pak

webscalist was referencing a 12 year old joke: https://www.youtube.com/watch?v=b2F-DItXtZs

You know we’re doomed when half the comments here are taking this seriously, and not as the satire it clearly is (1KB of state? come on people)

Props to the OP for showing once again how lightheaded everybody gets while gently inhaling the GPT fumes…

Big fan of tqdm in python, so I ported it to ruby 5 years ago:

https://github.com/powerpak/tqdm-ruby

(shameless plug and an invitation for pull requests)

People already do need it! In the US alone, about a half million people are on dialysis. There are many health and functional consequences to both intermittent and peritoneal dialysis; they are not exactly benign treatments.

The major benefit to implanting it under the skin, as we do with pacemakers, is that doing without permanent holes or tubes through the skin reduces infection risk.

Consider also the danger of having something dangling from your body that is powered by your arterial blood pressure (from a major artery, as the kidney is). A trip and fall could be instantly fatal.

You'd probably enjoy this collage of GeoCities vibes:

https://www.cameronsworld.net/

The video evidence of the L-form switching is no doubt very interesting, but a more accurate headline would be “One cause of resistance to certain antibiotics in UTIs identified.” Or the original article’s title, which is “Possible role of L-form switching in recurrent urinary tract infection”; see https://www.nature.com/articles/s41467-019-12359-3

I would love to see data on how common this phenomenon is in various populations of UTI patients (elderly, young, inpatient, outpatient, etc), given different prior exposures to antibiotics; for now it looks like 30 patients were assessed.

There are obviously many different causes of resistance previously identified, going all the way back to penicillinase enzymes inactivating penicillin. As often happens with lay summaries, this makes it sound a little too much like the cause of all antibiotic resistance has been found.

Well, for starters, it's hard to get 200 people who might be eligible for life-preserving surgery to volunteer to possibly get a sham procedure for the exclusive benefit of othewars; not to mention build a team of surgeons, hospitals, etc. willing to do the trial; and someone to pay for millions of dollars in treatment and administrative costs. Clinical trials involving surgery, especially with sham procedures as a proper control, are exceedingly rare in the US for these reasons. (this is discussed in the OP itself.)

I found the Statistical Learning self paced course on Stanford's site to be a great formal intro to ML algorithms implemented in R, and it is taught by the inimitable Hastie and Tibshirani: http://statlearning.class.stanford.edu

This post on ML in medicine is a pretty good overview of everything that has been going on recently and the nuances often lost in the current hype: https://lukeoakdenrayner.wordpress.com/2016/11/27/do-compute...

So what good does increasing US medical school graduation rates do? OK, it would displace some IMGs/FMGs from residency positions, but it doesn't ultimately create more doctors. You can't be licensed to practice independently in the US unless you enter a residency, take the USMLE Step 3 after intern year, and typically you also take a specialty board exam at the end of residency.

See this to understand why the bottleneck is residency positions, not how many US medical students there are: https://www.nytimes.com/2014/07/20/opinion/sunday/bottleneck...

Thanks for replying! I'll certainly be looking forward to the publication.

about 10% of people who come in to the cardiology clinic experiencing symptoms are diagnosed with an abnormal heart rhythm

OK, but I'd be more careful about staying apples to apples in your comparisons; your app is about asymptomatic AFib. So how many of those people going to the cardiology clinic had undiagnosed AFib; for how many of those would a new diagnosis of AFib have changed the plan of care; etc. Kind of like robbiep was saying, I would be interested in actual added value from the larger perspective.

Totally appreciate your point about perfect being the enemy of the good. The danger is that these semi-medical wearables currently straddle a strange zone between medical and consumer use. The inevitable marketing strategy is to co-opt the positive reputation of medical products while acknowledging none of the pitfalls of consumer products. Most of the screening methods you bring up are used by a doctor on symptomatic patients with a suggestive history, and only as a partial component of clinical judgement. The way Cardiogram seems to make the most money, on the other hand, is to sell the product to asymptomatic, casual users. (Furthermore, CHA2DS2-Vasc costs 30 seconds of talking or reading a medical record, not $700 in Apple products.) So you're inevitably running up against some doubts among physicians [0].

And finally, I agree that more machine learning practitioners should join medical research. I hope the field works to set more reasonable expectations, however, as in: ML will solve very specific subtasks in clinical reasoning (as in the diabetic retinopathy study [1]). Instead, the headlines usually ratchet that up to "AI will replace radiology/cardiology/$specialty in X years." That tends to hurt the people currently in the trenches, since their contribution in bringing about practical, incremental change is diminished. The top answer of this Quora thread [2] has a good discussion of the many dimensions of the problem.

