Tuesday, March 31, 2020
Sunday, March 29, 2020
Weekend binge watching
Anne Lamont - great lecture, serious with a humorous side, about what's really important in life.
02:29
03:07
03:22
03:52
04:32
05:01
05:17
06:16
06:41
08:06
09:40
10:08
10:44
11:08
11:54
13:02
13:48
14:30
https://youtu.be/X41iulkRqZU
Randy Pausch - dying of cancer, he gave a great lecture about what drove him through his amazing career.
"Experience is what you get when you didn't get what you wanted"
“The brick walls are there for a reason. ... The brick walls are there to give us a chance to show how badly we want something. Because the brick walls are there to stop the people who don't want it badly enough. They're there to stop the other people.”
"Experience is what you get when you didn't get what you wanted"
“The brick walls are there for a reason. ... The brick walls are there to give us a chance to show how badly we want something. Because the brick walls are there to stop the people who don't want it badly enough. They're there to stop the other people.”
This is Us
Alone
Fyre festival
Experience quotations
"Experience is what you get when you didn't get what you wanted."
Randy Pausch
Experience comes from bad judgment.
- various attributions
Saturday, March 21, 2020
11 y.o. Sky Brown skateboarding Olympic hopeful phenomenon
https://youtu.be/gdg8Ubt0vr4
An utterly delightful excitable kid with a great attitude and spirit about her sport.
Wednesday, March 18, 2020
Monday, March 16, 2020
Alcohol consumption and DVT - PTE
"Evidence from a 2015 study suggests that excessive alcohol consumption may raise the risk of DVT."
"Drinking more than three ounces of liquor per week – which is two shots of hard alcohol – increases the risk of DVT by 5 percent...there may be a stronger correlation between binge drinking (four or five drinks in two hours) or AUD than just the amount of liquor consumed per week."
https://www.alcohol.org/effects/blood-clots/#ways-that-alcohol-abuse-increases-risk-of-blood-clots-and-cardiovascular-damage
"Drinking alcohol raises your risk of getting six kinds of cancer...your body breaks it down into a chemical called acetaldehyde. Acetaldehyde damages your DNA."
https://www.cdc.gov/cancer/alcohol/index.htm
"Drinking alcohol raises your risk of getting six kinds of cancer...your body breaks it down into a chemical called acetaldehyde. Acetaldehyde damages your DNA."
https://www.cdc.gov/cancer/alcohol/index.htm
Sunday, March 15, 2020
A poem both ept and ert
A poem both ept and ert
I knów a lÃttle mán both épt and ért.
An Ãntro-? éxtro-? Nó, he's júst a vért.
Shéveled, cóuth, kémpt, pecúnióus, áne,
His Ãmage trúdes upón the céptive bráin.
An Ãntro-? éxtro-? Nó, he's júst a vért.
Shéveled, cóuth, kémpt, pecúnióus, áne,
His Ãmage trúdes upón the céptive bráin.
When life turns sipid and the mind is traught,
The spirit soars as I would sist it ought.
Chalantly then, like any gainly goof,
My digent self is sertive, choate, loof.
The spirit soars as I would sist it ought.
Chalantly then, like any gainly goof,
My digent self is sertive, choate, loof.
Saturday, March 14, 2020
How Do Turboprop Planes Get Delivered To Far Away Customers?
The aircraft range is short, and shipping the plane is much more expensive than flying it, but how do you fly it that far over oceans?
From the comments section:
From the comments section:
"Dash8-Q400 Delivery from Bombardier's factory in Toronto to the Philippines starts in Downsview Airport, Toronto with three pilots and three engineers in a complete aircraft cabin configuration. There are five refuelling stops and four Rest Overnight stops including a one day rest. Below are the flight stops:
"...extra fuel tanks can be installed...can range from a custom-made metal tank to a simple bladder made of rubber, placed on an empty seat...or in the aircraft’s cargo hold."
"Extra large temporary tanks and a life raft are required. Often travel in pairs."
