Jumat, 29 April 2016

An America woman who survived a real bear attack has called the depiction of a bear attack in movie, The Revenant as “risibly faked” and absurd. The 68 year old woman said she found the scenes laughable as a bear attack isnt that easy to deal with. She then revealed graphic photos from her own attack to prove that the scene didnt make sense .

Allena Hansen was mauled by a bear on her Californian ranch back in 2008 - losing her nose, ears and 14 teeth.




Comparing her horrific injuries to Leo’s superficial facial scratches, she laughed at the “absurdity” of the Oscar-nominated movie.

The survivor said she had to endure dozens of surgeries and years of rehab as a result of the attack.
When she was attacked, Allena managed to fight the bear off with the help of her two large dogs - and by poking the bear’s eye with her thumb nail.

Allena said that Leo’s scene struck her as “risibly faked” and was also amused by the scene where Leo’s character gallops off a cliff edge – killing his horse but not him.

She added:
“Having gone off a cliff or two on horseback, I can assure you that: 1. Leo can’t ride for s*** and 2. Appaloosas [the breed of horse he rode] are a lot smarter than that.”

Source - TheSunUK
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Kamis, 28 April 2016

In a 3-2 decision, the Supreme Court of West Virginia ruled that narcotic addicts may sue pharmacies and physicians for facilitating their addictions.

A suit was brought on behalf of 29 pain center patients who had been treated with narcotics for various injuries and became addicted. One article quoted the Chief Justices explanation: "A plaintiff’s wrongful or immoral conduct does not prohibit them from seeking damages as the result of the actions of others."

The court recognized that most of the plaintiffs "admitted their abuse of controlled substances occurred before they sought help "at the pain clinic.

Another story said, "The justices paved the way for people to claim damages for allegedly causing or contributing to their addictions of controlled substances—even if they broke the law by doctor shopping."

In a dissenting opinion, one justice wrote that the decision “requires hardworking West Virginians to immerse themselves in the sordid details of the parties’ enterprise in an attempt to determine who is the least culpable—a drug addict or his dealer.”

In response to the ruling, the West Virginia Medical Association issued a statement: "It may cause some physicians to curb or stop treating pain altogether for fear of retribution should treatment lead to patient addiction and/or criminal behavior. It may create additional barriers for patients seeking treatment for legitimate chronic pain due to reduced access to physicians. It would allow criminals to potentially profit for their wrongful conduct by taking doctors and pharmacists to court."

A post on the American Pharmacists Association website explained that pharmacists were included in the ruling "because they were aware of the pill mill activities of the medical providers. The plaintiffs said these pharmacies refilled the controlled substances too early, refilled them for excessive periods of time, filled contraindicated controlled substances, and filled synergistic controlled substances."

One newspaper summarized the public reaction to the ruling in an editorial stating, "Those who are illegally abusing prescription narcotics should be prosecuted to the fullest extent of the law. The same goes for medical professionals who are found guilty of committing a criminal act. But telling a drug addict or someone who is illegally abusing prescription narcotics that it is OK to go to court and file what could very well be a frivolous lawsuit is both baffling and shameful. This ruling by the Supreme Court justices is a clear back eye for West Virginia. And it does nothing to help West Virginia’s rampant drug problem."

As I wrote last year, I think the prescription drug abuse epidemic all stems from a 15-year campaign that declared pain is the fifth vital sign—a concept which is both untrue and as we have come to learn, harmful.

I agree with the WVMA. If I were practicing in West Virginia, I would be very reluctant to prescribe narcotic pain medication to any patient.

What do you think?
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10:14 AM

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Variation is not causation

I made a rookie mistake in statistics of the “correlation is causation” genre by confusing variation for causation in the recent JAMA Surgery paper referred to in my last post. I contacted Dr. Timothy M. Pawlik, the lead author of the Johns Hopkins study, who said the following:

"The model is explaining and attributing variation in readmission and not attributing readmission itself to the different domains. The model suggested that only 2.8% of the variation in readmissions was attributable to surgeons. This is different than saying that only 2.8% were the fault of surgeons. A more accurate interpretation would be that only 2.8% of the variation seen in readmissions was attributable to provider level factors. The majority of the variation in readmission was due to patient factors."

