Wednesday, March 22, 2017

Incidental

What is the meaning of words. Take "incidental". In medicine it oftentimes has an ominous meaning. Say we do a physical. The patient looks fine. The patient is a marathon runner, no heart problems, no other issues. Great lipids, low blood sugars, great blood pressure, EKG perfect. The on a CBC we see an incidental finding. The thrombocytes look a bit off, well, quite a bit off.

This incidental finding then leads to a bone marrow test. Ooops. Myelodysplastic Syndrome, MDS. This patient may be 6 months away from AML and another six months away from death! The patient hears incidental, the physician hears terminal.

Beware of the downplaying of incidental. Especially in espionage. You see, good intelligence, against them or us, just ask MI6 about their blunders, all those Communist Spies from Cambridge, that the incidental can expose a foreign entity as well as a domestic.

Beware of "incidental". It can be deadly!

I Guess You Can Correlate Anything!

We know that Type 2 Diabetes is caused in almost all cases by obesity. The causative path has been well defined via the inflammatory results of obesity. Now along comes a bunch of authors who find that the change in local temperature, also known as Global Warming, is the putative cause of this obesity. Namely that fat people live in warm States.

The authors state:

Our findings indicate that the diabetes incidence rate in the USA and prevalence of glucose intolerance worldwide increase with higher outdoor temperature.

This is a correlation at best and NOT a causation. The problem is that one must look at the socioeconomic status. Just look at West Virginia. I know it well. Low economic status, poor diets, less exercise, and many folks on Government type meals, aka high carbs. It is not the temperature.

If one were to look worldwide, hot climates do not engender high BMI and in turn high rates of Type 2 Diabetes. It is just the opposite. The Congo is not filled with obese people and has low Type 2 Diabetes.

Besides all the authors are from the Netherlands. Perhaps a trip through West Virginia would help. Can they even find it on a map!

Saturday, March 18, 2017

The Trivium

Current Academics have been promulgating the use of what at best is "sloppy English". Namely that we should not penalize or even comment on poor Grammar. But the NY Times presents an interesting case where Grammar applies. Namely:

The debate over commas is often a pretty inconsequential one, but it was anything but for the truck drivers. Note the lack of Oxford comma — also known as the serial comma — in the following state law, which says overtime rules do not apply to:
The canning, processing, preserving, freezing, drying, marketing, storing, packing for shipment or distribution of:
(1) Agricultural produce;
(2) Meat and fish products; and
(3) Perishable foods.
Does the law intend to exempt the distribution of the three categories that follow, or does it mean to exempt packing for the shipping or distribution of them? Delivery drivers distribute perishable foods, but they don’t pack the boxes themselves. Whether the drivers were subject to a law that had denied them thousands of dollars a year depended entirely on how the sentence was read. If there were a comma after “shipment,” it might have been clear that the law exempted the distribution of perishable foods. But the appeals court on Monday sided with the drivers, saying the absence of a comma produced enough uncertainty to rule in their favor. It reversed a lower court decision.

Thus words and punctuation have consequences. There is a trend in schools that we should accept common usage of English because it is a fluid language and if some child makes up some phrase then we should not tell them otherwise. It would be threatening to them. Tell that to the folks who lost $10 million. Perhaps their attorneys should return to the Fifth Grade at Blessed Sacrament Grammar School. Sister Rosita drilled this into us then.

Words have meanings and words have consequences. Everywhere! God Bless Sister Rosita!

Also remember that the Trivium was the required study of Grammar, Logic, and Rhetoric, in that order, during the High Middle Ages. First, words mean something. Then, second, words that mean something alone can only mean something when assembled in the proper manner. Third, explaining your conclusion must be done in a rational and reasoned and articulate manner. Once you have mastered this you can get a College degree. Don't master these in the 14th Century and you shovel dung for a few decades at best!

Opioid Abuse

The CDC in this weeks MMWR notes:

The probability of long-term opioid use increases most sharply in the first days of therapy,  particularly after 5 days or 1 month of opioids have been prescribed, and levels off after approximately 12 weeks of therapy. The rate of long-term use was relatively low (6.0% on opioids 1 year later) for persons with at least 1 day of opioid therapy, but increased to 13.5% for persons whose first episode of use was for ≥8 days and to 29.9% when the first episode of use was for ≥31 days. Although ≥31 days of initial opioid prescriptions are not common, approximately 7% do exceed a 1-month supply. Discussions with patients about the long-term use of opioids to manage pain should occur early in the opioid prescribing process, perhaps as early as the first refill, because approximately 1 in 7 persons who received a refill or had a second opioid prescription authorized were on opioids 1 year later. As expected, patients initiated on long-acting opioids had the highest probabilities of long-term use. However, the finding that patients initiated with tramadol had the next highest probability of long-term use was unexpected; because of tramadol’s minimal affinity for the μ-opioid receptor, it is deemed a relatively safe opioid agonist with lower abuse potential than other opioids  

