doc w/ pen

a journalist becomes a doctor before your eyes

Category: Published Research

For the Record …

Patient: What was my blood pressure at my last visit?

Doctor: That’s part of your medical record. I’d rather not say.

Sounds absurd, right? It is. And I’m guessing not many doctors have had that attitude. But prior to Congress passing the Health Insurance Portability and Accountability Act (HIPAA) in 1996, there was no federal law requiring health care practitioners to give you access to your own medical records or information. (Some states did have a law to that effect, though.) Now that access is guaranteed – even if you haven’t paid your bill – although practitioners are allowed to charge a “reasonable” amount for providing the information.

As more and more practitioners and facilities transition to electronic health records, some are piloting a new type of on-demand access: electronic patient portals. While they differ some in format or the extent of information available, the idea is that the portal is a secure, online repository of your medical information, from physician notes, to medication lists, to lab or test results, to upcoming visit schedules, and so on. These portals are often also interactive, allowing patients to schedule appointments, message their practitioners, and request medication refills.

Rush University Medical Center, which my internist is affiliated with, offers “MyChart,” its own patient portal system. There never seemed to be much reason to view it, though. After my recent run-in with the medical establishment, I decided to check it out, more for curiosity than anything.

Through the MyChart patient portal, I have access to a wealth of medical information, including these lab values.

It’s really pretty cool (at least for a curious pre-medical student such as myself; its efficacy for the general public is still a matter of debate; more on that later). For example, I was able to view all my labs from when I was in the ER, everything from my mono test (positive) to my strep culture (negative) to all of my CBC values. Upon opening up the CBC link, for example, two columns appear – both the standard ranges and my values.

OK, I’m no doctor (yet). So when I see values outside the normal range, or narrative values that make no sense to me, I have the tendency to become curious (at the least). For example, what the heck does “ATYP LYMPH / MODERATE” (at the very bottom of the screenshot) mean? Enter my good friend Google: this signifies that my immune system is actively fighting an infection. One Web site I found even specifically referenced infectious mononucleosis, explaining that mono produces a lymphocyte morphology with a dented cytoplasm, in addition to some other specific characteristics. So. I’ve got dented lymphocytes. Who knew?

So far, my use of MyChart has really been more for curiosity’s sake than anything, though. The true purpose of an electronic patient portal is to better patient outcomes, increase transparency in health care, improve coordination and continuity of care, enhance practitioner-patient communication, and foster a sense of ownership regarding one’s care (among other things). The question is: do patient portals live up to these goals?

To answer this particular query, I turned to another dear online friend, PubMed.* While my search on the subject is by no means exhaustive (or particularly scientific), here is a theme I found repeated:

We don’t know yet.

In fancier, more scientific language:

Evidence is mixed about the effect of portals on patient outcomes and satisfaction, although they may be more effective when used with case management. The effect of portals on utilization and efficiency is unclear, although patient race and ethcnicity, education level or literacy, and degree of comorbid conditions may influence use.

[Source: “Electronic Patient Portals: Evidence on Health Outcomes, Satisfaction, Efficiency, and Attitudes,” Annals of Internal Medicine, 2013]

Like I said.

The reason we don’t yet know how beneficial patient portals are is that they are relatively new, which means studies on them lack the longitudinality, detail, and context necessary to make convincing conclusions. The review article quoted above mentioned that in the studies they looked at, patient attitudes regarding the portals are “generally positive.” On the other hand, it seemed that not all patients had equal access to or understanding of the information available: “… more widespread use may require efforts to overcome racial, ethnic, and literacy barriers.” In other words, it becomes a health literacy issue, one complicated by the involvement of technology.

The review article’s bottom line:

Portals represent a new technology with benefits that are still unclear. Better understanding requires studies that include details about context, implementation factors, and cost.

That said, there is anecdotal evidence that patient portals are a positive development. Another article in the Annals of Internal Medicine, from 2012, looked at a group of 105 primary care doctors who provided electronic links of their visit notes to some 13,564 patients across three different practice sites. The self-identified goal of the study was to “evaluate the effect on doctors and patients of giving patient access to notes over secure Internet portals.”

The overarching result of the study:

At the end of the experimental period, 99% of patients wanted open notes to continue and no doctor elected to stop.

