alphaoverlord

I don’t think the examples shown reflect an element of critique.

The nordicc trial was published last year. This is recent results, trials with 10 year followup take a long time to run.

https://www.nejm.org/doi/full/10.1056/NEJMoa2208375

If you have complete AV block, a leadless pacemaker is less good than one with multiple leads, since it allows pacing multiple chambers and maintaining synchrony between A and V.

Not all treatments are equally likely as well. Given how good dietary science is outside of cancer, less optimistic at rigorous studies in this area.

It’s a research dataset, similar to MNIST or CIFAR. Stanford does not want to be in the business of monetizing patient data, so it restricts commercial use.

With AIMI, we released EchoNet-Dynamic, the largest open dataset of echocardiograms (cardiac ultrasounds) and expert cardiologist labels as part of a paper published last year. The dataset went through a rigorous review to make sure no identifying information was leaked as part of the process. Happy to answer any questions.

There are definitely doctors who will space it out if you’re stable or do a phone refill

I have absolutely nothing against CGMs, but the author confounds measurement error (which can happen in both blood tests as well as subcutaneous measurement which a CGM does), thresholding on a population level (I doubt anyone thinks an A1c of 4.5 and 5.6 are the same), and weak evidence of impact in actual health outcomes. It’s fun in the same way a Fitbit/Apple Watch is fun, but I don’t think one should oversell it’s utility.

I think number of launches was used as a proxy for number of satellites launched in the last month - more satellites/launch shouldn't impact it that much.

Medical doctors at universities and medical schools generally make 50% of salaries for private practice.

Less, it’s not on label for aortic regurgitation, only aortic stenosis.

As a physician, I can say that is not true

Anti-inflammatory drugs do reduce risk.

https://en.wikipedia.org/wiki/Canakinumab

http://www.nejm.org/doi/full/10.1056/NEJMoa1707914

Not op but cortisol is elevated in "just stress" as well as critical illness. An elevated cortisol is not a diagnostic test that can deferentiate between a serious medical problem and stress.

For the uninitiated, could you explain the difference?

Yes, but that does not require complicated structures like blood vessels. Embryos and ova are small enough to grow on cell culture in which diffusion is enough to provide oxygen and nutrients, with only the need to replace culture fluid every few days.

Would you want someone to get you water from a sink? With a tiny cup meant for spitting? Most doctors offices have water coolers or bottled water that they can give you. They probably didn't want to interrupt the flow of the exam and are on a tight schedule so don't want to be late for the next patient.

https://en.m.wikipedia.org/wiki/Chronic_Lyme_disease

Chronic Lyme is very controversial and likely not the true etiology

All three links are about the same small startup that is being funded by SBIR through the NIH, which is all about trying to give seed funding for experimental technology. The patents are listed on their website and links don't show anything more advanced than ubeam.

It is not true that ultrasound is used to power pacemakers. Citation definitely needed.

I'm going to be a cardiology fellow at Stanford in July, we use ultrasound often for both bedside informal exams as well as diagnostic echocardiogram. I've used handheld devices like the Lumify and Vscan, as well as the large tractor sized epiq machines. Similar to what is written in the article, my impression is that the actual hardware, specifically the transducer, is quite expensive to manufacture. The software and processing power continues to get cheaper but to have to best quality pictures, require expensive transducers. I've actually been very very impressed by the Lumify and I think it is getting near if not better than the quality of the gigantic epiq machines, primarily by having a very high quality transducer. This is indeed a hot area and knowing people who are actively doing development in the field, there are poeple trying things like having a giant paralleled transducers over the entire chest for continuous 3D images and other interesting ideas that are limited more by hardware than processsing power or imagination.

The mycarelink is the interface for an implantable loop recorder. That is a small flash card sized device implanted in the chest for long term ecg monitoring. This is not a pacemaker or a defibrillator but rather only monitors the heart long term. It is frequently used for patients to identify rare arrhythmias, often in the setting of unexplained fainting. This device is purely sensing and does not have the ability to pace or shock the heart.

TTR amyloid most certainly is not the or even a major cause of death in older adults. While associated with cardiomyopathy and nephropathy and etc, it's not associated with coronary artery disease, stroke, or cancer - the main drivers of mortality (yes, even in the oldest people).

I see this as Ubers endgame- it doesn't have to beat lyft or other rideshare options, it has to outlast insolvent public transportation options and fickle taxpayers and be the biggest network such that they can get these government contracts. We are seeing more and more of these local deals as it is a superior option in quality and cost to public transportation except in certain mass transport situations.

I had a good experience on American Airlines. Volunteered when the announcement was made and had flight attendants that were attentive, helpful, and appreciative of my help. I didn't ask for anything but they thanked me as I left the plane - to my suprise, a couple of days later I got an email saying I was credited 25k points on my frequent flier account. I was quite far away from my seat and didn't realize they kept track of who I was. Was very pleasantly suprised and thought things went well.

