safety in confined spaces

Safety in Confined Spaces: Some Things You Need to Know

An expert has the answers to your questions about gas detection.

Being responsible for customer training, I have had the privilege of meeting thousands of safety professionals. I have a very talented team with a particular understanding of adult learning and of knowledge transfer from teacher to student. I ask everyone I meet a simple question: "Are you leaving this class with fundamentals that you can immediately apply to your working life and, will this information ultimately keep you and those around you safer?"

While the answer is always "yes," I further probe to learn what they found valuable and useful in the training. I felt this was a good opportunity to share a few examples of things students have learned through gas detection training in the hope that I might answer a couple of questions that you might have about gas detection.

Sampling Takes Time

Best practices state that a worker should sample prior to entry, continuously during entry and prior to re-entry into a confined space. Because some gases are lighter than air and others are heavier than air, stratification can occur. Gas samples should be taken in 4-foot intervals in every direction of travel to address this gas stratification. Gas monitors and their sampling pumps are great tools to use in doing this, but they are not magic wands. They need time to do their job. This is a common oversight made by many gas detection end users.

The first thing to consider is sample time. For most gas monitors, the flow rate is between 0.25 and 0.5 liters per minute. When pulling a gas through sample tubing, it is best to allow 2 seconds per foot of tubing for the sample to travel. Additionally, a gas monitor needs time to react once the sample is delivered to the sensors. Most gas monitors will reach to 90 percent of the applied gas in 30 seconds with a fresh sample delivered, and 100 percent of the applied gas in 120 seconds.
For example, if we were taking a sample through 20 feet of tubing, the sample time would be 2 seconds per foot of tubing or 40 seconds (2 x 20) to deliver the sample. Time also should be allowed for the gas monitor to react to the sample. To reach 100 percent response, an additional 2 minutes would be required. In this example, when sampling through 20 feet of tubing, the user would need to allow 2 minutes and 40 seconds to obtain 100 percent response and an accurate sample.

Cross Sensitivity Does Occur

In a perfect world, a toxic gas sensor only would react to the gas it is targeted to monitor; which means other toxic gases should not cause an inaccurate response. A carbon monoxide sensor only would detect carbon monoxide and a hydrogen sulfide sensor only would detect hydrogen sulfide. Unfortunately, technology has not yet made this a reality and while most sensors are quite specific, cross sensitivity does occur.

Cross sensitivity is a sensor’s reaction to an interfering gas. Exposing a sensor to a gas that is not the target gas can cause an undesirable response, either positive or negative. With a positive cross sensitivity, the user can get the impression that more of a target gas is present than actually is present. This may cause the user to induce ventilation or take corrective action to remove the gas hazard, which may not be necessary. This condition causes the user to err on the safe side and while it is inconvenient, it does not cause a safety concern.

When a cross sensitivity is negative, it is a greater concern. In this case, you may have a cross-sensitive gas that causes the sensor to react in a negative manner. If this is the only gas present, the user will see a negative number on the gas monitor’s display and may elect to zero the instrument or assume there is a problem with the instrument. Even worse, if a negative cross-sensitive gas and the target gas exist together, you may have a cancelling effect. This can be potentially dangerous if you are unaware of this phenomenon or do not know the potential gases in a sample.

Most gas detection manufacturers publish toxic gas sensor cross sensitivity charts. These charts can help the user understand and anticipate cross-sensitive conditions with their gas monitors and empower them to react accordingly. In this sample chart, the sensor type is along the top axis and the sample gas is along the side access. To help you better understand how to read this chart, we will use carbon monoxide as an example.

If our target gas is carbon monoxide and we have 50 ppm of hydrogen gas present, we can use the chart to determine the cross sensitivity of a hydrogen gas exposure on a carbon monoxide sensor. In this case, it is 60 percent, which means if we have 50 ppm hydrogen present, we can multiply 50 x 0.6 (60 percent) and estimate our cross-sensitive response to appear as 30 ppm carbon monoxide when in fact we have only hydrogen present. Of course, we could have a combination of gases that ultimately will raise the complexity of the situation.

If our target gas is carbon monoxide, and we have 40 ppm of nitrogen dioxide gas present, we can use the chart to determine the cross sensitivity of a nitrogen dioxide gas exposure on a carbon monoxide sensor. In this case, it is -20 percent, which means that if we have 40 ppm nitrogen dioxide present we can multiply 40 x -0.2 (-20 percent) and estimate our cross sensitive response to appear as -8 ppm carbon monoxide when in fact we have only nitrogen dioxide present.
Confined spaces are dangerous places to work and those who enter must make decisions that will ensure their safety and the safety of those around them. Having a better understanding of the gases that are present, how to sample for them and how they will react can mean the difference between a safe or unsafe condition. Today, there are many training options designed to provide workers the tools needed to ensure they go home safely at the end of their shift.

Dave Kuiawa is the director of training and field services at Industrial Scientific Corp. Kuiawa has been with the company for 24 years and has held positions in customer service, repair service, training, product management, sales and field services. He can be reached at [email protected]

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Likely On Vacation… The Anticipated Added benefits

The intent of these content articles won’t be to recall what you know currently, but fairly to enable you while researching different destinations for your future holiday break. We will therefore highlight a range of destinations, as well as the simplest way to ebook them if they fit you, and also facilitate a significant reduction of time to pick out the destination of your dreams. In fact, how many of you immediately after extensive hours of function have been forced to sit as soon as yet again in entrance of their computer system, and ebook their vacation? How many instances have you fought due to the fact Mr. or Mrs. disagreed on the period decided on to go on vacation, option of destination, the charge of the keep and itinerary or activities chosen?

Permit us not respond to these issues now, but fairly inquire ourselves about the genuine rewards anticipated while heading on vacation.

 For centuries, travelling for enjoyment was a luxury reserved for the wealthy. Even so, with the expanding revenue of the center course and the contribution of the automotives and airplanes to lower the distances, the early 20th century has specified accessibility to practically all segments of our society, the prospect to travel for enjoyment to go on vacation.

Many many years of exploration on tourism have concluded that commonly, the anticipated rewards of leisure are essentially variables indicative of customer behaviour in travel, fairly than their revenue or other socio-demographic properties.
 People are heading on vacation due to the fact they want to escape the day-to-day routine, truly feel rejuvenated, reach standing and prestige, fulfill individuals, master something, or just admire the landscape. These rewards related to Leisure can be a considerable and helpful commitment for a fan of travel, fairly than the only notion of charge.

Travellers anticipate a few principal rewards of their vacations.
The initially profit is just relaxation and relaxation, with the principal aim being detachment from the every day setting, relaxation and tension aid, and no “plan”.  Indeed, just about two-thirds of adult travellers say that this profit is quite crucial in a enjoyment journey.

The second variety of profit relates to the servicing of relationships with loved ones and close friends. In this scenario, a single of the principal goals of the journey is to retain loved ones ties, to enrich the traveller’s connection with his or her partner and children, to accumulate memories and renew own ties with persons other than loved ones.

 The 3rd variety of profit relates to studying and discovery. Travellers are trying to find new and different encounters, they want to learn the background and cultures of other areas, and they look for to enrich their viewpoint on everyday living by stimulating their intellect. Only just around a quarter of travellers spot a quite crucial price to this profit.

The rewards that travellers anticipate to achieve from their vacations or their enjoyment journey does not only revolve all over their demographic properties. Realizing that Holidays indicates a departure, travellers pick out a destination in which they can merge the rewards they are looking for.

Whoever we are, whichever job we are doing, we will need to go on a holiday break at a single time or a further.  We will need to depart, ignore our everyday living and day-to-day routine, consider about something else, and depending on what we want, we will go to the supposed destination.
And due to the fact excellent travel encounters usually have a everyday living time outcome on you and your everyday living, organizing and getting them is far too crucial to be left to probability.


Planetary Science Journal Icarus, the “Wow!” Signal of Intelligent Design

Here’s a new paper that can be added to the growing stack of intelligent-design articles in peer-reviewed journals. Even though the authors do not use the phrase “intelligent design,” their reasoning centers on the detection of an intelligent signal embedded in the genetic code — a mathematical and semantic message that cannot be accounted for by a natural cause, “be it Darwinian, Lamarckian,” chemical affinities or energetics, or any other.

Dr. Vladimir I. shCherbak, a mathematician at the al-Farabi Kazakh National University of Kazakhstan, and Maxim A. Makukov, an astrobiologist at Kazakhstan’s’s Fesenkov Astrophysical Institute, gave their paper a catchy title: “The ‘Wow! signal’ of the terrestrial genetic code.” Their paper has been accepted for publication in the prestigious planetary science journal Icarus, where it’s already available online.

Their title comes from a curious SETI signal back in 1977 that looked so artificial at first, a researcher wrote “Wow!” next to it. With no follow-up examples, that signal has remained interesting but inconclusive. shCherbak and Makukov looked into “biological SETI” — the “biological channel” of communication (e.g., DNA) and concluded “Wow!” — the genetic code has features that defy natural explanation. The abstract states:

Since intelligent design theory doesn’t consider the question of the identity of the designer, design by space aliens is one possible intelligent cause; however, the phrase used here, “seeded intentionally,” would appear to refer to a broader class of intelligence(s).

From there, the authors explore a number of fascinating patterns they find in the genetic code itself (not necessarily in animal genomes) — i.e., the relationship between the base pairs of DNA and the 20 amino acids. They are driven to the conclusion of design not only by what they observe, but also “by the fact that how the code came to be apparently non-random and nearly optimized remains disputable and highly speculative.” This reasoning is similar to Stephen Meyer’s in Signature in the Cell in which all the possible natural causes for a phenomenon were considered before inferring design.

The signal of intelligent origin, they reasoned, was strong because both arithmetic and ideographic signals are apparent, both using the same symbolic language. They predicted that a signal, if it exists, should be robust from modification. They did their best to avoid arbitrariness, considering what natural causes could be available to explain their findings. They identified two dimensionless integers — redundancy of codons and number of nucleons in the amino acid set — as “ostensive numerals” forming the basis of the signal, showing in detail how the patterns in those numerals satisfy the conditions for intelligent signals.

