Win-Win Situation in Education

An old classmate came visiting the other day. His daughter was studying in final year, which was probably the cause of the visit. After an initial patter, he came to the point.
"Students are not taught these days the way we were taught, huh?" he said.
"What do you mean?" I asked.
"Lectures are not taken at all" he said.
"Did your daughter tell you so?" I asked.
"Yes."
"But we are very particular about teaching students" I said. "If a lecture is missed due to any reason, we reschedule it."
"I did not mean your department. Teaching in your department is meticulous. In XXXXXXX department, not a single lecture has been taken in last one year."
I thought about it for a while.
"Is it same in the other departments?"
"Most of them."
"Why do you not tell the Boss? I am sure he will want to improve things."
"What? Then the concerned departments will victimize my daughter."
"But the head of XXXXXXX department gives adequate attendance certificate to all students. I know, because eligibility for appearing for exams is jointly checked by all departments."
"Zero out of zero is 100%" he said. That might be inaccurate mathematically, but was logical.
"And all teachers keep complaining that students do not attend their lectures" I said.
"That is true for many students, especially when they have exams of other subjects" he said.
Then it dawned on me. It was a win-win situation. The teachers got to not teach, and the students got to stay away from lecture halls and still got required attendance certificate.
"Do you expect me to tell the Boss about this?" I asked.
"Umm..." he said, "that would be nice."
And make enemies of all those teachers? I suddenly recalled a few faculty who came to me time and again and indirectly urged me to fight their battles for them. 'Fight your own battle' I wanted to say, but decided not to.
"I will have to tell him your name" I said.
He thought about it a bit.
"I think my daughter will self study" he said. "Let us not bother your Boss with such trivial things."

CIN: Decision Making Tool

Students get bored with the same pattern of learning. Students are tech savvy these days, and prefer methods that involve electronic gadgets. Some of them like decision making tools. With these points in mind, I used Microsoft Powerpoint to make an interactive presentation on cervical intraepithelial neoplasia (CIN). When one plays it in a Powerpoint Viewer, it keeps offering different options. One has to select that option on each screen that applies to his/her own patient. Then the tool offers another screen with more options. Finally one reaches a recommendation for that patient. I used to do it in Visual Basic. But Powerpoint is easier to work in, does not involve compilation, and creating a setup file, and does not require the user to setup the file on his/her computer. Most people have Powerpoint or equivalent program installed on their computers. So additional software is not required. The starting screen of the tool looks like this.

I showed it to my students today when I taught them CIN. I promised to make it available to them, so that they could use it. It will help them learn the topic. It might inspire some of them to do better than that piece of software. You can click on the image above to download it.

Beware Of Backpackers

A backpack is very common in Mumbai. Not only do the school and college students use backpacks, but even adults going to work do. It is a bit of a problem when children, those bundles bursting with energy, rush into a city bus and push their way through. The backpacks,sometimes  bigger than the children themselves, push people this way and that. Old people can even fall with such pushing.

Another problem with these backpacks is that they are made of material which is quite thick and rough to feel from the outside. It can be quite traumatic to the skin, especially of older people. A few days ago I had to buy some equipment for my department. I took a train. When it arrived at the station, a lot of people rushed in. They ran on all sides, and the backpack of one (or more) of them rubbed past my left elbow. It was hurting quite a lot while I stood in the train compartment, unable to move due to people pressing in from all sides. When I got off the train at my destination, I checked the elbow. About 1.5" diameter patch of skin had been scraped off my elbow by that backpack. The blood had clotted. I could attend to it only after I reached home after finishing my purchases.

I remembered one of the previous bosses at the institute telling a foreign visitor, "the public transport is not at all suitable for people like us. We have to travel by airconditioned cars." I had thought that was a sentence reeking of a superiority complex. Looking at my injury, and wincing every time someone touched it or brushed against it made me think he was perhaps right. I have traveled by train again after that incident. No further injuries occurred. Perhaps I should remember that I have become old and should avoid boarding trains and buses when they are crowded. Perhaps people who visit this city will read this blog post and be careful when they are here.

Solving EXIF Metadata Problem

Images captured on smart phones and tablets have a special type of metadata called EXIF metadata. It was actually a minor part of TIFF files. But with the advent of these imaging devices, this metadata has gained importance. A user tends to rotate the camera to obtain the best shot of a given field. The EXIF metadata decides how the image will be displayed. When such an image is uploaded on the net, it may be seen sideways or upside down, depending on how the camera was held when the image was captured.

