Day 5

Day 5 – Back to Normal!

Day 5 was back to a normal day with Dr. Bloom! Upon my arrival, Mrs. Bridges and I examined today’s patient schedule to plan which patients I could visit with. The following are some of the day’s highlights…

9:45am patient (40 year old male): This patient was here for an office visit, regarding a 2 week follow-up on his left clavicle fracture, which happened 4 weeks ago. As soon as he arrived, he was sent to the x-ray room, where the x-ray technician took his 3rd x-ray. In the x-ray, the bone in the clavicle was evidently protruding. Dr. Bloom later explained to me that his fracture was known as a comminuted fracture, meaning that part of the bone sticks out on top of the other. A callus then forms around the bone, which causes a small “walnut-shaped” bump. The patient detailed that he has been pain-free the past two weeks and fells like his is plateauing in his healing process. He has been doing leg training fro exercises, as well as some dumbbells and bands with his right arm. Dr. Bloom advised him to begin some aerobic exercises, such as bike riding and the elliptical, for this helps to speed up the healing process. Dr. Bloom then had the patient take his shirt off and tested his movement and strength with various exercises. The patient was pain-free throughout the examination, even when Dr. Bloom pressed along the fractured spot. Dr. Bloom explained that the patient is healing properly and that he is about 60% healed (a clavicle fracture takes about 8-10 weeks to heal). He said that the patient can start some slight arm training (exercises below the shoulder), as long as he is not loading the collar bone and that he can begin running at the 6 week mark, as long as the symptoms don’t worsen. The patient also asked if he was able to use a bar for squats instead of a belt, and Dr. Bloom assured him that this was fine, as long as the bar didn’t load the collar bone. The patient will return in 3 weeks for a follow-up appointment, and then in another 7 weeks to be cleared for contact sports.
11:15am patient (55 year old female): This patient came to the office for an urgent visit, concerning a follow-up on bronchitis. 8 days ago, she was seen in urgent care for her condition, where they ran a chest x-ray and blood test for her white blood cell count, and then prescribed her some cough medicine and an antibiotic. She has had bronchitis for a week and a half now. She took a week off from playing tennis but started playing again last night. She has been improving, with no pain in her sides and back when she coughs, but still has some shortness of breath (especially when she was playing tennis). She finished all of her prescribed medications and hasn’t taken the cough medicine for the last 2 days. Dr. Bloom listened to her breathing and then checked her throat, which both sounded and looked good respectively. He recommended that she take Albuterol 15-20 minutes before exercising, which will help with the shortness of breath. Dr. Bloom also said that hot and humid days will be harder on her breathing. He assured her that she is healing well and is on the “mending track.”
11:45am patient (11 year old male): This patient came to the office for an urgent visit, concerning arm pain. During a baseball game, he had been swinging the bat when he noticed an abrupt onset of right upper shoulder pain. He was unable to throw the rest of the game and began having difficulty moving his right arm. He did not pitch this past weekend. Upon his arrival at Dr. Bloom’s office, he rated his pain level an 8 out of 10. Dr. Bloom ordered for him to receive an x-ray and diagnosed his condition as proximal humeral epiphystitis or little leaguer’s shoulder. He will have a follow-up appointment in 2 weeks and until then, he is not allowed to do any throwing or batting. He was given some gentle range of motion exercises for the next 2 weeks.
1:45pm patient (46 year old female): This patient came to the office for an urgent visit, concerning a follow-up from her appointments on Tuesday and Friday due to poison ivy. Dr. Bloom prescribed her prednisone, which she began to take last Wednesday; however, she developed a rash along her neck. Dr. Gavankar then met with her on Friday, ordering her to stop taking prednisone if the poison ivy/rash continued to spread. The poison ivy spread to her hands and up her arms and the rash grew along her neck. Thus, she stopped taking prednisone on Saturday. There was a chance that she was allergic to prednisone, but this was her 4th time taking it. She did detail to Dr. Bloom how she has had more reactions to prednisone this time, including restlessness, nervousness, and lack of sleep. Dr. Bloom and Dr. Gavankar met to discuss her recovery plan. They prescribed her Medrol dosepack (a tablet) and Clobetasol ointment to be put on her neck/chest twice a day. She will be sending them a My Chart message tomorrow with an update. Mrs. Bridges also called a dermatologist to schedule the patient an appointment on Friday, if the symptoms do not improve or worsen.
2:15pm patient (43 year old female): This patient was here for an office visit, regarding the removal of keratosis. The patient had some sort of spot on her neck that she wanted removed. Dr. Bloom performed cryotherapy, which is a method of removal by freezing the area desired. Dr. Bloom had a styrofoam cup of “dry ice” that he applied to the patient’s skin with a Q-tip. He squeezed the area around the patient’s keratosis and gently dabbed the Q-tip repetitively. He dipped the Q-tip back into the dry ice multiple times before finishing. He explained to her that there might be some slight irritation the next few days, but it will heal on its own.
2:45pm patient (40 year old female): This patient came to the office for an urgent visit, concerning an acute cough. She has had the cough for the past 3-4 weeks and feels as though there is a film covering her lungs that she can’t cough up. She has been taking Mucinex the past 3 days, which Dr. Bloom was content with, since that medication helps with drainage. Her coughing is much worse at night and has led to her having trouble while sleeping; last night was the first night she could sleep normally (she raised her pillow). Dr. Bloom checked her ears, which have slight fluid in them, and then checked her throat and breathing, which both looked and sounded good respectively. He explained to me that with these conditions, it’s important to determine whether it is infectious, caused by allergies, etc. Dr. Bloom advised her to continue taking Mucinex, and he also prescribed her Robitussin with narcotics at night to sleep better. He said that if she still isn’t better by Friday or if she gains more infectious symptoms (such as a fever), then she should portal him.

