Here is a video about opening pawn structure for the intermediate chess player.
Pawn Structure
Sunday, May 17, 2015
Friday, May 8, 2015
This Month in Anesthesia: May
James Young Simpson, M.D.
This Month in Anesthesia History: May
1734 May 23: Franz Anton Mesmer was born. "Under the protection of Marie Antoinette, this Viennese physician received a grant of 30,000 francs from Louis XVI to study the magnetic influence of the stars on human beings. His Memoire sur la decouverte du magnetisme animal[1779] described cures with magnets and hypnosis." [Accardo, The Medical Almanac] Mesmer died in March, 1815. In the years before ether's anesthetic properties were demonstrated by Morton in 1846, such British surgeons as James Esaile, John Elliotson and James Braid experimented extensively with "mesmerism" as a method of surgical pain relief and published various accounts of their successes.
Franz Anton Mesmer
1744 May 31: Inventor Richard Lovell Edgeworth was born in Bath , England . In his long career Edgeworth served as a member of Parliament and was a Fellow of the Royal Society. His friends included French philosopher Rousseau, engineer James Watt, and Dr. Erasmus Darwin, Charles' grandfather. Edgeworth was both a prolific author and inventor. One of his inventions was the "tellograph" for which 30 tall towers were built across the 130-mile distance between Galway and Dublin. Coded messages were to be transmitted in eight minutes using large triangular pointers; however, Ireland 's weather prevented the consistent visibility needed for success of the project. Edgeworth fathered 22 children by four wives. One of his daughters, Anna, married Dr. Thomas Beddoes, who along with Humphry Davy and numerous others investigated the properties of nitrous oxide inhalation in Bristol in 1799 and 1800. Another daughter, Maria, became a novelist of some note and was a frequent observer of the nitrous oxide experiments. Edgeworth was also a financial patron of Beddoes' Pneumatic Medical Institute where those experiments were conducted. Edgeworth died in 1817; his amazing life is detailed in D. Clarke’s biography, The Ingenious Mr. Edgeworth.
Richard Lovell Edgeworth in 1812
[1744-1817]
[1744-1817]
1794 May 8: Antoine Laurent Lavoisier [b.1743], a tax collection official, was beheaded in the early days of the French Revolution. Also a chemist, Lavoisier proposed "oxygen" as the name of the substance isolated by Joseph Priestley, who had called it "dephlogisticated air." Lavoisier is known as the father of modern chemistry because of his theories of combustion, his creation of a new system of chemical nomenclature and his authorship of what is considered the first modern chemistry textbook.
1819, May 31: Walt Whitman, one of America's greatest poets, was born in West Hills, New York. In 1855 Whitman self-published the first version of his collection Leaves of Grass; he would continue to expand and revise the work until his death in Camden, New Jersey, on March 26, 1892. Whitman's great work is, among other things, a portrait of the United States that includes such technological advances as photography, locomotives, steam-driven ferries--and the use of ether for surgical pain relief. During the Civil War Whitman served unofficially as a nurse in several hospitals in the Washington, D.C., area. His poem "A March in the Ranks, Hard-prest" twice mentions "the smell of ether" along with "the odor of blood" and "the doctor's shouted orders." A recent biography of Whitman is Walt Whitman: The Song of Himself by Jerome Loving [University of California Press, 1999].
1829 May 29: Sir Humphry Davy died; he was born in 1778. In addition to his pioneering work with nitrous oxide in Bristol in 1799 and 1800, Davy in 1815 invented a miner's safety lamp that saved many lives in British coal mines. Davy served as Professor of Chemistry at the Royal Institution in London from 1802-1812 during which he made numerous contributions to that science. In 1820 he was elected President of Britain's Royal Society, and at his death he was one of the world's most renowned scientists. His great contribution to anesthesia history is the massive book Research, Chemical and Philosophical, Chiefly Concerning Nitrous Oxide, published in the summer of 1800. Davy was the first human to inhale that gas.