I faced this problem when I uploaded images for our online journal JPGO. I had to use images sent by the authors of the articles. Asking them to correct the orientation was no good. If they knew how to address the problem, they would have been careful and not let it crop up in the first place. So I had to find the solution myself. Google search did not help. It told me about the cause of the problem, but did not offer any solution. I tried the following.

1. I rotated such an image in Windows image viewer. Then I uploaded it. It was still seen sideways. So I realized that rotating it sideways was only for display at that time, not forever.
2. I opened the image in Microsoft Paint, rotated it through 90 degrees, and saved it. Then I uploaded it. It was still seen sideways. So I realized that rotating it sideways and saving it saved the EXIF metadata as it was before, and that resulted in the image still being seen sideways.
3. I opened the image in Microsoft Paint, rotated it through 90 degrees, selected it, copied it, and pasted in a new Paint image. I saved the new image and uploaded it. This one was seen properly. So I knew this method worked. 

I encountered this problem day before yesterday, while uploading images of our balcony garden on my blog in this post. I took screenshots to explain what I have written above, so that you can understand it.

This image shows the images to be uploaded in my Windows Explorer. They are upright.

This image shows the files on image uploader of Blogger. They are seen sideways. I did not add them to the blog post, because there was no point in making people turn their heads sideways. Most people would move on without doing that.

This image shows the newly created images after the older images in image uploader of Blogger. The older ones are still seen sideways, while the newer ones are upright. They looked upright in the blog post too, after I added them.

Magic Garden

I know a lot of people grow plants in pots kept in their balconies and terraces. Those who are richer buy second homes away from their homes in cities, get people to grow gardens for them there. A problem with that arrangement is that one does not get to see the greenery and the flowers on a daily basis. My wife has 36 plants in pots in our balcony. I cannot say we have, because it is her who takes care of the plants, except that I water them sometimes when she is busy with other things. It was my dream to have a house with a garden. I know that dream will remain but a dream. I have my wife to thank for the great garden she has cultivated in our balcony. Looking at it, I don't mind that my dream will never be fulfilled. Here are some shots of her garden.

Look Or See?

A senior consultant in Delhi told me this story.

A driver does not look out of the window while driving. He sees things on and around the road, which can interfere with his driving. Old doctors are like drivers when they manage things in the hospital. A lot of things are going on at the time, which are looked at by many people, but seen by a very few.
"Who has put that saline bottle on the sterile trolley?"
"It is the trainee nurse from another institute, Sir."
"Its outer surface is unsterile. Now the whole trolley is contaminated. We cannot use it for any patient. If we do, there will be infection. How come no one saw it?"
No answer.
On another occasion, "See that syringe on the trolley?"
"Yes, Sir. It is of local anesthetic solution, for an episiotomy."
"How do you know it contains local anesthetic?"
"It has a label on it."
"But labels are not sterile. So now the trolley is contaminated. Our patients deserve better, don't you think?"
"Yes, Sir."
"If they label a syringe, it must be prepared well in advance. That means there must be more of them."
Yes,Sir. There they are."
Indeed, there was a tray with twenty loaded syringes, all of them proudly bearing the label 'lignocaine'.
"How come no one notices this? Though these are meant to be used during surgery, they cannot be used for that purpose. Their outer surface is not sterile."
No answer.
One would think the eyesight starts failing as age advances. It must be paradoxical that older doctors see many things that others probably look at and forget they looked, never seeing the consequences.
Or is it life in a fast lane, with no time to see anything? But then, drivers in Formula 1 races are in very fast lanes, and still they have to see things if they have to survive. Our lanes are relatively slower, but involve many more lives than in those races.
It must be the curse of old age, when one has to see things which trouble a mind that would rather be at peace.

Mask For Siamese Twins

Surgical masks are available in sterile form, one each in sealed plastic bags. Those are for buyers with a small requirement. Our hospital sometimes buys them in bulk. They are not sterile. They are autoclaved prior to use. I found the mask shown below in the drum with such autoclaved masks.

There are two masks, with three ties at three corners each, and a long tie joining the fourth corners of the two masks. It must have been manufactured in some small scale industry, and the worker sewing the ties (tapes) to the masks must have forgotten to cut the long one joining the two. It reminded me of Siamese twins or conjoined twins. I showed it to my colleagues and residents in the OT. They were also surprised to see such a mask. There was merriment all round when I said, "It must have been meant for use by Siamese twins".