SAS Work Experience Day 5

Today all of the Cary Academy students doing the SAS work experience program were together again to learn about and work with the specific software and technologies that employees at SAS use to analyze data and create visuals. From being introduced to the programming system, the SAS design studio, and the visual analytics program, we were learning and experimenting all day – with a mid-day break for chicken tenders at Building T’s cafeteria of course.

One of our main activities was learning about SAS’s programming system. Since I, and all of the other CA students, had never programmed before the idea of this was somewhat daunting. However, with a detailed, step by step introduction to programming, it was much less complex than I had originally imagined. Below are some screen shots of the work we did.

For our data, we entered in some random numbers and then ran the program to create a frequency analysis and means analysis. Some things we learned include always remembering to put a semicolon at the end of each action, and also how to make notes that sit within the code but do not actually run through the system – these show up in green. Also, if the run fails, we learned to go to the log tab – shown below – and see if there are any errors or notes to indicate what went wrong, which is very useful.

After learning the basics of SAS programming, we were introduced to the SAS design studio where visual analytics can be created from data. Together we went step by step through a few examples, with various types of visuals like bar graphs – pictured below, line charts, lists, and more.

Once we had completed these models, we were able to work independently and experiment with the program to create our own visuals. What made this entire process especially interesting is that we were using real data from the UN about frequency and pricing of foods in different nations. Pictured below is one visual that I created with a pie chart and list, set up so that when you select a certain food on the list the pie chart will depict the frequency of it in specific nations.

Overall, today was an amazing introduction to the world of data science, programming, and analytics, which will be extremely useful in the future!!!

Day 5 – Carbon Printing Fun

After a traffic-packed morning on I-40, I made it back to Chesterfield for another day of fun and adventure! Today, I worked with Brian, a PHD student working to create orthopedic applications. The issue Brian is trying to tackle involves patients that have deteriorated knee joints that require fillers to help their mobility. Often times, the surgery required to install these fillers will lead to bacteria-caused infections, complicating the process and potentially requiring extra-procedures that might damage the patient’s health even more. Once more, there are not many effective methods to apply antibiotics to these infections once the surgeries are complete. Thus, Brian is developing a specially designed reservoir containing antibiotics that is to be put within the bone implants to combat potential infections. Antibiotics are either stored in a paste or a hydrogel inside of the reservoir. The goal of the project is to create a reservoir which will be easily implemented into the fillers, but also to have an extended amount of extrusion time. After a surgery, the reservoir is intended to constantly extrude antibiotics from the paste to the patient’s blood for a period of over 90 days. In order to achieve an extrusion process for such a long time, the reservoir must be carefully designed to let out small amounts of antibiotics over a large period of time. Brian is studying the numerous amounts of designs up for consideration.

