New York Subway

Here is a typical subway wall in NYC. Miles of dirt, leaks, rodents, and general disrepair. Have they no shame? And we want these folks to run our health care?

Putin: A Psychological Profile?

I am addressing the book by Hill and Gaddy, Mr. Putin, Operative in the Kremlin[1]. It is worthy of a review in light of the ongoing neo-con pressures in Washington and the resultant putative geo-instability resulting therefrom.

Let me begin by first placing a few bona fides on the table. First, my Russian, poor at best, works in taxi cabs and in restaurants, learned from a fellow lifeguard in New York City in the early 1960s who was Ukrainian, so when I spoke Russian, I sounded like some émigré Ukrainian! In the early 1970s while at MIT I was involved in the Coalition for a Democratic Majority, a Democrat right wing group in Massachusetts and worked closely with such scholars as Richard Pipes at Harvard. I found Pipes a brilliant man and yet not having spent time in the Eastern European sphere did not have a basis for many of his ideas. From Pipes and the others in CDM came many of the current neo-cons.

Now my first extensive direct contacts with the Russians was in the 1970s when I spent time as a senior technical consultant to the Arms Control and Disarmament Agency supporting the Comprehensive Test Ban Treaty Negotiations during the Carter Administration. My role was to design and consider the operations of the monitoring network and as such was involved in several meetings with the Soviet groups. I assume that both sides had bios and profiles of the other side and there were real technical people and there were real KGB folks. The treaty did not reach any conclusion. As a young neo-con at the time it frankly was an achievement since one could not in my opinion trust the Soviets.

In 1993 I managed to spend time in St Petersburg, again fine tuning my Russian but staying in an Intourist hotel as one of the few if only westerner there. The other westerners were in the fancy European hotels. But staying in the old Soviet hotel gives one a better understanding of the comings and goings. In 1996 I started my international Internet carrier company. My first meeting was in Moscow, and there I met my erstwhile partners, a mix of Soviet era technologists and otherwise. It was clear that in the mix was an array of former KGB folks and that they knew who I was so there is an advantage to old profiles.

From there my Russian partners introduced me to a Czech partner, the Soviet chosen Czech who was the former Minister of Communications, PhD from University of Moscow, and now working for various western telecom companies. He would become my partner, and the six degrees of separation had become two degrees. Thus I found myself in the midst of a collection of Cold War players. We built our network on Gazprom lines and had partners ranging from old time Moscow players to Stasi holdouts in Munich. For ten years we built out networks and installed Internet systems. During this period I made friends, and dealt with adversaries, and did so not as any US entity but as one who had the technical and financial where with all to effect the network, dealing with vendors, and handling political issues. I managed to meet a collection of characters which fill out the book by Hill and Gaddy. My travels through Russia and its environs was as a somewhat accepted insider who had been an adversary, thus I had the unique opportunity to see the buildup of Putin and the current political structure in Russia.

Let me begin with two observations. First in 1993 in St Petersburg I saw people in churches, weddings and funerals, and crowds returning to Orthodoxy as if nothing had transpired. As Catholicism was to slowly slide away in Poland, Orthodoxy became the replacement for the Communist control, but a culturally accepted and even desired replacement. It was out of this St Petersburgh that Putin arose and the recognition of the power of Orthodoxy most likely was evident to him as well. Second, in 1996 driving to and from the airport in Moscow one passes an old tank, a German tank, clearly a remnant from 1943, just sitting there. Possibly oblivious to some residents but clearly seared into the minds of all Russians. Whether it was Napoleon, Hitler, or the hoards from the East, the Russians always felt vulnerable and thus wanted to have buffers between them and any adversary. Thus in those days the buffer was Belarus, Ukraine, Georgia, and even Mongolia.

Thus in the Russian mind post the fall of the Soviet was the power and influence of Orthodoxy and the need to have buffers from their putative enemies. It was clear to me but I felt that it was not clear to many back in the US. If it had been then things may have turned out quite differently.

Now to Hill and Gaddy. Their book is alleged to be a psychological profile of Putin, what made him what he is. The book is a complex and difficult work to follow, mainly because the authors have the habit of jumping from decade to decade in a single paragraph and then back again. Secondly the authors are clearly neo-cons in their outlooks.

