Headlock

Currently Listening: Let Go (Frou Frou)
[Still] Reading: Thinking, Fast and Slow; The Isaac Newton School of Driving
Recommended Reading: Mindfulness in Plain English (Bhante Gunaratana, 1992), The Machine Stops (E.M. Forster, 1909 short story)

“You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You must do the thing you think you cannot do.” – Eleanor Roosevelt

The most annoyingly epic 38-point #Scrabble play. #ZEN

Human relationships are a wonderful way of pushing your own boundaries and learning about yourself. In my most recent lesson, I realized that not only do I spend a a LOT of time thinking about random things, I have also locked myself in my head. My mind is a safe zone. I protect myself from losing the illusion of control I get from remaining in my head and outside of the sensational world. I am self-conscious. Not really about how I look, no. But about the physical manifestations of my soul... (does that sound weird or make any sense at all?)

In moderation, self-consciousness and deliberation are excellent constructs. They are tools for personal growth and development. Without self-awareness, I would not have this blog. Without deliberation, I would not be focused enough to work towards the person I'd like to become.

I can avoid an overall stasis and yet I cannot avoid paralysis in situations where it is essential to be in the moment. You see, I have this idea in my head that when I finally find the ability to "let go" and lose my inhibitions, I'll be able to dance and sing and feel things around me--truly live in the moment. I can't remember a time I ever felt truly lost "in the music" or "the rhythm" or even in nature. For example, I went to Rave of Thrones, my first [semi]rave, this week in SF and while I enjoyed myself, I recall myself caged in thoughts of what other people thought of me, my appearance, my inexperience... all because it was new to me and outside of my comfort zone. Why can't I just step out of my shell and embrace the vulnerability?

Everyone struggles with this. This entire "Life Cartogprahy" blog basically documents my efforts to deconstruct and restructure my world, find balance, and live life with conviction and managed inhibition.

Yes, I've been cultivating confidence all this time but the epiphany here is the existence of this headlock. Understanding my mental framework is the first step. Andrea "Unlocked" will take time; baby steps, baby steps.

Someone recommended mindful meditation as a way of processing my existing states. I prefer therapeutic jogs, but after knee surgery, I might need to turn to meditation to stay sane.

Mmmm... let's get it on, 2015.

Musings on Science and Psychology

[Belated Post]



Disclaimer: I am not a physicist and I apologize for skimming over the scientific concepts presented in this post! The ideas presented here might be used to generate interesting conversations about science and philosophy but the ideas are by no means comprehensive. I don't have time to go too deep into the details!

While I concede I had a fascinating romp through the history of atomic physics and psychology, I don't recommend reading Deciphering the Cosmic Number for leisure.... It was a chore reading through the heavy physics of the book. I probably would have enjoyed it a lot more if I was concurrently studying (quantum) mechanics since it goes through Wolfgang Pauli's scientific life in depth - but for me, this book took a lot of brainpower and focus to read. The most enjoyable moments for me were when I read about the science from a historical context. We take for granted how much we know now about atomic physics and don't realize how much there is still yet to know.

Overall, this book is a synthetic piece on the lives of Wolfgang Pauli (physicist) and Carl Jung (psycho-analyst), who are in their time premiere experts of their respective fields. They come together and, essentially, muse on the mysteries of the universe. Many of these musings were represented through geometric figures, archaic symbols, and numerology. A large portion of the book focused on dream interpretation and imagery and, by extension, the mystique of consciousness and life. Interesting stuff.

You can read an excellent review about the the book and its writing style here.

What exactly is the cosmic number according to Jung and Pauli? There was a very long debate in the book between the number 3 and the number 4. Both of which represents different types of spiritual completeness.

Number 3: Represented by the Holy Trinity in Christianity and appears multiple times in biblical stories. The triangle is a representation of strength and stability and Pythagorean properties are unique in geometry. In popular culture, three is often considered an important iterative number (e.g. "third time's the charm" and the Wiccan rule of three). Our physical world is known as three dimensional.