He added that some of the 82.8% variation in readmissions attributable (note: attributable doesn’t mean it’s the patient’s fault) to the patient could be modified by better medically managing patients comorbidities or not operating on some of these patients.

That readmissions can be explained by a single domain or a single person is simplistic. Dr. Pawliks clarification confirms my original concern that attributing differences in patient outcomes solely to differences in technical quality of surgeons is probably inaccurate, statistically speaking.

Variation is not causation but variation is still a call to action. Regardless of who is to blame for unfavorable outcomes, surgery is a team sport. The incision is just as important as the community care. In this regard, I am certain that ProPublica and I are on the same side. Let’s work together so that we see the whole story behind the numbers.



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Debunking the Xena Comparison

At this weekends 2014 San Diego Comic-Con, Warner Brothers released the first official photo of actress Gal Gadot as Wonder Woman from the upcoming  Batman vs Superman: Dawn of Justice film. Immediately fan boys took to the interwebs to compare Dianas outfit to that of Xena, played by Lucy Lawless  in 1995-2001. I suppose many of the so-called "fan boys" thought they were being cleaver in referencing a t.v. series thats been off the air for over 10 years. If any of them were true fans they would have known that Princess Diana of Themyscira has been rocking the warrior princess look in comics before Xena ever hit the small screen.



Throughout the years Wonder Woman has had many different costumes but she has been sporting the Warrior look since the 1980s, Thats right folks; the 80s which was long before the Xena television series was created. If you need proof, feel free to Google Warrior Wonder Woman by George Perez which was done in the 80s and you will see for yourself. Princess Diana has been kicking butt in it ever since. If anything, Xena was inspired by Wonder Woman not the other way around.  Perhaps you should stop calling yourselves fan boys when it seems like your only goal is to rip apart uncompleted films. You have demonstrated an obvious lack of knowledge on the history of the character in comics. 

For those of you who say the movie costume is a rip off of Xena; your argument is invalid.








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You may be tired of hearing about the Surgeon Scorecard—the surgeon rating system that was recently released by an organization called ProPublica. Like many others, I have pointed out some flaws in it. You can read my previous posts here and here.

I had decided to stop commenting about it because enough is enough, but a recent paper in the BMJ raises a question about one of the criteria ProPublica used to formulate its ratings.

ProPublica defined complications 1) as any patient readmission within 30 days and 2) "any patient deaths during the initial surgical stay."

The authors of the BMJ paper randomly selected 100 records of patients who died at each of 34 hospitals in the United Kingdom. The 3400 records were reviewed by experts to determine whether a death could have been avoided if the quality of care had been better.

The number of patient records in which a death was at least 50% likely to have been avoidable was 123 or 3.6%.

There was a very weak association between the number of preventable deaths and the overall number of deaths occurring at each hospital. By two measures of overall hospital deaths, the hospital standardized mortality ratio and the summary hospital level mortality indicator, the correlation coefficient between avoidable deaths and all deaths was 0.3, not statistically significant.

From the paper: "The absence of even a moderately strong association is a reflection of the small proportion of deaths (3.6%) judged likely to be avoidable and of the relatively small variation in avoidable death proportions between trusts [hospitals]. This confirms what others have demonstrated theoretically—that is, no matter how large the study the signal (avoidable deaths) to noise (all deaths) ratio means that detection of significant differences between trusts is unlikely."

The Surgeon Scorecard was derived from administrative data. No individual analysis of patient deaths was undertaken. According to a ProPublica article discussing some key questions about their methodology, "As for deaths, we took a conservative approach and only included those that occurred in the hospital within the initial stay."

Maybe that wasnt such a conservative approach after all.

And maybe we need to rethink that 2013 paper claiming that medical error caused up to 440,000 deaths per year.
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Cosplay Spotlight Margie and Ned Cox

On my recent visit to Georgia I had the pleasure of meeting and spending time with Margie and Ned Cox, the powerhouse cosplay couple.

