Saturday, May 18, 2019

"...he returns every summer to the northern-Swedish landscape he knows from his childhood. His love of the place is premised on the knowledge that he will not always be able to return; that he, or it, will not be there forever..."

If God Is Dead, Your Time Is Everything

Martin Hägglund argues that rigorous secularism leads to socialism.


"The problem with eternity is not that it doesn’t exist (Hägglund is uninterested in the pin dancing of proof and disproof) but that it is undesirable and incoherent; it kills meaning and collapses value. This is a difficult truth to learn, because we are naturally fearful of loss, and therefore attached to the idea of eternal restoration. Hägglund, who was born and reared in Sweden and now teaches comparative literature at Yale, begins his book by telling us that he returns every summer to the northern-Swedish landscape he knows from his childhood. His love of the place is premised on the knowledge that he will not always be able to return; that he, or it, will not be there forever..."

No Permanent Fix: MACRA, MIPS, and the Politics of Physician Payment Reform

 2018 Dec 1;43(6):1025-1040. doi: 10.1215/03616878-7104431.

No Permanent Fix: MACRA, MIPS, and the Politics of Physician Payment Reform.

Author information

1
University of North Carolina at Chapel Hill.
2
Columbia University.

Abstract

Organized medicine long yearned for the demise of Medicare's Sustainable Growth Rate (SGR) formula for updating physician fees. Congress finally obliged in 2015, repealing the SGR as part of the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA established value-based metrics for physician payment and financial incentives for doctors to join alternative delivery models like patient-centered medical homes. Throughout the law's initial implementation, the politics of accommodation prevailed, with federal officials crafting final rules that made MACRA more favorable for physicians. However, the era of accommodation could be short-lived. The discretion that the Centers for Medicare and Medicaid Services had during the first two years of implementation is ending. Additionally, euphoria over the SGR's repeal has given way to concerns over the new program's value-based purchasing arrangements and uncertainty over their sustainability. MACRA eliminated the SGR, but not the politics of physician payment.

"Back when we were honest, we suffered more."

Friends of the Pod

FAVORITE MURDER PODCASTS??

"Podcasts were the first medium designed to be listened to primarily on headphones, by a single person. Hell is other listeners.
Actually, hell is other fans — specifically, fans of podcasts we don’t listen to. People give each other recommendations, barely better than the algorithm’s, and describe it as “discovery.” “You have to check out Pod Save America,” we hear a journalism student say to a barista. A rookie error, to admit to not listening; once you do, you’ve brought the proselytizing upon yourself. By now we have learned to lie, just like we learned to lie about watching Six Feet Under. Of course we love 99% Invisible! That episode about the artists squatting in a room accidentally built into the mall? So good. Back when we were honest, we suffered more."

Obesity-related hospitalisations at record highs

Obesity-related hospitalisations at record highs

People in Coventry were more likely to be admitted to hospital due to obesity, than the national average

"This was a jump of 11 percent from 5,878 admissions in 2016/17, and is more than double the 2,981 incidences recorded in 2011/12, the earliest figures available."

"The right way to create a young scientist who’s going to be on fire by the time they’re in college is to let them pick something, some subject, that has really excited them...whatever their dream is, let them dream."

A Legendary Scientist Sounds Off on the Trouble With STEM

E.O. Wilson on the next big thing, the gladiatorial nature of academe, and the world beyond the human senses

"Now, I’m going to say something startling. And I’m going to get myself in trouble. But heck, that’s why you’re here.
Q. Yes.
A. And I’m going to say: Nonsense!
The right way to create a young scientist who’s going to be on fire by the time they’re in college is to let them pick something, some subject, that has really excited them. If they dream of space exploration, if they dream of curing a cancer, if they dream of going to distant jungles and discovering new species — whatever their dream is, let them dream."

Friday, May 17, 2019

Merry Christmas Mr. Lawrence - Ryuichi Sakamoto

Merry Christmas Mr. Lawrence - Ryuichi Sakamoto

Colon cancer striking the young in increasing number worldwide

Colon cancer striking the young in increasing number worldwide

"But why the surge among the young? According to Araghi, the increase is likely driven in part by increases in certain risk factors, specifically obesity and poor diet."