Number 4: Pauli believed strongly that the number four was the 'next level' three. While there did exist the Holy Trinity, the addition of a fourth (probably the human spirit or some other representation) made wholeness and completion. Jung believed that there are four major archetypes within the human psyche. In Pauli's field of work, atomic physics, the fourth quantum number was necessary in understanding electrons and quantum mechanics. Originally, the theory encompassed three but was not unified before the introduction of the fourth quantum number (electron spin, ms). Our world's fourth dimension, time, is quintessential in our understanding of the perceived universe.

Reasonably, these numbers would have special meaning from a mystical perspective.

But in the end, according to Pauli, what was the real cosmic number?

The fine structure constant. Or, to remember it better, the square inverse of 137.03597.

The fine structure constant is a dimensionless quantity derived from many fundamental physical constants such as elementary charge, speed of light, and the Planck constant. It is also known as the "coupling constant" or alpha, and is used to explain the mysterious electromagnetic force that governs interaction between electrons and photons (elementary particles and light). The constant was determined while the Bohr model was the cornerstone of atomic physics in 1916. At this time, everyone knew that Bohr's model could not explain the splitting of spectral lines in H2 molecules. Thus, the introduction of this number was pivotal.

From a numerological perspective, the number is very mysterious. It finds itself related to the golden ratio and is theorized to be the value for stable matter, and thus the number that makes "life" possible.

I presume that physicists and psychologists seeking to reconcile science and consciousness would be fascinated with the idea of a constant that describes life on a fundamental level. An extension of this is the possibility of objective beauty and unity in life that springs out of the chaos and increasing entropy of the universe. (am I getting too poetic here?)

Pauli's famous quote is this: 'When I die, the first thing I shall consider asking the devil is -- What is the meaning of the fine structure constant?'

Perhaps the meaning of the fine structure constant was the answer to Asimov's The Last Question: 'Can entropy be reversed?'

Antiquated Anecdotes

Currently Reading: Thinking, Fast and Slow (Daniel Khaneman, 2011), The Isaac Newton School of Driving: Physics and Your Car (Barry Parker, 2003)
Finished Reading: The Communist Manifesto (Karl Marx, Freidrich Engels, 1848, audiobook/paperback), The Last Question (Isaac Asimov, 1956, short story), Divergent (Veronica Roth, 2011)
Currently Listening: Dancin' in the Moonlight (King Harvest), Beautiful People (Sam Ock)

Blurbs from the past two weeks.:

1. I have decided to change my weekly blog post day from Monday to Wednesday. Monday was very difficult for me to keep apace with!
    
2. I will be getting knee surgery (ACL Reconstruction) for Christmas. I got my knee imaged by MRI and saw an orthopedist. I need the surgery, though. Apparently there was no ACL to be found (PCL intact; ACL was completely torn...) and there was significant meniscus damage. Totally knew this would be the case, though. I have been struggling with my left knee for quite some time. I will need all of the moral support I can get from my friends and family. It didn't scare me at first but now I'm rather nervous about it, especially when I consider if I should get an allograft vs an autograft. My approach to knee surgery now is a lot different than my reaction to surgery in high school. Now, it's more like "Challenge accepted."
     
3. Spent Thanksgiving with the family. We had Thanksgiving lunch together and saw Big Hero 6. BH6 was a very memorable and funny movie. (Ba da da da da. I cannot deactive until you say you are satisfied with your care.) I also spent a few hours (distributed over 3 days) working on my first art project in years, thanks to the mentorship of my youngest sister (a high school senior). She has been applying to colleges and art school.
    
4. The art project was a gift for a very special guy. ;) I sometimes like to think we are the bananagrams dream team.
    
5. Been busy reading. I downloaded the audiobook for The Communist Manifesto so I could listen to it on my way back up to Northern California. The word "antiquate" and its variations were oft used. I like that word. Also, the manifesto is quite intense but a worthwhile political read. I was never really into politics but I realize now that the backbone of politics is philosophy. And philosophy is interesting. (Thanks, Tiffany, for lending me the paperback copy.)
    
6. Got in touch with old friends during my the Thanksgiving break! (Albert, Jimmy, Ann, Tiffany, Jayce, etc.) Most notably, an old high school flame. It was nice reconnecting; we have done so sporadically over the years.
    
7. Went to a murder mystery birthday party! (Ann!) 'Twas awesome. She did a terrific job organizing the party and getting people to go with the role play, involving steampunk wardrobe and time travel.
    