Considerations of brevity prohibit giving a complete analysis of their arguments, but let an example suffice. Of the 20 amino acids, only proline holds its side chain with two bonds, and has one less hydrogen in its block. The effect of this is to “standardize” the code to a 73 + 1 block nucleon number. Yet the distinction between block and chain is “purely formal,” they argue, since there is no stage in amino acid synthesis where the block and side chain are detached. Here’s their comment:

But this criterion is equivalent to asking if it is possible at all to embed informational patterns into the code so that they could beunequivocally interpreted as an intelligent signature. The answer seems to be yes, and one way to do so is to make patterns virtual, not actual. Exactly that is observed in the genetic code. Strict balances and decimal syntax appear only with the application of the“activation key”.

Could these patterns be due to selection or any other natural process? Could they be mere “epiphenomena” of chemical pressures for mass equalities, or something else?

But it is hardly imaginable how a natural process can drive mass distribution in abstract representations of the code where codons are decomposed into bases or contracted by redundancy…. no natural process can drive mass distribution to produce the balance … amino acids and syntactic signs that make up this balance are entirely abstract since they are produced by translation of a string read across codons.

Even more convincing, no natural cause can produce semantics — particularly the kind involving “interpretive or linguistic semantics peculiar to intelligence,” they write. “Exactly the latter kind of semantics is revealed in the signal of the genetic code.” Here’s a summary of the patterns they conclude show design:

In total, not only the signal itself reveals intelligent-like features — strict nucleon equalities, their distinctive decimal notation, logical transformations accompanying the equalities, the symbol of zero and semantic symmetries, but the very method of its extractioninvolves abstract operations — consideration of idealized (free and unmodified) molecules, distinction between their blocks and chains, the activation key, contraction and decomposition of codons. We find that taken together all these aspects point at artificial nature of the patterns.

Lest anyone perceive a creationist message, they write: “Whatever the actual reason behind the decimal system in the code, it appears that it was invented outside the solar system already several billions years [sic] ago.” In other words, their favored position is panspermia. (Keep in mind, though, that there are multiple versions of panspermia.)

If their thesis of “biological SETI” sounds a little like ideas floated by Paul Davies, the authors thank Davies in their Acknowledgements, along with Manfred Eigen in Germany.

No, it appears the only way out for Darwinists would be the “Dawkins Dodge.” You may remember that one from the documentary Expelled, where Dawkins admits the possibility of panspermia for Earth, so long as the designers themselves evolved by a Darwinian process.

What’s most notable about this paper is the similarity in design reasoning between the authors and the more familiar advocates of intelligent design theory. No appeals to religion or religious texts; no identifying the designer; just logical reasoning from effect to sufficient cause. The authors even applied the “design filter” by considering chance and natural law, including natural selection, before inferring design.

#academic-freedom, #intelligent-design, #science-news


24 February 2017

The Ship of Theseus. FTFY*

The Ship of Theseus has been a staple of philosophical discussion and teaching for millennia. The folk version of this conundrum is grandfather's axe, in which the axe in question is favoured despite having had its head and handle replaced many times. Can it be the same axe? Grandfather thinks it is, and we the audience hearing the story doubt that it can be. I have certainly not surveyed every instance of it, but introductions to this story always seem to take the same approach to the problem and to leave it hanging as a paradox.

So why does this problem continue to fascinate philosophers? Partly, I think, philosophers like problems that can be argued over but not resolved (and their worldviews resist a resolution). However, I think it is also because the ship is a metaphor for ourselves. We visibly change over time and, at least for philosophers, this raises the question of identity. The combination of continuity and change seems to be particularly problematic for philosophers, East and West.

The locus classicus of the story is Plutarch's Lives of the Noble Greeks and Romans:
The problem is often portrayed as having only two mutually exclusive answers with nothing to decide between: it is either the same ship or a different ship. And thus the story contains a kind of paradox. I will try to show that it is only a paradox because of the way the problem is framed and that by reframing it we can resolve the paradox. I suspect that all apparent paradoxes are related to framing problems.

Over the years philosophers have added new twists to the problem. What if we collect all the discarded old planks and build another ship out of them? Can there be two boats that we identify as Theseus’ ship? What if Theseus stays aboard the ship as it travels, but running repairs result in the same exchange of old timbers for new. Does Theseus arrive on the same ship that he set out on? And so on. All of these trade on the same framing of the problem.

The framing here focusses on the relationship of the complex wholes and parts (which may themselves be simple or complex). I want to reframe the problem by pointing out that in all of the arguments about Theseus's ship, no one ever questions that the structure is a ship and no amount of plank changing alters this fact. And this gives a clue to how to deal with the question. Let us start with the idea of "ship".

What is a ship?

What are the minimal features an object must possess so that we can recognise it as belonging to the category "ship". And here I'm going to ignore the complexities of the semantics of ships versus boats and all their myriad variations. For my purposes ship here represents water-craft in a very general way.

Firstly, any material that can be made watertight and is malleable can be used. One can build a ship from paper, wood, concrete, or steel. What really matters is the average density of the volume contained by the ship's hull. Any object which is less dense than water will float in it. A ship's hull encloses a large volume of space with a thin wall so that the average density of the enclosed volume is very much smaller than the density of the building material, and less than the density of water. Hence, we can build a ship from steel which is eight times denser than water, by ensuring that the hull encloses more than eight times the volume of the steel used.

Secondly, the hull must be water-tight, or as close to it as possible. In practice most ship designs in the ancient world would have been leaky. Planks can be made to fit together with sub-millimetre accuracy, but still have to be caulked. (For a fascinating insight into ancient boat building techniques see the Jewel of Muscat Project)

convergent evolution
Thirdly a ship needs to be hydro-dynamically efficient, i.e. it needs to move through the water easily. The best configuration for this is a hull that it is considerably longer than it is wide. A broad-beamed ship will still make way, but with considerably more effort than a long and narrow ship. A prow that converges to a point is also advantageous, though not essential. River boats often opt for a flat bottom and blunt prow, for example. A smooth surface is also advantageous. The efficiency of these criteria can be seen in the way that the evolution aquatic animals has tended to converge on the same long, thin, pointy, smooth design.

Lastly, a ship needs some kind of motive power to propel it through the water. A water-craft that is not propelled is a raft. A ship can be propelled by any number of sources of power, though in ancient Greece it would have involved a combination of oars for rowing and a square or lug sail for the wind. Both methods impose constraints on the design. A mast must be stepped and stayed, and sailing requires a method to prevent leeway for example; while oars require a fulcrum and somewhere for rowers to sit (or stand in some designs).

With just these features, an object may be called a ship. But there is something more going on here. A ship is not a ship merely because it possesses some intrinsic features. A log possesses most of these features. A ship performs a function. The function of a ship is to transport people and/or cargo over water. Note also that we can use "ship" as a verb and it is no longer confined to moving cargo by ship. As John Searle has pointed out, a function is an observer relative feature of the object. In other words the object we are calling a "ship" can perform the function of transporting Theseus to Minos and back, but this is not an intrinsic feature of the ship. The intrinsic features a ship has make it suitable for performing this function, but the function itself is relative to the observer. And observer relative features of an object are created by the mental states of the observer.

For example, if we take the ship out into the middle of the desert and show it to people who've never seen a large body of water, they might not be able to deduce its function from intrinsic features. They may well conclude that rather than displacing water, the hull is designed as a cistern for storing water. And that the configuration makes it easier to drag over sand. The intrinsic features of the object alone do not tell us what function it serves for human beings. We have to have the concept of a ship in our minds as well.

Consider also someone visiting Athens who did know the story of Theseus. They might see a ship, but they would not see Theseus's ship. The connection between the ship and Theseus does not exist for them, because they haven't heard of Theseus. One might argue that Theseus exists despite his not being known about and that even in ignorance the ship is still Theseus's ship. However, the uninformed visitors could not discover this information through examining the ship. The ownership by Theseus is not an intrinsic property of the ship. The association with Theseus is also observer relative.

So "ship" is an observer relative feature of an object with the appropriate intrinsic properties. Thus, a "ship" is not an ontologically objective fact. Nor is "Theseus's ship" an ontologically objective fact. The "ship" is an epistemically objective fact, but ontologically it is subjective, i.e. it only exists relative to mental states in the observer.

So in fact the idea of "Theseus's ship" involves some intrinsic subjectivity. And part of what makes the ship interesting is the analogy of our own identity. I'm a good example because my name appears to be unique in history. There is, and has only ever been, one being called Jayarava. The fact that I am Jayarava is an ontologically subjective fact. But in my Sangha it is epistemically objective - everyone in my milieu knows that's who I am, and many do not know me by any other name (i.e. did not know me before my ordination). On the other hand parts of me are ontological objective. If you literally run into me, you'll certainly feel it. And parts of me are both ontologically and epistemically subjective, i.e. my private thoughts. So my "identity" as Jayarava spans all these possibilities (and possibly more) depending on the point of view of the observer.

The identity of Theseus and of Theseus's ship both rely on a range of types of facts and this makes the problem very much more complicated. There are no simplifying assumptions we can make without excluding essential information.

Part/Whole Gestalt

A ship, as I have defined it, is a combination of materials and construction. Considerable time and effort is required to turn the materials into an object with the necessary intrinsic features to perform the function of ship. The parts have to be shaped and then fixed together in ways that create the necessary structure and give it enduring integrity. However, the usual way of framing the problem of Theseus ship, only looks at materials and ignores the structure itself. This may be why no one seems to notice that despite all the changes, the ship is still a ship.

