Archive for April, 2011

Ram’s Island

Yeah I know you’re all bored sick of Coney island.

Well we found a new one. By found I don’t mean we actually found it. It’s been there for a while now, and we’ll not be first to claim discovery or anything…

Sorry if the screen grab is a bit small. But you can see that Ram’s is a fair bit bigger and further out than Coney is.

My only knowledge of it growing up was that it was full of rats and no one went near it.

Apparently the environment folk had someone working all over the lough for 18 months solid solely to rid the islands of rats. Quite the job really.

The birds are flourishing there now, a sure sign that there are no rats left.

We started out at Gawley’s gate, which seemed to be a pub with a jetty and launching point out the back of it. It’s covered in cloud on the google map so I didn’t mark it

The best bits of these trips are the trees. Something like what Ireland might have looked like, an awful long time ago. There’s not many places like that left so it’s nice to see them.

It was a good 15 minute walk from where we landed to the “populated” end of the island

This jetty isn’t in regular use…

The whole walk was covered like this. the indents you can see are our footprints. Very cool.

Every now and again you find old remnants of previous structures. The website has some interesting stuff on the history. One of the most interesting bits is that the lake used to be 6 acres up till recently when the lough was controlled and lowered and it’s now 40 acres

The bit Simon’s standing on would have previously been the shore and the rocks were piled up to stop erosion.

It had at one point been a landscaped garden as the daffodils here give tell to. The flowers are missing because there’s a current population of rabbits there that have a liking for them. They’re trying to work out how to control the rabbit population without causing some other ecological niche to go out of kilter.

the round tower is apparently fairly old. As they tend to be. It’s been patched up here and there.

The story goes that the Americans put the hole in it while using it as target practice in WW II when they were based on the shore about half a mile away. So much for cultural heritage…

The joys of canoeing on fresh water is that you don’t have to worry about your canoe washing away on the tide

No comment

The main jetty is to the right

The whole place is largely volunteer maintained. There’s a guy who stays there in a moored old barge every weekend with his family and does a lot of work at the place.

Hopefully we’ll camp there at some point, but you have to wait till after June and the birds have finished their laying and all that.

Eric the gardener – part 2

the garden is flourishing.

it’s kind of cool. you put something very small in the ground and after a while something cool grows out of it. And you don’t even have to do anything for that to happen.

The photos below are a few weeks old now so there’s been a bit more growth since

This is probably my coolest thing. This was originally an old water tank lying out the back of the shed when we moved in. I refashioned it with a couple of holes in the bottom and put a bit of wood across it about 10 inches from the top and filled it with compost.

The wood slipped initially and needed a few screws to hold it in place. It seems to be holding well now but drainage isn’t quite as good as I would have liked.

Spinach on the left and rocket on the right

on the left is the ever rampant mint, which even Phil with a strimmer couldn’t manage to kill when we first moved in.

the green on the right is the flat leaf parsley, though i suspect it’s done too many seasons.

the dead twiggy thing in the middle was a rosemary plant that friends had bought us but didn’t get time to get established before the snow killed it off

the little green shoots are red onions just starting.  i bought these as little tiny onion bulbs or whatever you call them.

these are peas or beans or something. I can’t quite remember which. Definitely something that will need the cane in the photo anyhow

the yellow tulips are lovely, we planted some as bulbs last year and that’s what makes up the strip largely. Left of the shed is all the compost i was trying to make from grass clippings that i forgot to use before planting this year. D’oh…

The “greenhouse” is something I found in my Dad’s workshop that Liz was kind enough to let me steal. It works pretty well considering.

In it are virtually all tomatoes. They were started indoors under the kitchen table but seem to be coping ok now that they’re outside

There’s some basil and coriander in the polystyrene at the top right. I just repotted them today and i think i left it a bit late, the rootlets were starting to dig into the polystyrene.

The tomatoes need thinned out a bit too i think.

Oh and the green thing at the bottom is mainly chives with some severely struggling oregano in there too.

Diuretic Strategies in Patients with Acute Decompensated Heart Failure N Engl J Med 2011;364:797-805.

This paper should be kind of a big deal I think.

We treat a lot of heart failure, and we don’t really know how to treat it. We give lots of drugs to make you pee, to “dry” out the lungs but we have no real evidence that it works or does anything.

These guys tried to answer a bit of the question.

Allowing that we’ll give them diuretics even without evidence, what about the dose (high vs low) or the mean by which we give the drug (bolus vs infusion)

Enrolled sickish CHF patients but excluded the real ICU cases. They enrolled them once in the hospital, not from the ED.

Low dose was their daily, chronic dose but in IV form, and high dose was 2.5 times their normal daily dose.

The fascinating thing was that they found diddly-squat of a difference no matter what treatment they got. Not only was there no difference in their primary outcome (a basic “do you feel better at 48 hours” but there wasn’t even any difference in harm! If we gave them 2.5 times the does, the kidneys did pretty much the same.

When I rooted around in the supplementary appendix for the mortality rate (and why wasn’t it in the paper?) it was roughly 15% at 60 days for all 4 groups.

This should really beg the question – if it doesn’t make a difference how or how much we give of it should we be doing it at all?

Of course us empiricists have been asking this for a while, we just don’t have the answer yet.

Over my 6 years working, i’ve changed a lot in my use of diuretics, from low dose, to mega-dose, to almost homeopathic dose these days. It’s hard to admit a patient with CHF without giving some, people look at you funny.

Urine Test Strips to Exclude Cerebral Spinal Fluid Blood West J Emerg Med. 2011;12(1):63-66

When I did my elective in South Africa we used to diagnose TB in the casualty dept. by sticking a cannula in the pleural effusion, sucking out some fluid, diluting it 1:9 with tap water and then dropping some on a urine dipstick. If you had 3+ of protein you had TB.

These guys did a somewhat similar idea with CSF samples looking for blood.

Absolutely cracking idea for a study.

Few problems (which they acknowledge)

– they looked at whatever CSF came into the lab that wasn’t grossly xanthocromic. Lots of these weren’t for SAH and indeed they don’t tell us how many were +ve for SAH

– it’s not clear if time delay to testing would be relevant. They tell us it was within a week but it’s not clear if it’s significant

They found moderate (about 90%) sensitivity and specificity in the 50s. Not good enough for SAH in my opinion. Gold standard was spectrophotometery here, which is better than a guy in a lab holding up the tube against a sheet of white paper deciding if it looks a bit yellow or not.

Worth some follow up study

PS the Werstern Journal of Emergency Medicine has some nice stuff but doesn’t appear to be on PubMed?

Imitation of life

We’ve had a lot of death and sorrow this week.

A much loved member of our church died this week, and we’ve been the church as we should be in such circumstances.

In work, we also had our memorial service for the people who donated their bodies for use in the anatomy department. The service happens every few years and the families of those involved are invited, and the students and staff run the service.

One of my colleagues (from a Muslim background) was moved by how the way we deal with death and mourning rites differs from those in her own country.

Death comes to us all but perhaps in Christianity, and in how I’ve seen it iterated this week in the church, it can (and even should) be a normative (though mourned and expectant for liberation) part of  our existence

 


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