Let me now examine several sections of the book:

pp 76-77 The authors discuss the Survivalist mentality of Russians and Putin in particular. Putin was born after the end of WW II. Thus he did no endure the siege of St Petersburg but his family did as did those with whom he grew up. St Petersburg suffered more than Moscow, hundreds of thousands died as a result of the German hoards. Moscow remembers the attack stopping at the gate if you will, St Petersburg remembers the dying days of winter and the abandonment by Stalin as well. Moscow was burned down when Napoleon entered, and if one goes back even further one sees attack after attack, and survival was the standard. Thus to understand the Russian one must as I noted earlier understand survival, and survival demands a strategy of stand-off isolation.

p 89 Stories are what define us. I think of the philosopher Cassirer and his semiotic constructs, we live through stories and myths. Putin tells his stories and they are metaphors for a philosophy of being. The authors present an interesting argument here but frankly this is a classic way to deconstruct a person, looking and examining the tales they tell, as ways the teller wants to be perceived. It is never clear what the true event were but the teller of the tale constructs and molds it in a manner in which they want others to perceive them and to understand them.

p 97 Nationalism, and being a Russian was a significant issue examined by Stalin. It was an argument that ensued between the Stalinists and the Marxists like Rosa Luxemburg. To Stalin, and in a sense to Putin, Russia and Russians are a united whole, and individualism is an anathema. That is in sharp contrast to de Tocqueville's Americanism, a slowly fading way those in the United States had viewed themselves.

Chapter 6 discusses the Outsider in Putin. This is a common understanding of the non-Muscovites. It frankly is even worse for those from east of the Urals. But in many ways St Petersburg always competed with Moscow, culture, universities, history. They complemented and contrasted each other and that is even more so today. Those from St Petersburg on the one hand felt inferior because of their location but superior due to their perceived class. St. Petersburg retained its history and class whereas Moscow rapidly assumed the culture of the west, becoming almost a downtown Tokyo! Thus this may help understand Putin, yet one can assume he may have shed this differential due to his KGB training as well as time spent in Germany. The authors make this an all too simple explanation for a highly complex environmental inculturation.

p 117 is a classic example of the extreme use of the authors conjectures. They state that Putin while in Dresden may have lost touch with what was happening back in Russia. First Dresden was not the end of the world. I lived in Prague and it was a two hour drive to Dresden. Dresden also linked to Leipzig and thus a window on the culture of the west. Access to the events both east and west, and especially of the east via the west, such as Radio Free Europe, was significant. One would have expected a KGB agent to have been exposed to RFE. However, for Putin that again is conjecture. This is a strong failing in my opinion about this entire work, excessive conjecture. Worse the conjecture is all too often a means to portray a neo-cons world view of Putin and Russia.

p 211 This is an interesting and telling tale of why many feel that democracy and democratically elected positions fail. Putin does not tolerate fools well, and as such if one fails to function properly the consequences are often much more sever that not getting reelected. Thus often, the argument is, things work better. At least that is what the authors try to relate. Putin does "buy" his loyalty with the oligarchs. However Putin and Russia face a bigger problem. I would call is the Walmart deficit. Namely for decades China was a supplier to Walmart, and one could never find a "Made in Russia" product. That is because Russia has two main economic engines; extraction economies like gas and oil and weapons. For Putin and any Russian leader to survive they must keep those elements functioning, thus the meaning of the conjecture on this page.

p296 NATO was created to stop the Soviet menace. It was a vehicle to protect a weak Germany, a disorganized France and a decaying England. It was an American artifact whose raison d'etre post the collapse of the Soviet Union was in doubt. However Putin saw that as the west expanded NATO to include the Baltic states and onward to Ukraine that this step was an existential threat, it breached the key element of their isolation strategy, namely placing western arms on the Russian borders. Putin saw this evolve and its evolution was a neo-con dream driven by the United States. Unfortunately the neo-cons saw this as a sine qua non step whereas Putin saw this as more tanks lining up on the road to the airport. It was a gross mis-step by the west, especially the United States, driven by neo-cons who lacked any understanding of Russia and the Russians.

p 301 The 9/11 fiasco was clearly anticipated by Russia and Putin. The Russians knew Afghanistan quite well have bled badly there. Russia also had good intel in place whereas the US was generally clueless, focusing on other issues at that time. On September 9^th the leader of the Northern Alliance was assassinated by ben Laden and his forces and this was a clear red flag even for the Russians, especially since the Northern Alliance had CIA contacts and ben Laden was aware of them. The Russians felt the next step was a mass move against the US. Putin tells Bush and Bush seemed clueless. The neo-cons dismissed the information and the results are well known. Unfortunately the authors seems to miss all of these linkages.