Essentially, the design is a half moon shape since that will most easily fit into the knee filler’s open space. Current knee fillers are made of a bone cement material that is not particularly strong, so Brian is making his filler prototypes with a stronger material, RPU 60, a polyurethane. Some of the reservoir prototypes are also being made in the form of cubes for easier testing. As depicted in the images, each of these reservoirs has a holes, or channels, in the walls so that antibiotic paste can disperse into surrounding liquid overtime. The diameter, length, and orientation of these channels are the main factors being tested. As you can see in the image with the half moon samples, there are tiny channels on the walls where the antibiotics can escape. These holes may also connect to tubes that extend into the reservoir. The length of these tubes is a strong factor that affects the time it takes for all the antibiotic paste to disperse into surrounding liquid. The longer the time, the better. Brian has already made hundreds of different reservoir samples using a carbon printer in the lab, and has tested reservoir samples for antibiotic concentration, obtaining massive collections of useful data. One of his designs has exceeded the expected 90 day requirement and reached a 105-day span until all the antibiotics were extruded into surrounding liquid!

Brian creates all of the reservoir samples using a carbon printer: a sophisticated machine that prints using resin and a UV light. This machine even has a foot-motion activated door! First, the desired compound is ejected using a gun into a beaker. The RPU 60 material that Brian uses contains two components that need to be mixed thoroughly before printing. The gun’s tip helps to mix them well. As depicted in the image below, the gun’s nozzle has a long spiral design that receives two separate substances but quickly mixes them thoroughly. After the required amount of resin is extruded from the bottle (77 mL in this print), it is poured into a clear bed in the printer. The door closes, and a platform lowers into the bed to touch it. The technology behind the print lies in the UV light. As UV light shines underneath the bed, any resin exposed to the UV light will solidify. The plate above helps to create a mask above any resin that is not to be solidified. Layer by layer, the plate raises by only a few millimeters per hour to create the print. Each a layer receives a unique mask that will cover parts that don’t need to be solidified and expose parts that do. After about 2 hours, our print was successfully made to an extremely high precision quality. Today, we printed two more unique reservoir designs, a funnel used to aid in pouring the powder into vials to make the antibiotic paste, and a stirring rod. Brian designs all his prints using AutoCad, a highly sophisticated program that allows for extremely precise creations that can take hours upon hours to design.

The finished products were quite a sight! They were stuck to the top plate, as usual, but the carbon printer has some quirky characteristics, one being that a lot of the original resin is stuck to the products. The resin is highly viscous and is a slight pain to clean up. Nevertheless, there are certain cleanup procedures that make the process a little easier. First, the items are pried off of the top plate and placed in a tub of isopropyl alcohol (2-proponal) and shaken until the viscous resin gets off of the solid products. At the same time, the clear tub and top plate are both cleaned out with isopropyl alcohol and acetone is used to wipe down the clear tub’s glass. Though messy, the cleanup process is crucial to ensuring that the finished products set properly and that the printer’s parts can be reused for future prints. To clean the hollow cubes thoroughly, a syringe is used to pump isopropyl alcohol in and out of the small channels to ensure a resin-free product. After everything is sparkling clean, the products are placed in an oven set at 120 *C for 4 hours to allow the material to achieve its highest potential in terms of its structural properties.

In the afternoon, Brian and I designed a Cary Academy charger horse keychain on AutoCad, and we plan to print it out tomorrow using the carbon printer! After much troubleshooting, the design turned out fairly pleasing. Although today was a short day, I learned substantial knowledge about the different medical applications 3D printers can truly bring forth. With all the advanced technology Chesterfield Lab has, there are an endless amount of possibilities for the devices one can create. The sky is truly the limit on this one!