I have longed admired Margie and her husband Ned for their incredible talent in costuming. Their costumes are flawless and their photos are nothing short of stunning. Theres also an element of romance to them; I have always found it romantic when couples cosplay together.  This husband and wife team are quite the dynamic duel in the world of cosplay and are highly respected and admired. They have inspired many, including myself and I was thrilled to have the chance to meet them on my recent trip to Georgia.

Victoria: How did the two of you meet?

Ned: We met in college--nothing too interesting. She had taken Army ROTC as an elective while I was in the midst of my four-year pre-commissioning training to become an officer. She didnt care for me at first, as she likes to recall, but I can be pretty bad with first impressions, admittedly.

Victoria: How long have you been married?

Margie: We’ll be married six years in May.

Victoria: When did you begin cosplaying together?

Ned: Toward the end of college, my love of comics hit a boiling point where I felt the need to LIVE in the fantasy world. Totally healthy of course. Im kind of a big kid at heart and running around as Batman as an adult in 2012 isnt much different than what I was doing in 1992 as a child after watching episodes of The Animated Series, I just tend to be better dressed for the occasion. When I told Margie that this was what I wanted to do, she was a bit apprehensive. She liked comics and superheroes, but this took it to another level. When I told her that I was interested in looking into doing this beyond conventions as a way to give back to the community and help charitable childrens causes, she became more interested.

Victoria: Whats your favorite couple to cosplay?

Margie: Oh, I don’t know what Ned’s going to say, but I honestly really like being Carol and Hal (Star Sapphire and Green Lantern). I think the reason is that we only have two couples costumes (Star Sapphire and Green Lantern, Batman and Catwoman) and Ned’s personality is a lot more of a Hal Jordan personality than Bruce Wayne (Batman) personality. Anyone who knows Ned will probably say that “That guy doesn’t break character for anything.” Ned is naturally a goof-ball and I love him for it. However, as a comic fan (and someone who doesn’t like to alienate new potential friends and bystanders), I appreciate that he keeps that part of his personality locked down in certain situations or wearing certain costumes.

Ned: Agreed. Its great that, after so many years of pretending to "just be friends" as some of our JLA characters, Margie and I finally got to be Green Lantern and Star Sapphire and really be a couple just
like Hal and Carol.


Victoria: You recently debuted your New 52 Wonder Woman at this years MegaCon. How long did it take to construct the costume?

Margie: I have a day job and mostly I work on costumes at night and on weekends, but it took me a few months. That was with the sanity breaks I took, where I would stare at a boot for a week and think “I wish I had briefs to go with those boots…” Four weeks later: “I guess I need armor to go with this corset….”. Five weeks later: “I’m going to get Velcro to hold up this armor since it’s not going to stay on with magic.” My overwhelming guilt at staring at hundreds of dollars of untouched costuming materials is how most of my costumes get finished. I’ve actually been staring at a creepy plaster hand that I’ve had in my basement for a few weeks knowing I need to get started sculpting my Huntress armor.

Victoria: What costumes do you have planned for in the future?

Margie: I’m working of the New Huntress costume and a Sith costume. I would also like to do the new Starfire costume, but I’m honestly waiting (and hoping) that DC caves and gives her a bit more coverage. I really like the new costume, except for that part.

Ned: Im going to work on classic Giant-Man (Hank Pym) from the Avengers. After costuming as Cyclops, I feel a sort of connection to the misunderstood and damaged characters in comics. Besides that, hes a classic Marvel character that gets no respect. And the Giant-Man costume looks REALLY cool. Margie and I are also hoping to join the Sith soon--our first costumes outside of superheroes as well as "good guys." It should be fun!

Victoria: You both do a lot of charity work for your community. Could you tell my readers more about that?

Margie: Heroes Alliance is a charity that I’ve been involved with in some way since I first got into costuming. Basically it’s collaboration of costumers, photographers, and general comic fans who
would like to use their art to reach out to their communities, to charities, and also to support local comic shops. I’m the coordinator for the Atlanta group and I have a soft spot for children’s charities, so the majority of events that we do here are for special needs children. Some of the groups I’ve worked with over the last year are FOCUS, Down Syndrome Society of Atlanta, Children’s Healthcare of Atlanta, Extra Special People, and CASA.