"mainland of the US to Japan ...Seattle to Boeing field to Dutch harbor than Adak then onto Sendai in Japan in piston planes...From Australia you would go to Vanuatu American Samoa Christmas island Maui or Oahu and then to Santa Maria or Oakland"
"Sometimes people use [fuel] bladders which need to be secured very securely since they can roll. there are incidents of people taking off and the bladder rolling to the stern of the aircraft and people losing control...Another problem with bladders if there is an air bubble stuck somewhere in it it will eventually rise to the top and fuel flow will cease until you go back open the filling cap on the top of it and let the air out...Being pressed shoulder-to-shoulder in your seats and nowhere to go since the ferry tanks maybe all the way to the ceiling behind you."
1) Gander, Newfoundland, Canada
2) Reykjavik, Iceland
3) Le Bourget, France
4) Luqa, Malta
5) Luxor, Egypt
6) Sharjah, UAE
7) Ahmedabad, Gujarat, India
8) Dhaka, Bangladesh
9) Rayong, Thailand
Then to Manila, Philippines where the aircraft will undergo standardization."
"...extra fuel tanks can be installed...can range from a custom-made metal tank to a simple bladder made of rubber, placed on an empty seat...or in the aircraft’s cargo hold."
"Extra large temporary tanks and a life raft are required. Often travel in pairs."
"mainland of the US to Japan ...Seattle to Boeing field to Dutch harbor than Adak then onto Sendai in Japan in piston planes...From Australia you would go to Vanuatu American Samoa Christmas island Maui or Oahu and then to Santa Maria or Oakland"
"Sometimes people use [fuel] bladders which need to be secured very securely since they can roll. there are incidents of people taking off and the bladder rolling to the stern of the aircraft and people losing control...Another problem with bladders if there is an air bubble stuck somewhere in it it will eventually rise to the top and fuel flow will cease until you go back open the filling cap on the top of it and let the air out...Being pressed shoulder-to-shoulder in your seats and nowhere to go since the ferry tanks maybe all the way to the ceiling behind you."
https://simpleflying.com/how-do-turboprops-get-delivered-to-far-away-customers/
A book of tales of ferrying airplanes - So You Want to be a Ferry Pilot Book by Spike Nasmyth https://g.co/kgs/wopQcS
A book of tales of ferrying airplanes - So You Want to be a Ferry Pilot Book by Spike Nasmyth https://g.co/kgs/wopQcS
Tuesday, March 10, 2020
Naproxen against coronavirus (and chloroquine)
"Based on the fact that the COVID-19 virus is single-stranded RNA virus and Naproxen has an antiviral activity via inhibiting nucleoprotein (NP) binding to RNA in the replication process of RNA-viruses like influenza A/B, the use of Naproxen as a probable agent for control of widespread novel coronavirus infection may be assumed."
https://www.bmj.com/content/368/bmj.m406/rr-9
I found a 2013 study suggesting benefit of naproxen (and another for indomethacin) against the coronavirus family (SARS etc.) It seems like an easy risk-benefit decision, not that there aren't significant risks of prolonged Naprosyn administration (those with PUD at risk for GI bleed, or on anticoagulant, or at significant risk of MI.)
https://www.bmj.com/content/368/bmj.m406/rr-9
I found a 2013 study suggesting benefit of naproxen (and another for indomethacin) against the coronavirus family (SARS etc.) It seems like an easy risk-benefit decision, not that there aren't significant risks of prolonged Naprosyn administration (those with PUD at risk for GI bleed, or on anticoagulant, or at significant risk of MI.)
I love how they modeled the receptor, then searched out putative drugs that might block that receptor in 3-D models. Very sophisticated computer sleuthing.
Pain reliever shows anti-viral activity against flu:
"The nucleoprotein's three dimensional structure, solved in 2006, provided the basis for searching for new drugs that could interfere with its action. The researchers did a virtual screening within the Sigma-Aldrich online catalog of biochemicals. That screening identified Naproxen, better known as the over-the-counter pain reliever Aleve, and as expected, it bound to the nucleoprotein, and impeded RNA binding"
"naproxen blocks the RNA binding groove of the nucleoprotein, preventing formation of the ribonucleoprotein complex"
Structure-Based Discovery of the Novel Antiviral Properties of Naproxen against the Nucleoprotein of Influenza A Virus.