pp 388-397 Here the authors lay out Putin as the existential threat. Unfortunately the true existential threat is China not Russia. China has strategic locations in the Pacific, the South China Sea. China has a massive economic infrastructure and its work in bio-tech dwarfs even the US in many areas. Putin and Russia could and should be co-opted "European" allies to counter the Chinese threat. To do that one must understand Russia and the Russians and thus Putin. Putin wants a safe zone between Russia and its putative adversaries, and having a Ukraine NATO alliance is a direct attack against that. It was a well known and deliberate assault. It would be as if we agreed to take Hong Kong as a new Pacific territory. It would not only not work but it would be perceived, and rightly so, as an assault.

Overall the authors in a rather haphazard manner align various "facts" about Putin to set him up as a new evil empire overlord. He is a Russian in Russia. That is a fact we have to live with. To live with it we must have some way to communicate with him and his country. Regrettably many like these authors in my opinion find that an anathema.

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[1] https://www.amazon.com/gp/product/0815726171/ref=ppx_yo_dt_b_asin_title_o08_s00?ie=UTF8&psc=1

Technology vs Tax

In a recent MIT press release they discuss a carbon dioxide extraction technology which seems quite viable and cost effective. They note:

The device is essentially a large, specialized battery that absorbs carbon dioxide from the air (or other gas stream) passing over its electrodes as it is being charged up, and then releases the gas as it is being discharged. In operation, the device would simply alternate between charging and discharging, with fresh air or feed gas being blown through the system during the charging cycle, and then the pure, concentrated carbon dioxide being blown out during the discharging. As the battery charges, an electrochemical reaction takes place at the surface of each of a stack of electrodes. These are coated with a compound called polyanthraquinone, which is composited with carbon nanotubes. The electrodes have a natural affinity for carbon dioxide and readily react with its molecules in the airstream or feed gas, even when it is present at very low concentrations. The reverse reaction takes place when the battery is discharged — during which the device can provide part of the power needed for the whole system — and in the process ejects a stream of pure carbon dioxide. The whole system operates at room temperature and normal air pressure.

Thus is CO2 is an issue the solution seems to be technical not taxation. Economists continually fail to understand human nature and the very economic system they allege to explain. Taxing CO2 is a highly regressive tax. Implementing such a system as the above make eminent sense.

Cancer Markers?

In a recent paper by Bax et al (Bax et al Review and Comparison of Cancer Biomarker Trends
in Urine as a Basis for New Diagnostic Pathways, Cancers, 2019, 11, 1244) the authors present some summaries of urine based markers for a variety of cancers. 

Now markers can be the result, the driver, an intermediary of any collection thereof. Markers must however play some role in effecting the malignancy, 

 For bladder cancer the authors note:

The levels of succinate, pyruvate, oxoglutarate, carnitine, phosphoenolpyruvate, trimethyllysine,
isovalerylcarnitine, octenoylcarnitine, acetyl-CoA, carnitine palmitoyltransferase and carnitine acylcarnitine translocaselike protein were found to be higher in BlC patients than controls The levels of melatonin, glutarylcarnitine, decanoylcarnitine and dihydrolipoyl dehydrogenase were found to be lower in BlC patients than controls

 Were these findings a cause, a result, a coincidence? We believe that any reasonable marker must have a well defined role in the overall process, albeit not specific but identifiable. 

Similarly they note for the prostate:

Sarcosine was significantly higher in urine sediments (AUC 71%) and supernatants (AUC 67%) of PrC patients; Uracil, Kynurenine, Glycerol- 3-phosphate, Leucine, Proline were elevated upon disease progression

Yet we again ask, what is the rest of the story? 

We believe that there is a significant amount of work that can connect markers, the cancer process, and efficacy as an indicator.   

NATO, Russia and Nuclear Weapons

Rand has issued an interesting study on the use of nuclear weapons in the event of Russian action in the Baltic. Among other things they note:

Despite its global advantages, the North Atlantic Treaty Organization (NATO)'s current deterrent posture in the Baltic states is militarily weak and generally questionable. A Russian invasion there would almost surely capture some or all of those states' capital cities within a few days, presenting NATO with a fait accompli. The United States is currently considering tailored deterrence strategies, including options to use nuclear weapons to deter Russian aggression in the Baltic states. This report examines what role nonstrategic nuclear weapons could play in deterring such an invasion. As part of that analysis, the authors review relevant deterrence theory and current NATO and Russian nuclear and conventional force postures in Europe. They draw on wargame exercises and qualitative modeling to characterize the potential outcomes if NATO, Russia, or both employ nonstrategic nuclear weapons during a war in the Baltic states. The authors then discuss implications for using such weapons to deter a Russian invasion. The insights derived from the research highlight the reality that, even if NATO makes significant efforts to modernize its nonstrategic nuclear weapons, it would have much stronger military incentives to end a future war than Russia would. That is, Russia would still enjoy escalation dominance.