8. Went indoor rock climbing for the first time with Marvs and my upper body is INCREDIBLY SORE. But the sense of accomplishment you get from it is so much fun! It is such a functional/useful workout. I had so much fun that I purchased a Groupon for lessons/day passes at Bridges Rock Gym in El Cerrito and will go with Eric this Saturday! I might continue pursuing this hobby after knee surgery. (After the hip hop dance classes? haha... too many things I want to do in life...)
    
9. Notes to Self: Scrabble, Hiking, Just Dance, CAH charades
    
10. I have shifted very far from my happy baseline. I am more than happy these days... I have "so much zest" and I am inspired. This shift probably has very much to do with blurb #5. Somehow this person makes me simultaneously confident and vulnerable; strong and weak; hopeful and anxious.... Some kind of madness, I tell you! Madness!

That's it for now!

Libros Antes del Fin de Año

Ahora Escuchando: Madness (Muse), Explorers (Muse)
Ahora Leyendo: Divergent (Veronica Roth, 2011)

1. Divergent (Veronica Roth, 2011)
2. Cat's Cradle (Kurt Vonnegut, 1963)
3. Thinking, Fast and Slow (Daniel Kahneman, 2011)
4. Snow Crash (Neal Stephenson, 1992) or Babel-17 (Samuel R. Delaney, 1996)
5. Insurgent (Veronica Roth, 2012)
6. Allegiant (Veronica Roth, 2012)

Aquí está una lista de libros para que yo no me olvido. Es muy larga ahora. ¡Necesito leer mas! Mi objectivo es leer estos antes del año 2015. Muy ambiciosa... Casi un libro por semana.

Espero tener tiempo porque tengo muchas cosas nuevas que estudiar para el trabajo. Pero, me siento como que puedo completar.

Me siento como que puedo hacer cualquier cosa - que todo es posible. Me siento de esta manera muchas más, por alguna  razón indescriptible, cuando estoy con un cierto hombre que me gusta mucho. Soy tan feliz... casi demasiado feliz. Tengo miedo de ser demasiada emocionada. Pero, esta vez siento que ser valiente es vale la pena.

Que cómico. Por alguna razón, estoy más dispuesta a escribir sobre mi vida amorosa en español...

Digital Health Commons

Are larger health institutions and hospitals capable of supporting a digital health commons?

Last Thursday, I attended a Stanford Medicine X meetup with Teresa "On Peer-to-Peer Healthcare and Human Centered Design." The speaker, Sean Ahrens, a down-to-earth guy that spoke to the audience on a beanbag chair, beer in hand, spoke on how public good can be created with the advent of an online community that allows truly shared health data (a digital health commons).

Sean talked about his website, Crohnology, which serves patients diagnosed with Crohn's disease, a chronic condition with no cure. Inflammation can occur anywhere within the digestive system, taking a huge toll on a patient's quality of life. Sean developed a website in many ways reminiscent of sites like Livestrong and Weight Watchers because it builds a community where people can talk about their health progress, share information, and motivate each other. However, the site also serves a broader public good: it accumulates health data that contributes to research for, at the very least, quality of life management. If you want to think with a little more grandeur, it may one day help researchers find a cure for Crohn's. I was most impressed with the intuitiveness of patient journals - they report on how they are feeling in their journal on a scale of 0 to 100. This perceived health would then be charted against the diet, medications, supplements, and lifestyle changes they report to manage their disease. Patients can look at their own data over time and see how that compares with other people who have Crohn's.

Ultimately, the goal is to build a "Patient-Powered Research Network." Sean shared his struggles with creating Crohnology - he journeyed from trying to make a business out of his patient-powered research network to realizing that monetizing the site didn't align with his personal values. But if there is no return on investment, funding and support for the site is extremely difficult to find. Currently, Crohnology is kept alive with the help of the Patient-Centered Outcomes Research Institute (PCORI).

Key issues for this type of platform include:
1. Funding: How do you keep true to your philanthropic goals without selling yourself out? The website needs to be supported monetarily.
2. Open Access: How do you maintain open access and protect privacy?
3. Integration: Can data be shared between other information sources? For example, health data from Fitbit?