1846 May 8: First major battle of the U.S. war with Mexico was fought at Palo Alto, Texas. Ether anesthesia was first used in a military conflict in this war, sometime in the spring of 1847 under the direction of American surgeons Edward H. Barton and John B. Porter. [See Aldrete JA, Marron GM, Wright AJ. The first administration of anesthesia in military surgery: on occasion of the Mexican-American War. Anesthesiology 61:585-
1848 May: The first annual meeting of the American Medical Association was held in Baltimore.
This meeting produced an extensive report by the Committee on Surgery: Anaesthetic agents. T
This meeting produced an extensive report by the Committee on Surgery: Anaesthetic agents. T
1859 May 22: Arthur Conan Doyle was born. His creation Sherlock Holmes first appeared in print in A Study in Scarlet on December 1, 1887. [See Maltby JR. Sherlock Holmes and anaesthesia. Can J Anaesth 35:58-62, 1988 and Bergman NA. Sherlock Holmes and his gasogene. Pharos 58(3): 35-37, summer 1995]
1862 May 6: Henry David Thoreau, American naturalist and author, died from bronchial and respiratory problems at age 44. Thoreau moved into his famous cabin on Walden Pond on July 4, 1845. Thoreau apparently had just one experience with anesthetics a few years later. In May 1851, Thoreau received ether when his dentist removed some teeth. On May 12, Thoreau described the event in his journal. "By taking the ether the other day I was convinced how far asunder a man could be separated from his senses," Thoreau began the lengthy journal entry. "You expand like a seed in the ground. You exist in your roots, like a tree in winter. If you have an inclination to travel, take the ether: you go beyond the farthest star." In the final paragraph of his description, Thoreau seems to undercut his own enthusiasm. "It is not necessary for them to take ether, who in their sane and waking hours are ever translated by thought..." His account is one of a number from the late nineteenth and early twentieth centuries that describe mystical experiences while undergoing anesthesia. Thoreau was born in Concord, Massachusetts, on July 12, 1817.
Daguerreotype by Maxham of Henry David Thoreau from 1856
1863 May 2: Confederate General Thomas Jonathan "Stonewall" Jackson was wounded by fire from his own troops at the battle of Chancellorsville. "Jackson's left arm was shattered 2 inches below the shoulder joint by a ball that also severed the brachial artery with a second ball passing through the same arm between the elbow and the wrist." Under enemy fire, his men lifted and dragged Jackson toward their lines. Finally placed on a litter, he fell off when one of the bearers was killed. Another bearer stumbled, dropping Jackson again. At last Jackson reached a field hospital, and he was placed under the care of Dr. Hunter Holmes McGuire, an innovative surgeon and expert on the use of chloroform. Early on the morning of Sunday, May 3, McGuire, aided by his anesthetist, a Dr. Coleman, amputated the left arm about two inches below the shoulder. Open drop chloroform was used. Jackson soon awoke, but by the following Thursday had taken a turn for the worse. Finally, on Sunday, May 10, Jackson died with his wife and child by his side. "Let us cross over the river, and rest under the shade of the trees" were his final words. [See Albin MS. The wounding, amputation and death of Thomas Jonathan "Stonewall" Jackson --some medical and historical insights. Bull Anesth History 19(4): 1, 4-7, 15-16, October 2001]
1870 May 6: Scottish physician James Young Simpson died. Simpson discovered the anesthetic properties of chloroform and introduced the agent into obstetrical practice. At the time of his death Simpson was one of the best known physicians in Europe; 80,000 people were said to have lined the streets of Edinburgh for his funeral procession.
1886 May 15: American poet Emily Dickinson died. One of her most famous poems includes: "Pain has an element of blank;/It cannot recollect/Where it began, or if there were/A day when it was not."
1899 May: Paterson described a face mask with an air dilution port.
1920 May: Arthur Guedel’s first paper “on the importance of the physiologic factors in inhalation anesthesia” [Keys, The History of Surgical Anesthesia, p. 77] appeared in the Bulletin of the National Anesthesia Research Society.
1922 May 19: Heinrich Irenaeus Quincke, German internist died in Frankfurt am Main [Quincke was born on August 26, 1842]. Among other notable medical achievements, in the early 1890s Quincke introduced lumbar puncture as a diagnostic and therapeutic tool.
