Of the arts

by reestheskin on 24/04/2018

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Born in Buckinghamshire in 1942, Sulston described his young self as a mechanically minded artisan who preferred science to sport

From an obituary of John Sulstan (by Judith Kible), whom I meet only once when some of our red hair work was featured on the Christmas Lectures. But the phrase harks back to a true characterisation of some types of science. Tool makers; and theorists.

What to say?

by reestheskin on 23/04/2018

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As the surgeon reached for a scrub brush, the medical student lingered back, his thumbs incessantly and rhythmically tapping on the screen of his phone. The surgeon peered at him with frustration, annoyed that again his student appeared more interested in his smartphone than the pathology. In an effort to engage him back to the case, the surgeon asked: “Can you tell me what tendons lie in each of the extensor compartments in the hand?” The student’s head snapped up, and he quickly rattled off the answer with ease. Smiling momentarily, he then asked, “Could I get your thoughts on this new video describing nerve transfers rather than tendon transfers for radial nerve injuries that was just uploaded to our educational portal? See, I have it pulled up right here, it was just presented last week at the plenary session…”



by reestheskin on 20/04/2018

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“Why do doctors feel the need to do this? A study in The BMJ in 2015 suggested that there is an association between increased defensive practice and a reduced likelihood of being involved in litigation.2 One might conclude that defensive practice is a logical behaviour in the face of a culture that leads to doctors being fearful of the consequences of making an error or even of a known adverse outcome.

“No doctor sets out to practise defensively, but a system has been created where this is inevitable. The GMC acknowledges that medicine has become more defensive.3 Doctors often lack confidence in the fairness and competence of investigations and continue to see the GMC as threatening.”

Tom Bourne quoted in the BMJ

Risk to patients?

by reestheskin on 19/04/2018

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A “world renowned” consultant radiologist has been suspended from the medical register for six months after being convicted of failing to pay more than £400,000 in tax on his private practice earnings. XXX a professor of cardiovascular imaging, was given a 15 month suspended prison sentence and fined £200,000 in 2015. The GMC argued that he should be erased from the register. But the medical practitioners tribunal concluded that he made a unique contribution to the care of critically ill patients and the development of cutting edge techniques.

Bmj September 30 , 464, 2017

That old cosmic balance

by reestheskin on 18/04/2018

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“he rose because of the widespread but baseless hunch that people with little outward charisma must possess great depth by way of cosmic balance.”


The robots are already here.

by reestheskin on 17/04/2018

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Modern medicine is full of doctors who are already robotic. But good medicine is like any other subject that requires one to make judgements based on prior cases. You can follow rules, or you can think. The first kidney doctor (who I saw multiple times) never bothered to actually think.

Roger Schank

Nail in the coffin

by reestheskin on 16/04/2018

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And third, the internet is disrupting death as it has life. Comparison sites shed light on funeral providers’ services. And though not many bereaved relations yet “bring their own coffin”, a quick browse online gives people a far better idea of what it should cost. Startups are offering more radical disruption: rocket-launches for ashes; QR codes on graves linked to online tributes; new ways of disposing of bodies besides burying or burning.

I like that you can now go ‘direct’. Purgatory is now optional.


Go where the messes are

by reestheskin on 13/04/2018

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(Isaiah)Berlin had learned that if you studied them with philosophical intent, certain second-rate minds grappling with first-rate problems could teach you more than first-rate minds lost in the shrubbery. (Another reason, perhaps, that he abandoned analytic philosophy.).

Mark Lilla in the NYRB

Which for some reason reminds me of a quote from the Economist:

Professors fixated on crawling alone the frontiers of knowledge with a magnifying glass.

Nails and plate tectonics

by reestheskin on 12/04/2018

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Despite my professional area of interest, I always forget how fast fingernails grow. But no longer.

Thanks to plate tectonics, America and Europe are moving apart at about the speed that fingernails grow. (Thanks to Bill Bryson)

Its about control, stupid!

by reestheskin on 11/04/2018

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As anyone who has worked in a large organisation knows, people who are put in charge of a complex activity that would be better left alone, never do nothing; they seek to justify their existence by simplifying and restricting that activity so that it can be controlled.