Virtual Oxygen Therapy

I was surprised to find a patient in the labor ward with nasal prongs in place, without any indication.
"Why does this patient have nasal prongs?"
"She had acute fetal distress" came the answer. "Wh gave her oxygen through them."
"How is the fetal distress now?"
"We gave her oxygen and Ringer's lactate rapid infusion. Now there is no distress."
"But why is she still receiving oxygen?"
"No. We have switched off the oxygen."
I checked. The water through which the oxygen is passed before being given to a patient was without any bubbles. So there was indeed no flow of oxygen.
"But why are the nasal prongs still in place?" I asked. This was quite curious.
I leave the answer to the imagination of the readers. A few choices are as follows. There could be other answers too.

a) So that we can switch on the oxygen as soon as there is fetal distress again.
b) So that the patient feels that she is receiving some treatment - a sort of placebo therapy.
c) We forgot to remove the prongs.
d) If we put them out somewhere, they would get contaminated. They are quite OK in her nose.
I have put the radio buttons just for those students who are habituated to selecting one choice when they see multiple choices*. This is not a response form that will get sent anywhere after one clicks on a choice. :-)
(* That is the result of the entrance tests they have to pass through for getting admission to a graduate and then a postgraduate medical course. I wish the University would adopt some better method than this one. But I am not big enough to influence the opinion of University officials.)

Finishing School For Resident Doctors

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We at Seth Gordhandas Sundardas Medical College teach soft skills to residents in addition to university curriculum.

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Visit this link to find details

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One response by email, amongst many such:
I appreciate the efforts you took into training your residents, to help them tackle the stress and remain humane. I wish I had a teacher like you. I really want to thank you for all the efforts you take to send better doctors into the society.

Astrology Guides Doctors?

Opinion is divided on whether Astrology is a science. There are people who are staunch believers in Astrology. Then there are those who say it is all humbug. Finally there are those, me included, who don't know if it is a science or not, but don't want to challenge either of the other two beliefs. I found out the meaning of the word 'Astrology' from a few dictionaries, which is in the following table.

Source	Definition
WordNet	A pseudoscience claiming divination by the positions of the planets and sun and moon
Oxford dictionary	The study of the movements and relative positions of celestial bodies interpreted as having an influence on human affairs and the natural world.
Macmillan Dictionary	The study of the movement of the stars and planets and how some people think they influence people's characters and lives.
Cambridge Advanced Learner's Dictionary	The study of the movements and positions of the sun, moon, planets, and stars in the belief that they affect the character and lives of people.
The Wordsmyth English Dictionary	The study of the positions of the heavenly bodies in relation to each other with the aim of predicting their influence on human affairs.

You must have noticed that WordNet calls it a pseudoscience, while the other sources are noncommittal.
Most of the doctors go through their professional lives doing their work scientifically. Some of them resort to astrology when it comes to things in personal life, like matching horoscopes before fixing a marriage. The times had a story about some gynecologists who were good gynecologists, and still let Astrology guide their professional decisions. They meant well for their patients. One such great gynecologists used to write down horoscopes of his patients, and take actions as dictated by the planets. There was one who did not operate when the planets were not in favorable position, so that patients do not develop complications or die. There was another one who did not operate in such situations, but would assist others operate at those times. Then there were those who would let patients select the day and time of their cesarean sections, but it could have been just good business sense than faith in Astrology. :-)

Microphone Troublesooting

We have a large number of lecture halls in the institute. Each one has its own audio equipment (public address system). The maintenance system is not on a preventive maintenance basis, but on demand basis. Which means you call a service engineer when the system malfunctions, and he will repair it when he finds time, if he can do it. If he cannot, he calls the manufacturer who will repair it in due course. Minor malfunctions are often neglected. I cannot open up such a system and repair it. I dare not try it too, because it belongs to the institute, and unauthorized people are prohibited from touching the insides of the systems.
I have found methods of addressing two malfunctions of the microphones. I believed I had written about the first one in the past, but a Google search of the blog did not show it. So here it is again.