Targeted Therapies for Brain Metastases

 2019 May 16;34:125-137. doi: 10.1159/000493057. [Epub ahead of print]

Targeted Therapies for Brain Metastases.

Author information

1
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA, niraax@UPMC.EDU.
2
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
3
Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Abstract

The most common primary cancers that metastasize to the brain are lung cancer, breast cancer, and melanoma. The established management approaches for brain metastasis include stereotactic radiosurgery, fractionated radiation therapy, and surgical resection. In the past the role of medical therapies in brain metastases was limited. In the last decade, our understanding of molecular drivers of brain metastases and CNS penetration of drugs across the blood-brain barrier has improved. The molecular targeted tyrosine kinase inhibitors have shown effectiveness in brain metastases with activating mutations from non-small cell lung cancer, breast cancer, and melanoma. More recently, immunotherapies have also shown efficacy in the management of these patients. These agents can be effective for both intracranial as well as extracranial disease and are being actively employed in this patient population.

How a Few Lucky Civil War Soldiers Started Glowing and Healed Faster

How a Few Lucky Civil War Soldiers Started Glowing and Healed Faster

'Close confinement tells very much upon a man': Prison Memoirs, Insanity[,] and the Late Nineteenth- and Early Twentieth-Century Prison

 2019 May 16. pii: jrz027. doi: 10.1093/jhmas/jrz027. [Epub ahead of print]

'Close confinement tells very much upon a man': Prison Memoirs, Insanity[,] and the Late Nineteenth- and Early Twentieth-Century Prison.

Author information

1
University of Warwick - History, Coventry, West Midlands, United Kingdom.

Abstract

This article explores prisoners' observations of mental illness in late nineteenth- and early twentieth-century British prisons, recorded in memoirs published following their release. The discipline of separate confinement was lauded for its potential to improve prisoners' minds, inducing reflection and reform, when it was introduced in the 1840s, but in practice led to high levels of mental breakdown. In order to maintain the integrity of the prison system, the prison authorities played down incidences of insanity, while prison chaplains lauded the beneficent influence of cellular isolation. In contrast, as this article demonstrates, prisoners' memoirs offer insights into the prevalence of mental illness in prison, and its poor management, as well as inmates' efforts to manage mental distress. As the prison system became more closed, uniform and penal after the 1860s, the volume of such publications increased. Oscar Wilde's evocative prison writings have attracted considerable attention, but he was only one of many prison authors criticizing the penal system and decrying the damage it inflicted on the mind. Exploration of prison memoirs, it is argued, enhances our understanding of experiences of mental disorder in the underexplored context of the prison, highlighting the prisoners' voice, agency and advocacy of reform.

"Old friends bumped into one another, clutching at lattés, trading news, dropping casual references to the 'capitalocene.' A scholar described some new project or life development; her friend nodded, wide-eyed and hypercaffeinated, uttering that trending expression of assent among the grotesquely overeducated: the rapid-fire 'YahYahYah!' All around them, the humanities burned."

Academe's 
Extinction Event

Failure, Whiskey,
and Professional Collapse
at the MLA



"Old friends bumped into one another, clutching at lattés, trading news, dropping casual references to the 'capitalocene.' A scholar described some new project or life development; her friend nodded, wide-eyed and hypercaffeinated, uttering that trending expression of assent among the grotesquely overeducated: the rapid-fire 'YahYahYah!'
All around them, the humanities burned."












Against the nihilism of 'legal age change': response to Räsänen

 2019 May 15. pii: medethics-2019-105475. doi: 10.1136/medethics-2019-105475. [Epub ahead of print]

Against the nihilism of 'legal age change': response to Räsänen.

Abstract

Räsänen has attempted to make a moral case for permitting some people to change their legal age: if someone considers that their chronological age does not correspond to their emotional age or biological age, and they face age-based discrimination as a result, they may change the legal record of their age. This response considers some of the problems with Räsänen's paper, including its reliance on equivocation. It concludes that what is billed as a moral argument turns out to be a conflicted case for deception which relies on a nihilistic outlook on reality.