One explanation can be expanding criteria and/or earlier diagnosis. Earlier diagnosis, even with the same treatment efficacy, will lead to records of improved survival, and expanding criteria of particular diagnoses will often identify borderline cases that likely don't have the same morbidity and mortality.

What is the difference between this and aic/bic?

As a physician, I find comments like this disturbing. Barring special circumstances (cancer related pain), there is almost no need for chronic opiates. In fact, the body rapidly becomes accustomed to opiates and will require higher and higher doses that can become dangerous. The united states uses orders of magnitude more opiates than all other countries, and that often comes from potentially a cultural aversion to pain, but also many patients specifically seek out and ask for pain meds.

In fact, the scenarios you mention, of post herpetic neuralgia, trigeminal neuralgia, and neuropathy should NEVER be treated with opiates. There are highly effective neuroleptics and medications like carbamazepine, gabapentin, and TCAs that are first line and highly effective for these syndromes. While painful, given that it is neuropathic pain, often with rapid onset and offset, opiates, even PRN medication, is not appropriate management and does not help with its treatment. Adjuvant therapy including topical creams like capsaicin as well as minor procedures like nerve blocks and injections are pursued if first line treatments do not work. Often I see people in clinic who were aggressive about opiates and got opiates for these syndromes and spiral into addiction and problems while the underlying problem is untreated.

Opiates are not a panacea for all pain, and its troubling with patients see it that way, and often insist on opiate medications.

I absolutely agree with Shinkei. I had a few more thoughts, but summarizing, I worry that this is a case of an 1) incidentally found, 2) benign, 3) asymptomatic, 4) slow or non-growing mass was removed despite the recommendations of multiple neurologists and after fishing for a neurosurgeon who was willing to cut it out.

The story starts with an accidental, incidental finding. The wife recently underwent thyroid surgery, and the husband pressures the wife to get an MRI of a different anatomical location when the patient feels well and did not have any symptoms. This mass is an incidentaloma — something found on a fishing expedition and not by looking for a particular cause to a problem. The problems with such an approach are well described in this old New York Times article, however the synopsis is such: When we look for problems with very precise tests, we can always find something to intervene upon and see something wrong. This is a problem well known in the statistics of screening tests in that even very good laboratory tests have significant harms when applied indiscriminately to everyone and everything. For people not in medicine, this can be analogous to not adjusting in frequentist statistics when one does multiple hypothesis testing and simply using one p-value of 0.05 to make decisions.

The article describes the management of a meningioma, of which the vast majority of cases are entirely non-malignant, either non-growing or slow growing, and asymptomatic (often only found on autopsy or incidental imaging). The wikipedia article on meningiomas says this:

In a retrospective study on 43 patients, 63% of patients were found to have no growth on follow-up, and the 37% found to have growth at an average of 4 mm / year.[23] … In another study, clinical outcomes were compared for 213 patients undergoing surgery vs. 351 patients under watchful observation.[24] Only 6% of the conservatively treated patients developed symptoms later, while among the surgically treated patients, 5.6% developed persistent morbid condition, and 9.4% developed surgery-related morbid condition.

The very fact that the article mentions the surgeon thought that a partial resection of the mass was a success suggests that there was little to no concern for malignancy. One does not try to take out only part of a malignant neoplasm (with the potential to grow significantly) without offering chemotherapy or radiation as adjunct therapy. In fact, I would rather argue that the husband’s big triumph was realizing that the two MRIs had shown the meningioma had little to no interval growth — and such a conclusion would recommend against rapid, aggressive surgery.

From all appearances, the article suggests the wife did not have any symptoms. She could have had the meningioma since birth — a harmless birthmark that was hidden until she underwent a superflous but expensive and highly sensitive imaging test. While it is true the meningioma is close to her eye, I would be surprised if a surgeon could intraoperatively tell the progression of the mass more than multiple MRI imaging studies. While it is true that there is always a small risk that a meningioma will grow, the slow progression on MRI suggests to me that symptoms would only slowly occur and there is a low likelihood that she would ever need emergent surgery. Finally, surgical resection causes inflammatory changes in the area which could exacerbate mass effects at the site and there is a high chance that it would come back (particularly with a partial resection).

https://medium.com/@davidouyang/providing-optimal-care-576ab...

There was a recent Washington Post article which showed the exponential distribution of drinking the US now - ie. the vast majority of drinks of a very small sliver of the population. I wonder if that was true then as well, or more uniform as it was a standard liquid of choice.

[1] http://www.washingtonpost.com/blogs/wonkblog/wp/2014/09/25/t...