It seems that many philosophers are blind to the role of structure in the world. Ships are complex objects, made of many parts assembled in the right order to fit the category of ship. There is a tendency to default to a reductionist paradigm in which only the parts are relevant to the question of identity. We do not see structure as real. We only see substance as real. Therefore if we are going to invest identify in anything it ought to be, in this view, in substance. Structure is apparently incidental.

If we replace one plank of wood in a ship made from dozens of planks, we have no problem in identifying the structure as the same, with a repair. If we replace all the parts we struggle because in reductionism the parts are where identity is vested. If there are no original parts then identity is lost. Somewhere in the middle is a cross-over point. We're not quite sure where it might be, but at some point we begin to suspect that if we replace that arbitrary number of parts, then the identity of the whole somehow changes. And this despite the fact that the ship is continually existent as a structure.

This see-saw—yes/no—approach has characterised Western philosophy for years. Eastern philosophy was mired in its own problems, but clearly the Buddhist philosophy that I am familiar with also tended to reductionism and thus did no better at dealing with change. However, there is a better approach.

It is better to acknowledge that the ship is both made from parts and constitutes a whole. When we analyse the ship into parts we see that parts on their own are not ships and mostly do not have the necessary intrinsic features to be a ship. The epistemically objective "ship" only emerges when we assemble all of the parts into the appropriate structure and we, the observer, have the appropriate mental states. The integrated whole has features which the the parts to not possess: especially buoyancy, hydrodynamics, and motive power. To fully understand the concept of ship we have to take into account both sides of the coin: substance and structure; as well as the observer relative status of the concept of "ship".

In this view, the structure of the ship is causal. The structure causes the ship to float, to displace water, and to move in ways that parts alone cannot. The materials on their own do not have these features, or at least not enough of them to fit into the category ship. A lump of steel rapid sinks in water. But if we hollow it out so that it encloses a volume more than eight times the volume of the original lump, then it will float. Given the density of steel as a substance, we expect it always to sink. But a steel ship floats because it is ship-shaped. Here structure is more important than substance in understanding the nature of a ship.

The structure also persists over time, despite the replacing of some or even all of it's parts. So the structure also exists and is causal. The structure does not exist independently of its parts, but since identical parts can be substituted with no change in the structure, then structure is not absolutely dependent on its parts. Indeed, we can often remove parts from a structure and it remains intact as a structure. Removing a plank from above the water-line of a ship does not destroy the intrinsic features of the object, nor does it stop the object from performing the function of ship.

Thus we can say that the structure is real. Reductionists assert that only substance is real. Antireductionists assert than only structures (or systems) are real. My view, following Richard H. Jones (2013), is that both substance and structure are real. The planks and the ship are both real, and the structure has emergent features that are not features of the planks. Planks have their own important features that enable them to function as a good building material. The individual fibres or cells of wood do not have the features of a large tree cut into planks.  At every scale we look at both substance and structure are important. However, if you dismantle a structure into its parts, the features of that structure no longer exist. So the reductionist approach to structure nets us no information because it destroys the object of interest. This is a fact every biologist is aware of.

I've already pointed out that identity is an observer relative function and not something intrinsic to insentient objects. We may project it onto objects, but in this case the identity is something we believe and someone who does not believe this will not be able to deduce it from simply interacting with the object. In this section I want to raise some other problems with how Theseus's ship is identified.

Is the ship that sits in the harbour and gradually has all its parts replaced, Theseus's ship? The question assumes that Theseus is a point of reference. But Theseus himself is subject to change. He ages. He sails to Minos and kills the Minotaur. How could such events not change him? Is he the same man afterwards? Well, yes and no. The structure that we think of as Theseus has been extended by having new experiences and some of the parts have been exchanged, but the fundamentals are still there. When Theseus returns, everyone recognises him as Theseus. But they probably also notice that the events at Minos have changed him as well. There is both continuity and change.

Some people approach the question of the identity of Theseus's ship by ignoring the continuity and focussing on the fact of change. In this case neither Theseus nor the ship are the same. And the difference takes on an exaggerated importance when continuity is excluded from the equation. And some ignore the change and focus on the continuity.

I can walk out my door and within a few minutes be standing on top of a large mound of dirt, piled up by the Normans in 1068 CE, which has commanding views of Cambridge and the surrounding area. The mound has been there for about 950 years as I write this. Or, on a slightly longer walk, I can visit buildings that were constructed in the 13th Century. These are structures that have persisted for centuries. Not without change and/or repair, but still, arguing that they don't exist is nonsensical. There they are, and there they have been for centuries! One has to go under, over, or around them, one cannot just pretend they are not there. For those who believe that a brick wall does not exist, the recommended procedure is to bash your head against it repeatedly, until wisdom dawns.

These objects are real by any sensible definition of the word. Real and impermanent. Impermanence does not make an object unreal, it only makes it temporary. Buddhist intellectuals have struggled with this because ancient Buddhists defined existence as permanent. An impermanent object cannot be said to exist. In fact they were mixing up experience and reality. The original target of the criticism was the existence of absolute being (ātman) in experience (pañca-skandhāḥ). Since experience is impermanent, no absolute being could be found in experience. Unfortunately they went too far with this and equated all being with absolute being. From this they argued that no being of any kind could be found. But this is simply a misunderstanding of an ancient criticism of ātman

Over time, structure persists. In the light of this we can say that the structure of the ship once owned by Theseus persists, helped by the exchange of rotten planks for good ones. At the same time the substance of the ship has changed so that no plank of the original is left; but because planks are essentially identical this doesn't affect the structure. If we vest identity solely in the structure then this is Theseus's ship. If we vest identity solely in the substance, then it is not Theseus's ship. There is no paradox here, because where we vest identity is simply an arbitrary decision we make, though probably motived by presuppositions and non-reflective beliefs.

Similarly if we take the old planks and build a new ship, how we see it depends on whether we focus on structure or substance. The new ship is a new structure, made from old substance. So if identity is substance this is the same ship, and if it is structure it's a completely different ship.

The two extremes are not the only possible answer here. Part of what philosophers do to win arguments is to back us into corners by artificially making us choose one side of a duality. This is another example of the arborescent fallacy, which sees us frame the question as having an either/or answer. In this fallacy, the world appears to us as a series of binaries. The term arborescent is also used in graph theory and botany; and was the title of an album by Ozric Tentacles. Another name for this is false dilemma. Edward de Bono independently wrote about this problem as a feature of neural networks, which he called knife-edge discrimination (1990: 108ff).

After my critique of the tree metaphor in evolution (Evolution: Trees and Braids) I stumbled onto the same critique produced by Gilles Deleuze and Félix Guattari (1980), whence the name arborescent meaning 'tree-like' (from arbor 'tree' and the suffix ‑escent  'a process or state of being'). Unfortunately, having looked at their book I found it suffered from all the usual faults of French philosophy of that period: the writing style is obscurantist and the argument jumbled and poorly structured. So I still don't know what they say about the fallacy except what is on Wikipedia (so potentially I know nothing).

The problem of Theseus ship is framed according to a logical fallacy that results from a cognitive bias to see things in binary terms. Once I realised that both substance and structure were real, the problem I knew as grandfather's axe no longer seemed to me to be an either/or problem. The apparent paradox is simply a limitation artificially imposed by intellectuals who haven't fully grasped the situation they live in. They labour away with theories about how the world should be, based on idealistic or romantic fantasies. Education is a good thing, but all too often it leaves us with unexamined presuppositions that hinder our understanding. For example, most people finish their science schooling believing in reductionism and this is an obstacle to understanding because reduction is strictly limited in its application.

Another complaint is that identity is a fairly slippery concept. It makes more sense to speak of a conscious entity having identity, than a ship. Without a mind, the ship itself has no sense of identity. Therefore any identity that we perceive is a quality that we have projected into the ship. Identity in this case doesn't reside in the ship at all. It resides in our own minds! What we're really wondering is whether we recognise the ship as being the same or not, which again comes down to whether we look at substance, structure, both, or neither. And I argue that we have to look at both.

Since no object is entirely stable, no matter how long it persists, insisting that identity is a function of some fixed quality rather than something dynamic is just arbitrary. Castle mound is by no means exactly the same as it was ~950 years ago when it was heaped up as the base for a defensive stockade to guard a key crossing point on the River Cam. But it is a mound and there has continuously been a mound on that spot for ~950 years. A mound exists. Whether the mound exists is just something to argue about in a framework that doesn't allow a resolution. If we focus on the grains of soil, then it is not the mound, but another identically shaped mound in the same location as yesterday (by coincidence apparently). If we focus on the structure itself it is the same mound, but the parts have all changed.

Answers are so often already implied by how we frame questions. Logic doesn't stop us getting things wrong.

So to recap, the problem of Theseus's ship is problematic mainly because of how it is framed and the presuppositions of the person who asks the question. Reductionist methodologies cannot cope very well with persistent structure. Reasoning from the assumptions and methods of reductionism on its own produces nonsense and/or contradictions.

To understand and appreciate structure requires an antireductive approach. We have to see structures as persistent, dynamic systems, with their own (emergent) features and causal powers: e.g. buoyancy and hydrodynamism. Such a structure can function as a ship, but only in relation to other systems, such as the ocean. Also the function of the object as a ship, is an observer relative function. While it is epistemically objective, the fact of being a "ship" is ontologically subjective. A naive observer would not look at a ship and conclude that it could convey people and cargo across the ocean, especially if they were not familiar with oceans.

Identity is not vested in either parts or wholes of any inanimate object, but in our own conscious states. Any identity Theseus's ship might have is a projection from our minds onto the object. It is Theseus's ship if, and only if, we believe it to be so. Different people, at different times and places, may have different reasons for believing that it is Theseus's ship, but apart from a tiny number of long dead eye-witnesses (whose testimony may still be inaccurate), the rest of us take it on faith.

If we restrict ourselves to focussing on substance and change then the ship is not the same. But if we restrict ourselves to structure and continuity then it is the same. But the dichotomy is not intrinsic. Any object we can see has both structure and substance. Both are real and therefore when considering the question of Theseus's ship, both are equally important.