 I have spent some time in these states and they generally are small, easily accessible along the Baltic, and abut  a small part of Poland, a larger section of Belarus, and on the east and west Russian territories.

Nuclear weapons are deadly, small or otherwise and their destructive potential are massive. The impact on surrounding countries and Russia itself would be horrendous.

Small yield tactical nukes have floated around US arsenals for decades.  These are 1-5 KT "clean" weapons useful for field applications against a massive Soviet tank attack. These alleged "clean" weapons still result in massive amounts of radioactive products, albeit of shorter lasting time. Yet destruction would be massive.

It is worth reading through this document to see where current US and Russian thinking could be. Perhaps speaking with the Russians to avoid "ambiguity of expectations" would help. In my prior experience in the 70s on the CTBT it was clear that both sides were terrified as regards t an all out nuclear war and in my almost decade long working with the Russians the old fear remained. New generations of planners may have yet to face the terror of such weapons. Perhaps now is a good time to rethink the approach.

Weaponized Therapeutics?

There is an ever building concern that a multiplicity of prescription and over the counter medications are not only tainted but can be weaponized against the US. In a recent Becker's article we see just a small tip of the iceberg. They note:

The FDA has named  ... one of the main culprits behind the manufacturing of tainted blood pressure medicines. The agency has issued a warning letter to ... for violating several good manufacturing practices and said the drugmaker "has been one subject of an ongoing global investigation into nitrosamine impurities in angiotensin II receptor blockers such as valsartan, losartan and irbesartan." The FDA said the drugmaker had manufacturing issues at its plant in India that contributed to the production of tainted blood pressure drugs. 

Given the complexity and targeting capability of many of the newer therapeutics a foreign manufacturer could actually target individuals.

Frankly allowing off shore manufacture of aspirin, ibuprofen, etc opens the gates for massive attacks on the homeland. The FDA just does not have the resources to monitor these plants.

Star Chamber

In the text by Hart, The Rule of Law (1603-1660) the author recounts the hated Star Chamber, a Court that the rulers used to avoid any of the rights of the subjects, not yet citizens, in England. As Hart notes:

In fact, the conciliar origins of these courts (as compared to those created by statute or confirmed by ancient custom or common law tradition) always made them suspect. That was certainly true of the court of Star Chamber, the other great central institution spawned by the Council’s general supervisory jurisdiction. Star Chamber had evolved in much the same fashion as Chancery, and to similar purpose - to relieve the Council of the need to deal with private complaints. What distinguished the Council’s work in Star Chamber (and later its jurisdiction as a formally constituted court) were allegations of criminal misconduct or violence. 

The Council understandably had always taken special interest in all breaches of ‘the King’s Peace’ and, under the leadership of Tudor chancellors, especially Thomas Wolsey, consciously expanded its purview to include a wide range of criminal offenses. These included allegations of public disorder - riot, rout, unlawful assembly - and, more particularly, crimes which compromised the integrity of the judicial system - forgery, perjury, maintenance, subornation of witnesses, bribery and so on. As Star Chamber’s jurisdiction was consciously expanded over the course of the sixteenth century, the Crown and its legal officers increasingly began to make use of the court, pursuing and prosecuting offenders on their own  nitiative, often on the basis of leads provided by government informers. 

As in the case of Chancery, the collective authority of Star Chamber’s officers, and the compelling demands of maintaining good order, argued in favor of allowing the court to exercise wide discretionary powers. Star Chamber was not required to observe any of the rules which governed common law criminal proceedings. Prosecutions could be initiated on the basis of simple information (rather than as a consequence of a formal grand jury indictment) and could be concluded on the basis of evidence taken by the court itself (without the need to resort to jury trial). Nor was the court constrained in terms of penalties. Apart from capital punishment - which the constitution insisted had to proceed from a common law trial by a jury of one’s peers - Star Chamber was free to inflict whatever punishments - corporal or financial - it deemed necessary or appropriate. In fact, Star Chamber offered advantages to all parties. 