[Source: “Inviting Patients to Read Their Doctors’ Notes: A Quasi-Experimental Study and a Look Ahead,” Annals of Internal Medicine, 2012]

More detailed statistical findings, summarized below, were quite interesting as well (statistical ranges are given to represent the differences between practice sites).

Of the 5,391 patients who opened at least 1 note and completed a postintervention survey:

  • 77% to 87% across the three sites reported that the open notes helped them feel more in control of their care
  • 60% to 78% of those taking medications reported increased medication adherence
  • 26% to 36% had privacy concerns
  • 1% to 8% reported that the notes caused confusion, worry, or offense
  • 20% to 42% reported sharing the notes with others

After the intervention, the physicians were surveyed as well:

  • 0% to 5% reported longer visits
  • 0% to 8% reported more time addressing patients’ questions outside of visits
  • 3% to 36% of doctors reported changing documentation content
  • 0% to 21% reported taking more time writing notes

This anecdotal study has both strengths and weaknesses. A strength, and something I appreciate as a future physician, is that the authors did survey the doctors as well – important because anytime you introduce something new like this, you need the doctors on board to make it work. Making conclusions from this study, though, is dicey. The authors acknowledge this upfront with a “Limitations” section at the top of the paper: Only three geographic areas were studied. Most patients were already experienced in using such portals. Both doctors and patients choosing to participate and complete the final survey “may tend to offer favorable feedback.” The end survey response rate was low (41%).

Still, the results are something to think about. If, somehow, we could develop strategies for overcoming the racial, ethnic, and literacy barriers (as cited by the first review article), then maybe we could see more of these positive results across the general population.

Or … maybe not. But if it might help people take ownership of their health, I think it’s worth a try.

 

 

* In case you’re not familir with PubMed, it is basically a ginormous collection of scientific and medical journal articles online, curated by the US National Library of Medicine and the National Institues of Health. Some of them are free; others are available for purchase on the specific journal’s Web site. Being a Northwestern University employee, though, I have access to most of the articles at no charge. Gotta love connections.

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Flaky Science

“The nitrogen in our DNA, the calcium in our teeth, the iron in our blood, the carbon in our apple pies were made in the interiors of collapsing stars. We are made of starstuff.”
― Carl Sagan, Cosmos

One of the things I talked about in my MD/PhD interview was my sense of awe with science – those moments where you realize, as Carl Sagan points out in the above quotation for example, that we are indeed made of starstuff. It started right when I began working in Prof. Richard Minshall’s lab at UIC, and hasn’t let up (thankfully). That feeling of wonder doesn’t only apply to medicine, though. And it gives me great joy to see other people – other scientists – getting down and nerdy.

My most recent foray into other realms of science: snowflakes. That’s right, those six-sided crystals that fall from the sky and make our commutes hell on earth. It all started when I was looking for a different type of wintry image for my desktop background. Search “winter” on Google Images and you’ll come up with a lot of images of fields and trees covered in snow. While these are fine images, I wanted something out of the ordinary. So I scrolled, and searched (other winter keywords), until I came up with this image:

Playdough? Claymation? Nope. Snowflakes under an electron microscope.

At first glance, it looks like playdough, or a frame from a claymation movie. Wikimedia (where I found the image) directed me to the photo’s source, the Electron Microscopy Unit Snow Page of the USDA. EM images of snowflakes? What a concept. Exploring the site further, I found an incredible, yet easy to understand, amount of information, including how these images were recorded (through Low Temperature Scanning Electron Microscopy). Another discovery was that scientists classify snowflakes into dozens of categories through a nomenclature system called the Magono and Lee Classification of Snow Crystals (Part 1 and Part 2). Examples (with images of course!) include the following:

After seeing all of these photos, reading all of the accompanying information, the thought that comes to my mind is: Snowflakes are made of starstuff, too.

Library Access: A Lab Job Perk

PubMed is a great resource. For those of you who aren’t familiar with it, PubMed is an online resource hosted by the U.S. National Library of Medicine and the NIH. It has more than 22 million citations to biomedical literature. Some of those citations have links to full text articles. But unfortunately, many of the more prestigious journals charge for their articles (often as much as $30 or $40 per article). Given my current broke status, I can’t exactly afford to buy article access.

So I recently e-mailed my PI at the UIC lab where I work asking whether I could get journal access through UIC (major universities usually provide this type of access to their students and some employees). He told me that all I needed to do was plug my laptop into the UIC network (via a network cable at the lab) and I would automatically get access to everything.