Indomethacin has a potent antiviral activity against SARS coronavirus.
Efficacy of Addition of Naproxen in the Treatment of Critically Ill Patients Hospitalized for COVID-19 Infection
https://clinicaltrials.gov/ct2/show/NCT04325633
Tissue culture of bronchial cells shows benefit:
"In VeroE6 cells and reconstituted human primary respiratory epithelium models of SARS-CoV-2 infection, naproxen inhibited viral replication and protected the bronchial epithelia against SARS-CoV-2 induced-damage."
https://www.biorxiv.org/content/10.1101/2020.04.30.069922v1
"At present there is no evidence of severe adverse events, acute health care utilization, long-term survival, or quality of life in patients with COVID-19, as a result of the use of NSAIDs. "
https://www.who.int/news-room/commentaries/detail/the-use-of-non-steroidal-anti-inflammatory-drugs-(nsaids)-in-patients-with-covid-19
This is what led me to search for NSAIDS and coronavirus in the first place.
Cyclooxygenase‐2 facilitates dengue virus replication and serves as a potential target for developing antiviral agents .
"Cyclooxygenase-2 (COX-2) is one of the important mediators of inflammation in response to viral infection, and it contributes to viral replication"
https://www.nature.com/articles/srep44701
Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro.
"...[monkey] cells were infected with nCoV-2019BetaCoV...Efficacies were evaluated by quantification of viral copy numbers [by] PCR...chloroquine...potently blocked virus infection at low-micromolar concentration"
https://www.nature.com/articles/s41422-020-0282-0
Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro.
"...[monkey] cells were infected with nCoV-2019BetaCoV...Efficacies were evaluated by quantification of viral copy numbers [by] PCR...chloroquine...potently blocked virus infection at low-micromolar concentration"
https://www.nature.com/articles/s41422-020-0282-0
Canadian vs US health care
Here's a video that plays to the kind of sensationalism and fear-mongering that we've all seen with the coronavirus. It's called "The truth about healthcare."
So, what's the truth, really? A huge question. I'm in a similar position of having worked in both systems extensively. I would still much prefer the Canadian system, both because everyone is covered without question, and because it costs less per capita in terms of percent of GDP. Sure taxes are higher in Canada. In my income tax bracket, my tax rate is a little higher than 35% in Canada, and a little lower than 30% in the US. A small price to pay for universal health care, and there's the apples to oranges of the cost of housing and living, cost of long-term care, cost of insurance and so on between the two countries.
Waiting lists for elective orthopedic surgery in Kelowna were typically 13 months, but highly variable, and shorter if there was a compelling reason.
Waiting a few months for screening colonoscopy is typical in Canada, and wait times are shorter in the US. The typical growths found at colonoscopy are a few mm, but yes, there would be occasional substantial tumors caught a little earlier in the US. Is this worth spending twice as much as other G7 countries on health care? I don't think so.
https://medium.com/@GregCampNC/enlightened-self-interest-and-the-healthcare-debate-20ef0d94b032
My wife might have been diagnosed a few years earlier with her breast cancer, but would she have lived longer? Maybe, maybe not. It's a relentless disease no matter what treatment, perhaps having spread at the time of diagnosis no matter how early the diagnosis, for triple-negative tumors like hers. Breast cancer may be a systemic (body-wide) disease from the outset.
1) in Canada, an on-call team of ultrasound or other radiology personnel is available, but has to be warranted. Pain during pregnancy is best discerned with a history and physical, a laying on of hands, and if warranted based on this assessment, a diagnostic study. Despite any amount of whining from patients or meddlesome husbands, the call team aren't called in unless needed. At any point if her symptoms had worsened, suggesting an abruptio or other disaster, things would've happened fast in both the Canadian or US system. Sure, you can get an ultrasound 24/7 at any small hospital in the US, but is this worth spending twice as much on healthcare? I don't think so.
