01/22/2021
Tiffany DohertyLast year we did an episode on the third annual Shkreli Awards from the Lown Institute – ten examples of profiteering and dysfunction in healthcare. The ins and outs of the healthcare system are the bread and butter of this channel, so we were more than happy to dedicate another episode to the fourth annual Shkreli Awards, and this year’s did not (or did?) disappoint.
08/10/2020 guest contributorWestyn Branch-Elliman, MD, MMSc is an Assistant Professor of Medicine at Harvard Medical School and a specialist in infectious diseases. She is formerly the Medical Director of Infection Control for the Eastern Colorado VA Healthcare System. She is a clinician investigator at the VA Center for Healthcare Organization and Implementation Research with expertise in epidemiology and implementation science. Her research is focused on measuring the risks and benefits of different infection prevention strategies and on expanding infection control beyond traditional inpatient settings. You can follow her on Twitter: @BranchWestyn 
One of the cornerstones of infection control is hand hygiene, but it can be challenging to impart to kids why it is important, and also how to perform hand hygiene most effectively. As a former hospital epidemiologist, promoting compliance with hand hygiene was one of the most important parts of my job: hand hygiene really does save lives.
In my role as Medical Director of Infection Prevention, one of the strategies I found to be the most effective for showing the importance of basic hand hygiene was the “handprint” experiment. The basics are simple: make a handprint on one agar plate, then wash your hands, then make a handprint on another agar plate and compare them. The results of this experiment are usually dramatic—and can lead to a long-lasting memory about the effectiveness of hand hygiene among participants.
Because of the effectiveness of this teaching method, I spent a long time thinking about how to translate it into an at-home or in-school experiment so that kids could also benefit from the visualization of seeing what is living on their hands (at least the bacteria), and how hand hygiene (either with sanitizer or soap and water) impacts bacterial growth, or the “germs living on your hands.” In thinking through how to do this myself, without the back up of a fully functioning microbiology laboratory, the biggest roadblock I encountered was the lack of an incubator—pretty much everything else is readily available on the web. My husband inadvertently solved that problem when he purchased himself a folding proofer for his bread making. One day, we were sitting in our kitchen and he was proofing his bread at a particularly high temperature. While he was programming the machine, I noted that his collapsible proofer could hold a temperature of at least 97 degrees for days at a time and I realized—much to my husband’s horror—I was finally in business.
At the time I designed these teaching experiments (step-by-step instructions can be found here), my kids were in first and third grade, and so I tailored the teaching and the framing to different grade levels. I kept things simple for the younger kids, and just designed a simple pre-/post experiment with hand sanitizer (Option 1 in the step-by-step instructions).
For the older kids, I tried to incorporate some teaching about the scientific method, including developing and testing a hypothesis (Option 2 in the step-by-step instructions). For this version, I split the class in two, with half of the students performing hand hygiene with soap and water, and half performing hand hygiene with hand sanitizer. Then, I asked the kids to make a prediction about which one would work better, and then we tested that prediction (they were surprised by what they found!).
Our Real-World Findings:
Their hypothesis was that soap and water would be superior to hand sanitizer.
Some pictures of the paired hand sanitizer results:
Note that there are many more little dots (e.g., different bacterial colonies) on the pre-plate than the post-plate. The number of different dots is what you (and the kids) should be looking for to measure efficacy. The post-plate does have one big circle, but that is just one large colony!
This one (also a hand sanitizer example) is particularly good for demonstrating the difference between pre- and post hand hygiene:
Here are a few more examples:
These were some of the examples where you can really see that the hand hygiene worked, and the counters of the fingers on the “pre-plate.”
Each kid in the class graded their own plates and we tallied the results as a group. Here are the approximate results:
Being an epidemiologist, I actually calculated a p-value (using a chi-squared calculator to test the significance of the difference between pre and post in soap and water versus hand sanitizer): P= 0.046—statistically significant (which was a surprise—I did not expect it to be with such a small sample)!
How We Interpreted the Results:
We found that our hypothesis was incorrect: in our experiment, hand sanitizer appeared to be superior to soap and water hand washing. This is probably because sanitizer is more user-friendly. We find this pattern in other settings as well, and trials in schools have also suggested that sanitizer is probably better than soap and water. When thinking about infection control strategies, it is always important to think about practical issues and implementation outcomes!