The problem is that we seek something essential in a complex object in which the parts are being changed for identical parts but the structure remains stable. To simply ask "Is it the same ship?" is an incomplete question. One might counter, "the same as what?" Or in other words, what is the point of comparison?

If we resolve the paradox by reframing the problem and selecting appropriate methods to understand it, does it shed any new light on the problem of identity? I'm not sure that it does. We all have this experience of continuity with change. We have memories that provide us with continuity, even if they are not 100% accurate. Over a normal human lifespan change occurs rapidly at the beginning, slowly in the middle, and rapidly at the end. But we experience ourselves as continuous through our lives. Not, as some Buddhists insist, as unchanging, but as connected over time. We all understand that we change physically and mentally. Externally we age and internally we accumulate experience.

That there is change-with-continuity or continuity-with-change seems fairly obvious when you think about it. However, everywhere we turn this is denied. Theists argue that we have an unchanging eternal soul. Buddhists deny any kind of continuity when discussing metaphysics, but insist on continuity when discussing morality. Philosophers frame the problem of Theseus's ship so that it is a paradox. But everyday experience is of change and continuity. There is a dialectic between substance and structure and it is helpful to acknowledge the contribution of both to experience.

* FTFY Fixed That For You (h/t David Chapman)

de Bono, Edward. (1990) I Am Right - You Are Wrong. Penguin

Deleuze, Gilles and Guattari, Félix. (1980). A Thousand Plateaus: Capitalism and Schizophrenia . Continuum, 2004. [First translated into English 1987; originally vol. 2 of Capitalisme et Schizophrénie]

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Hematology Case Study: Monocytosis in An Elderly Patient

An 81 year old presented with fatigue and not feeling too well. CBC revealed marked leukocytosis and monocytosis.

  • White cell count: 85.1 K/uL (elevated)
  • Hemoglobin: 8.6 g/dl (decreased)
  • Platelet count: 79 K/uL ( decreased)

Review of peripheral smear revealed leukoerythroblastosis with monocytosis (19.57 K/uL) along with presence of numerous immature monocytoid cells, dysplastic myeloid precursors and 7% blasts, consistent with myelodysplastic/myeloproliferative neoplasm such as chronic myelomonocytic leukemia-1.

For further evaluation of disease progression and/or transformation to acute leukemia, bone marrow evaluation was recommended.

Diagnostic criteria for chronic myelomonocytic leukemia

  1. Persistent peripheral blood monocytosis >1 K/uL
  2. No Philadelphia chromosome or bcr-abl 1 fusion gene
  3. No rearrangement of PDGFRA or PDGFRB
  4. Fewer than 20% blasts in the blood or bone marrow**
  5. Dysplasia in one or more myeloid lineages.

**Blasts include myeloblasts, monoblasts and promonocytes

Prognosis and predictive factors

Survival of patients with CMML is reported to vary from one to more than 100 months, but the median survival time in most series is 2- to 40 months. Progression to AML occurs in approximately 15-30% of cases. A number of clinical and hematological parameters, including splenomegaly, severity of anemia and degree of leukocytosis, have been reported to be important factors in predicting the course of the disease.

Vajpayee,Neerja2014_small-Neerja Vajpayee, MD, is the director of Clinical Pathology at Oneida Health Center in Oneida, New York and is actively involved in signing out surgical pathology and cytology cases in a community setting. Previously, she was on the faculty at SUNY Upstate for several years ( 2002-2016) where she was involved in diagnostic work and medical student/resident teaching.

Molecular Perspectives of Diffuse Large B-cell Lymphoma

A 100 year old female was seen for follow-up for her hypertension, mild renal impairment, and fatigue. The patient also stated a three week duration of pain in the area of the right upper quadrant that radiates to her back. No other symptoms or concerns were expressed.

An abdominal CT was performed which showed a 6.6 x 2.1 cm soft tissue mass in the right posterior chest wall that also encases the 11th rib. Given the concern for a malignant process, a core needle biopsy was obtained for histology only.

H&E, 20x
H&E, 50x

The H&E stained sections show a diffuse infiltration of atypical lymphoid cells that are large in size with irregular nuclear contours, vesicular chromatin, and some with prominent nucleoli. Frequent apoptotic bodies and mitotic figures were seen. By immunohistochemistry, CD20 highlights the infiltrating cells, which are positive for BCL2, BCL6, and MUM1 (major subset). CD10 is negative within the atypical lymphoid population. CD3 highlights background T-cells. Ki-67 proliferation index is approximately 70%. EBER ISH is negative.

Overall, the findings are consistent with diffuse large B-cell lymphoma, NOS with a non-GCB phenotype by the Hans algorithm.

Diffuse large B-cell lymphoma (DLBCL) is the most common B-cell lymphoma in adults comprising 30%-40% of new adult lymphomas. Approximately 50% of patients will be cured, even in advanced cases; however, those that fail conventional therapy ultimately succumb to their illness.1 Up to 30% of patients have refractoriness or relapse after initial therapy with rituximab based regimens, particulary R-CHOP (ritixumab, cyclophosphamide, doxorubicin, vincristine, and prednisone).

In the era of new molecular techniques and in the context of the heterogeneous nature of DLBCL, it has become important to accurately assess cell of origin (COO) as this has prognostic implications. With the seminal paper from Alizadeh and colleagues, gene expression profiling (GEP) by a microarray platform produced the concept of germinal center (GCB) versus activated B-cell (ABC) types of DLBCL.2 In the context of prognosis and R-CHOP therapy, the GCB type has a 3 year PFS of 75% as opposed to the ABC type that has a 3 year PFS of 40% (P<.001).3 Although GEP analysis is considered the ideal modality for determining COO, however, given the constraints of most modern hematopathology practices, surrogate immunohistochemical algorithms were developed to aid in COO determination. Of the multiple algorithms, the Hans algorithm is the most widely used and accepted for IHC determination of COO.

Adapted from Hans et al., Blood, 2004

The COO determination has revealed multiple genetic alterations that are shared between the GCB and ABC phenotype while distinct changes have been identified in each type. Molecular mechanisms at play include, but are not limited to, histone modification, blocks to terminal differentiation, cell cycle activation, PI3K/AKT signaling activation, mTOR pathway activation, as well as a multitude of other signaling cascades. A common shared dysregulated pathway between GCB and ABC types include mutations in CREBBP and EP300, which is in approximately 30% of DLBCL cases and slightly enriched in the GCB group. Mutations/deletions in these genes result in inactivation and alter histone modification subsequently thought to contribute to acetylation of BCL6, which is a key regulatory protein in lymphomagenesis. Up to 33% of DLBCL have mutations in MLL2, which has a broad effect on chromatin regulation and epigenomic alteration. Approximately 35% of DLBCL cases with up to two- to three-fold increase in ABC type cases have genetic alterations in BCL6, particularly chromosomal rearrangements and mutations in the 5’ sequence. Pasqualucci et al also described other factors that lead to BCL6 inactivation, including mutations in MEF2B and FBXO11.4

ABC type DLBCL often displays canonical pathway activation of NF-ƙB signaling, which ultimately promotes survival, proliferation, and inhibition of apoptosis. This potentially is a result of alterations in the CBM signalosome (CARD11, BCL10, and MALT1) with up to 10% of ABC-DLBCL cases having a mutation in CARD11. Another modality of ABC activation is through the B-cell receptor signaling pathway in which 20% of cases harbor a CD79A or CD79B mutation.  Interestingly enough, recurring mutations in MYD88 occur in ~30% of ABC-DLBCLs, which results in upregulation of NF-kB and Janus kinase-signal transducers. Other important genetic alterations include involvement by signaling pathways of spleen tyrosine kinase (SYK), PI3K, Bruton tyrosine kinase (BTK), and protein kinase C-β (PKC-β).

GCB type DLBCL often expresses CD10, LMO2, and BCL6 and has a less understood and distinct pathway when compared to ABC-DLBCL. The most common alterations include t(14;18) IGH-BCL2 (30-40%), C-REL amplification (30%), EZH2 (20%) and PTEN mutations (10%). These changes are almost never seen in ABC-DLBCL.

Adapted from Pasqualucci et al., Semin Hematol, April 2015

Although the findings in GCB and ABC type DLBCL are described, they are not absolute and multiple studies done by whole exome sequencing (WES) and whole genome sequencing (WGS) have elucidate further complexities and genetic changes. In 2015, data from Novak and colleagues revealed CNAs and mutations that were associated EFS, which also underscored the important 24 month milestone for survival.5 Morin et al in 2013 described 41 novel genes in DLBCL which demonstrated just how complex and heterogeneous DLBCL truly is (see figure below).6

Adapted from Morin et al., Blood, 2013.

As common as DLBCL is, there is much to be understood not only for lymphomagenesis, but for correct classification and risk stratification. Many targeted therapies have been designed and are in trials at the moment, but given the nature of DLBCL and its heterogeneity, more work on the molecular front is needed. Modalities for assessing COO are currently on the market but are not widely used. Perhaps COO determination by IHC may be an antiquated method, but it is currently the standard by which most pathologists practice. Overall, DLBCL in all its forms is not a uniform entity that can easily be defeated, but requires thought and diligence in achieving a cure.

  1. Lohr, JG et al. “Discovery and prioritization of somatic mutations in diffuse large B-cell lymphoma (DLBCL) by whole-exome sequencing,” Proc Natl Acad Sci USA. 2012; 109(10): 3879-3884
  2. Alizadeh AA, et al. “Distinct types of diffuse large B-cell lymphoma identified by gene expression profiling,” Nature 2000, 403:503-11
  3. Sehn, L and Gascoyne, R “Diffuse large B-cell lymphoma: optimizing outcome in the context of clinical and biologic heterogeneity,” Blood. 2015;125(1):22-32
  4. Pasqualucci, L and Dalla-Favera, Riccardo, “The Genetic Landscape of Diffuse Large B Cell Lymphoma,” Semin Hematol. 2015 April; 52(2): 67-76
  5. Novak, AJ et al. “Whole-exome analysis reveals novel somatic genomic alterations associated with outcome in immunochemotherapy-treated diffuse large B-cell lymphoma,” Blood Cancer Journal (2015) 5
  6. Morin, R et al. “Mutational and structural analysis of diffuse large B-cell lymphoma using whole-genome sequencing,” 2013;122(7):1256-1265

-Phillip Michaels, MD is a board certified anatomic and clinical pathologist who is a current hematopathology fellow at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. His research interests include molecular profiling of diffuse large B-cell lymphoma as well as pathology resident education, especially in hematopathology and molecular genetic pathology.