Study: Health worsening among less-educated adults over last 20 years

Study: Health worsening among less-educated adults over last 20 years



"All less-educated adults—across racial, ethnic[,] and geographical lines—have seen worsening health between 1997 and 2017, especially within the increases in obesity. And the biggest growth in health disparity has been among white adults with more or less education. Conversely, health disparities for black adults with a high school degree or less narrowed slightly since 2011."

Well-differentiated papillary mesothelioma with invasive foci

 2014 Jul;38(7):990-8. doi: 10.1097/PAS.0000000000000200.

Well-differentiated papillary mesothelioma with invasive foci.

Author information

1
*Department of Pathology, Vancouver General Hospital, Vancouver, BC, Canada †Department of Pathology, The University of Texas Medical Branch Galveston §Department of Pathology and Genomic Medicine, Houston Methodist Hospital **Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX ‡Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY ¶PhenoPath Laboratories, Seattle, WA ††Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, AZ ‡‡Department of Pathology, University of Virginia Health System, Charlottesville, VA ∥Department of Pathology, CHU Caen, Caen, France #Department of Clinical Pathology, Ospedale dell'Angelo Venezia, Mestre, Italy.

Abstract

Well-differentiated papillary mesotheliomas (WDPMs) are usually encountered as incidental findings in the peritoneal cavity in women. Most WDPMs are benign, and the histologic features that indicate a more aggressive course are controversial. We report 20 cases of WDPM, which contained invasive foci. Thirteen cases arose in the peritoneal cavity, 1 in a hernia sac, 3 in the pleural cavity, and 3 in hydroceles. The female:male ratio was 16:4, and age range was 7 to 74 years. Tumor was multifocal in 15 cases. Some tumors showed back-to-back papillae, a pattern mimicking invasion but discernible on pan-keratin stain as compressive crowding. True invasive patterns ranged from simple bland-appearing glands invading the stalks of the papillae to solid foci of invasive tumor of higher cytologic grade than the original WDPM. All 5 tested cases were negative for p16 deletion by fluorescence in situ hybridization, but 2/3 had abnormal karyotypes. Recurrences were seen in 8 patients, and in 4 multiple recurrences were documented. Of 16 patients with follow-up, 14 are alive from periods of 6 months to 6 years (average 3.5 y), and 2 have known recurrent disease. One patient died of disseminated tumor at 8 years but without histologic confirmation of the nature of the tumor. We conclude that WDPM with invasive foci in the papillae appear to be prone to multifocality and recurrence, but that they rarely give rise to life-threatening disease. We suggest that these lesions be called WDPM with invasive foci to alert clinicians to the possibility of recurrence.

I am a Candidate for College of American Pathologists' President-Elect, 2019-2021 term. My vision is here. #MembershipGrowthPathologistPayment

I am a Candidate for College of American Pathologists' President-Elect, 2019-2021 term. My vision is here.

Membership Growth. Pathologist Payment.

Your Robot Therapist Will See You Now: Ethical Implications of Embodied Artificial Intelligence in Psychiatry, Psychology, and Psychotherapy

 2019 May 9;21(5):e13216. doi: 10.2196/13216.

Your Robot Therapist Will See You Now: Ethical Implications of Embodied Artificial Intelligence in Psychiatry, Psychology, and Psychotherapy.

Author information

1
Institute for History and Ethics of Medicine, Technical University of Munich School of Medicine, Technical University of Munich, Munich, Germany.
2
Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar at Technical University of Munich, Munich, Germany.

Abstract

BACKGROUND:

Research in embodied artificial intelligence (AI) has increasing clinical relevance for therapeutic applications in mental health services. With innovations ranging from 'virtual psychotherapists' to social robots in dementia care and autism disorder, to robots for sexual disorders, artificially intelligent virtual and robotic agents are increasingly taking on high-level therapeutic interventions that used to be offered exclusively by highly trained, skilled health professionals. In order to enable responsible clinical implementation, ethical and social implications of the increasing use of embodied AI in mental health need to be identified and addressed.