Closing Thoughts:
There are lots of ways to do these experiments—these are a couple of designs that I hope will get you thinking about what you can do! For example, when I did the experiment with my son’s class, I did not include teaching on proper hand washing technique, because I wanted to demonstrate how well soap and water performed in real-world settings, and to compare that performance to the real-world performance of hand sanitizer. Teaching about how to do soap and water could certainly be incorporated into a slightly different design!
Thank you!
Thank you to Ms. Sarah Hammond and her third-grade class for participating in this experiment with me, and to Jasper for permitting me to share his results! I also need to thank my husband, for letting me use his bread proofer (I promise I fully disinfected it afterwards 😊).
04/16/2020 multiple authorsWe (Rob Stevens and Austin Frakt) are putting together a survey of people’s predictions about post-pandemic behavior and key trends. We wonder what people think some aspects of life will be like in, say, 2025. Below are the kinds of questions we’ve thought of so far. What are we missing? Tweet at us to let us know. Rob is at @robgstevens and Austin is at @afrakt. You are also free to email Austin.
All questions are “agree/disagree” as of 2025. For items that pertain to changes (e.g., “doubles,” “drops by more than 50%,” etc.), those are relative to the state of the world before the pandemic (December 2019 or so).
02/18/2020 Austin FraktThe theme is Viennese Post-Romanticism (Strauss, Bruckner, and Mahler). The concert will be on Sunday, March 8, 2020, 3pm at the First Baptist Church of Arlington (819 Mass. Ave., Arlington, MA). Admission is free with a $10 suggested donation.
As always, if you come, please find me at intermission or afterwards and say hello.
Program
Richard Strauss
Vienna Philharmonic Fanfare
Feierlicher Einzug der Ritter des Johanniterordens (Solemn Procession)
Festmusik der Stadt Wien
Anton Bruckner
Cristus Factus Est
Scherzo from Symphony No. 4
Gustav Mahler
Trauermarsch (Funeral March) from Symphony No. 5
Resurrection Suite from Symphony No. 2
The Great Call
Primeval Light (vocal soloist: Andrea Wozniak, soprano)
Resurrection
Now the Sun Wants to Rise as Brightly from Kindertotenlieder
Finale “What Love Tells Me” from Symphony No. 3
10/28/2019 Austin FraktWhen: Sunday, November 10, 2019 at 3:00 PM – 4:30 PM EST
Where: First Baptist Church of Arlington, 819 Massachusetts Ave, Arlington, Massachusetts 02476
What: The third season opener of the Mystic Brass Ensemble will include a combination of organ and brass performing Baroque and Romantic compositions. Full program below.
Admission: Free (Suggested Donation: $10)
Program:
Strauss: Fanfare to Also Sprach Zarathustra
Charpentier, Clarke, Mouret: Suite of Baroque Marches
Paul Hindemith: Sonata No. 2
Gabrieli: Canzon in Double Echo
– Intermission –
Strauss: Battle Scene from Ein Heldenleben
Handel: Suite from Watermusic and The Royal Fireworks
Gigout: Grand Choeur Dialogué
If you come, please find me and say hello.
06/04/2019 Austin FraktI just returned from the AcademyHealth Annual Research Meeting (ARM), where I caught up with dozens of colleagues and met a few new ones. Turns out a very good ice breaker is, “Can we sit? My feet hurt.”
Yes, the plantar fasciitis I beat is back. I had about a month completely symptom free during which I gradually transitioned from protecting my feet and stretching to adding some walking and strengthening.
I guess it wasn’t gradual enough. When it came back, it came back with surprising strength and persistence. This is how soft tissue injuries go sometimes. It’ll probably be years before I fully understand how to manage it, judging from my experience with other over-use/repetitive strain injuries.
For now I’m back to minimizing walking/standing, 3x per day stretching, night splints, tape, and massaging like mad.
When I told people at the ARM why I needed to sit, it seems like half of those over 40 said they’d had (or currently have) plantar fasciitis too. My guess is that this crowd skews active (lots of runners) and this is a common ailment among aging, active people.
As I told many of my colleagues, my best advice that I didn’t write about already is to find yourself a rock shaped like the one pictured below — flat bottom, tapering in a sort-of domed top pyramid. I found it in Costa Rica just as I was failing to find online something just like this.