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Milen and I began our fifth day at Field2Base by once again attending the development team’s daily stand- up meeting. After the meeting, we helped Mary with part of a form for a customer. In this form, we pulled from a spreadsheet to output a branch name, number, and up to six relevant email addresses to be displayed on a page and automatically used throughout the filling of the form as a whole. After we scripted the SQL for this to function, we tested the form both in forms designer’s preview mode and on an android tablet to assure the new functionality worked with no issues. After this, we started another form for Mary except this time from scratch. Given the form backgrounds, we built the buttons and functionality in order for the user to navigate the form and have extra pages appear when needed at the press of a button. After lunch, we had a video call with another one of the developers, Ravi. Ravi lives in Charlottesville Virginia so he works remotely for the development team. We talked with him for about an hour about his career path and his thoughts on the software industry as a whole, given how constantly evolving it is and that personal education in the software field is constant and doesn’t stop after college. Once we were done talking to Ravi we continued work on the form for Mary. We finished the functionality of that form and headed home for the evening.

Day 1 with Valassis Digital

Today was my first day working with Valassis Digital. Valassis Digital is a digital marketing and advertising agency that focuses on using digital ads so consumers buy national brands in retail stores rather than online. Valassis Digital is special because it prides itself on its defining characteristics of massive owned intelligence and ad safety. First Valassis receives information about consumer through internet habits, IP addresses, etc. Then using all this information Valassis maps devices to physical addresses to ensure consumers are receiving the proper sorts of ads. Valassis then works with advertisement branches of companies and outside consultants to ensure the proper type of ad reaches the proper audience. Through ad auctions that occur when a site page is loading, Valassis bids to have their ad shown. Secondly Valassis is known for ad safety because they use a special algorithm to weed out robots versus people. A lot of companies do not bother to do this because it can boost their profits; however, Valassis wants to make sure they are doing the best and most accurate job for the client.

I am working specifically in the Business Development sector of Valassis Digital. The Business Development team is in charge of figuring out and implementing where the business wants to be in 3 to 5 years. The BD team works closely with the product team to figure out who/what is the competition as well as what needs to be done in order to stay a competitive company. The Business Development team has 3 main choices when achieving a client’s goal. Valassis can partner, create the product ourselves or buy the product from another company. Valassis Digital is beginning to get into the pharmaceutical advertising business so today I researched possible conferences and consultants. I made spreadsheets with information about healthcare advertising conferences and possible healthcare advertising agency consultants. Overall it was an awesome day and I learned a lot.

Day 5-New Faces

On Monday, I met Judge Rader. Judge Rader is the head judge for the Wake County District Court. He was the one that allowed me to do an internship with the judges, but he had been on vacation in Italy for all of last week. Because Judge Rader was back, Judge Davidian could finally return to the criminal side of the courts and escape family law. His regular room was room 202, which he described as the “garden variety” of cases. They mostly involved Class 3 Misdemeanors, which often would only result in a fine depending on how many other crimes that person had committed. If they had committed more than three previous misdemeanors, they could be sent to jail, but only for a maximum of 120 days. Therefore, Judge Davidian is provided with a printout that shows how many other misdemeanors people have committed. I was surprised; the numbers ranged from forty-five, to thirty-eight, to no priors at all. It amazed me that some people had been to court almost fifty times.

In 202, there is a lot of paper pushing mostly due to the sheer number of cases. I’m constantly impressed by the number of people that manage to get arrested in Wake County. I also learned that because of the 5^th amendment, you are not allowed to talk to a prosecutor without an attorney present so you don’t accidentally say something you’ll regret. However, lots of the lawyers have many cases at once, so they have to rotate rooms and often show up later. This causes some backlog, but the schedule ran smoothly regardless. In the event that some people show up late to court, Judge Davidian makes them wait until the end of the day for their trial because he hates doing the paperwork that he has to file when people don’t show up. I see it as a win-win: Less paper for the judges and also less frustration by the people.

In 202, I saw Mr. McCoppin, who I will be interning for this summer. It was interesting to see a preview of what I would be doing and also to know that I will be coming back to court and get to see all of the Judges again.

For lunch, Judge Rader took me to the Women’s Club, where a Wake County Bar lunch was being held. The Wake County Bar was an optional bar with member fees, but it gave perks like free lunch and also managed awards for lawyers. At this meeting, they gave out some awards to outstanding attorneys and also made all the guests stand up and be introduced. When I was introduced, I recognized someone that had come in as an Alumni from Cary Academy on Career Connections day. She recognized me as well, and I thought that was very cool. Also, at my table, one of the men told me that his daughter was in 8^th grade at CA. I got to see just how far the alumni network reaches and also meet some very successful lawyers.