Litigants were attracted, as they were to Chancery, by the relative ease and alacrity of the court’s process, and by the potentially intimidating authority of the court’s decree - essentially, given the near-duplication of personnel, a declaration, in all but name, of the King’s Council. Its decisions, in short, were beyond challenge or appeal. For that reason, Crown prosecutions in Star Chamber also served as a very powerful weapon of intimidation and deterrence, and inevitably the court became a convenient tribunal through which the Crown could pursue and punish those who stood out against its policies (not least because, in doing so, it could bypass the need for potentially uncooperative juries)

In fact, Stalin found this means to justice also quite useful. 

Grad Student Strike?

The Harvard Crimson details the current status of the proposed Grad Student strike. They note:

Graduate students across the University will begin voting Tuesday whether to authorize a student worker strike, marking an escalation in the negotiation process that began exactly one year ago.
Harvard Graduate Students Union-United Automobile Workers’ bargaining committee announced their plans to hold a strike authorization vote Oct. 8 as major contractual issues — including compensation, healthcare, and harassment and discrimination protections — remain unresolved.
“This is our chance to make our voices heard loud and clear to the administration, and to declare forcefully that the Administration must move on our key issues we care most about and negotiate the contract we deserve,” the bargaining committee wrote in an email to its members Friday.

It should be interesting. Demands seem to be escalating and the question is; who teaches classes if no grad students? Also does striking mean no work on thesis, labs come to a halt, etc. There can be a lot of unanticipated consequences. It should be fun to watch.

The Academy is no longer what it used to be. Most likely I could never get admitted in today's world, and that is something coming from someone who lived through the 60s riots in Harvard Square.

Alumni funding fifty years from now should be interesting.

Precision and Accuracy

I remember from my first class in surveying, yes I took a class in surveying somewhere in the Catskills, we were told the difference between precision and accuracy. Precision is how detailed is your measurement, say in feet, 2.00136 feet. Accuracy is a measure as to how close to reality is that precise measurement. One can have great precision and horrible accuracy. People feel comfortable with precision. People are clueless about accuracy. Tell a patient that they have six months to live, and they can deal with it, horrible as it may be. Tell a patient that he has a 20% chance of survival, and the patient always thinks they are in the 20%.

Now to climate change or whatever it is called today. Stanford has an interesting piece on this issue. They note:

“Scientists who acknowledge that their predictions of the future cannot be exactly precise and instead acknowledge a likely range of possible futures may bolster their credibility and increase acceptance of their findings by non-experts,” said ...a Stanford professor of communication and of political science and a co-author on the paper. “But these gains may be nullified when scientists acknowledge that no matter how confidently they can make predictions about some specific change in the future, the full extent of the consequences of those predictions cannot be quantified.”

 They continued:

To find out, the researchers asked half of their respondents to read a second statement acknowledging that the full extent of likely future damage of sea level rise cannot be measured because of other forces, such as storm surge: “Storm surge could make the impacts of sea level rise worse in unpredictable ways.” The researchers found that this statement eliminated the persuasive power of the scientists’ messages. When scientists acknowledged that storm surge makes the impact of sea level rise unpredictable, it decreased the number of participants who reported high trust in scientists by 4.9 percentage points compared with the participants who only read a most likely estimate of sea level rise. The findings held true regardless of education levels and political party affiliation. Not all expressions of uncertainty are equal, ... said: “Scientists may want to carefully weigh which forms of uncertainty they discuss with the public. For example, scientists could highlight uncertainty that has predictable bounds without overwhelming the public with the discussion of factors involving uncertainty that can’t be quantified.”
 
What is most compelling  is that none of the curves we see promulgated have any error bands in them, NONE. What is the accuracy of the thermometer in 1886, 1929, today. Take sea level. One may logically ask; is the sea rising or the land sinking? Good question. We know that the outer banks move, they are plastic in nature, sand like plasticity. Can we measure rising versus sinking? Perhaps, but not with the accuracy we require. Back to accuracy again.

The problem is that for those of us who have spent their careers dealing with uncertainty, we accept it as a matter of course. However that group who accept it as day to day are not the rest of society. Indeed the climate folks need to be truly honest about their data, put some error bounds on them so we can understand, and "I don't know" is also a good answer.

To diagnose or not diagnose?