Heinrich Irenaeus Quincke
1997 May 19: Francis F. Foldes, MD, died. Dr. Foldes was an expert on muscle relaxants, local anesthetic agents, and myasthenia gravis who published almost 600 papers and co-authored four books. In 1962 he became the first Chair of the Department of Anesthesiology at Montefiore Medical Center in the Bronx, New York, and served in that post until his retirement in 1975. Dr. Foldes was born June 13, 1910, in Hungary. An obituary published in the ASA Newsletter can be found in the July 1997 issue.
Francis F. Foldes, MD
[1910-1997]
[Source: Hungarian Society of Anaesthesiology and Intensive Therapyhttp://www.anesztinfo.
2000 May 25: The first National Anaesthesia Day was held in Great Britain under the auspices of the Royal College of Anaesthetists.
2004 May 2: John D. (Jack) Michenfelder, M.D. died at the age of 73. He completed his residency in 1961 at the Mayo Clinic and then joined the anesthesiology staff there. Dr. Michenfelder is known world-wide for his contributions to neuroanesthesia, especially for his work on cerebral blood flow and metabolism and their responses to anesthetic agents and hypothermia. He had also published important articles on venous and cerebral air embolism. He was the first President of the Society for Neurosurgical Anesthesia and helped to create the establishment of neuroanesthesia as a subspecialty of anesthesiology. Jack Michenfelder was honored by the ASA with the Award for Excellence in Research in 1990 and was the 1988 E. A. Rovenstine Memorial Lecturer. He was a member of the editorial boards of many journals dedicated to the neurosciences and from 1979-1985 was the Editor-in-Chief of Anesthesiology. As a signal honor, Dr. Michenfelder was one of only a handful of anesthesiologists ever elected to the Institute of Medicine of the National Academy of Sciences. --Maurice Albin, M.D. [UAB Anesthesiology Tuesday Report, May 18, 2004]
2006 May 8: Prominent European anesthesiologist Jan F. Crul died. Between 1950 and 1995 Dr. Crul authored more than 100 scientific papers in both English and Dutch. He edited three textbooks, Legal Aspects of Anaesthesia (1989), Mass Spectrometry in Anaesthesiology [with M.D. Vickers, 1981) and Patient Monitoring (with J.P. Payne, 1970). Dr. Crul was very active in the Netherlands Society of Anaesthesiology.
Saturday, May 2, 2015
Some information regarding my career in Anesthesia.
When I first started this blog, I was speaking mostly about my experiences in the field of anesthesia. Today I am going to go back to the type of information. Recently I have posted some clinically relevant information about the practice of anesthesia. These posts haven't been as popular as the older posts I have put up that talked about my personal experiences.
Today I will touch on my experiences since I have finished residency.
I finished my residency from Baystate Medical Center which is part of Tufts University and it is located in Springfield MA. It is a great program for learning. The first year of residency is called intern year or CA0 (clinical anesthesia year zero). I did required rotations in surgery, medicine, ICU, SICU, pediatrics and pain management. I would say that of all the rotations the SICU and the ICU rotations were the most enjoyable and the most brutal as far as time commitment. I would arrive by 5am and leave around 6pm if not on call. If on call I would arrive at 5am and not leave until 12pm or 3pm the next day. I know there are new time requirements for residents and interns, however, I personally believe that we as physicians are supposed to be the individuals who work their best under intense psychological and physical pressure. I for one enjoy the testing of my self. It is like a training ground for a navy seal. We are pushed to our limits and we either crack or excel. Luckily I excelled.
After intern year it is the first year of being an anesthesia resident (CA1 year). This is the year that I learned the fundamentals of anesthesia. Next is year two of residency (CA2 year) where I learned the skills of the more complex surgical cases. This is where the nuances and the fine tuning of the skills of the anesthesiologist come into shape. Year three (CA3) is the best. It is getting ready to be on my own. To perfect my skills in the areas of my interest. My interest lay in regional anesthesia, obstetrical anesthesia, and outpatient anesthesia. Regional anesthesia is multifaceted, and my interest was in regional blocks. I have become highly skilled in performing a number of nerve blocks using ultrasound guided techniques.