The results are below:





and also:


They conclude: 

Transitions from acute to long-term therapy can begin to occur quickly: the chances of chronic use begin to increase after the third day supplied and rise rapidly thereafter. Consistent with CDC guidelines, treatment of acute pain with opioids should be for the shortest durations possible. Prescribing 1 week of opioids or when authorizing a refill or a second opioid prescription because these actions approximately double the chances of use 1 year later. In addition, prescribers should discuss the long-term plan for pain management with patients for whom they are prescribing either Schedule II long-acting opioids or tramadol.

This is a significant and important result. All physicians for license renewal must take a course and be tested on dealing with opioid abuse. Hydrocodone and Oxycodone have been distributed somewhat freely in the past and their impact not fully understood. Today with the above results as a start much more careful handling is essential.

Thursday, March 16, 2017

Poverty, Chastity and Disobedience

In the 13th and 14th centuries various religious orders took vows. Sometimes it worked at others it led to a mess. Just look at the battle between William of Ockham and the non resident Bishop of Rome in Avignon, John XXII. That was over the definition of poverty.

Along comes the MIT Media Lab where they will issues a Disobedience Award. Perhaps an award for the other two vows, reversed of course, as well. Just think, a greed award (Wall Street), an award for licentiousness (Hollywood) and disobedience (MIT or the Academy at large). Pity that MIT used to be an academic bastion but it now seems to become land of snowflakes.

The Tech states:

The topic of civil disobedience has sparked conversation in pockets around MIT, and was recently brought into the spotlight by last week’s launch of the Media Lab’s Disobedience Award. The $250,000 award will go to an individual or group, anywhere in the world, that is engaging in “extraordinary disobedience for the benefit of society,” according to the Media Lab. Joi Ito, the director of the Media Lab who helped conceive the award, sees it as a way to support and encourage those furthering society even when laws get in the way. Launching the award from the Media Lab, however, raises the issue of what disobedience has to do with the Media Lab and the broader MIT community. In Ito’s view, MIT is a place ripe for thoughtful disagreement, where creativity and controversial ideas are welcomed.

 In the above there is a difference between disagreement and disobedience. Scientific progress is often driven by disagreements. Try disobedience in a cancer lab. "Why can't I eat my PBJ sandwich at my lab bench! Johnny does it?"

There are rules, agreed many may be foolish, but there are some which can save your life. Like; don't light that Bunsen burner over that open ether can!

But enough is enough. The real question is; whose quarter million is being spent on this? What is the role of the Media Lab? Does MIT Administration support and approve the use of the Institutes name for this effort? Ultimately one should ask; how does this affect alumni funding? There is well over $10 billion at stake.

Tuesday, March 14, 2017

The Distinct Disadvantage of Experience

In my experience and in my opinion, Academic lawyers generally have never done anything real, especially with regard to the operations and technology of a broadband fiber system. Like walk a town and do a pole count. Like try and get a pole attachment agreement. Like scheduling fiber pulls across front laws and then dealing with the blow-back from home owners. Like trying to sell fiber to the home. Like managing a fiber data network. Like trying to raise funding for what "you" want to do.

Unfortunately and fortunately I have been in all of those spots. So I have a basis upon which to opine. In contrast the academic attorneys most likely would not in my opinion be accepted as an expert witness. The Daubert rule most likely would knock them out. Hearsay does not an expert make.

Now in Backchannel one of these folks states:


We do need fiber, everywhere. But we’re talking about basic infrastructure when we talk about fiber. And it is not in any private company’s short-term interest to make that basic fiber infrastructure — which amounts to a substantial upgrade to the last-century copper and cable lines with which Americans are now stuck — available to everyone at a reasonable price. Google’s retreat is all about the bottom line. It wanted an unrealistic rate of return on basic infrastructure. It wanted to see rapid cost declines per subscriber, like the Moore’s Law changes in productivity that have taken place when digital technologists squeeze costs from other legacy businesses.

Now in my opinion and in my experience there a mass of less than correct statements in the above. First we do NOT need fiber everywhere. I have argued elsewhere that wireless, especially 5G, will very effectively compete with fiber. Secondly fiber is very very expensive. Been there done that. Why the costs? Duh! Politics. Pole attachments, rights of way, franchises, local boards, and on and on. If one has ever tried this then one can see what happens. 

So when I see articles of this type I am amazed that they continue. That at no point do they ever ask; what really happened. Google was in my opinion wrong from the start. I think I know what may have happened, but all too often it is egos and too much money.