Diagnosing cancers is all too often a challenge. In a recent article in the Wall Street Journal, an Oncologist bemoans the fact that medicine has made little progress in this effort and worse the means and methods of treating the more advanced forms is still archaic and brutal[1]. The author specifically argues[2]:

What we need now is a paradigm shift. Today, the newest methods generating the most research and expense tend to be focused on treating the worst cases—chasing after the last cancer cells in end-stage patients whose prognoses are the worst. We need instead to commit to anticipating, finding and destroying the first cancer cells. We must reliably detect the faint footprints of cancer at the beginning and stop it in its tracks.

Such prevention represents the cheapest, fastest and safest alternative to the terrible, longstanding treatment trio of slash, poison and burn. It’s the most universally applicable way to save lives, and the estimated cost-savings from early diagnosis add up to over $26 billion a year, more than any other new approach can promise. Earlier detection is also the most humane way to improve cancer outcomes. Status quo treatments—the combination of surgery, chemotherapy and radiation for solid tumors, or chemo and bone marrow transplants for liquid ones—can be brutal and indiscriminate killers. Treatments often leave patients in agony, while providing mere months of added survival. The new immunotherapies can be even more.

The author's construct of the faint footprints is compelling but alas a distant goal. We simply cannot test everyone for everything. Various Government bodies bemoan using the PSA test for prostate cancer while allowing massive usage of mamographies and identifying numerous DCIS yet denying PSA testing. Many Internists may miss the most obvious of melanomas while identifying various cardiac arrythmias.

We have previously discussed the issue of just what is a cancer. We used PCa and thyroid cancers as examples. Thyroid cancers, especially microcarcinomas are small collections of ill formed cells showing certain aberrant nuclear formations. Yet there is no evidence that they would ever metastasize. HGPIN in the prostate has the ability to just disappear rather than progress. Bladder tumors are often CIS, and may be evident due to small hematuria.

These may all lead to highly invasive tests and even more invasive and putatively morbid surgeries. Thus, despite the authors plea, many of these putative cancers are all too often remedied by the patient's own immune system. On the other hand, the same immune system may be used against the patient to protect and nourish the ever-growing lesion. Perhaps there is no simple answer. Indeed, in cancers there are too often no simple answers.

We examine herein some of these issued as focused on bladder cancer, BCa, a malignancy which is on the on hand complex, and on the other all too often a chronic disease.

Bladder cancer is a malignancy of parts of the bladder. It is not as common as prostate yet can be costly to treat because of ongoing recurrence. As NCBI notes[3]:

Bladder cancer is a disease in which certain cells in the bladder become abnormal and multiply without control or order. The bladder is a hollow, muscular organ in the lower abdomen that stores urine until it is ready to be excreted from the body. The most common type of bladder cancer begins in cells lining the inside of the bladder and is called transitional cell carcinoma (TCC). Bladder cancer may cause blood in the urine, pain during urination, frequent urination, or the feeling that one needs to urinate without results. These signs and symptoms are not specific to bladder cancer, however. They also can be caused by noncancerous conditions such as infections.

Currently the diagnosis of bladder cancer is performed by a cystoscopic exam, excision of tissue, and histo-pathological examination. There is now a proliferation of extensive imaging technologies which arguably provide alternatives to such a process. We examine some of these modalities herein and look at them in the context specifically of bladder cancer. In a recent paaper we pose a prime question examined herein is:

Can imaging modalities, especially mpMRI, be used as an adjunct in staging bladder cancer? Furthermore, can mpMRI be used in place of invasive pathological studies in diagnosing, staging and prognostic evaluation of bladder cancer?

We use existing literature to consider this issue. Specifically, we examine:

1. The current understanding of bladder cancer, BCa, and how it is diagnosed, staged and treated. These are generally histo-pathologic measures of cell structure, morphology, and aggregates of cells as well as some immunohistological measures.

2. The underlying measures which can be obtained non-invasively that reflect the existence of BCa with such samples as miRNA, proteins, DNA, and other exomic measures.

3. The target genetic changes which relate to the initiation and progression of BCa.

4. The use of a multiplicity of imaging modalities which assist in diagnosis

5. The specific use of mpMRI, using multiple MRI modalities, to assess their ability to non-invasively diagnose, stage, and give prognostic data.

6. A discussion of a multiplicity of related issues including the putative application of AI.

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[1] See Raza, We Need a New Start, WSJ, Oct 4, 2019.

[2] https://www.wsj.com/articles/cancer-is-still-beating-uswe-need-a-new-start-11570206319

[3] https://www.ncbi.nlm.nih.gov/medgen/14150