Hoorays for several things:

First, I think they're just about done putting girders into the new hospital wing. The uprights that I can see all have cross-pieces on them now. I'm sure it'll be a few weeks before they finish filling in the joists for the floors, then it'll be a major cement pouring operation. I hope the winter isn't too rainy here or at least is consistently wet or dry. Flaky weather is bound to drive the guys in charge of mixing the cement crazy.

Second, I actually got the syndromic surveillance analysis software to work two days running! I didn't expect that. I didn't expect it to not run, but given that I had to change the input data file that was a definite possibility. I even got Excel to re-name the facility field automatically. The next step is to get the process automated and to write a protocol for responding to "flags" or aberrations in the data.

There were two flags in a row for fever with neurological symptoms at one of the facilities. The data today did not generate a third flag. There were only three cases in two days and the demographic data indicated a couple of kids with headaches and fever. Probably not WNV, but could be LAC. I'd bet neither kid got tested for arboviral encephalitis, though I'll keep my fingers crossed just in case.

Thirdly, I got complimented about my work. I had sent an e-mail inquiry about a hepatitis A case which was complicated by the patient also having liver cancer and recently having his gall bladder removed. Patient has had symptoms consistent with HepA for several months. Patient has positive test for Hep A IgM. Elevated IgM indicates infection in the past 4 to 6 months, but the duration of the disease is much shorter than that. Patient was also vaccinated several years ago. Patient's liver enzymes were elevated, but that is to be expected with liver cancer and a pissed off gall bladder. Since the liver history and its associated symptoms could very well have obscured any symptoms from an acute Hep A infection, the decision was made to give IG to the patient's wife and family contacts. Better safe than sorry.

I'm not convinced this is an acute incident of hepatitis. Patient's vaccination should prevent acute infection, though should not result in positive IgM test result. Even if patient did not become immunized by the vaccine, we've got no way of knowing when in the past several months during which he was sick was the period when he was sick with Hep A. Prophylaxis is only useful if given within two weeks after the last exposure to the virus. That could have been months ago. The elevated liver enzymes are to be expected since the patient has liver disease. I'd love to see a second test result on this patient, esp if I could get IgM and total anti-Hep A. That would hlep clear up whether this is an acute infection or something else. Acute infections lead to positive IgM and negative total anti-HAV. There would also be an increase in IgM level as the patient's immune system reacted to the infection.

I think the patient's physicians ran a hepatitis panel as a shot in the dark after the cancer diagnosis. This is exactly the kind of testing which destroys the positive predictive value of tests.

Anyway, I e-mailed to get an opinion from a colleague on this case. I told him I wasn't convinced the patient was an acute case and explained why. His response was that I had provided an excellent summary (with explanation point!). He also said he agreed with everything I said.
W00t! That just totally rocks.

I also asked the colleague if he ever finished reading Arrowsmith since I had seen him reading it a month ago at a software training course. He said he did, but did not find it as engaging as the person who had recommended it had found it. I've got a copy of Arrowsmith and Main Street on my shelf. (Raided my mom's stash of lit books a long time ago.) I started Arrowsmith at one time, but never got very far. It just wasn't good bedtime reading. I may have to pick it up again and use it as evening reading. Right now I'm just starting the 4th Harry Potter book as my bedtime reading. I haven't got anything picked out for evening reading. Mostly I've been knitting and blogging in the evenings.

Walking and eating and cooking:
I only walked for 15 minutes today. I kept running into people in the parking lot and talking instead of walking. It was also pretty hot out. I ate Spanish Millet for lunch along with a tomato and some raspberry yogurt. It was quite tasty. I think it would be more flavorful with the addition of cumin, but that will have to wait until my next grocery store trip. Tonight I'm going to cook up a "mess of greens" and maybe mash up some more potatoes to go along with them.

Now for the bad news....for dinner I had one snickerdoodle, four twizzlers and some cheese and crackers. I'll make some soup in a little while. I'm feeling a bit dehydrated today, even though I drank 64 ounces of water at work.

The yard:

Moles have now reached the deck. It's kind of neat. It's like watching a siege, complete with tunneling up to the castle. I'm hoping the little critters will just keep on moving into the neighbor's yard. I really wish I could get the backyard tilled up. I would like to take apart and clean the tiller carburetor this weekend, but my time would be much better spent actually unpacking and organizing the inside of the house. Can you tell by how long it's taking me to unpack just how much I like unpacking? I thought so. :o)

Sprayed the rosebushes with insecticidal soap tonight to kill the spider mites. Accidentally spritzed the praying mantis. I thought she'd left. I hope I didn't get any soap in her eyes. That'll sting and I'm pretty sure her front legs aren't really designed for wiping her eyes very well. I wonder if she'll eat spider mites or if they're too small for her to bother with.

So, last weekend, I overseeded part of my back yard. It's not rained since. I haven't bothered to water, mostly because I haven't remembered. I remembered tonight. Now I'll have to remember to turn the water off.

I'll have to mow this weekend. Since I de-thatched the front yard, the runners from the bermuda/zoysia grass are all sticking straight up like it's got bedhead. It's kind of cute. It would be more cute on a freshly awakened 3 year old kid.

Website of the day:

Brooklyn Superhero Supply. Now you know where to go to buy your favorite superhero any supplies he or she may need.


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