Hematopathology Case Study: A 69 Year Old Female with Persistent Monocytosis

Case History

A 69 year old female with a past medical history significant for endometrial adenocarcinoma, traumatic brain injury, atrial fibrillation, hypertension, hyperlipidemia, and persistent monocytosis (absolute monocyte count ranging from 1.6-3.7 K/uL) who had an indeterminate lesion identified in the T5 vertebra, read as “hemangioma, although surrounding edema is worrisome for malignancy” upon staging imaging for history of endometrial carcinoma.

CBC at the time was: WBC 9.8; HGB 12.9; HCT 37.6; PLT 154; MCV 92 fL; MCH 31.7.

Automated differential showed: 43.0 Neutrophils; 34.8 Lymphocytes; 20.0 Monocytes; 1.4 Eosinophils; 0.2 Basophils; 0.6 Immature granulocytes.

Absolute monocyte count was 1.95 K/uL.

This lesion was biopsied and given the findings, a subsequent bone marrow biopsy was performed on 5/4/2017. The bone marrow core biopsy contained multiple compact aggregates of spindle shaped cells with hypogranular cytoplasm, morphologically compatible with atypical mast cells. Within these aggregates, numerous eosinophils are present. By immunohistochemistry, the mast cells are brightly positive for CD117 and mast cell tryptase. Concurrent bone marrow aspirate flow cytometry demonstrated a small population of mast cells that co-expressed CD2 and CD25.

Of note, the patient was found to have a persistent absolute monocytosis. Flow cytometry revealed an abnormal population of monocytes that displayed aberrant phenotypic expression of CD2 and CD56 (subset).

Next-generation sequencing revealed two truncation mutations in the TET2 gene (K988* in 34.6% of the reads and Q1138* in 36.4% of the reads). Cytogenetic analysis revealed a normal female karyotype (46,XX).

Overall, an immunophenotypically abnormal population of mast cells and monocytes are present in the context of a long-standing absolute monocytosis and the presence of two TET2 truncating mutations, supporting a diagnosis of systemic mastocytosis with an associated hematologic non-mast cell lineage disorder (best classified as chronic myelomonocytic leukemia).

A diagnosis of systemic mastocytosis is a combination of clinical, morphologic, immunophenotypic, and molecular analyses, as required by the World Health Organization (WHO 2008). By current consensus guidelines, SM variants are partly distinguished by clinicopathologic criteria referred collectively as B and C findings. B findings include: >30% of bone marrow mast cells (MC) on biopsy and/or serum tryptase levels >200 ng/mL; increased marrow cellularity/dysplasia without meeting diagnostic criteria for another myeloid neoplasm; or enlargement of liver, spleen, or lymph nodes without evidence of organ damage. C findings include: evidence of organ damage caused by a local MC infiltrate, such as abnormal liver function and/or ascites, hypersplenism, cytopenias, large osteolytic lesions/fractures, and malabsorption with weight loss caused by MC infiltrate in the gastrointestinal tract.

Systemic mastocytosis commonly occurs in two types with different clinical courses based upon the aforementioned findings. Indolent SM (ISM) is defined by the absence of C findings. Smoldering SM is a subtype of ISM that displays 2 or more B findings. ISM may become more aggressive and a descriptive term of advanced SM refers to a category including aggressive SM (ASM), mast cell leukemia (MCL), and “SM with an associated myeloid neoplasm.” The latter entity comprises more than 90% of cases that have previously been referred to as SM with an associated hematologic non-mast cell lineage disorder (SH-AHNMD).

ASM and MCL are characterized by organ damage and histologic characteristics. ASM often exhibits multifocal bone marrow infiltration of atypical mast cells that are often spindled in shape with hypogranular or immature morphology. Marked fibrosis often accompanies the infiltrate as well as a KIT D816V mutation. MCL is codified by more than 20% of the marrow aspirate nucleated cells represent by mast cells and on core biopsy, a compact infiltrate is often identified with usually low level fibrosis. In MCL, circulating mast cells are greater than 10% of nucleated cells but according to Gotlib et al., the aleukemic MCL (less than 10% circulating mast cells) is more common.

In the context of our patient, myeloid neoplasms associated with SM are often represented by MDS, MPN, or MDS/MPN overlap disorders, and occasionally AML.

Associated lymphoid or plasma cell neoplasms have been described, but in a much lower frequency.

In accordance with the diagnostic implications, KIT D816V mutational analysis is important therapeutically. Most patients with SM harbor the KIT D816V mutation (>80% in one clinical series; 90-100% in research studies using purified MCs), which is a considered imatinib-resistant mutation. Midostaurin (a second generation TKI) may provide some disease response while nilotinib or dasatinib are usually less likely to lead to a durable response. The rare patients who have a juxtamembrane domain KIT mutation are much more likely to respond to imatinib or masitinib.

For disease response, criteria were first published in 2003 by Valent, et al. In a reiterated version published in 2007, the evaluation of clinical evidence of organ damage (C findings), was the foundation for determining appropriate response. Another facet to determining response was in relation to BM MC burden, serum tryptase level, and organomegaly, which further subcategorized the levels of major response (MR). MR was defined as normalization of 1 or more C findings. In turn, MR was divided into 3 categories:

  1. Complete remission (resolution of MC infiltrates in organs, serum tryptase less than 20 ng/mL, and disappearance of SM-associated organomegaly)
  2. Incomplete remission (decrease in MC infiltrates in organs and/or serum tryptase levels and/or visible regression of organomegaly by >50%)
  3. Pure clinical response (without decrease in MC infiltrates, serum tryptase levels, or organomegaly)

Partial response (PR) is defined as incomplete regression of 1 or more C findings and include good partial response (GPR; >50% regression of 1 or more C findings) and minor response (<50% regression).

Lastly, the Mayo Clinic published revised response criteria in 2010 which established minimal baseline laboratory abnormalities for organ damage to be evaluated in order to allow for more accurate assessment of response to therapy that is clinically more relevant.

Overall, systemic mastocytosis is a rare entity that displays a range of presentations that can be described as indolent up to an aggressive (advanced) phenotype. The hallmarks for diagnosis include histologic, immunophenotypic, molecular, and clinical findings.

  1. Gotlib, J et al. “International Working Group-Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) & European Competence Network on Mastocytosis (ECNM) consensus response criteria in advanced systemic mastocytosis,” Blood, 2012.
  2. Horny HP et al. “Mastocytosis,” In: Swerdlow S et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon: IARC Press; 2008:53-63
  3. Valent P et al. “Aggressive systemic mastocytosis and related mast cell disorders: current treatment options and proposed response criteria.” Leuk Res. 2003;27(7):635-641.
  4. Pardanani A, et al. “A critical reappraisal of treatment response criteria in systemic mastocytosis and a proposal for revisions. Eur J Haematol. 2010;84(5):371-378.

Hematology Case Study: An 80 Year Old Male with History of CLL

Case History

80 year old male patient with history of CLL presented to the emergency room with cough and not feeling well. He was diagnosed with CLL 4 years ago; had been asymptomatic and hence had not received any treatment. CBC done in the emergency room revealed a markedly elevated WBC count of 136 K/uL, decreased hemoglobin of 6.4 g/dl and mildly decreased platelet count at 131 K/uL.

Examination of peripheral blood smear revealed marked lymphocytosis (114.91 K/uL). Majority of the lymphocytes were small with round to oval nuclei. Few larger cells with morphology consistent with prolymphocytes were also noted (overall <5%). Further there was increased polychromasia and spherocytes were easily identified. The patient’s blood type was A positive and the antibody screen was positive. Direct antiglobulin test was positive (IgG) and the antibody identification panel was consistent with the presence of a warm autoantibody. His bilirubin and LDH were both elevated at 3.1 g/dl and 574 U/L, respectively.

The findings were consistent with warm immune mediated hemolysis.

Image 1. Prolymphocyte, smudge cell, and abundant lymphocytes.

Autoimmune hemolytic anemia (AIHA) due to the presence of warm agglutinins is mostly always due to the presence of IgG antibodies that react with protein antigens on the red blood cell (RBC) surface at body temperature.

Underlying causes or conditions that may be associated with AIHA include the following:

  • Preceding viral infections (usually in children).
  • Typical AIHA due to the presence of warm agglutinins has been described in patients with HIV infection.
  • Autoimmune and connective tissue diseases (eg, systemic lupus erythematosus, autoimmune lymphoproliferative syndrome).
  • Immune deficiency diseases, such as common variable immunodeficiency.
  • Malignancies of the immune system (eg, non-Hodgkin lymphoma, chronic lymphocytic leukemia [CLL], with a higher incidence in those treated with purine analogs).
  • Prior allogeneic blood transfusion, hematopoietic cell transplantation, or solid organ transplantation

The incidence of autoimmune hemolytic anemia (AIHA) in patients with CLL is difficult to determine with certainty. As many as one-third of patients with CLL may develop AIHA over the course of their illness unrelated to treatment modality. The prevalence increases with disease stage, from a rate of approximately 4 percent in Binet stage A to 10 percent in stages B and C. The incidence of AIHA may be higher following purine analog treatment.

Hematology Case Study: A 12 Year Old Female with Thrombocytopenia.