[0] https://twitter.com/Abraham_Jacob/status/860119573915287552

[1] http://jamanetwork.com/journals/jama/fullarticle/2588763

[2] https://www.quora.com/Why-is-machine-learning-not-more-widel...

We need to see the full, published study and its methods (particularly around recruitment and exclusion criteria) before we can judge it properly. Until then, the presented statistics about accuracy, sensitivity, and specificity potentially bear no relation to real world usage, if the cohort and data quality were tightly controlled, as you'd expect for an initial study involving the makers of the algorithm. A few other thoughts:

1. Even at 98% sensitivity and 90% specificity [0], which I don't think would hold up with real world usage in casual, healthy users, if AFib has a prevalence of roughly 2-3% [1] then by a quick back of the envelope calculation a positive test result is still 5× more likely to be a false positive than a true positive. With those odds, I don't think many cardiologists are going to answer the phone. You'd still need an EKG to diagnose AFib.

2. There is huge variance among people's real world use of wearable sensors, and also among the quality of the sensors. (Imagine people that wear the watch looser, sweat more, have different skin, move it around a lot, etc.) You'd likely need to do an open, third-party validation study of the accuracy of the sensors in the Apple Watch before you can expect doctors to use the data. My understanding is that the Apple Watch sensors are actually pretty good compared to other wearable sensors, but I don't know of any rigorous study of that compares them to an EKG.

3. Obviously, this is only for AFib. AFib is a sweet corner case in terms of extrapolating from heart rate to arrhythmia, because it's a rapid & irregular rhythm that probably contains some subpatterns in beats that are hard for humans to appreciate. As others—including Cardiogram themselves [2]—have pointed out previously, many serious arrhythmias are not possible to detect with only an optical heart rate sensor.

[0] https://blog.cardiogr.am/applying-artificial-intelligence-in...

[1] https://www.ncbi.nlm.nih.gov/pubmed/24966695

[2] https://blog.cardiogr.am/what-do-normal-and-abnormal-heart-r...

As of right now, the USB-C hub situation is actually pretty dire, as in the only all-in-one solutions are $100+, or not yet released [1] [2]. My past experience with non-powered USB hubs has taught me they're pretty hit-or-miss with a new device, so I don't see how cramming audio, video, and pass-thru power into them is going to help that situation.

See the first five minutes of this video [3], which actually involves Apple's "Digital AV Multiport" adapter, to see the near-term experience of "dongle hell."

[1] http://www.bourgedesign.com/

[2] http://www.macrumors.com/2016/11/03/owc-debuts-13-port-thund...

[3] https://vimeo.com/189525997

The upgrade from floppy to optical only, or optical to bigger hard drives and SSDs and fast WiFi, are leaps in capability that don't even compare to the marginal gain of USB-C over USB3/Thunderbolt 2... especially when that "upgrade" is paired with the number of ports on an entry-level MBP dropping from 7 to 2 (not counting audio, which thankfully survived).

With only 2 ports, you need a ridiculous number of big dongles or hubs to get serious work done, and any pro user with >1 external HD, display, or gigabit wired is rightfully wondering what the hell Apple was thinking.

Speaking of people picking up refurb last-gen models, I'm going to post two links here for your consideration.

Before the MBP 2016 announcement: https://web.archive.org/web/20161028012214/http://www.apple....

And today: http://www.apple.com/shop/browse/home/specialdeals/mac/macbo...

Notice any differences?

Get them while they're still in stock. That's all I can say, it's what I just did. I cannot stand the new microwave-keypad feel of the new keyboard, and the lack of useful ports and price hike is just the extra slap in the face for me to wake up. This is probably going to be the last Mac laptop I buy.

I love this brief history of the Ruby ecosystem and its community, maybe the Trump parody I've enjoyed most. Maybe, the best.

Incidentally, I suppose the first 5 minutes of fighting with a three-way dongle and a poor connection, having to restart the talk, etc. is just a little preview of what every 2016 MBP owner will soon have the pleasure of experiencing themselves.

Well, if you want to become a doctor, at least in the US, knowing some biology will certainly help you on the first step of licensing exams... :-)

But the general point does hold that yes, a high level of math or CS training is advantageous for anyone moving into a career in the life sciences, since it appears that that's where much of the foreseeable growth (in careers and research funding) seems to be.

It's also been said by many that it's easier to learn some biology after training rigorously in CS/math, rather than the other way around. Dudley Herschbach (a Nobel-prize winning chemist) once said to me that his one piece of advice for young researchers would be simply, "Learn as much math as you can."