1. The microphone in one lecture hall in the college was making vibrating noises when I spoke into it. It was quite disturbing. I asked the students if it did the same thing at other times too. They said it did. So the fault was not with my speech. I looked at it and thought that there must be something in the upper end which picked up audio and vibrated. I also remembered that posh microphones had some sort of cloth on the surface - felt, duster cloth or sponge. This one was all metal. So I took out my folded handkerchief, wrapped it around the upper end and spoke into it. The students kept watching. This was probably more entertaining than the drab lecture on some gynecological topic. When I spoke, the audio came out perfect. The students grinned all over their faces. I hope they told the subsequent teachers how to address that issue.
2. The microphone in our own seminar hall does something funny. When the audio volume is increased, and one speaks into the microphone, it makes a keening noise that raises goosebumps on sensitive people, and irritates everyone. I had heard somewhere that air currents from fans can cause this effect. The seminar was not being presented well because of this disturbance. Then I had an idea. "Hold the microphone upside down and then speak into it" I said. My theory was that air currents would not enter it if it was directed towards the floor. The resident was reluctant to do so, probably because it would look funny. It must have looked funny to others, because many people laughed and some people even took out their phones and snapped pictures. I had to scold them not to embarrass the speaker, and even threaten to confiscate the phone of a senior faculty. That stopped the merriment. But the main thing was that it actually worked. I hope this post helps when people face this problem. I made an illustration to show how it was, rather than post one of the pictures people shot of the resident doctor. I could not embarrass that resident further, especially when the original idea was mine, not that of the resident. My illustration is shown below. It was a cordless microphone.

For Those Who Cannot Read From Computer Screens

This experiment is to see if the blog can be made friendly to those who are
visually challenged. If it does, I can put important stuff in that speech. The
guy speaking has an American accent, though he looks Indian. The guy's
appearance is due to the software I have used, and his accent is due to the text
to speech service I have used. If he runs out of things to say and becomes
silent, it is time to move on. If you missed what he said, you could refresh
your web page. I can program it to say something else after he is done and the
reader asks for more. But if people do not like this one, the effort will be
wasted.

A Kind Soul

I had made an appeal for anyone to suggest a place on the web where I could post my free ebooks on Obstetrics and Gynecology. Finally a kind soul replied. He/she did not disclose his/her identity, so we have to refer to the kind soul as he/she. He/she suggested Google Drive, DropBox, Box, and One Cloud. These sites permit online storage and file sharing. One Cloud seems to be a paid service. I uploaded my books on the Google Drive for many reasons. The first was that I liked Google. It has given me solutions to many difficulties, and I thought these books should help people through Google. The second reason was that Google would show these ebooks on priority when searched. It was indeed the case. When I searched for 'Shashank Parulekar free ebooks', the first link was the page where I put these links. Actually I have given links on the images of my books shown in one of my blog posts HERE. When a blog reader clicks on that image, the ebook opens. It can be saved from there. I do not have to share the links with people. They just do Google search, reach that page, and click on the book images. That is really quite smooth and satisfying.
I had submitted one book to project Gutenberg too, and it can be downloaded from there. Actually I am feeling quite proud that my ebook is available on such a prestigious site. Google search shows that link too. It is HERE. The process of submitting an ebook there is a bit lengthy. When I find time, I will post the other ebook there too.

I am grateful to that anonymous kind soul for his/her suggestion. I hope this post will help others who want to post their free ebooks on the net. After all, our kind soul may not read their appeals and email them as he/she emailed me.

Variant Cestrum nocturnum

My wife's hobby is gardening. We have a balcony garden with more than 30 plants, most of them flowering ones. One of the recent additions was Cestrum nocturnum, which in Marathi is called Ratrani (रातराणी). It has extremely fragrant flowers which bloom at night. When our plant bloomed, I could get a closer look at the tiny flowers, which is not possible in gardens, because they cannot not be seen in the dark. Ours was unique. Most dicotyledonous plants have five petals, monocotyledonous ones have three. Our plant had some flowers with five petals and some with four. It is not known to happen in nature. I searched Google images, and all Cestrum nocturnum flower images had five petals. Try it. For those who want to look at our flowers, here are two images. The first one shows flowers with five petals, and the second one shows flowers with four petals.

They are seen clearly enough. I have not put any arrows to mark them. Do write to me if you think they should be pointed out with arrows.

Reproduction Instinct

When I was a kid, my mother would give me coconut sprouts to eat, whenever they were found inside coconuts we bought. Then I went to college and it stopped. Then I stopped eating coconuts and hence did not get to even see those sprouts. But I still recall - they used to be perhaps 1-2 cm i n diameter. The other day someone gifted a dry coconut to my wife. When we opened it, it had a huge sprout in it, measuring about 5 cm in diameter. The coconut was perfectly dry, and the sprout was looking perfectly healthy.

'That is the reproduction instinct,' I thought. 'This coconut has dried up, but it has somehow nurtured its sprout.'