Case History

A 12 year old female presented with thrombocytopenia. Previous platelet count performed at a different facility showed a platelet count of <100K.  Patient signs show history of bruising, no history of trauma, intermittent epistaxis.

Family history shows no history of anemia or hypothyroidism from either parent. Incidental finding of hypothyroidism was revealed for this patient when laboratory testing was performed.

Light staining, “gray” platelets.

Laboratory results

DAT: Negative

PT 11.7/INR 1.1

PTT 38.3

Platelet aggregation studies: Decreased response to ADP-Collagen-Epinephrine and Arachidonic Acid. Results of which are consistent with platelet dysfunction due to storage pool defect.

vonWillberand panel shows within range results for Factor 8, vW antigen and vW Ristocetin.

Peripheral blood smear shows light staining (gray) appearance of platelets.

Diagnosis: Gray Platelet Syndrome

Gray platelet syndrome (GPS) is an inherited platelet disorder that presents with thrombocytopenia and characteristic pale/gray appearance of platelets under light microscopy. This gray appearance of platelets is due to the absence of alpha granules and their constituents.

According to Gunay-Aygun et al., the diagnosis of GPS requires demonstration of the absence or marked reduction of α-granules in platelets observed by electron microscopy (EM). Megakaryocytes also show decreased α-granules. Platelet dense bodies and lysosomes are unaffected. Alpha granules, the most abundant vesicles in platelets, store proteins that promote platelet adhesiveness and wound healing when secreted during platelet activation. Some α-granule proteins (eg, platelet factor 4 and β-thromboglobulin) are synthesized in megakaryocytes and packed into the vesicles, whereas others are either passively (eg, immunoglobulins and albumin) or actively (eg, fibrinogen) taken up from the plasma by receptor-mediated endocytosis. Proteins synthesized in megakaryocytes are markedly reduced in GPS, whereas other α-granule constituents are less affected. Studies of granule membrane-specific proteins have shown that platelets and megakaryocytes of GPS patients have rudimentary α-granule precursors. Therefore, the basic defect in GPS is thought to be the inability of megakaryocytes to pack endogeneously synthesized secretory proteins into developing α-granules. (Gunay-Aygun et al, 2010).

Most patients who present with GPS are characteristically macrothrombocytopenic and the number of megakaryocytes in the bone marrow appears normal. However platelet survival is reduced. This inability of megakaryocytes to survive is due to the alpha granule deficiency of this disorder therefore leading to thrombocytopenia. Myelofibrosis and splenomegaly is also apparent on patients with GPS but severe hemorrhage is unlikely, bleeding tendencies tend to be mild to moderate for GPS.

Most patients had bleeding symptoms from infancy with the average onset of 2 years of age. Average age of diagnosis is 10-14 years of age; some patients who have Gray Platelet Syndrome have presented with initial diagnosis of ITP (idiopathic thrombocytopenic purpura).

Gunay-Aygun, M., Zivony-Elboum, Y., Gumruk, F., Geiger, D., Cetin, M., Khayat, M., . . . Falik-Zaccai, T. (2010). Gray platelet syndrome: natural history of a large patient cohort and locus assignment to chromosome 3p. Blood, 116(23), 4990-5001. doi:10.1182/blood-2010-05-286534

-Written in collaboration with Stephanie Foster, BS MLS

Hematopathology Case Study: A 7 Year Old Transplant Patient with Neck Swelling

A 7 year old male with a history of restrictive cardiomyopathy status-post orthotopic heart transplant in June, 2010 that was on maintenance doses of tacrolimus and mycophenolate mofetil presented to his primary pediatrician left neck swelling. Starting in January 2017, the patient began with neck pain and swelling in the context of a recent gastrointestinal illness. Per CT report of the neck, a rim enhancing well-defined suppurative level III lymph node measuring 1.4 x 1.2 x 2.1 cm with adjacent soft tissue inflammatory changes extending into the left parapharyngeal space was identified. The patient was subsequently started on antibiotics and was discharged home with some improvement of swelling and pain.

The patient then presented again with continued neck swelling, although painless this time, and the patient’s cardiologist was contacted, who recommended a decrease in tacrolimus dosing. An otolaryngology evaluation was requested and given the concerning findings, the patient was admitted for further work-up, including a biopsy with a lymphoma protocol.

Flow Cytometry

Flow cytometry revealed a kappa restricted CD10 positive mature B-cell population.

On biopsy examination, a population of monotonous lymphoid cells that are large in size with round to mildly irregular nuclear contours, open chromatin, and multiple inconspicuous nucleoli are present in a diffuse pattern. Abundant apoptotic bodies and mitotic figures are noted and occasional “starry sky” features are present. By immunohistochemistry, BCL6 highlights the neoplastic lymphocytes while BCL2 highlights background T-cells. EBER is negative.

Overall, despite a negative t(8;14) IGH/MYC translocation, the findings are best considered to be of an EBV-negative post-transplant lymphoproliferative disorder with morphologic features consistent with Burkitt lymphoma.

Post-transplant lymphoproliferative disorders (PTLD) are a relatively rare complication in a variety of transplants that occurs in 2-10% of post-transplant patients. Overall, following a solid organ transplant (SOT), PTLD development is 1-5% of recipients with the highest incidence in intestinal and multivisceral transplantations (5-20%). Another factor is EBV status of the recipient, for which those that are EBV-naïve and lack cellular immunity to EBV are susceptible to graft-mediated EBV infection and ultimately developing an increased incidence in early PTLD. This population is overrepresented by pediatric transplant recipients1.

The presentation is highly variable and ranges from benign proliferations to overt lymphoproliferative disorders. Classifications for PTLD include early lesions, which are oligo- or polyclonal proliferations of EBV positive B cells have either a predominant infectious mononucleosis-like proliferation or a plasmacytic hyperplasia form. Polymorphic PTLD is a similar concept to the early proliferative lesions but the host architecture of the native structure is disrupted. Lastly, monomorphic PTLD is an entity that fulfills criteria for a non-Hodgkin lymphoma and is diagnosed according to the criteria of non-transplant associated lymphomas. Within pediatric registry studies, monomorphic PTLD accounts for 35-83% of all PTLD cases. B-cell lymphomas, particularly DLBCL, comprise the vast majority of monomorphic PTLD with plasmacytoma and T-cell lymphoproliferative disorders much less common2.

In this particular case, with the patient having been 7 years post-transplant and negative studies for EBV present, it is not surprising that germinal center phenotypic markers are highly expressed, such as CD10 and BCL6, which has been well elucidated by Jagadeesh, et al. Although not many genetic studies have been performed on post-transplant B-cell lymphomas, regardless of EBV status, there is some data demonstrating trisomies of 9 and/or 11 with translocations 8q24.1 (C-MYC), 3q24 (BCL6), and 14q32 (IGH). Rinaldi et al. noticed a lack of genetic lesions characteristic of postgerminal center derivation, such as gain of chromosome 3 (FOXP1, BCL6, and NFKBIZ) and 18q (BCL2 and NFATC1) together with losses of 6q (PRDM1 and TNFAIP3) in post-transplant DLBCL.  A number of DNA mutations have also been described including genes associated with somatic hypermutation (SHM) such as PIM-1, PAX5, C-MYC, and RhoH/TTF. These particular mutations are also found to be independent of EBV status1.

Overall, post-transplant lymphoproliferative disorders occur in a variety of transplant settings across many age groups and can be dependent on EBV and CMV status as well as the type and degree of immunosuppression. Although many variations take place in PTLD, patients with the monomorphic type are diagnosed according to their non-transplant counterparts. Current perspective includes further analysis of molecular and cellular mechanisms incorporated into research projects, which could better aid in prognostic implications and future therapeutics.

  1. Morscio, et al. “Molecular pathogenesis of B-cell posttransplant lymphoproliferative disorder: What do we know so far?” Clinical and Developmental Immunology 2013.
  2. Mynarek, et al. “Posttransplant lymphoproliferative disease after pediatric solid organ transplantation,” Clinical and Developmental Immunology 2013.

Sickle Cell Anemia

  1. Parmet, S. (2015). Adults with sickle cell disease cured with stem cell transplants. Retrieved March 25,2017, from https://news.uic.edu/cure-for-sickle-cell


Tag Archives: spirituality

Happy Belated Beltane and First Blog of the Year!

Intensity and Growth

I’ve really missed dancing.

Love and Heartbreak

“Place” written by Zoey Hart

The Love Environment

I woke to the angry tapping of my window glass against the frame as it sat restlessly in the pane, the once sweet slumber of my bedroom’s sole occupant destroyed by the harmless wind that had no idea how hard it was for me to get to sleep last night. Tossing and turning, I tried to shut out the noise. Of course, I couldn’t. Thoughts churned in my mind, turning over and over on how love is about embracing and accepting things that don’t always rub you the right way. Love has a way of stretching us, of taking us past our comfort zone and teaching us about ourselves through the lessons it gives. I know I have learned the most about myself in my love experiences, from the painful ones to the joyous ones.

Photographer, D. Sharon Pruitt.

Photographer, D. Sharon Pruitt.

Friendships are with people you love. At least, I hope so. I’m going to assume (cringe @ ass-u-me) your friendships are with people you care for and not void fillers. Love has many flavors, many shades and expressions that can look like anything we understand or receive as caring. The love I have for my children is different from that of a lover, another family member, or a friend. Even friends have their different levels of closeness and depth. All are different aspects of love. I have yet to meet a person I could not love or try to love in some way. Some of these people have no idea how much I care, while others second-guess it. That is ok. Love is something you can feel on your own; however, the expression of it/the action bits require some form of mutual participation.

Balance plays a big part in the perception of love and how well a relationship functions. Most people see balance as tit-for-tat, or you give me this and I pay you back (and vice versa). That is a trade relationship, in my opinion. Last time I checked our interpersonal relationships are not business transactions. Our relationships are about connection, and everything I’ve seen involving keeping score brings an element of competition to relationships that degrade the foundation of connection. Viewing love with expectations, which are about your viewpoint rather than what the other person sees, is a sure way to place distance and stress on a relationship. Being in a curious state of mind, seeking to understand instead of to blame goes a long way in keeping connections flowing freely.