Paul Seabright

Higher education (but not so high after all)

by reestheskin on 10/04/2018

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A Wonke podcast well worth listening to featuring Matt Robb of EY Parthenon on higher education. I think it will all end in tears, but it has the virtue of laying out what is happening and — to use one a phrase I detest — the direction of travel.

Wonkhe podcast here.

Some selective notes below (not necessarily his views): there remains much misery to go around.

  • increasing rate of change
  • the nature of change
  • HE is increasingly commercial and internationalised
  • universities having to be more extroverted
  • HE sector facing segmentation
  • global elite versus high-end Russell and the low-end…..
  • (some) protection by grouping by brand
  • international students to drive research to drive rankings to attract students…
  • your ranking is under threat
  • rise of TEF
  • the TEF proof of ‘value added’ at bottom of rankings is the only defence against the ‘too many going to university’ argument. (Well, too many are going…)
  • the great challenge (for part of this sector) is to explain what teaching looks like if it is not research led teaching (which is not the mass of higher education).
  • contract lecturers ……more ‘financial’ flexibility
  • online / blended allowing……. more ‘financial’ flexibility
  • Segmentation rules!
  • University Leadership does not have the strategic competence or backup to run universities.
  • a nice analogy between spreadsheets, and strategy versus planning.

Never underestimate the ability of the UK to reflect on, and then destroy its own brands, particularly if consultants are involved.  You can make a lot of money as the ship goes down.

Only robots will apply

by reestheskin on 09/04/2018

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This article is about truck drivers in the US, where getting a license requires a big investment. The article states that there is now a shortage of truck drivers and argues that this may be a result of the ‘inevitable’ rise of automated drivers.

Many young people are reluctant to pay $5,000-$10,000 to learn to drive an 18-wheeler at a time when experts are predicting that it is a dead end career.

This is akin to what I wrote about before. When people know that a line of work is ‘unlikely’ to continue, they are prone not to want to invest in it. It is not too fanciful to see this happening in medicine. Start with imaging specialties first; and then look at the use of paramedical staff in restricted clinical domains.

Slow service

by reestheskin on 05/04/2018

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M&S mental health drop ins

by reestheskin on 03/04/2018

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Restaurants have also lagged behind retailers in offering “experiences”, as the trade jargon has it, rather than the usual broccoli. This is how the more innovative retailers now try to differentiate themselves in a crowded market. It also lets them do something with their underused floor space.  ….John Lewis, for instance, opened its 49th store in October with 20% of the space dedicated to eye tests, children’s car-seat fittings and free styling services for men. Selfridges, another big department store, marked the 400th anniversary of Shakespeare’s death in 2016 by performing “Much Ado about Nothing” in store, and last year it staged concerts. Waitrose hosts yoga classes, and Marks & Spencer mental-health drop-ins called Frazzled Cafés.

People say we spend too much on health, but business does not view it this way. As things approach the margin, there is even more to sell.


Fear of the known

by reestheskin on 02/04/2018

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Universities are certainly putting their courses online. The question is “why?” I talked last week with a University President whom I have known for many years and asked him why he was building online courses. His answer, unsurprisingly, was “fear.”

Roger Schank

This is an old quote, but still redolent.

When the core is peripheral

by reestheskin on 30/03/2018

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Most, if not all, of us, if asked to be cared for by a television doctor if we had a serious medical problem, would select Dr. Gregory House of the TV series House. He would fail most of the core competencies except for knowledge and skill.

Sidney Herman Weissman in Academic Medicine.

There is a parallel argument used in business: about rounding out the edges leading to less hard thinking. I might agree.

Five years (left to cry in)

by reestheskin on 29/03/2018

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There are periodic evaluations, but a poor result means losing only a fraction of your funding, says Schuman, who previously held one of the plum positions in U.S. science: as an investigator funded by the Howard Hughes Medical Institute on a 5-year contract. “I did not realize how the renewal clock of 5 years dissuaded me from going for risky ideas until I became a Max Planck director,” she says.

Cue, David Bowie:


Does Using an iPad Make an Intervention Innovative?

by reestheskin on 28/03/2018

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Well, just as I approached utter despair, it seems the authors of this Editorial in the Annals of Internal Medicine, say no. Whew! Gee, they will soon wonder if texting patients appointment times might occasionally be a good idea.