I thought that the challenges presented here were particularly interesting because the idea of "patient powered" research seems erroneous. Scientists would be skeptical in the validity of this research because of the sheer amount of subjectivity and myriad confounding variables (McKenna 2011). However, more and more, patient-reported outcomes (PROs) are becoming a valid research model - because a patient's happiness, outlook, and support group correlates with survival (Kyte 2013). I would argue that the more data they can obtain over a specific population, the more we could try to deduce and intrepret. Traditionally, we look at PROs with questionnaires that calculate an outcome measure on a scale or a score so it is less subjective and mores scientific. 

The key to creating a digital health commons, however, is giving patients the tools and the guidelines for them to look at their health objectively. In Crohnology's case, the system--a perceived health rating scale alongside other tools for recording objective data and the potential to add in data from other sources like wearable devices--is simple enough for patients to understand and comprehensive enough for self-awareness development.

In thinking about some of the problems Sean was dealing with, I thought about the potential of the VisionTree platform my team is working on implementing with Dr. Damato and Dr. Dunn. The cloud-based platform stores clinical information from existing EHR and creates a portal for patients to log in and answer questionnaires--thus creating a central space for data analytics to take place between PROs and clinical outcomes. Our main goal, ergo, is to enable research in PROs, based on validated psychometric and psychosocial measures. But a platform for patients to simply log in and fill in questionnaires seems too limited in scope.

What if we built in a forum or an analogous health data commons within VisionTree? UCSF patients could have a single portal where they learn about their disease and look at their medical records and images, fill in questionnaires for the hospital's own research, and provide a personal account of their own outcomes, thoughts, and feelings. Provided a patient was willing to volunteer their anonymous personal data via informed consent, they could freely participate in the data commons and learn about how other anonymous patients are dealing with their issues. Patients could then build a community within VisionTree that doctors could also see - enabling unprecedented feedback and understanding of their patients.

However, I foresee plenty of things wrong with this idea.

1. Institutional protection of data and lack of open access to other people outside of the community may conflict with the values of a truly "shared" community. This could create an "Uber" of the health industry.
2. Privacy concerns are always present. Although a patient signs informed consent, it does not mean they will always know how to manage their anonymity on the internet. This is an inherent "internet of things" problem.
3. A radically different relationship between doctors and patients could develop as patients will naturally discuss their misgivings about the care they receive from the healthcare institutions. This could have a negative impact on the economic incentive of the institution enabling a Data Commons within the platform. Antagonism may be inherent in this kind of community. On the other hand, this would encourage hospitals and providers to become more patient-centric.
4. A lot of developer work and maintenance is required. A large commission would be needed to develop a platform and maintain it. As mentioned, funding is very difficult to obtain because, in general, the return on investment for obtaining patient-reported outcomes data is uncertain. The trade-off, of course, is the sheer amount of subjective data we could obtain in conjunction with the objective data collected in the clinics, including medical images, tumor sizes, genetic factors, visual acuity, etc. But thinking of the kinds of questions we could answer from a research funding standpoint is a whole new ballpark.

So is this a feasible idea? Is it better to leave digital health commons to more separate entities, subject to altruistic funding? Or would institutions be willing to take on the potential challenges associated with hosting a platform?

I don't really know much about the landscape from a clinical or logistics standpoint - I am mostly, out of curiosity, laying out my thoughts and wanted to bounce it off of someone.

References:
1. Stanford Medicine X <https://medicinex.stanford.edu>
2. Crohnology <https://crohnology.com/>
3. Patient-Centered Outcomes Research Institute <http://www.pcori.org/about-us>
4. Measuring patient-reported outcomes: moving beyond misplaced common sense to hard science. Opinion. McKenna, Stephen. doi:10.1186/1741-7015-9-86 <http://www.biomedcentral.com/1741-7015/9/86>
5. Patient-reported outcomes helped predict survival in multiple myeloma using partial least squares analysis. Kyte, Derek. doi:10.0001/jama.2013.277222 <http://jama.jamanetwork.com/article.aspx?articleid=1741830>
6. VisionTree Software, Inc. <http://www.visiontree.com/>

New Projects, New Pivots

Currently Listening: Assassin's Tango (John Powell)
Currently Reading: I, Robot

View from my Wednesday office!