The best foot massager. For scale it’s about 1.5 inches tall.
It is the absolute best foot massager. It’s better than balls and rollers because it comes to a finer point. (For a ball to feel similar, it’d have to be closer to marble sized, but that wouldn’t work because your foot would just fold around it and rest on the floor.) Because it doesn’t move, you can really lean into it and pull the foot fascia — stretching it. Balls are fine for mashing, but not pulling.
Sometimes you want to mash and pull! Someone should make this. Manufacturers get cracking!
Anyway, conferences are very hard when you can’t stand or walk much. But, I managed to come home in better condition than I left. (#winning)
It was very helpful to have sympathetic ears. It seems everyone wants to talk about their feet if you just get them going.
05/08/2019 Austin FraktI’m in two concerts the weekend of May 18-19.
8pm, Saturday, May 18 in Jamaica Plain, MA: I’ll be playing in Nocturno by Mendelssohn (here’s a recording). It’s part of a larger program by the Weston Wind Quintet & Friends. Details here.
3pm Sunday, May 19 in Arlington, MA: I’ll be playing with the Mystic Brass Ensemble. There’s a lot to the program (details here), which ends with suites from Star Wars.
If you come to either, please say hello. If you come to both, say hello twice!
04/02/2019 Austin FraktI’ve been so busy I forgot to note this last month:
Using state-of-the-art statistical methods, this means I’ve been blogging for half my career and with NYT/Upshot for one-quarter of it.
By the way, this week was the first week I ever skipped my regular slot at Upshot. Just been too busy. I’ll be back at it in two weeks.
02/25/2019 Austin FraktOn Sunday, March 10 at 3pm, the Mystic Brass Ensemble takes a winter trip to Saxony for “An Afternoon in Leipzig,” featuring the music of Bach, Mendelssohn, and Wagner, all of whom spent a substantial portion of their careers in the city of Leipzig, Germany. I am one of the trumpet players in the group, and I hope you will join us. If you do, please find me during intermission or afterwards and say hi.
Location: First Baptist Church of Arlington, 819 Massachusetts Ave, Arlington, MA
Time: 3pm, March 10
Program
J.S. Bach:
Mendelssohn:
– Intermission –
Wagner:
Suggested donation: $10.
01/06/2019 Austin Frakt
What: “An Evening in Vienna”
Beethoven: Overture to Egmont, op. 84
Schoenberg: Chamber Symphony No. 1
Mozart: Symphony No. 41 (“Jupiter”)
When: Friday, January 11, 2019 at 8 PM
Where: St John’s Church, 1 Roanoke Ave, Jamaica Plain, Massachusetts 02130 (House open 30 min before concert. Venue is wheelchair accessible, restrooms require assistance for wheelchairs.)
Tickets: Available online or at the door
$25 General Admission
$20 Senior
$10 Student
Pay What You Can
Season Passes Available
More About the Concert: Beethoven’s most loved concert overture, his overture to Egmont starts this exciting program. This is followed by an early masterpiece of Schoenberg’s, his Chamber Symphony No. 1. Written before he developed his famed twelve-tone technique, this work grows out of Richard Strauss’ style and provides a fascinating bridge between the music of the late German Romantics (Mahler, Strauss, and even Brahms, in particular) and 20th century modernism. Indeed, Schoenberg is able to successfully channel the immensely diverse color palette of a Mahler symphony into a work for only 15 instrumentalists. A brief intermission will follow, and the evening will close with Mozart’s greatest symphonic masterpiece, his “Jupiter Symphony.”
About the Apollo Ensemble: Founded in the summer of 2018 by Elias Miller and Michael Tabak, the Apollo Ensemble of Boston is a new, 40-member chamber orchestra made up of some of the area’s best musicians. Apollo’s inaugural concert, a performance at the First Baptist Church of Medford in June, 2018 featured the music of Strauss, Wagner, and Stravinsky. Elias Miller conducted the well-attended and well-received event. In the future, the Apollo Ensemble looks forward to many more community concert performances in the Boston area featuring music written for both chamber orchestra and for large chamber ensemble.
(I am honored to join the ensemble on trumpet. If you attend the concert because of this post, please find me during intermission or afterwards and say hello.)