Hmm, well as a counterpoint to your point about the FDA, fidaxomicin was approved in 2011 for general use against C. difficile colitis, because it showed certain outcomes that compared favorably against the current standard of care (oral vancomycin) [1]. The reason it isn't used more often is probably because it is one of the most expensive antibiotics available. Antibiotics aren't typically approved only as "last resort"; it remains at the discretion of the physician to jump straight to the big guns before drug susceptibility test results are available (which is part of the problem).

[1] https://en.wikipedia.org/wiki/Fidaxomicin

Teixobactin is cool, but if it's only active against gram positives, it's never going to work against most of the bacteria listed in the article: E. coli, Salmonella, Klebsiella, N. gonorrhoeae, etc. Most of the terrible new drug resistance genes are showing up in gram negatives.

Sure, new methods of finding antibiotics are in the works, although the article you link has plenty of experts recommending caution about their potential. The bigger point is that in 2016 there is a looooooong road from antibiotic "candidate" to FDA-approved drug. That road involves decades of trials and costs billions of dollars per approved drug.

The larger problem is that there is little if any incentive for pharma companies to invest in antibiotics compared to traditional blockbuster drugs that are supposed to be taken chronically (and therefore have better ROI). It's the same reason little R&D goes into making new vaccines. It doesn't matter how many candidates are found if they can't make it to market in a timely fashion (the point of the CDC bar graph), and this is what the "slow catastrophe" really is. It is not that scientists will never figure out new ways to kill bacteria.

Whoa, let's not put words in my mouth here. First of all, I said nothing about denying people access to their medical data. Once the tests are done, yes, it's the patient's data (and in the US, HIPAA concurs). We're not in disagreement there.

Secondly, there may be all kinds of other uses for glucose tests that one could research, but consumers running tests on themselves in an uncontrolled manner is not research. I would never say that no other uses will ever be discovered, but let's do that scientifically, please. My specific issue was with how diabetic glucose self-testing was used as rhetorical evidence that more blood tests help people, while failing to note that those tests are done to dose (potentially dangerous, fast-acting) medications, not to "keep tabs" on anybody's diabetes in a diagnostic sense, as was implied by the omission.

You say below that "people are coming around on glucose in the same way that we now understand that the cardio signal [...] are predictive of an enormous number of physiological and psychological phenomena." That's a lovely hypothesis, but please tell me who these people are, and please show me the evidence of the predictive value.

Until then, the Credentialed Professionals are perfectly justified in shrugging their shoulders at post-prandial glucose data from healthy patients (who, contrarily, will demand that needless and dangerous follow-up procedures are ordered for them), and the companies selling consumers these tests will not be helping anybody become healthier. I could go on, but this comment sums up the societal effects better than I could, even referencing your "ideal" of the ECG for screening. https://news.ycombinator.com/item?id=11694341

There's a difference between false positive rate and positive predictive value:

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

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

The latter depends on the prevalence of the test condition in the population, which is one of the major points of the OP.

A test can have a low false positive rate but still have a low positive predictive value if the test condition is sufficiently rare (as it is for most diseases). brianwawok was probably referring to tests with a low positive predictive value.

The history of blood glucose testing is informative here.

You're conflating a diagnostic test with a test that patients need to control dosing (of insulin). To make a diagnosis of diabetes, such frequent testing is not any more informative. Better tests, such as HbA1C, have been developed to indirectly measure blood glucose levels over a 3-month timescale, which is more appropriate for diagnosis.

I don't think there's any evidence yet that people being able to monitor their lipid levels while eating provides any useful medical information, unless you have some kind of (incredibly rare) inherited lipid metabolism deficiency.

comparing blood tests between a bipolar person's manic and depressive phases would be fascinating, but no one does it.

There in fact has been plenty of work on this, but in a research setting, where it belongs. See section 6 of http://www.ncbi.nlm.nih.gov/pubmed/27017833

it's the twenty-first century and the rate of iodine deficiency is 9%.

Micronutrient deficiencies are usually a result of dietary choices. This problem is more easily solved by encouraging everyone to take a daily multivitamin, which would be completely prophylactic, than by encouraging the same population to subscribe to series of blood tests that may or may not reveal the problem, and would require follow-up action. Again, think about it from a population health perspective.

You've missed the other side of the equation, which is: what if there is no cure for the 27% with the supposed condition? What help has been provided then?

What if there are some recommended follow-up treatments, but they are all expensive and risky, with the possibility of terrible complications?

This is how over-diagnosis actually leads to worse outcomes on a population scale. Medicine is often viewed as this big near-perfect algorithm where information is always enabling. In fact, too much information can be counterproductive for a patient and doctor.