Ned: Margie and I joined at the same time, shortly after the Heroes Alliances founding in Tampa. Ive had the honor of being elected council chairman for the second year in a row and Im extremely proud of our teams across the nation (and world, with our UK partners). Weve built a great community of volunteers who have a very unique role among charity groups in bringing a real-life superhero experience to children with illnesses and disabilities. I love conventions and seeing my spandex-clad friends, but Ive found so much more fulfillment in the Heroes Alliance than I ever imagined.

Victoria: Margie, you are a very accomplished writer. What are you currently working on?

Margie: Thanks! I have a Bachelors from USF in English with a specialty in Creative Writing—my family thought I was insane for coming off the Pre-Med/Microbiology track, so I’m elated that I’ve been able to do a few dark, gritty, artistic pieces which have proven to them that I was more insane than they ever imagined.

A few years ago, I finished my novel, Southern Gothic Confidential, a dark regional comedy/tragedy that entwines the cultural evolution of a small town with the personal renaissances of some of it’s inhabitants. The backdrop of characters is very colorful. In the foreground of the Historic District is Ms. Jane Bradshaw, a very prim and proper Southern lady. She is President of the Red Hat Society and Secretary of the Garden Club. When her neighbor is decapitated in an auto accident, she finds herself living next to his estranged mother, Crazy Deb, and Crazy Deb’s very strange husband, Wild Ernest, who have been certified uncrazy due to the overload of patients in Chattahoochee Mental Institution. This state of affairs sets off a chain of events which will forever change the Historic District and the characters. Luckily, SGC got into the hands of someone in the industry via my husband’s boss who was nice enough to send it to a professional proofreader. After the proofread, they sent it to a publisher for me. It was super nice of them. We’ll see where it goes.


Currently, I found a pretty sweet gig writing a comic with Eugene Selassie called Rock, Paper, Scissors. It’s a 12-Issue story that deals with the super-powered crime underbelly of Chicago. It is morally gritty and I’d like to think that the characters are rather likable although they are in a very ethically challenged climate. It was great being able to work on a team of very talented, fresh artists and writers. It was like walking into a room that was bursting at the crown molding creative energy. We were like artistic vampires feeding off of each other’s talents and ideas. Issue One exceeded my expectations art and story wise. I’m a huge fan of Tarentino and Puzo. We all brought our love of crime noir, modern classical mafia literature, and comics to the table. I don’t know how much more I can say since we’re talking to a few publishers now, but we’re building a damn good story.

Victoria: Many people like myself, see you both as an
inspiration in the world of cosplay. How does it feel to be role
models?

Margie: I’m so honored and humbled that you feel that way. When I started out, I just had a few friends who costumed (I could count them on both hands) and we were just supportive of each other. We’d find a few photos of ourselves online from time to time, but other than that, I don’t think anyone was terribly well known. I don’t feel very far removed from that experience except I can’t count the people I know on my hands anymore. It’s really easy to treat people well when I’ve been so well treated. I feel pretty much the same, but I’m very grateful for any good vibes that I’ve been able to send to people. It feels great to know that maybe I’ve made a difference.




Ned: Im humbled, perplexed, and honored that you say that. Its something I didnt expect but Im always very happy to hear whenever Ive had any sort of positive impact in peoples lives in any way.
Ive found myself in leadership roles from time to time--in the Army, through the Heroes Alliance, and now at the company I work for. Those are all very different environments with different leadership
requirements but Ive found some common truths among them: be honest, be consistent, and take care of the people you care about. Its always served me right.

As for being an inspiration, Ive always been just an, "Im just happy to be here" kinda guy. If I bring positivity and joy to a situation or group then all the better. Ive met some of the most wonderful people doing this (another unexpected blessing) and they inspire me. Its easy to be positive when youre around great people.




Victoria: What is your personal favorite costume?

Margie: Wonder Woman.

Ned: Im going to say Green Lantern. Ive accepted that Ill probably die as Hal Jordan--a Green Lantern Corps emblem on my tombstone. Thats fine. Im very happy to be known for that and I absolutely love the character, the Corps, and all of my fellow Lanterns. Its a wonderful thing.


My thanks to Mr. and Mrs. Cox and be sure to check out Margies Facebook Fan Page to keep up with this Cosplay Goddess!
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