A few weeks ago, I spent a little downtime getting some of the articles I wanted. When you download an article from some of these publishers’ sites, a little window will pop up with “recommended readings” based on what you just looked up. I noticed at some point that not a journal article, but a book chapter, popped up as one of those recommended readings. I hadn’t thought about book chapters. But as I did think about it, the idea appealed to me. A book chapter would provide a great deal of background, which is what I am looking for right now. So I wondered, “Could I get the whole book?” The answer: “Yes!” Then my follow-up question: “Are there more available books on my subject?” The answer, again: “Yes!”

From home, I used the UIC library’s Web site to find available eBooks. Then while a gel was running at lab, I downloaded them, chapter by chapter (you can’t download the whole book directly). Back at home, I put them on my iPad.

Granted, I’m not going to read every single page of every single book I downloaded any time soon. But I want to be able to skim them, to decide what I want to read and not read. So getting entire books made sense.

After I had finished getting my books, I was curious – how much would all of these books have cost had I purchased them? Being the absolutely nerdy person I am, I made an Excel spreadsheet to calculate the cost of buying the hardback book directly from the publisher, the eBook from the publisher, the hardback from Amazon.com, and the eBook from Amazon.com (yes, I actually did this). I was amazed – the hardback books from the publishers would have cost more than $2,000 (eBooks and Amazon.com hardback prices were somewhat less). One more reason to be affiliated with a major research institution, and to be grateful for my lab job!

Here is my lovely spreadsheet:

library savings

My First Research Symposium

One thing I have learned about “being” in science is that it involves poster presentations. Some people like them, some people hate them, but they are a part of the job. I saw my mentor and supervisor at UIC, Olga, make several posters (to present at various conferences) while I was working there. And for the Drosophila genetics conference, Dr. Kreher made one as well (which I wrote about earlier, and which included me as a secondary author!).

Today, I will present my first and very own poster at Dominican University’s “Undergraduate Research, Scholarship, and Creative Investigations Expo” (“URSCI” for short). This is an annual event at Dominican, where students from across different disciplines present their research work through both presentations and posters. For the poster portion, which is what I am doing, you have a designated time that you are supposed to stand by your poster and explain it / answer questions about it to anyone who is interested. While this might make some people nervous, I am really excited about the opportunity. I love talking about science (obviously), and I am also adept at explaining it in more basic language for people who might not be familiar with the concepts or procedures. That is one thing I learned well in journalism – you have to know your audience. So I know how to tailor my explanation, based on the people with whom I am talking.

The title of my poster is “Antibiotic Resistance of E. coli to Rifampicin and the Mutagenic Effects of Caffeine.” The work stems from a project I did in my Research Methods in Molecular Biology class, which I took last spring with Dr. Kreher. (I am currently working in his genetics lab with the fruit fly larvae.)

Ecoli_Caffeine_LEM

It was a fascinating project, and it had two components. As a class, we reproduced the experiments done in the late 1980s by two researches, Jin and Gross. They investigated how E. coli develop antibiotic resistance to a drug called rifampicin, which is used for tuberculosis. Based on their research, and previous work, they determined that rifampicin inhibits the bacteria’s RNA polymerase (which is what transcribes mRNA, which is later used to synthesize proteins). That’s bad for the bacteria, because without the necessary cellular proteins, the bacteria will die. But Jin and Gross also discovered that the bacteria can develop, at a particular rate, specific mutations in the gene (rpoB) encoding for a particular subunit of its RNA polymerase. These mutations allow the bacteria to survive treatment with rifampicin.

We repeated Jin and Gross’s experiments, growing E. coli on agar plates containing rifampicin (as well as another antibiotic, carbenicillin, to which our bacteria had been engineered with a resistance gene, so that only the bacteria we were studying would grow – no random bacteria from the environement would grow, because the carbenicillin would kill it). We were able to generate resistant bacterial colonies as well, and sequenced their DNA. In comparing the sequenced DNA to the wild-type rpoB (RNA polymerase) gene, we found some of the same nucleotide mutations as Jin and Gross, as well as a couple of mutations that were unique to our experiments.