OBJECTIVE:

This paper assesses the ethical and social implications of translating embodied AI applications into mental health care across the fields of Psychiatry, Psychology and Psychotherapy. Building on this analysis, it develops a set of preliminary recommendations on how to address ethical and social challenges in current and future applications of embodied AI.

METHODS:

Based on a thematic literature search and established principles of medical ethics, an analysis of the ethical and social aspects of currently embodied AI applications was conducted across the fields of Psychiatry, Psychology, and Psychotherapy. To enable a comprehensive evaluation, the analysis was structured around the following three steps: assessment of potential benefits; analysis of overarching ethical issues and concerns; discussion of specific ethical and social issues of the interventions.

RESULTS:

From an ethical perspective, important benefits of embodied AI applications in mental health include new modes of treatment, opportunities to engage hard-to-reach populations, better patient response, and freeing up time for physicians. Overarching ethical issues and concerns include: harm prevention and various questions of data ethics; a lack of guidance on development of AI applications, their clinical integration and training of health professionals; 'gaps' in ethical and regulatory frameworks; the potential for misuse including using the technologies to replace established services, thereby potentially exacerbating existing health inequalities. Specific challenges identified and discussed in the application of embodied AI include: matters of risk-assessment, referrals, and supervision; the need to respect and protect patient autonomy; the role of non-human therapy; transparency in the use of algorithms; and specific concerns regarding long-term effects of these applications on understandings of illness and the human condition.

CONCLUSIONS:

We argue that embodied AI is a promising approach across the field of mental health; however, further research is needed to address the broader ethical and societal concerns of these technologies to negotiate best research and medical practices in innovative mental health care. We conclude by indicating areas of future research and developing recommendations for high-priority areas in need of concrete ethical guidance.

Were our critics right about the Stasi?

 2019 Spring;38(1):32-61. doi: 10.1017/pls.2018.27.

Were our critics right about the Stasi?

Author information

1
1Max Delbrück Center for Molecular Medicine.
2
2University of Maryland.

Abstract

BACKGROUND:

Disinformation, now best known generically as "fake news," is an old and protean weapon. Prominent in the 1980s was AIDS disinformation, including the HIV-from-Fort-Detrick myth, for whose propagation some figures ultimately admitted blame while others shamelessly claimed credit. In 2013 we reported a comprehensive analysis of this myth, finding leading roles for the Soviet Union's state security service, the KGB, and for biologist and independent conspiracy theorist Jakob Segal but not for East Germany's state security service, the Stasi. We found Stasi involvement had been much less extensive and much less successful than two former Stasi officers had begun claiming following German reunification. In 2014 two historians crediting the two former Stasi officers coauthored a monograph challenging our analysis and portraying the Stasi as having directed Segal, or at least as having used him as a "conscious or unconscious multiplier," and as having successfully assisted a Soviet bloc AIDS-disinformation conspiracy that they soon inherited and thenceforth led. In 2017 a German appellate court found our 2013 analysis persuasive in a defamation suit brought by a filmmaker whose work the 2014 monograph had depicted as co-funded by the Stasi. Question and methods. Were our critics right about the Stasi? We asked and answered ten subsidiary questions bearing upon our critics' arguments, reassessing our own prior work and probing additional sources including archives of East Germany's Partei- und Staatsführung [party-and-state leadership] and the recollections of living witnesses.

FINDINGS:

Jakob Segal transformed and transmitted the myth without direction from the KGB or the Stasi or any element of East Germany's party-and-state leadership. The Stasi had trouble even tracking Segal's activities, which some officers feared would disadvantage East Germany scientifically, economically, and politically. Three officers in one Stasi section did show interest in myth propagation, but their efforts were late, limited, inept, and inconsequential.

CONCLUSION:

The HIV-from-Fort-Detrick myth, most effectively promoted by Jakob Segal acting independently of any state's security service, was not, contrary to claims, a Stasi success.