2) operating on back pain in the absence of neurological deficit is definitely not recommended and can lead to a lifetime of regret. I almost went down that path myself, and have seen colleague's and patient's lives ruined by surgery. Sure you can find a surgeon willing to operate tomorrow in the US, but at what cost?
Even when the reason for operating on back pain is justified, the results are poor. Looking to the Cochrane library, an impartial source I trust on such matters, they say
"Proposed advantages of these [back surgery] techniques regarding the incidence of iatrogenic instability and postoperative back pain are plausible, but definitive conclusions are limited by poor methodology and poor reporting of outcome measures among included studies."
3) colonoscopy earlier: routine screening for colon polyps is spread out every ten years for normal risk, every 5 years for people with a family history as he had, and there's good reason people don't get a colonoscopy every month. Waiting a year versus a month may have very little difference in outcomes (though anyone would acknowledge the anxiety that keeps people up at night during the wait.)
The long wait times in Canada have, of course, been subjected to careful scrutiny. Waiting longer does not significantly increase risk, or the size of tumor at time of diagnosis.
"There was no effect of time to endoscopy on the presence of lymph node positivity or distant metastatic disease at the time of diagnosis"
They actually found the opposite result in this study - if you waited longer there was less chance you had substantial disease. Clearly what was happening here was the doctors were moving people up in the queue if their symptoms were worrying, also called triage.
"Forty-six per cent of patients waited longer than CAG targets, with a mean (± SD) wait time of 79±101 days. Higher cancer stage was associated with shorter wait time, likely as a result of triaging."
So I think the fellow who made this video is fear-mongering, and I would much prefer the Canadian healthcare system over the US one.
HSA spending
What if you forget to use your HSA account credit card for a health expense?
Using the "online expense tracker, you can easily enter medical expense information and securely upload receipts and supporting documentation"
Monday, March 9, 2020
Sunday, March 8, 2020
COVID Common Sense (with links)
People are asking me whether Seattle is over-reacting to the COVID-19 paranoia. With one patient critically ill in our ICU, the worry about disease transmission is palpable amongst my coworkers. Even if you're not in a high-risk group (elderly, frail) you can serve as a vector (carrier) if you don't follow these simple steps.
Hand washing and disinfectants are far more important than wearing face masks - the only useful thing about face masks is they remind you not to touch your face when out in public.
You don't have to descend into a bunker or retreat to the mountains, but some common sense about handwashing and disinfectants is worthwhile. This would apply during any flu season, but is particularly relevant with this virus with its moderate contagiousness and higher-than-typical-flu case fatality rate.
Sing "Happy Birthday" twice while you wash your hands to ensure you have soap on there long enough.
We all do a very poor job of washing our hands adequately. Make sure to turn the tap off with a paper towel, not your hands. (This is probably the most common mistake.)
I'm sure you're doing this already, but having disposable gloves and using Lysol wipes on surfaces you touch throughout the day is worthwhile during the pandemic. The following link is useful to read about disinfectants. https://www.cdc.gov/coronavirus/2019-ncov/community/home/cleaning-disinfection.htm
(Cloth and plastic surfaces hold virus perhaps 100 times longer than the bare metal surfaces that everyone worries about on public transport... https://www.reuters.com/article/us-china-health-surfaces-explainer/explainer-how-long-can-coronavirus-survive-on-surfaces-idUSKCN20M3BK )
An ENT colleague who worries a lot had the following recommendations.
Consider putting your keys, your glasses, the stuff in your pockets in a simple home UV sterilizer when you get home each day. It might be overkill, but it's a simple way to make sure these frequently-touched "fomites" (surfaces that can transmit disease) are thoroughly clean.
Home UV-C sterilizer, $99
Consider putting your keys, your glasses, the stuff in your pockets in a simple home UV sterilizer when you get home each day. It might be overkill, but it's a simple way to make sure these frequently-touched "fomites" (surfaces that can transmit disease) are thoroughly clean.