Yesterday, I got hired for another project at UCSF in the Department of Physiological Nursing, involving a pivot in my specialization. I always just assumed health tech and databases were just a side interest - something I'd continue knowing a bit about because of my degree (Master of Translational Medicine) and tech savvy. However, it turns out, employers were always most intrigued with the computing skills and education on my CV (C++, SQL, MATLAB, etc). Of course I had to study all of this for my engineering degree and I'm by no means any expert nor am I very good/fluent but I'd never been very passionate about healthcare IT anyway. Its impact felt more indirect compared to the patient interaction I was seeking in clinical research. However, I'm sort of falling into it as a natural progression. Healthcare IT is prevalent across all aspects of medicine and, in my case, clinical research is supplanted by data and there is certainly a lot of it.

I started out at UCSF in a team that is implementing a new cloud-based platform. It would act as both a patient data registry and a portal for patients to log in, learn about their disease (mostly ocular melanoma or retinablastoma), and answer questionnaires that would enable research in PROMs (patient-reported outcome measures). From a technical standpoint, it hasn't been that difficult working with the tech vendor since they are doing all the development work. My job has mainly been to coordinate everything, from patient recruitment to platform evaluation to mapping data input between our existing EHRs (electronic health records) and the new platform. It has allowed me the freedom to practice a little bit of project management and people skills, working between the different facets of translational medicine (industry, academia, clinics, patients), while remaining patient-driven and focused on creating integrated care in Ocular Oncology practice.

The new group I will work with in late December already has an existing SQL database in a later stage of development. They have a lot of data that is dynamic - such as that found in physiological monitoring systems like EKGs or pulse oximetry. This complex data needs to be pooled, analyzed, and interpreted, which is where the PI was hoping to create a role for me. The group is working on very interesting problems in critical care and neurology, which I think will help me in my long winded path towards neurological rehabilitation. :D This project's a lot more technical and very challenging, in a different way from my position in the ophthalmology department. However, I'm excited to refine a skillset that will obviously come in very handy in the future.  The Bay Area is still a growing hub for digital technology; I'm even going to a networking event tomorrow on digital health technology!

Cheers to the future! Research is fun!

Bonito

Currently Listening: Sunshine (Flight Facilities ft Reggie Watts), All For The Taking (Meanwhile OST)
Currently Reading: I, Robot (Isaac Asimov, 1950)

Tratando de investigar un par de buenas canciones en español para estudiar y encontré un buen sitio (A Quick Guide..). Necesito tratar algunos más porque no me gusta el ritmo de algunos de ellos. Oído "Bonito" y "Tortura" cuando estudié español en la escuela secundaria. Bonito es una canción tan divertido, así que estoy empezando con eso. La canción habla de la belleza que se pueden encontrar en la vida y que, en general, lo bueno supera a lo malo. Mi frase favorita es "Que bonito que te va cuando te va bonito" (how beautiful things can be, when you let them be beautiful). Buena canción para un día de lluvia :)

Yo también considerando la posibilidad de leer (una vez más) un libro favorito - "El Alquimista" en español. Pero podría tratar de hace demasiado, muy temprano. ¡Se me sigue olvidando a jugar Duolingo! Ugh. Necesito un rutina ... Tratando estudiar español es difícil.

Aquí están algunos modismos fresco para el estudio: 15 Common Idioms For Sounding Like a Native.

En el trabajo a UCSF, existe la posibilidad voy a trabajar en un segundo proyecto - muy interesado en trabajar con un médico que está interesado en los datos fisiológicos y interfaz de la máquina cerebro. Podría ser muy impresionante trabajar con él. Además, la perspectiva de un ingreso adicional es agradable.

Mi vida está bien en este momento. Estoy muy ocupada con mi trabajo y la vida social y mi vida es gratificante, mas o menos. Me quedo con las dos partes (aunque mi calidad de sueño no es muy buena). Es difícil, a veces, para mantenerse en contacto y ser el mejor amiga que puedo ser. Pero me siento muy bendecida porque mis amigos son muy empáticos. Además, se siente muy bonito que hay un hombre en mi vida, que también está muy ocupado - pero tratamos de hacer que el tiempo para ver el uno al otro. Él es impresionante .. Sentio el "barrer de mis pies" empazando a ocurrir ... Gah !! SENTIMIENTOS ..:3