The second part of the project was to choose a substance – any substance within reason, that could be procured at a store or from a chemical supply company – and see how that affected the mutation rate. Each student (there were eight of us in the class) had to choose something different. I chose to work with caffeine, which is a suspected mutagen, based on some scientific literature that I found. So my hypothesis was that treating the bacteria with caffeine would increase the rate of mutation, and hence the rate of antibiotic resistance. I tested two concentrations of caffeine, 1 mg/mL and 3 mg/mL. What I found was very interesting – not only did the caffeine fail to increase the mutation rate, it actually (especially at the higher concentration) killed much of the E. coli! So I did some more literature research, and found that caffeine has been shown to also have an antimicrobial effect on E. coli. Who would’ve thought?!

I absolutely love science. You don’t always get what you expect, in terms of results (I certainly didn’t), but you usually learn something. And that’s the point: discovery.

Drosophila Conference: Part II

Things are coming together, thanks to the Drosophila genetics conference I have been attending this week. What exactly do I mean? What I mean is that I think I have discovered what I want to study for my PhD. And it represents a beautiful dovetailing of my research passion, and clinical compassion.

Let me explain. On Thursday afternoon, I attended a session at the conference entitled “Drosophila Models of Human Disease.” This was the session I was most excited about, because disease is what I am interested in. Although until Thursday, I wasn’t sure which disease. That became more clear to me after a presentation by Dr. Susumu Hirabayashi from Mount Sinai School of Medicine. He presented his work on “A Drosophila Model Linking Diet-induced Metabolic Disease and Cancer.” In other words, a compelling example of how diabetes and cancer are connected. (Which is something I was not aware of previously.) I found myself riveted throughout the presentation – it was an elegant, and eloquent, demonstration of the use of Drosophila melanogaster genetics to explore a disease that has devastating implications for the people who suffer from it. To be more precise, some 25.8 million people in this country alone, according to the American Diabetes

Association (http://www.diabetes.org/diabetes-basics/diabetes-statistics/). That is, approximately, a whopping 8.3% of the U.S. population. And that proportion is only going to get higher as baby boomers age, and as more and more people become overweight and obese.

Diabetes is not unfamiliar to me. In fact, only a few days ago, I wrote a blog post about a diabetic patient at the free clinic where I work as a Spanish medical translator who refused to start taking insulin, and the lessons I learned from that encounter. Probably the majority of the patients for whom I translate have diabetes, in part due to the fact that Latinos are at a higher-than-average risk for this disease (as are African-Americans). From those translating sessions, and from conversations with doctors at the clinic, I have learned a great deal about the various complications associated with diabetes, as well as the treatments for it.

As I sat listening to Dr. Hirabayashi’s presentation on Thursday, it clicked: studying diabetes would represent for me a confluence of my passion for genetics research, my compassion for the Latino community, and also my clinical experiences and knowledge thus far. I found myself nearly bouncing with excitement (although I contained myself, for the sake of the conference attendees sitting behind me).

The next day, I rewrote my “significant research experiences” essay (which is for my MD/PhD application) to reflect what I had learned at the career luncheon, as well as to reflect my discovery of this new research – and clinical – interest. Which really isn’t so new; it’s more a matter of me only now putting the pieces together. I also began investigating laboratory research opportunities to study diabetes and other metabolic disorders at various graduate schools. I found many such opportunities, both at schools that were already on my “to-apply-to” list, as well as schools that were not. (I will likely be adjusting that list accordingly.) I also discovered that my dual experience with two of the most popular model organisms in science – mice and fruit flies – will serve me well, as most researchers studying diabetes use one of those animals in their work.

If I do indeed decide to study diabetes (for the PhD side), that would lend itself very nicely to becoming an endocrinologist (for the MD side). That would involve doing a residency in internal medicine, and then a fellowship in endocrinology. I have been wanting to find a research subject that coordinated with a medical specialty, and this does exactly that.

Do I have it all figured out? No. Could I change my mind on this? Sure. But it is nice to have a jumping-off point, and a potential goal, as I embark on this MD/PhD journey.

Drosophila Conference: Part I

Drosophila melanogaster (fruit fly)

Drosophila melanogaster (fruit fly)

Wednesday evening was the start of the Drosophila genetics conference. Over the last couple of days, I have learned so much, both about this amazing model organism, and about the research community that studies it. The first evening, there was an incredible presentation by a recent PhD graduate who had studied olfaction in both Drosophila melanogaster and in the mosquito. As I learned through her presentation, fruit flies have a natural aversion to carbon dioxide. However, they are attracted to decaying fruit (they eat the microorganisms inhabiting the fruit). And fruit emits carbon dioxide. This presents a paradox: why are the fruit flies attracted to the fruit, if they are naturally avoidant when it comes to carbon dioxide? She discovered that there are various compounds (also emitted by the fruit) which inhibit the flies’ carbon dioxide odor reception mechanism. She then extended this work to mosquitoes, which have significant gene homology (similarity) to fruit flies when it comes to their carbon dioxide receptors.