Home UV-C sterilizer, $99
HoMedics UV-Clean Portable Sanitizer, Grey https://www.amazon.com/dp/B07ZQKVBPP/ref=cm_sw_r_sms_apa_i_65tzEbBWKXNAE
Stay safe out there!
The Global Shortage of Medical Masks Won't Be Easing Soon | Time
Foxconn, which manufactures Apple's iPhones in China, has switched some of its production to masks; the company aims to produce two million units a day by the end of the month. Others, like an auto-maker in south China's Guangxi Zhuang Autonomous Region, are making masks too.
Unable to produce enough of the protective gear to meet its own demand, Beijing has also been sourcing medical masks from overseas. Indonesian officials said at the beginning of February that China had placed "large orders" for Indonesian-made masks, equating to as much as three months of production, and Vietnam has exported huge quantities of masks to China. There are reports that Chinese traders have started sourcing supplies in markets as far away as Kenya and Tanzania.
Saturday, March 7, 2020
Colorizing and upscaling video, all done with AI
Original movie:
Colorized and upscaled version:
"we expect that the frame interpolation and upscaling were done [using artificial intelligence to get] to 4K and 60fps [then used a] Neural Network to automatically colorize the footage."
"...the results are once again surprisingly good—as long as you don't punch in too close. The biggest disappointment is probably the colorizing, which is okay for some parts and abysmal for others.
https://petapixel.com/2020/02/24/using-ai-to-colorize-and-upscale-a-109-year-old-video-of-new-york-city-to-4k-and-60fps/Still, the fact that all of this was automatically, and produced such a surprisingly watchable result—creating frames, resolution, and color out of thin air—is mind-blowing in and of itself."
Here's an opinion from a trained museum conservator:
... from a conservator point of view , I guess I would just say that so long as they're making a copy of the original and changing the copy and keeping the original untouched, then that is fine.
Conservators don't like to introduce new material into an original and if they do, for example, if they do an infill and an inpainting on a painting, for example, they make it clear what is new material and what is old material, and the new material, for the most part should be removable/reversible, so that the old original material remains preserved.
Thursday, March 5, 2020
Cost of batteries getting lower
"According to Bloomberg, the cost of batteries dropped by 13% last year. From $1,100/kWh in 2010, the price went down to around $156.kWh in 2019. This is predicted to come close to the target $100/kWh by 2023."https
www.teslarati.com/tesla-battery-day-doomsday-legacy-carmakers-electric/
How much fiber?
I think the powder is a lot more palatable at the doses recommended - having 4 cups of Bran Flakes a day would be hard to swallow. The metamucil that contains real sugar is a lot more palatable than the sugar-substitute kind, for me.
Metamucil gives you "Fiber content of Metamucil Orange Smooth Powder: 6 grams per 2 rounded tablespoons."https://www.healthline.com/health/digestive-health/whats-the-best-fiber-supplement#psyllium
"one cup of bran flakes contains about 5 g and one-half cup of 100 per cent bran cereal delivers 12 grams of fiber"
https://www.theglobeandmail.com/life/health-and-fitness/health/bran-vs-fruits-and-vegetables-whats-best-for-your-bowels/article29586587/
"Women younger than 51 should aim for 25 grams of fiber daily. Men younger than 51 should aim for 38 grams of fiber daily. Women 51 and older should get 21 grams of fiber daily. Men 51 and older should get 30 grams daily."
https://www.webmd.com/digestive-disorders/dietary-fiber-the-natural-solution-for-constipation
"one cup of bran flakes contains about 5 g and one-half cup of 100 per cent bran cereal delivers 12 grams of fiber"
https://www.theglobeandmail.com/life/health-and-fitness/health/bran-vs-fruits-and-vegetables-whats-best-for-your-bowels/article29586587/
"Women younger than 51 should aim for 25 grams of fiber daily. Men younger than 51 should aim for 38 grams of fiber daily. Women 51 and older should get 21 grams of fiber daily. Men 51 and older should get 30 grams daily."
https://www.webmd.com/digestive-disorders/dietary-fiber-the-natural-solution-for-constipation
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