Checking judgment is also vital to the love experience. How many times has someone shared something with you that was just as surprising to you as it was for them to actually say? In a space that is safe, where you know retaliation or negative speak will not come, is the space of non-judgment. I am a highly sensitive person, and if I see judgment on someone’s features (or worse out of their mouth) I am not likely to be very vulnerable with that person again. Opening up is a risk, and is an indicator of how safe someone feels with you. Being in a place of non-reception is a disservice to the honor a person gives by handing you a piece of them. Stowing thoughts about what you would do in someone else’s shoes is a great way to begin active listening and bridge the gap of understanding. Which moves you closer to true connection, something we all want.

photo credit: Gerhard Singer via photopin cc

photo credit: Gerhard Singer via photopin cc

Curiosity and empathy help to edify communication and freedom. Asking “why” and double checking your reception of statements help your loved one feel understood and heard. What an amazing feeling to experience and hold inside as you move through the world! Empathy is closely associated with compassion and is more than just trying to logically understand where someone is coming from. Empathy means pulling from your own similar experiences to viscerally understand where someone is in their experience of the moment. It means remembering that once you were not as knowledgeable as you are now, and that we all learn as we go. We take in our experiences and grow from them, or we keep experiencing them until we do.

How we communicate our level of caring, the words we choose, the space we give them to be themselves, how well we listen to understand, and how often we reach out creates an environment of trust and acceptance for others. Hopefully, we are creating a similar environment that we would also like to feel at home in. Love, trust, and communication is a doorway that swings both ways. Working together with an attitude of flexibility and empathy brings us closer to having the best experience of love each relationship brings to our mutual table.

Death and Freedom

What is it about death that makes me ache to let go of my limitations? Maya Angelou, Robin Williams, and now an Uncle are gone. Their light snuffed out forever. I look at the projected time I have left and know that I still have my training wheels on. Why? Why have I been so afraid to assume my own talents and passions? The answer is simple. They don’t look like societies version of life.  How many of you hate the idea of nine-to-five work? Me, too.  I can do it. At least, I have in the past. With fourteen years of military service under my belt, I’ve done more than the nine-to-five. It doesn’t fulfill me. Working for someone else’s dream makes me feel like a robot, and that is merely existing to me.

How can I teach my daughters to get to know themselves and to step into their dreams; how can I ask my friends what their passions are and how they move forward on their passions, yet not do the same for myself? I’d be a very hypocritical leader and teacher if I didn’t embody my own advice. I’ve had opportunities coming in small waves for over a year now, and I’d been to insecure to take some risks and step into my dreams. No longer. Life doesn’t have to be a struggle. It can be fulfilling, even if it doesn’t look like what everyone else is doing.

I know that I’m not the only one with my interests, though it seems we are a dying breed. Maybe that is why these passions burn so brightly in me, to bring them back into the light. Either way, there is no known second lease on life. Being here is a one-way ticket. Looking hard at this, I feel compelled to live as fully as I can, deeply, with as much love and excitement as possible. Bring on the adventure. Bring on the color. I want to be on the roller-coaster of hills and valleys with my hands held high and not clenched in my lap.  Life is too short to live it less than fulfilled.

Is there someone you always want to get to know better, but are too nervous to talk to? Do have a passion you hide from your friends and family?  Are your friends telling you what a great story teller/artist/singer/insert- your- thing-here you are?  Why not take some baby steps toward making those passions a reality? Why not allow yourself to shine in the way only you can? Join me as I step into myself, and into freedom. It is time to take the training wheels off and ride like the wind.

Follow Through

Several recent flirting expeditions brought to my attention how I see follow through in regards to relationships. Follow through? What is that? It looks like many things. Follow through is completing projects, calling when you say you will, and showing up when you say you’ll be somewhere. We all know that things happen. Sometimes something comes up, social anxiety hits, you get sick, etc. Part of follow through is making sure your excuses are not just excuses that land you on the sidelines. Did something come up just this one time and you followed through on the next attempt? Yes? That is acceptable. The problem with lack of follow through is in the consistency of it.

Follow through is not a desire or motivation issue, contrary to popular belief. It is a discipline issue. Teaching yourself to finish a goal is a matter of perspective, and is accomplished by breaking a large task into smaller, more manageable ones. You want to call that guy or girl, but anxiety is keeping you down? Text is ok for a while. Introduce playful banter, and then ask them to call you. Make it a game. Are you overwhelmed in the writing of your first novel and swimming in a sea of words, lost in your own timeline? Try note cards, a science project board with images and handwritten notes on it, or use a dry erase marker and your bedroom wall. The thing is to do something out of your ordinary, something you won’t forget or lose track of, which helps with consistency.

triumph powerful

In relationships, lack of follow through is a breeding ground for resentment and mistrust. It leaves the balanced power of a healthy and loving relationship extremely vulnerable to sabotage from inside, suffocating one (or more, if you’re polyamorous) partners power. Consistent lack of follow through can be a major reason a dating relationship never grows into more, and why an established relationship falls apart. The ability to date even after the relationship is “secured” by living together, domestic partnership, or marriage is imperative to the strength and health of the partnership. Lack of follow though in the long-term relationship creates distance and an imbalanced power dynamic. It affects dependability and respect, (yes the all-important “R” word). I find it extremely difficult to respect a friend or partner that has trouble with follow through. Mind you, if this is a known issue and the affected is really working at discipline, i.e. trying different methods to spark creativity, or using multiple reminders to remember appointments, etc., I tend to rethink the “R” word and cut them some slack.

woman triumph

Again, consistency is key, and we are not all machines. The ability to grow and evolve are very attractive qualities. Someone that knows they have an issue, that sees it, and instead of letting it victimize them uses that knowledge as fuel to grow and move toward balance, well…that is quite interesting. Admirable. Sexy. Inspirational. That is the kind of person I want to know, to be close to, to be friends with or possibly more.

You are not stuck with your “flaws”, they are pieces of you that are ripe for growth and evolution. They don’t define you, and they are definitely not all of who you are. Vulnerability is not just opening up about feelings. It is about honesty. One of the highest forms of love is honesty. Loving yourself is the first step to empowerment. Empowerment is about knowing yourself, why you make the choices you make, and knowing that you can make new choices.  Being able to change things in your life gives you freedom, which then leads to happiness. Empowerment is about seeing and effectively using personal power in a healthy way.  Lack of follow though is often an issue that can be investigated, troubleshot, and corrected if you approach it as an area that needs growth instead viewing it as a weakness you’re stuck with.

Back in my flirting life, I’m having lovely conversations and getting to know some great people. What separates friends from potential lovers (if there was initial attraction) is consistency, follow through, and the ability to evolve. Attraction is different for everyone, and one person’s criteria for a perfect ten will be different from another’s. Remembering that helps me see that there is someone for everyone. Maybe even someone for me.

Follow through affects more than interpersonal relationships. Please see below for a few links with more information on how to transform this condition.

An article outlining was to combat follow through in business:  http://psychologyforbusiness.com/articles_psychwork5.htm

A more personal take on how to get past the guilt and negative self-talk that comes from lack of follow through: http://blogs.hbr.org/2012/01/your-problem-isnt-motivation/

Lovely article, “The Art of Following Through”: http://www.pickthebrain.com/blog/learn-the-art-of-following-through-5-steps-to-ensure-you-will-achieve-your-goals/


Egoism vs. Egotism, X vs. Myopic X

I still feel there to be circular blockages. Are they really circular though? Firstly, I really want to Do Something New. By “want” I mean some combination of “desire,” “should,” “need to,” and “am afraid I won’t.” Firstly, my value system says that a little bit of something new is many times more valuable than just doing the same old. However, this leads to the same problem as the “myopic egotism problem.” The myopic x problem is the problem where I’m motivated by x, but I *cling* to x, and won’t do things that help me achieve x if they involve stepping outside of x for a moment. So being myopically x hinders my accomplishing x. I have the myopic egotism problem: when becoming a better person (ultimate goal is egotistic) means forgetting myself and being open and listening to other people (which involves temporarily suspending egotism), I have trouble. The myopic creativity problem is when I put myself in front of an empty screen and try to write, when coming up with something to write involves reading, watching, and studying books/movies/etc., talking to and doing things with people, and learning more about the world. Myopic egotism and myopic creativity together make me think everything I do should come from myself, and prevent me from “standing on the shoulders of giants.”

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Can a Fitbit Prove a Catastrophic Injury?

Categories: Personal Injury

fitbit prove catastrophic injury

Personal Injury Attorneys Helping Prove Catastrophic Injuries for Victims in Washington State

Wearable technology has become widely popular over the past few years. Even smartphone makers are now making wearable devices that connect to your phone so that you can text, email, and receive messages.

One of the more popular forms of wearable technology is the Fitbit. Fitbit offers a variety of wearable devices designed to monitor sleep habits, heart rate, number of steps, and active minutes during the day. These provide you with insight into your healthy and not-so-healthy habits, but they also do something else.

In some cases, a Fitbit or other personal fitness tracker could be used to help establish the severity of your injuries.

What is a Catastrophic Injury?

A catastrophic injury is one that is severe and not easy to recover from. When you suffer from an injury of this magnitude, you often have permanent deficiencies. For some, that could mean issues with cognition, while for others it could mean permanent paralysis, scars, or lost limbs.

These injuries can impact people’s daily lives, and prevent them from working or enjoying life as they did before. The costs for recovering from catastrophic injuries are extreme – because victims often need assistance for the rest of their lives, they will likely have a higher compensation value from their personal injury claim.

How Does a Personal Fitness Tracker Provide Evidence of an Injury?

