Sunday, June 17, 2012

Other Aspects of the Military

Schedule for COT


Primarily Monday through Friday, with studying, readings, and computer based training on the weekends. Trainee Group may organize weekend and after duty hours events. Expect to be very busy throughout the entire course.

0500-0615: Physical Conditioning 
0615-0800: Personal Time and Breakfast 
0800-1200: Training/Academics 
1200-1300: Lunch/Student Wing Activities 
1300-1800: Training/Academics 
1800-1900: Evening Meal 
1900-2200: Trainee Group Activities/Meetings
2200-2330: Personal Time or Sleep
2330           : Lights Out

I know next to nothing about being in the military. So far my experience has been: the recruiter lets you know what to do and what information to send his way and then you sit back and collect paychecks. This summer, however, I am scheduled for officer training which is like boot camp where you learn how to march, when and who to salute, and the history of the branch in which you are serving. The following conversation took place while trying to enroll my family in the military's health insurance.


"Hi, I'm trying to enroll my family in Tricare and I just received my active duty orders."


"You'll need to drive to the office and bring your orders in person."


"Okay."


A forty minute drive later. "Hi, I'm here to enroll my family in Tricare and here are my orders."


"These don't look like your orders."


"This was an attachment to an email I received that said 'Active Duty Orders.'"


"No, your orders should be lots of pages. I only see three here."


"I'm an Health Professional Scholarship Recipient. I'm only active duty for forty-five days while I'm at Commissioned Officer Training this summer."


"Why don't you come back closer to you ship date and bring your orders?"


"I don't exactly live across the street. Is there some way that my family can be automatically enrolled once I'm converted to active duty?"


"I'm sorry we can't do that. It's an automated system."


"........Thanks for you help. Bye."


I don't know any more than when I started. I'm not sure what military precision means yet, but hopefully I'll learn this summer. In the meantime, let's throw money at a problem and once it's buried with cash, we'll ignore it.

Monday, June 11, 2012

Done

The first year is over! That makes me feel like:

What do I do with free time?

I'm that good.
But now this is the only way I can fall asleep.

Sunday, June 3, 2012

Ethics in School

"If I did that, I'd get expelled." That's what I thought when I encountered another school's material appearing on one of our assignments...then on another...and another. Maybe there's something I don't know. Perhaps both institutions acquired the questions from a centralized bank that they pay a subscription to. Perhaps universities have an open sharing policy and allow others to use the material they create without acknowledgement, but I have my doubts.

During the muscle and bones course we are taking, we have small group discussions in which we create differential diagnoses, discuss pathophysiology, workup, and disease progression. Usually the only tool we are given is the internet and we are 'encouraged' to use medical databases like Up to Date and Emedicine along with the enormous texts of Robbins and Cotran Pathology and Harrison's Internal Medicine.  Usually, the information progression goes like this: wikipedia, then google, next Robbins, back to wikipedia (for clarification of issues), and maybe for a few very brave, ambitious souls, Harrison's.

This part of the curriculum is in place so that we can rely on a group problem solving system. There is nothing to turn in, the only points are from the quiz in lecture the next day which incentivizes us to understand the material. It is designed to be too much for one person to do alone. One of my classmates pointed out to me that he found our case...on another school's website. Worse than that, it is word for word. Who knows who stole from who. Neither site gave credit to the other. I can understand them not acknowledging where they got it. After all, wouldn't want to spoil the answers, would we? Here is what our case was:


An otherwise healthy 44-year-old man with no prior medical history has had increasing back pain and right hip pain for the past decade. The pain is worse at the end of the day. On physical examination he has bony enlargement of the distal interphalangeal joints. A radiograph of the spine reveals the presence of prominent osteophytes involving the vertebral bodies. There is sclerosis with narrowing of the joint space at the right acetabulum seen on a radiograph of the pelvis. Which of the following diseases is he most likely to have?


Which you can also find on University of Utah's medical school site here. The next day, a different professor and different set of cases did the same thing from the Medical University of South Carolina here


Marianne Jennings thoughts are:


"Enforcement is to any organization what integrity is to us individually. We hold fast to our ethical standards because of our integrity. An organization is able to hold fast to its ethical standards only if it enforces them absolutely, unequivocally, and in an egalitarian fashion... After being held to rigorous standards, they witnessed a leader doing something stunningly violative of clear standards. Dean Baker’s apology many not be enough if the culture and standards of the University are to hold firm."

The Transgender Issue

This story came at a time when we were talking about such issues in neuroscience. True hermaphrodites (able to both father and mother a child) are extremely rare so the large majority are somewhere in between. Androgen insensitivity syndrome means a developing male fetus does not respond to the testosterone that the testes secrete. It's a well documented syndrome and there's a paper by Imperato-McGinley and Canovatchel in the 1992 issue of Trends in Endocrine Metabolism that discusses a few case studies as well as the proposed mechanism.

Around week 7 of gestation, the SRY gene on the Y chromosomes of genotypic males is expressed to stimulate normal testicular development. The testes then secrete two hormones: Mullerian inhibitting factor (which blocks the default development into female reproductive tracts) and testosterone. Testosterone is converted by 5-alpha reductase to dihydrotestosterone which causes the male genitals to develop. All of that can happen just fine, but if the receptor for dihydrotestosterone is defective, then a 46XY genotypic male with normal and elevated androgen levels will develop into a phenotypic female.

This 'female' will be unable to have children since MIF is secreted normally which disrupts formation of the uterus and most of the vagina. Since SRY gene is expressed normally she will have testes in the inguinal area. Since they appear as a normal female, they are usually only diagnosed once they come in to be treated for amenhorrea.

Likewise, genotypic 46XX females can present with male genitals if they were exposed to high levels of androgens during development from congenital adrenal hyperplasia or very high maternal levels.

We know that Adam fell and that brought about some sweeping changes. "Because of the fall our natures have become evil continually" (Ether 3:2), "that old serpent did beguile our first parents, which was the cause of their fall; which was the cause of all mankind becoming carnal, sensual, devilish, knowing evil from good, subjecting themselves to the devil" (Mosiah 16:3), "the fall had brought upon mankind spiritual death as well as temporal" (Alma 42:9). It's also implied that the fall brought pain, anguish, struggle, but also the possibility for growth, achievement, and work which allows us to increase our capacity.

To what extent the fall affected our identity, reason, intellect, genetics, physiology, biochemistry, and emotions is a question that begs asking but unfortunately for now, lacks an answer. As members of the Church of Jesus Christ of Latter-day Saints we know that "gender is an essential characteristic of individual premortal, mortal, and eternal identity." In the case of the 1,000 or so born in the United States each year with ambiguous genitals, which gender do you choose? The genetic one or the phenotypic one?

Trasngender operations make the issue even more complicated. How do you assign priesthood responsibilities? To what extend can you choose your gender?