look at this image of people in a low balcony looking down upon the dissection. A student tries to connect what he sees with what is in the book. Others debate and contest and try to reconcile what they believe, what they’ve learned, and what they see. One silent man stands in the middle of all the bustle and somehow completely apart from all of it. He looks deeply sad or troubled. Is he a friend or relative of the person being dissected? Is he a competitor of the experts doing the demonstration? Who is he, and why does he seem both obscured and highlighted within the story the image is telling?
COMMENTS: This is a portion of a full skeleton by Shonbornio and dating from around 1590 (according to Barbara’s notes here). This is supposed to be a lesser quality imitation of one of Vesalius’ drawings. It still calls to me emotionally. The skeleton is frail and powerful at the same time, angry or miserable or tired, turning his back to us. We can say this is because the image was for students to study the bones of the back, but did the artist imbue those bones with some richer emotions for a purpose?
COMMENTS: I’ve been looking at this image all day. Each time, I see Adam and Eve at the tree, and then only afterwards realize that the tree is a skeleton. Even when I know that this is the case, I still see it the other way. When I look at the skeleton, I find it’s posture odd and disconcerting. Its legs are twisted and its hips cocked in an almost flirtatious way, but the torso is twisted and the head turned toward Eve, as if it is speaking to her. The image is simultaneously charming and disturbing.
COMMENTS: This is only ONE image from a seven volume set of beautiful, intricate, hand-watercolored paintings illustrating herbal medicine in France. The images are lush and richly colored, which is why it is neither fast nor easy to convert them to a coloring page. I tried several, and this was the only one that actually still worked after I fiddled with it digitally. These two images are both from the same plate, of “Carline,” which we know as Carlina acaulis, a mountain herb that is edible and antibiotic and which tells the weather forecast! It grows low to the ground in poor soil in the mountains and is a relative of the thistle.
COMMENTS: It was common previously to not leave a large portion of a page blank, but to fill in the blank space with something, either content or ornament. I don’t remember where either of these ornaments came from, which is easy to have happen when they have little to nothing to do with the content of the books! These were both from the Anatomy Exhibit, and I included them here simply because I thought they’d be fun to color.
Trattato geometrico di Pietro Antonio Cataldi … Doue si essamina il modo di formare il pentagono sopra ad vna linea retta, descritto da Alberto Durero. Et si mostra come si formino molte figure equilatere, & equiangole sopra ad vna proposta linea retta. http://mirlyn.lib.umich.edu/Record/000167243 (I’m not sure, I think it was from this book: https://www.flickr.com/photos/rosefirerising/2909081613)
COMMENTS: This was a special request, from another emerging technologies librarian on Twitter who is fascinated by the inclusion of mythological beasts in historical medical books. This image shows a strong leg stomping down a snake which is being tortured with nails hammered through its mouth and head area. I suspect that this is referencing the Catholic Church’s belief in “crushing the snake”. That suspicion is reinforced by the appearance of the phoenix in the right corner, which was in the Middle Ages a fairly common symbol of the resurrection of Christ.
The Shapiro Design Lab and THL collaborated on a hands on Design Your Own Coloring Book workshop last week. A repeat has been scheduled for February 11th, again in the Design Lab, and another version of the workshop will be included in the Teach Tech eMerge workshop series, Thursday, February 25 in North Quad. I had previously done this for the Cool Toys Conversations group, but I didn’t have slides for them.
The slides from last week’s workshop include a) an overview of the science behind the health claims for the adult coloring movement, educational examples and uses of coloring, and tools to create your own design; and b) image search examples and tips presented in the form of an alphabet coloring book. These two slide decks are available here:
The early tweets were mostly supportive, creating awareness of what is genuinely an eloquent and educational article, especially for those outside the field. There were, however, hints of the later discord even among the earliest tweets. Later concerns arose more from informed readers on the inside of the professions working with CRISPR and aware of the personalities and politics behind the piece, and then snowballed.
March 6, 2014. Doudna Patent, Methods and compositions for rna-directed target dna modification and for rna-directed modulation of transcription (US 20140068797 A1). http://www.google.com/patents/US20140068797
November 9, 2015: The Crispr Quandary: A new gene-editing tool might create an ethical morass — or it might make revising nature seem natural. http://www.nytimes.com/2015/11/15/magazine/the-crispr-quandary.html?_r=0
January 16, 2016: A Brief History Of The Gene-Editing Tool That Is Changing Science, Scientists have now actually watched the DNA-editing tool in action http://www.vocativ.com/news/263157/crispr-cas9/