"I do not have tips or tricks for becoming a philosopher to hand over to my students; my wisdom is contained in the slog of philosophical argument..."

Against Advice

by       in  Examined Life


"There is probably nothing wrong with this, as long as we do not let it bleed into those contexts in which real assistance is possible. I do not have tips or tricks for becoming a philosopher to hand over to my students; my wisdom is contained in the slog of philosophical argument—the daily grind of reading old books, picking out the premises, tearing them apart. I can make you better at that, by showing you how to do more of this and less of that. I can’t help you become a philosopher without being your philosophy teacher, any more than I can massage you without touching you. Someone who wiggles her fingers and pretends she has magical powers isn’t actually getting you anywhere."


The unreal science of Japan's 400kph bullet trains explained

The unreal science of Japan's 400kph bullet trains explained


The ALFA-X, Japan’s next-generation bullet train, will hit speeds of up to 400kph. But why does it look so weird?

The nose is designed to combat what engineers call the ‘piston effect,’ caused by trains pushing air through tunnels as they enter. “It’s like a piston going into its cylinder,” explains David Soper, a lecturer in vehicle aerodynamics at the University of Birmingham’s Centre for Railway Research and Education. “As the train enters into the tunnel it sets up pressure waves – it comes down to train shape, length, and speed.”

"If we want to describe politics in Darwin's language, artificial rather than natural selection would be the concept that performs better for explaining the courses of politics in real society."

 2019 Spring;38(1):72-102. doi: 10.1017/pls.2019.1.

Darwin's politics of selection.

Author information

1
1Universidad Nacional de San Agustín,Arequipa,Perú.

Abstract

The uses of natural selection argument in politics have been constant since Charles Darwin's times. They have also been varied. The readings of Darwin's theory range from the most radically individualist views, as in orthodox socio-Darwinism, to the most communitarian, as in Peter Kropotkin's and other socialist perspectives. This essay argues that such diverse, contradictory, and sometimes even outrageous political derivations from Darwin's theory may be partially explained by some incompleteness and ambivalences underlying Darwin's concepts. "Natural selection," "struggle for existence," and "survival of the fittest" are open concepts and may suggest some hierarchical and segregationist interpretations. Circumstantially, Darwin accepted social "checks," such as discouraging marriage of "lower" individuals to prevent them from reproducing, in a vein of Malthusian politics. This makes Darwin's theory of selection by struggle collide with his theory of social instincts, by which he explains the origins of morality. It also favors reading Darwin's On the Origin of Species or The Descent of Man from opposite, mostly ideological perspectives. Darwin's position is ambivalent, although hardly unreasonable. The recognition he makes of social instincts, as well as the use of the concept of artificial selection, entails accepting the role of human consciousness, by which social evolution cannot be reduced to natural evolution, as socio-Darwinians did next and as some neo-Darwinists seem to repeat. On these grounds, this essay argues the inadequacy of the conventional model of natural selection for understanding politics. If we want to describe politics in Darwin's language, artificial rather than natural selection would be the concept that performs better for explaining the courses of politics in real society.

"...obesity is usually seen as a moral failing."

Weight Bias Makes It More Difficult to Overcome Obesity

Negative assumptions about obese children are ‘very pervasive’ in the health care industry, experts said at the U.S. News Combating Childhood Obesity summit.

Stanford and her copanelist, Dr. Ihuoma Eneli, director of the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital, agreed that obesity is usually seen as a moral failing. Too often, Eneli says, physicians don't understand that patients who are obese have a disease that needs medical intervention, and scolding patients exacerbates the problem.
Surveys show that two out of three health care providers "have very low expectations of their patients in managing their weight. That in itself is a bias," Eneli says. "We think it's all about will power. We think it's about self-control" while ignoring underlying issues like genetics, socioeconomic status and family dynamics.


"...at its core, a question of when it’s worth diving deep into DNA databanks when there’s no obvious way to put that information into use." #EvidenceBasedMedicine #SkipTheHype

Questioning the value of a genetic test for obesity



"Scientists who recently announced an experimental genetic test that can help predict obesity got immediate pushback from other researchers, who wonder whether it is really useful.
The story behind this back-and-forth is, at its core, a question of when it’s worth diving deep into DNA databanks when there’s no obvious way to put that information into use."