The financialisation of higher education

by reestheskin on 23/03/2018

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Nice article in the FT. It is about the increasing use of capital markets by UK universities, and the deal by Portsmouth is highlighted. It joins some dots:

Because the Portsmouth deal is private, so are a lot of the details about it – the borrowing cost, the contractual stipulations. But one aspect in the public domain is the emphasis placed on university rankings in the deal’s press release. ]Text below] From that release:

According to The Economist’s own ranking of UK universities, the University does more to boost its graduates’ earnings that any other university in the UK. The University was ranked 37th in the 2018 Guardian University Guide (having risen for the third successive year from 43rd in last year’s guide and 49th in 2016) and for the third consecutive year, it ranked in the top 100 young universities in the world, in the Times Higher Education ranking of universities which are less than 50 years old.

Even if it is not an explicit part of a lender’s investment process, university rankings are a critical part of the emerging financial infrastructure for universities. They mediate both the demand of student-consumers (in line with the guidance of their parents and schools) and the overall marketing process of debt issuance (lenders, we assume, will be reassured by high or rising rankings).

On keeping a straight face

by reestheskin on 22/03/2018

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“It’s hard to keep a straight face and conduct professional conversations about finite element modelling or soil strength profiles when I’m in a site office surrounded by pictures of naked women.”

From a review of: Built: The Hidden Stories Behind Our Structures, Roma Agrawal Bloomsbury, 2018. 308 pp.

Reviewed in Science

Market Failure

by reestheskin on 21/03/2018

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So, where it this from?

At the peak of the crisis, the hospital had the equivalent of eight full-time pharmacy employees battling the shortage. Technicians worked through the night to mix saline by hand, while nurses injected the solution of salt in water into patients using syringes — a task normally done by the metal stands and plastic bags used for intravenous drips. “Sometimes we’ve had over 20 nurses at a time doing that,” ..

Yes, in the US, at the Cleveland Clinic. FT

Backward thinking

by reestheskin on 20/03/2018

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It is a truism that you never understand anything unless you can understand it more than one way. I like this one:

When he and his colleagues spun ClearMotion out of the Massachusetts Institute of Technology in 2008, their intention was to use bumps in the road to generate electricity. They had developed a device designed to be attached to the side of a standard shock absorber. As the suspension moved up and down, hydraulic fluid from the absorber would be forced through their device, turning a rotor that generated electricity. But, just as a generator and an electric motor are essentially the same, except that they run in opposite directions, so ClearMotion’s engineers realised that running their bump-powered generator backwards would turn it into an ideal form of suspension. And that seemed a much better line of business. They therefore designed a version in which the rotor is electrically powered and pumps hydraulic fluid rapidly into and out of the shock absorber. The effect is to level out a rough road by pushing the wheels down into dips and pulling them up over bumps.


Ebbinghaus redux

by reestheskin on 19/03/2018

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Ebbinghaus link

The neoteny of misery

by reestheskin on 16/03/2018

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Dr. Santos speculated that Yale students are interested in the class because, in high school, they had to deprioritize their happiness to gain admission to the school, adopting harmful life habits that have led to what she called “the mental health crises we’re seeing at places like Yale.” A 2013 report by the Yale College Council found that more than half of undergraduates sought mental health care from the university during their time there.

Yale’s Most Popular Class Ever: Happiness – The New York Times

Higher Ed 101:That was then, and this is now.

by reestheskin on 15/03/2018

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“The relationship of the individual student to their university is an unusual one. In Western higher education, for a long period, the student was generally viewed by the university authorities and its academic staff as some kind of apprentice to the academic discipline: there to learn, certainly, but not quite in the way a high-school student would learn; rather, to play a supporting role in the knowledge production process and thereby to absorb an understanding of the discipline concerned. Several important features of traditional university life followed from this conception. One was that students were considered to be members of the university, albeit junior members, with certain rights and responsibilities. The role was neither that of an employee nor that of someone attending merely to master a new skill, as they might be at a technical college in further rather than higher education. Another important feature was that teaching methods, as a school teacher would understand them, were considered less necessary for a university academic to grasp than a deep knowledge of the discipline and a research orientation towards it—with a desire to extend knowledge in that area. Students would, it was tacitly assumed, learn by exposure to this atmosphere of scholarship and research at least as much as by formal, structured teaching. It therefore also followed that students were expected to take a great deal of personal responsibility for their learning, with teaching contact hours (lectures, seminars, tutorials) comprising a small proportion of their time—though students in science and technology subjects usually needed to spend a good deal of time in the laboratory. (Medicine was always different, as students spent a large part of their time in hospitals and usually formed a distinctive community where professional norms typically took precedence over academic ones.)”