This skill has carried over into my career as an attending anesthesiologist. An attending is a fancy name for the boss or a doctor no longer in training. Some also refer to a practicing physician as a staff physician or a consultant. In other countries such as in Europe the terminology is slightly different. When I was about six months from completing residency, I began to interview for positions across the eastern United States. The position I settled on was at Cooley Dickinson in Northampton MA. The reason I prefered this position is because it was an independent contractor position plus I also would do my own cases without CRNA supervision. CRNAs are nurses that go for extra schooling after nursing school to learn how to administer anesthesia. I won't elaborate to much on this, unless I am requested to, as there are many facets to CRNAs and MDs and the politics and hierarchy involved, but lets just say that coming out of residency I wanted to practice on my own. In residency there is always an attending anesthesiologist that I had to answer to, that would critique my anesthesia plan and always be shadowing me to ensure that I followed the plan of the attending anesthesiologist. I wanted to do my own cases with supervising a nurse to learn the ins and outs of giving anesthesia that was entirely performed my me, solo. That decision, was a great decision. I have learned more about anesthesia and how I should practice and how I want others to practice that I will supervise than if I hadn't practiced on my own for a period of time.
Also when I first started to practice at Cooley Dickinson Hospital (CDH) I also was an independent contractor. This means I didn't belong to a bigger group and I had my own business to run. This was another excellent decision. Having the experience of being my own small business meant I had to learn how to start a business how to handle the finances of that business etc. If I could I would continue to be a 1099 S corporation. But that isn't how it has happened. The hospital thought that the anesthesiologists weren't a cohesive enough entity for the hospital to work with, so the hospital forced us to form a group. This is another great opportunity that I have been a part of. I had to dissolve my corporation set up a new corporation with a group of partners. I immediately became a partner in the new group and have advanced to Vice Chief and Administrative Director of this corporation. Not many anesthesiologists can say over a four year career that they have been a S Corp, dissolved that and started a group corporation, become a partner, practiced solo, and then practiced with a group of CRNAs. So far my career as anesthesiologist has been loaded with a lot of business and clinical practice experiences that I would never trade.
Once our I became a group with the other anesthesiologists in the hospital we had to make a lot of changes. We had to hire employees and a practice management group to help us oversee the running of the practice. This is quite a detailed story that I want to share to try to help other people understand the starting of a small business, or a corporation, and I will continue this at another time.
Today I will touch on my experiences since I have finished residency.
I finished my residency from Baystate Medical Center which is part of Tufts University and it is located in Springfield MA. It is a great program for learning. The first year of residency is called intern year or CA0 (clinical anesthesia year zero). I did required rotations in surgery, medicine, ICU, SICU, pediatrics and pain management. I would say that of all the rotations the SICU and the ICU rotations were the most enjoyable and the most brutal as far as time commitment. I would arrive by 5am and leave around 6pm if not on call. If on call I would arrive at 5am and not leave until 12pm or 3pm the next day. I know there are new time requirements for residents and interns, however, I personally believe that we as physicians are supposed to be the individuals who work their best under intense psychological and physical pressure. I for one enjoy the testing of my self. It is like a training ground for a navy seal. We are pushed to our limits and we either crack or excel. Luckily I excelled.
After intern year it is the first year of being an anesthesia resident (CA1 year). This is the year that I learned the fundamentals of anesthesia. Next is year two of residency (CA2 year) where I learned the skills of the more complex surgical cases. This is where the nuances and the fine tuning of the skills of the anesthesiologist come into shape. Year three (CA3) is the best. It is getting ready to be on my own. To perfect my skills in the areas of my interest. My interest lay in regional anesthesia, obstetrical anesthesia, and outpatient anesthesia. Regional anesthesia is multifaceted, and my interest was in regional blocks. I have become highly skilled in performing a number of nerve blocks using ultrasound guided techniques.