A personal fitness device, such as a Fitbit, tracks how much activity you do. If you had one before your injury, you could use the device’s data to show how active you were before the injury versus how active you were after the injury. You can show your limited mobility, increased heart rate from stress, and even sleep disturbances that you have experienced since your catastrophic injury. But, it is important to note that personal fitness data from wearable technology has not been widely used in such claims. It has only recently become a popular form of evidence in personal injury cases.

After an accident, there will be people who doubt the nature or full extent of your injuries. The attorneys for the insurance company have one goal: Do whatever it takes to lower your settlement amount. That means trying to prove to the court that your injuries are not as severe. One possible way to prove your injuries – and the harm they caused – is through your personal fitness data. You can show how dramatically your activity and lifestyle has changed, and the data cannot be altered.

Fitbit Data Might Do More Harm Than Good

While this data can be helpful, it can also damage your case. Fitness data from the devices is relatively accurate, but there are still inconsistencies. Some might count steps even though you are being wheeled in a wheelchair. You may also have increased activity hours during rehabilitation appointments.

In the event that someone is filing a false claim, fitness data could prove that he or she has not been impacted by the injury as claimed. So, it is imperative that you ensure your data correlates with all claims in your lawsuit.

If you are curious about what evidence you can use to prove your injury case, it is best to leave it up to a personal injury attorney. Brett McCandlis Brown, PLLC has been handling catastrophic injury cases for years, and we can help you receive the compensation you need to recover from your injuries.

Schedule a free consultation now at 800-925-1875 or contact us online to schedule an appointment.


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79. Moving on the river boat blows frequency ν0 =

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79. Moving on the river boat blows frequency ν0 = 400 Hz. An observer standing on the shore, sees whistle sound frequency ν = 395 Hz. Taking the sound velocity υ = 340 m / s, determine the speed of the ship. Zoom in or ship?

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13 June 2017

Zambia: Electricity Price Hike Raises Deforestation Fears

Zambia's energy regulator has approved a 75 percent boost in the country's electric rates, a move environmental groups fear could push more households to use charcoal and wood as an alternative energy source.

Francis Yamba, acting chair of Zambia's Energy Regulation Board, said higher electricity prices would allow Zesco to invest in new kinds of power generation "which are important to diversify the generation mix to avoid the devastating effects of drought that had recently been experienced".

But Peter Sinkamba, the president of Zambia's Green Party, warned that higher electricity prices are likely to boost forest losses as more people turn to charcoal and wood for energy.

That could aggravate climate change impacts in the country - including drought - because forests help stabilise rain patterns, he said.

Nearly 60 percent of Zambia's land is covered with forest, but forest losses are growing, as a result of expanding farming and growing demand for timber, firewood and charcoal, according to a 2004 report by Zambia's government and the United Nations Development Programme (UNDP).

"Due to the high electricity costs people have turned to massive cutting of trees for charcoal production and with this increment we expect deforestation to increase," Sinkamba said.

"Any commodity that people use as being essential to life and you push it up by 75 percent in an economy that is not growing, in an economy where inflation is below 10 percent, means you have placed a very heavy burden on the citizens that utilise the commodity - and that's exactly what (the government) has done to Zambians," said Milupi, an electrical engineer.

A women's rights group, the Non Governmental Organisations Coordinating Council (NGOCC) also has warned that more households will be forced to turn to cheaper energy - or grow poorer.

"The tariff increase, especially for domestic users, will have the potential to further accelerate and exacerbate the already high poverty levels. The increment will increase the proportion of people in the country using unsustainable forms of energy," said Sara Longwe, chair of the group.

The move "will further increase Zambia's vulnerability to climate change," she predicted.

Ester Mwenya, a charcoal trader at a suburban Lusaka market, said demand for charcoal had already been growing even before the electricity price hike as water shortages at the country's hydropower dams led to electricity shortfalls.

"On average I would sell like 15 bags of 50 kilograms of charcoal a day, but since the electricity load shedding last year we have been selling like 20 bags a day and the demand is high," she told the Thomson Reuters Foundation.

Inonge Mutukwa, a resident of Lusaka's upmarket Salama Park area, said charcoal had become a more economical cooking choice than electricity.

"If you want to cook food that takes a little time like beans it is better to use charcoal as it is cheaper than using electricity," she said.

Reporting by Whitney Mulobela ; editing by Laurie Goering

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Maryland Basketball: How Shaquille Cleare Can Win ACC Freshman of the Year

Ryan SatskyContributor IIIOctober 2, 2012

Shaquille Cleare
Shaquille Cleare

The University of Maryland hasn't produced an ACC Freshman of the Year winner since 1994, when Terps big man Joe Smith took home the trophy. Smith would go on to win the National Player of the Year award the next season.

Now, after waiting 19 seasons, Maryland finally has the opportunity to add another ACC Freshman of the Year winner to its accomplishments with the addition of 4-star center Shaquille Cleare.

Cleare, originally from the Bahamas, has lived in the Houston area for four years. He checks in at a massive 6'9'', 270 pounds. The Village School alum was ranked 30th in his class by ESPN.

Cleare was considered by many to be snubbed by the McDonald's All-American Game roster selections. Despite not being picked to play in the prestigious All-Star event, Cleare was ranked higher than three McDonald's All-Americans in ESPN's rankings.

The promising center is Maryland's most-prized commitment since Mike Jones in 2003, meaning Cleare was praised higher than future NBA picks James Gist, Greivis Vasquez and Jordan Williams.

In his player profile video on the new Maryland basketball website, Cleare said this about his decision to come to Maryland:

"After moving from the Bahamas to Houston, Coach [Mark] Turgeon had been recruiting me for, like, four years while I was down there. He wanted me to come to [Texas] A&M, but Maryland was my first option. But, after Coach [Gary] Williams retired, Turgeon took the job from A&M and came to Maryland, so I just killed two birds with one stone right there, and decided to commit to Maryland."

With so much hype building around a player, it's often difficult for that individual to manage expectations. Cleare certainly has the body, talent and attitude to compete for the ACC Freshman of the Year Award, but needs to accomplish a few things as the season progresses.

Here are some of the ways Shaquille Cleare can grab that coveted award.

Play his way into the starting lineup

Mark Turgeon hasn't hinted at any possible starting lineup. That being said, it would be wise to assume that James Padgett, the only non-transfer senior on the roster, will begin the season as a starter. Whether it be for leadership purposes, ACC experience or offensive rebounding prowess, Padgett should take up a starting position.

Also, it would be very surprising if the potential-laden center Alex Len didn't receive the starting nod to begin the season. Len stands at 7'1'', and has tons of promise. Turgeon will most likely start him and give him the opportunity to show how far he has developed over the offseason.

Put two and two together, and Cleare doesn't have a starting position—yet.

After a month or so, Cleare definitely can overtake James Padgett's spot in the starting lineup, and he needs to if he wants to compete for the ACC freshman of the year award.

To state it plainly, no bench player is going to take home an honor like that one. Cleare needs to produce right away, and play his way into the starting lineup if he wants any shot at claiming this award.

Lose a little more excess weight

To be completely fair, Shaquille Cleare has never struggled with same weight issues that Joshua Smith or Renardo Sidney dealt with in college. Still, Cleare measures a bit on the heavy side.

Throughout high school, the mountainous Bahamian has struggled with his conditioning and his ability to run up and down the court. When you can't move down the court, you often get benched, which wouldn't bode well for Cleare's ACC freshman of the year chances.

Cleare needs to stay on the court as much as possible, even if it does mean cutting out some his massive 270-pound frame.

Apparently, Cleare is already working on fixing this problem. Recently, fellow Maryland freshman Seth Allen posted this picture of the basketball team in the weight room on his Twitter via Instagram. Shaq looks absolutely built, and it is evident that he has already began to work on his strength and conditioning.

In addition, Maryland brought in Navy SEALs to train the basketball players last month. This video highlights the intensive workouts the players went through, meaning that Cleare's fitness is certainly improving.

These two examples are terrific, but Cleare needs to continue losing his excess body fat in order to stay on the court more often and compete for the ACC freshman of the year honors.

Improve his interior finesse game

Shaquille Cleare is a bruiser. He muscles his way to fight for rebounds, turns offensive boards into putback slams, and blocks shots ferociously.

All of those characteristics are wonderful, except they won't help his scoring average too much. If his points per game total maintains a single-digit value, Cleare's hopes of being named the ACC's top freshman will be shot.

Cleare seriously needs to work on his low-post finesse game in order to have an alternate way of scoring the ball other than points off rebounds. Powering through defenders won't work as well as it did in high school, so Cleare needs to develop some effective post moves.

Luckily, Cleare is playing right next to James Padgett, who has gradually improved his post game throughout his three-year career in College Park. Now, no one in the ACC uses his pivot more effectively than Padgett.

If Cleare can take note of what Padgett has transformed his post-game into, and become a consistent double-digit scorer, the big-bodied center will have a great chance to be chosen as the ACC's most outstanding freshman.

Cleare has work to do, but that work is manageable. If he can enhance all three of these parts of his game, he will give himself the opportunity to knock of the likes of Rodney Purvis, Marcus Paige and Rasheed Sulaimon, and take home the 2012-13 ACC freshman of the year award.


How I’d Fix It: The Dark Knight Rises

From the opening paragraph, Dan writes, "Also, I AM NOT SAYING THAT THE DARK KNIGHT RISES IS A BAD MOVIE. Because it isn’t. But then, I’m writing about it for this column, so there are more than a few flaws in it… and they’re pretty significant. I’ve generally been rather cooler on Christopher Nolan’s Bat-trilogy than a lot of other geeks. I get what he’s been going for, and there are things that I’ve loved about all three of the movies, such as the pre-Batman stuff in Begins, the Joker in Dark Knight, and Catwoman (yeah, she’s never named as such but dammit she’s Catwoman) in this one. But overall, I just don’t wholly jive with any of these Batfilms, and the reasons vary for each one. Since we’re just talking about TDKR, I’m going to be focusing on it’s problems."

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