Day 5- RTI

.We spent the morning doing some work on the reinvent the toilet project. Which although pretty smelly, was a really cool experience. It was a project that could make a real difference in the world, as it plans to create a toilet that is self-sufficient and doesn’t need additional water or energy, which could be monumental in solving health and sanitation problems, especially in India. Dr. Katie Sellgren, who is a main component of the project, has also designed an osmotic pump that uses forward osmosis as opposed to reverse osmosis to clean the water that will be used to flush the toilet. Kiera and I got to test several water samples using a variety of devices.

In the afternoon, we got to experience all the stages that go into making a medical implant. It was like a cooking show where they have pre-cooked items so that the host can continue doing the show without waiting for things to cook. Dr. Natalie had each stage of the implant pre-made, so instead of waiting in between steps, we could move forward. It was really interesting to see how these implants are actually made.

DAY 5: Lots of Smart People

It’s sort of a given that if you’re working in a medical research lab, you’re going to be surrounded by really smart people. Even if they don’t bear the title of Principal Investigator, everyone I’ve been surrounded by for the past few days has clearly radiated intellectual prowess. On Monday, I witnessed this phenomenon times a hundred, with a visit to the Genetics building for the monthly inter-lab meeting. The point of these monthly meetings, or “journal club”, is for different people to present scientific research that relates to their current field of study. Whether it’s a new technique that could serve as a better alternative to an existing one, or a particularly interesting set of data that reveals a finding that may change the course of their own research, journal clubs are designed to keep the researchers updated and informed.

When we all started learning foreign languages as sixth graders at Cary Academy, we often searched for words that we recognized in a sentence and used context clue to figure out what was being said. As an avid language learner, I was excited to try to use this strategy to get the most out of the lab meeting. However, I quickly realized that the tactic I used to get through those first few Spanish classes was not going to work when trying to understand complicated molecular biology and genetics. Through my exposure to the sciences especially, I’ve recognized the importance of building a solid foundation of knowledge from which to build off of. If your foundation is weak, you won’t be able to grasp more complicated topics. I’ll be very honest: a lot of the advanced concepts that were presented in the meeting flew straight over my head. In fact, there isn’t very much of the presented research that I could specifically reference and clearly describe right now, even just a day after attending the meting. However, what I did appreciate and enjoy was the engagement and discussion from the rest of the audience following the presentations. People weren’t afraid to challenge the claims made through certain charts and figures or to express their genuine interest in learning more about the subject.

While I may not have learned much actual science today, I did learn a lot about how science is communicated in a practical way. For example, graphs and figures need to be understandable and clear in order to deliver the intended message. One of the really interesting figures that we looked at in the meeting was a 3-D online model of the data that could be spun around to view from all angles. I also recognized how much effort scientists around the world put into making sure that their research can be shared, exemplified through the intricate 3-D online model.

Day 5- Absent (Sick)

DAY 5

Today was a bit different, as I spent almost the entire day over at the hospital. I began the morning by meeting with the CFO and CEO of the hospital, which was a highly intriguing experience. I was apprehensive going into it, as I knew I was going to be meeting some pretty important people. However, that apprehension quickly disappeared, as both of them immediately put me at ease with their charisma and character. It became very evident to me as to why they were in their respective positions- both seemed to be fantastic leaders.

I then sat with the office manager over at the hospital for an hour or so, and she explained to me what she does on a daily basis. It was a nice change of pace being over at the hospital, where all of the action was happening. I then met briefly with the OR Director, who, much like the CEO and CFO, humbled me with her leadership skills and charisma. Though our meeting was short and was interrupted by frequent thunder and lightning, I was impressed by her ability to be a strong leader while also clearly showing immense compassion for those who work with her.

I ended the day by meeting with the associate chief nursing officer. This was probably the most entertaining meeting of the day, as he seemed to have a relatively expansive life story. In a nutshell, he’s lived everywhere, worked everywhere, and seems to have done every job under the sun (in the medical field). As an administrator, he has quite a few duties he must carry out on a daily basis. I thoroughly enjoyed hearing about the career path he has taken over the years.

Tomorrow, I think I am headed back to the hospital again. It has definitely been a nice change of venue, and I look forward to it!