“Universities and Colleges: A Very Short Introduction (Very Short Introductions)” by David Palfreyman, Paul Temple

When Kissinger got the Nobel peace prize irony……

by reestheskin on 14/03/2018

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On the: Office for students (OfS).

We learned last week that not only was DfE’s compliance with the Commissioner’s requests woeful, but the interference by special advisors in Number 10 led to the effective no-platforming of candidates with any ties to the National Union of Students. It can now safely be said that we’re in a post-irony world. The minister also broke the rules about public appointments when choosing to appoint Ruth Carlson to the student experience board position, despite her not having been interviewed for the role and for not consulting on the appointment.

And if you thought that the way in which the whole episode was handled was as if Jo Johnson was writing his own episode of The Thick of It, we haven’t even got to the fact that Toby Young’s appointment was made without even a cursory glance at his Twitter history. By contrast, the original student experience role candidates had extensive checking by the “No 10 Googlers”, to see whether they had ever expressed any negativity about the Prevent duty, or dared to whisper the word “union”. The OfS board appointments were a shambles of the omni variety.

WONKE: Monday Morning HE Briefing – 5th March, 2018 and see here (OfS board appointments and the death of irony).

So, Orwell lives, and business as usual. Some are indeed more equal than others.

Value to whom?

by reestheskin on 13/03/2018

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From the Monday Note

What we need is MBA-like programs for journalism. (They will have to be less expensive than a year at Stanford Graduate School of Business, which can shoot up to $120,000. Last year, one of my classmates, a bright Indian woman, said to me, ‘I’m depressed for the whole week when I have to send my quarterly $40,000 check’; her Big Five consulting firm was too cheap and too short-sighted to pony up the cost, she had to resign and take a loan.

Book review on sun, skin and physics

by reestheskin on 12/03/2018

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The following is an excerpt from a review in press with Acta. You can see the full article with DOI 10.2340/00015555-2916 here


From the solar constant to thong bikinis and all stops in between. 

A review of: “Sun Protection: A risk management approach.” Brian Diffey. IOP Publishing, Bristol, UK. ISBN 978-0-7503-1377-3 (ebook) ISBN 978-0-7503-1378-0 (print) ISBN 978-0-7503-1379-7 (mobi)

Leo Szilard was one of half a dozen or so physical scientists who, having attended the same Budapest gymnasium, revolutionised twentieth century physics. In 1934, whilst working in London, he realised that if one neutron hit an atom which then released two further neutrons, a chain reaction might ensue. Fearing of the consequences, he tried to keep the discovery secret by assigning the patent to the British Admiralty. In 1939, he authored the letter, that Einstein signed, warning the then US President of the coming impact of nuclear weapons.

After the war, in revulsion at the uses to which his physics had been applied, he swapped physics for biology. There was a drawback, however. Szilard liked to think in a hot bath, and he liked to think a lot. Once his interests had turned to biology he remarked that he could no longer enjoy a long uninterrupted bath — he was forever having to leave his bath, to check some factual detail (before returning to think some more). Biology seemed to lack the deep simplifying foundations of the Queen of Sciences.

Just one point in your life?

by reestheskin on 09/03/2018

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Training gets a bad rap for a reason – it’s all a bit, well, dull and inflexible. At one point in my life I point blank refused to be in a room with round tables, a flipchart, coloured pens and a bowl of mints for inspiration.

Donald Clark Link. And please no breakout sessions.

Money talk

by reestheskin on 08/03/2018

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Already UK Biobank has transformed our understanding of health and disease, improving diagnosis and care for those with cancer and rare diseases. But if every participant has their genome sequenced, the prospects for understanding and treating disease, including obesity and mental health disorders, will be extraordinary. We do not know what we will find, but we can be confident it will transform our understanding of what it is to be healthy and what it is to be sick.

Dr Jim Smith is a developmental biologist and the director of science at Wellcome, the science and health foundation.  Link