This skill has carried over into my career as an attending anesthesiologist. An attending is a fancy name for the boss or a doctor no longer in training. Some also refer to a practicing physician as a staff physician or a consultant. In other countries such as in Europe the terminology is slightly different. When I was about six months from completing residency, I began to interview for positions across the eastern United States. The position I settled on was at Cooley Dickinson in Northampton MA. The reason I prefered this position is because it was an independent contractor position plus I also would do my own cases without CRNA supervision. CRNAs are nurses that go for extra schooling after nursing school to learn how to administer anesthesia. I won't elaborate to much on this, unless I am requested to, as there are many facets to CRNAs and MDs and the politics and hierarchy involved, but lets just say that coming out of residency I wanted to practice on my own. In residency there is always an attending anesthesiologist that I had to answer to, that would critique my anesthesia plan and always be shadowing me to ensure that I followed the plan of the attending anesthesiologist. I wanted to do my own cases with supervising a nurse to learn the ins and outs of giving anesthesia that was entirely performed my me, solo. That decision, was a great decision. I have learned more about anesthesia and how I should practice and how I want others to practice that I will supervise than if I hadn't practiced on my own for a period of time.
Also when I first started to practice at Cooley Dickinson Hospital (CDH) I also was an independent contractor. This means I didn't belong to a bigger group and I had my own business to run. This was another excellent decision. Having the experience of being my own small business meant I had to learn how to start a business how to handle the finances of that business etc. If I could I would continue to be a 1099 S corporation. But that isn't how it has happened. The hospital thought that the anesthesiologists weren't a cohesive enough entity for the hospital to work with, so the hospital forced us to form a group. This is another great opportunity that I have been a part of. I had to dissolve my corporation set up a new corporation with a group of partners. I immediately became a partner in the new group and have advanced to Vice Chief and Administrative Director of this corporation. Not many anesthesiologists can say over a four year career that they have been a S Corp, dissolved that and started a group corporation, become a partner, practiced solo, and then practiced with a group of CRNAs. So far my career as anesthesiologist has been loaded with a lot of business and clinical practice experiences that I would never trade.
Once our I became a group with the other anesthesiologists in the hospital we had to make a lot of changes. We had to hire employees and a practice management group to help us oversee the running of the practice. This is quite a detailed story that I want to share to try to help other people understand the starting of a small business, or a corporation, and I will continue this at another time.
Albino Bird
I am going to start catching up on some things that have happened to me in the past. Last July 2014, I was able to photograph an albino bird that I had seen around the neighborhood. I am not sure what type of bird it is, although it may be a robin or bluejay that is an albino.
Tell me what you think:
The photos are a little blurry. The camera base that I have is very good it is a Nikon D7100, however the Nikor 50-300mm lens isn't as good. When I save up some more money I am going to upgrade my lenses, especially my telephoto lens.
I couldn't get too close as I was walking my buddy, who isn't exactly the epitome of stealth.
Now just two months ago I happened to see another albino type bird as I was entering my car. I have also seen the other albino bird once again. However, this albino looks to be a morning dove or a pigeon. Interesting. Took this photo while in my yard, it was perched on the roof top of my neighbors home. Again, sorry for the graininess but I still have not purchased an upgraded telephoto lens.
While I have been through the fields of the local school I have found a lot of interesting nuts, berries, and trees. I will post those findings in a blog post at a later time.
Tell me what you think:
The photos are a little blurry. The camera base that I have is very good it is a Nikon D7100, however the Nikor 50-300mm lens isn't as good. When I save up some more money I am going to upgrade my lenses, especially my telephoto lens.
I couldn't get too close as I was walking my buddy, who isn't exactly the epitome of stealth.
While I was at the school down the street from me where I saw that bird I also happened to see another wildlife.
As I walked some more in the school yard I came across a blueberry bush that the children of the school had planted some time ago, the blueberries may be attracting the wildlife.
Also when I was looking in the school yard I came across some nuts that had fallen out of a tree that was loaded with these nuts. I looked them up in my tree almanac and discovered that they are an edible nut, called the black walnut.
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