Mosquito

Mosquito

Mosquitoes, though, have the opposite behavior when it comes to carbon dioxide: they are intensely attracted to it. In fact, that’s how they discover humans – by sensing the carbon dioxide plumes that we inhale. (Which I found fascinating; I had no idea that was how they found us!) She tested the same compounds that had inhibited the fruit flies’ carbon dioxide odor receptors, and found that they also inhibited the mosquitoes’ receptors. In essence, she may have found the next generation of mosquito repellents, which could be released into the air rather than applied directly to the skin. In related experiments, she also discovered compounds that mimic carbon dioxide’s appeal to mosquitoes. Her goal in doing this was to try to develop a more effective trapping mechanism for mosquitoes. Apparently, current mosquito traps involve producing carbon dioxide via burning propane or evaporating dry ice, two methods which are both expensive and cumbersome. She did indeed find several compounds that mimic carbon dioxide’s effect on these flying pests, which could be used to trap and kill them. These mosquito solutions may not be as relevant in this country, where mosquitoes are mainly annoying. But mosquito-borne illnesses such as malaria are devastating in many third world countries, and coming up with more effective ways to combat the spread of these diseases (via trapping mosquitoes, or repelling them) would be a significant accomplishment. Several wonderful, real-life applications of Drosophila genetics!

Thursday afternoon, I went to a career luncheon sponsored by the Genetics Society of America (GSA). I sat at a table with several undergraduate students, as well as a professor from Tufts and another professor from Albert Einstein College of Medicine. We students were there to learn about choosing the right graduate school (that was the topic at our table – other table topics included science writing, starting a lab, finding a post-doc position, etc.). The professors were very candid and helpful, in terms of helping us learn about the selection, application, and interview processes. I definitely feel I have a better sense of what PhD committees want to see in my research essay after the conversation I had with those professors. This led me to rewrite my “significant research experiences” essay, which is part of the MD/PhD application, yesterday. (And I think the essay is much improved!) One of my own questions related to how to discern the “environment” of a school, or a specific lab. For example, is it super competitive? Is the PI (principal investigator) a true mentor, or is he/she hands off? I told the professors that of course I would love to go visit a dozen schools, but I simply can’t afford to do that. As a student living solely on loans, I’m pretty much flat broke. The professor from Tufts suggested e-mailing graduate students from the PhD programs I am interested in and just asking them what it is like to work and live in that particular school environment. I’m not one to be afraid to ask questions, but I had honestly not thought about this. So that’s something I’m looking forward to doing. It’s tough, because I essentially have two sets of curriculum to evaluate – a medical school’s and a graduate school’s. And because I will (hopefully!) be spending seven to eight years wherever I go, I want it to be a positive experience, as much as possible. I also asked both professors about my own unique background – which is strong in journalism, and perhaps less strong in science than the PhD typical applicant – and how that would be perceived by PhD admissions committees. The Tufts professor said that I could turn what might be seen as a weakness by some into a significant strength. For example, with my writing background, I am in a much better position to successfully write scientific papers and grant proposals than other graduate students, who likely have weaker writing skills. That was very encouraging to me.

I realized this morning that this conference has, overall, been a fantastic opportunity for me to learn more about the research process, community, and experience. I have felt pretty confident in my knowledge about the medical aspect of my application experience and process, but until this week, I have simply had less exposure to the PhD community. What I have absorbed in the last few days will, I believe, help me achieve and succeed in the other half of what I want to do with my life. And that’s a good feeling.

When it comes to conferences – especially ones where you have to shell out some money – you never know what you’re going to get. Will it be worth your while, and worth the expense? In other words, will it deliver? This one definitely has.

A Good-Natured Resolution

I’m not much for making New Year’s resolutions. They seem to stick for about a month, and then … not so much. But this year, I decided to try what so many millions of people do and make my own resolution, one that hopefully I can (and will want to) keep. There is some additional incentive, other than just meeting a goal — I invested money in this resolution up front, so I’m betting on that keeping me motivated.