Also, the US has generally higher rates than the rest of the first world, and it's not entirely clear that this actually leads to better outcomes. I think more in the medical field are starting to rethink this.

See: https://www.statnews.com/2015/12/01/cesarean-section-childbi...

This is a very interesting little point, that consumer electronics (especially ports) have little physical safeguards to prevent errors—e.g., you can plug USB2 into USB3 for backward compatibility, but not vice versa, for the B plug; ungrounded extension cords try to prevent you from plugging in grounded plugs. Medical equipment generally doesn't do this. I think the problem is that there is a tradeoff between safeguards and allowing improvisation in a time of shortage or emergency; for example, I've seen blood draw lines repurposed as external irrigators (not as catheters) and that's totally safe as long as you dispose of the needle in a sharps bin.

The problem is you're arguing against a totally different position than where Geekette and myself are coming from. Let's go back to the first lines of the OP: "What are the ingredients of a good relationship? Trust? Communication? Compromise? How about a sense of smell?" ... followed by the statement by Dalton that "Smell is important in social bonding." That last statement there is an extremely broad, confident statement (consider how complicated social bonding is), and it's explained by Dalton with this "emotional contagion" idea.

Two studies that show statistically significant effects for a total of ~60 people smelling odors from two different conditions (fear and disgust) is not nearly enough evidence to back up an assertion as broad as "smell is important in social bonding," nor that a substantial range of emotions spread via odors (contagion). At best, these two studies are suggestive, at worst they are so flawed as to not lend any evidentiary value. "Statistical significance" is not a substitute for critical thought on how much evidence stands for and against the hypothesis (meta-analysis). If I set up two experiments that showed that gravity doesn't exist, p=0.04 for both, would you set aside the totality of the evidence saying it does? Perhaps you would criticize my methods, or the link from my results to my conclusions, no?

You set up a strawman by saying that I'm asking the impossible—that large-scale behavioral cohorts must be assembled for preliminary studies. I'm not. I'm simply expecting some honesty in how people report the conclusions of preliminary studies.

Did you even read either abstract? This is controlled for. There is a control group inhaling normal sweat

You are incorrect, probably because you did not read past the abstract. Perhaps you should be more careful about telling people how science works in the real world or whatever, because real scientific discussion involves reading methods sections. In the APS paper contrasting fear vs. disgust vs. control, the control condition contained unused compresses, i.e., no sweat at all. From the horse's mouth: "unused absorbent compresses [...] in our view constitute optimal control stimuli because other nonemotional bodily secretions (e.g., sweat from playing sports) can potentially contain other chemosignals."

So... I am supposed to believe that when recipients smelled sweat from the donors watching disgusting videos, compared to no sweat, feeling disgusted at the sweaty odor is some kind of "emotional connection" to how disgusted the donor felt while sweating? Give me a break—this is a sham negative control. The huge confounder, as Geekette rightly points out, is that many people are normally disgusted by any sweaty odor.

Geekette's concerns are really only validated by the references you give. They have a sample size of 28 and 36 smell recipients, respectively (all likely bored undergrads), which seems hardly representative of all cultures and human behavioral contexts.

It's probably a fair hypothesis that they would not hold up to larger validation studies with more participants and more emotions tested. And to more rigorously interpret what was measured by these experiments, both studies examined fear, which has a well-understood hormonal response (adrenaline, etc.) that is already understood to affect sweat content [1], and one study examined disgust, which as Geekette states is a reasonable default reaction to sweaty odor—enough that this would seem to be a unremarkable emotion to claim was "communicated".

Concluding that humans may communicate other more complex emotions (love, hate, sarcasm, uncertainty, trust, whatever) through sweat is what neurobehavioral scientists love to imply via these preliminary studies and have puffed up by the downstream media, but they are just that: only preliminary.

[1] https://en.wikipedia.org/wiki/Apocrine_sweat_gland#Sweating

The gawker domain might have triggered a few genuine flags, but I found that odd too.

Welcome to the rebirth of the "right-click blocking" scripts. Please, take a trip with me down memory lane, to the glorious days of DHTML in 1998, when there were serious attempts to use JavaScript to "prevent people from stealing your images and code!" http://www.java-scripts.net/javascripts/No-Right-Click.phtml

What is old is new, what is new is old.

You are probably talking about the comments for this article: http://scholarlykitchen.sspnet.org/2016/03/02/sci-hub-and-th...

I agree, some of the opinions tossed around by incumbents in the industry are mind-blowing. My favorites: "A PDF is a weapons-grade tool for piracy." ...And on parents of sick kids looking up articles: "Do you really think a search and downloading of technical medical literature means anything?"