Thursday, May 16, 2019

Your smartphone could be stressing you into an early grave

Your smartphone could be stressing you into an early grave


Many of those studies have focused on smartphones’ relationship with dopamine, the chemical released in our brains which is instrumental in forming habits and addictions. Science has found many phones and apps are specifically designed to trigger the release of dopamine to get us as addicted to checking and interacting with our devices.
Research has shown the average American "spends four hours a day staring at their smartphone and keeps it within arm's reach nearly all the time". That is probably the same for people in other countries.

"...the marimba solo by Bo Wagner has been honored as the best solo ever performed in a pop song."

Starbuck - Moonlight Feels Right


"...the marimba solo by Bo Wagner has been honored as the best solo ever performed in a pop song."

Ethical Criteria for Health-Promoting Nudges: A Case-by-Case Analysis

 2019 May;19(5):48-59. doi: 10.1080/15265161.2019.1588411.

Ethical Criteria for Health-Promoting Nudges: A Case-by-Case Analysis.

Author information

1
a Tilburg University.

Abstract

Health-promoting nudges have been put into practice by different agents, in different contexts and with different aims. This article formulates a set of criteria that enables a thorough ethical evaluation of such nudges. As such, it bridges the gap between the abstract, theoretical debates among academics and the actual behavioral interventions being implemented in practice. The criteria are derived from arguments against nudges, which allegedly disrespect nudgees, as these would impose values on nudgees and/or violate their rationality and autonomy. Instead of interpreting these objections as knock-down arguments, I take them as expressing legitimate worries that can often be addressed. I analyze six prototypical nudge cases, such as Google's rearrangement of fridges and the use of defaults in organ donation registration. I show how the ethical criteria listed are satisfied by most-but not all-nudges in most-but not all-circumstances.

The Carpenters - Goodbye To Love #BeforeCellPhones



The Carpenters - Goodbye To Love

The Carpenters - Close To You Live 1970

The Carpenters - Close To You 

Live 1970

"The day before we’re born is always Eden, and then the day after our children are born is always Mad Max."

Ian McEwan [4.16.19]

"Every loop of that has the effect of making us think that these new things are artificial or unreal or unnatural, and then all it takes is one generation of children extracting information from the world about these things that the previous generation has put in the world for them to become completely natural.

The day before we’re born is always Eden, and then the day after our children are born is always Mad Max. So, if we looked around the room now, we wouldn’t say, 'My god, these people are living in this unbelievably artificial setting. Everything around us is just the creation of a human mind. Nothing about us is natural.' I wonder if when we’re creating creatures, that to the four-year-old, that’s just not even going to be relevant."

"They know perfectly well what they’re supposed to do: shop for bargain groceries, buy fresh produce, cook healthful meals, get everyone to the table at the same time. They try. But..."

Eat Food. All the Time. Mostly Junk.

"At least six million obese teenagers in the United States are candidates for weight-loss surgery..."

Gastric bypass surgery works as well in adolescents as it does in adults, researchers report. But the procedure requires a major commitment.
At least six million obese teenagers in the United States are candidates for weight-loss surgery, experts estimate. Fewer than 1,000 of them get it each year.
Many of these adolescents already have complications of obesity, like diabetes or high blood pressure. But doctors have been uncertain just how well surgery works for young patients, and whether they can handle the consequences, including a severely restricted diet.

Wednesday, May 15, 2019

"We need to get a grip on this. As parents, we are giving our kids a death sentence...to make those choices for your kids and sentence them to this unhealthy life is criminal."


A crisis or a crime?



“We need to get a grip on this. As parents, we are giving our kids a death sentence,” said Debbie Mason, executive director of the Healthcare Foundation of North Sonoma County, after attending a recent meeting on the topic. “It’s one thing to be an adult, make those choices and live with the consequences, but to make those choices for your kids and sentence them to this unhealthy life is criminal.”