So what do I want to do? It’s not your typical resolution. My goal is to read Nature every week. (Well, not ALL of it, but a good bit of it.) For those of you unfamiliar with this magazine, it’s a weekly publication, and is one of the premier scientific journals in the world. Because of its prestige, its articles are only available to its paid subscribers. Countless times I have stumbled across a Nature article on PubMed and salivated over the abstract … but I had to move on, because there was no way for me to read it.

Thanks to some Christmas money from my grandma, problem solved! I subscribed the day after Christmas, and will be getting both the print edition, as well as online access going back more than a dozen years. (And of course, there is a Nature app for the iPad!) A subscription — even a student subscription, which is half the regular subscription price — cost a pretty penny ($99 students / $199 everyone else). But I think it will be worth it. After all, how can any self-respecting MD/PhD-wannabe NOT be subscribed to Nature? My point exactly.

Assuming that I do follow through with this “resolution,” I hope to post here about some of the things I read. There are very technical articles, of course, but also editorials, features, and other types of material in the magazine. I look forward to my year of Nature, and to writing about what I learn.

And as you may have noticed, I have made a new “discovery” related to blogging, as well. With the iPad blogging app I have (BE Write HD), you can set backgrounds for your blog posts. It took a bit of researching as far as how to reduce an image’s opacity so that it would work as a background (I downloaded a photo editor app, PhotoForge2, for that). But I’ve got it figured out now.

Gene-ious!

Geneticists, and scientists in general, may not exactly have a reputation as having a sense of humor. But, I argue, many of them truly do. I have evidence to prove it, which I will present in this post. I stumbled across this evidence when searching for an appropriate name for my iPad. I simply Googled “funny gene names,” and came up with a list of sometimes hilarious, sometimes poignant, sometimes culturally referenced, names for genes of various organisms (especially my dear Drosophila melanogaster). Here are some of my favorites, taken from a couple of Web sites that I found: jpetrie.myweb.uga.edu/genes.html, http://www.curioustaxonomy.net/gene/fly.html, and tinman.nikunnakki.info/browser. I hope they bring a smile to your face, as they did to mine.

These are all from Drosophila melanogaster:

 Gene name History behind name
 18wheeler This gene is expressed in 18 stripes in developing larvae.
 agnostic Agnostic flies fail to learn odors in certain temperatures. Agnostic people also have problems making up their minds.
 amontillado Mutant larvae do not hatch. In Edgar Allen Poe’s short story “The Cask of Amontillado,” a man who is still alive is walled in.
 brokenheart A mutation in this gene causes a defect in heart development.
 cheap date These mutants are very sensitive to alcohol.
 cleopatra In these mutants, an interaction with the asp gene is lethal. Queen Cleopatra supposedly committed suicide with a poisonous asp.
 clown Mutants’ eyes are red and white.
 coitus interruptus Mutant males literally engage in withdrawal during copulation (it lasts about 60% of the normal 20 minutes).
dachshund Flies have crippled legs, resembling this dog species.
dreadlocks The connections between nerve cells of these flies are not correct, and the result resembles the hairstyle of the same name.
drop dead These mutants’ brains deteriorate rapidly; they begin to walk in an uncoordinated way and then die.
dunce These flies have impaired learning.
glass-bottom boat These flies’ larvae are transparent.
grim, reaper These two genes together mediate programmed cell death (apoptosis) in the fruit fly.
groucho Mutants have a greater-than-normal number of bristles (like Groucho Marx).
icebox Female icebox mutants do not care about courting males.
ken and barbie Both male and female mutants lack external genitalia (like Ken and Barbie).
limo This gene is involved in protein transport.
lot A Biblical reference: mutants like salt more than usual.
lush Mutation causes increased desire for alcohol.
out cold Mutants lose coordination when the temperature falls, and eventually become paralyzed.
sarah Mutants are practically sterile (another Biblical reference, to Sarah, Abraham’s wife).
stuck Mutant flies get stuck in females.
swiss cheese Mutants have holes in their brains that resemble swiss cheese.
van gogh Swirling wing hair patterns resemble van Gogh’s paintings.
yuri Mutants have difficulty with gravity. The gene was found on the 40th anniversary of Yuri Gagarin’s historic space flight.

Thanks to the tinman Web sites I referenced above for these gene names and explanations; visit the site for more. Fun stuff!