Just a hobby, won’t be big and professional…

by reestheskin on 07/09/2017

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(As an aside, I was also playing with a new operating system called Linux, which Linus Torvalds had announced on the comp.os.minix newsgroup with one of those throwaway phrases that have gone down in history: “I’m doing a (free) operating system — just a hobby, won’t be big and professional…”.)

Play works!

Old News | Status-Q

You’re on Earth. There’s no cure for that

by reestheskin on 06/09/2017

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There’s a great line in Beckett,” she says, searching for a quote to capture this equipoise of light and dark. “I can’t remember who says it. ‘You’re on Earth. There’s no cure for that.’ There’s as much common sense in that as in all of Sophocles or Socrates or anyone else.”

Feels like it too.

Novelist Edna O’Brien on sex, books and a lifetime of defiance

Pulped in a bath of human piss

by reestheskin on 05/09/2017

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One thing about trying to put the Internet and computing in context, is that you are forced to look back at the history of other communication revolutions (pace Tim Wu, John Naughton etc). It is now a well trodden path, but one I still find fascinating. Even down to the details of how the cost of distributing images or 3D moulages had an effect on my own specialty. The following caught my eye — or maybe my nose.

“When paper was embraced in Europe, it became arguably the continent’s earliest heavy industry. Fast-flowing streams (first in Fabriano, Italy, and then across the continent) powered massive drop-hammers that pounded cotton rags, which were being broken down by the ammonia from urine. The paper mills of Europe reeked, as dirty garments were pulped in a bath of human piss.”

Link

Clinical skills

by reestheskin on 04/09/2017

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“Physical exam skills are eroding fairly significantly. We see that year after year. The masters who taught us are gone, and we’re not teaching the people below us well enough, for all the reasons we talked about.

At the same time, we grossly overestimated the average clinician’s ability to do an extremely good physical exam and to make all of the relevant physical findings. It has been documented over and over again that the average person’s ability to use a stethoscope and document a murmur accurately is a coin flip. The ability of the average house officer to do volume assessment based on a physical exam is terribly low.”

Here.

The Pen Is Mightier Than the Keyboard

by reestheskin on 31/08/2017

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“Taking notes on laptops rather than in longhand is increasingly common. Many researchers have suggested that laptop note taking is less effective than longhand note taking for learning. Prior studies have primarily focused on students’ capacity for multitasking and distraction when using laptops. The present research suggests that even when laptops are used solely to take notes, they may still be impairing learning because their use results in shallower processing. In three studies, we found that students who took notes on laptops performed worse on conceptual questions than students who took notes longhand. We show that whereas taking more notes can be beneficial, laptop note takers’ tendency to transcribe lectures verbatim rather than processing information and reframing it in their own words is detrimental to learning.”

Psychological Science – Pam A. Mueller, Daniel M. Oppenheimer.

Oh dear….

Minute particulars

by reestheskin on 30/08/2017

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This is from an article in Nature. And the problem is resolving differences in experimental results between labs.

But subtle disparities were endless. In one particularly painful teleconference, we spent an hour debating the proper procedure for picking up worms and placing them on new agar plates. Some batches of worms lived a full day longer with gentler technicians. Because a worm’s lifespan is only about 20 days, this is a big deal. Hundreds of e-mails and many teleconferences later, we converged on a technique but still had a stupendous three-day difference in lifespan between labs. The problem, it turned out, was notation — one lab determined age on the basis of when an egg hatched, others on when it was laid.

Now my title is from Blake:

He who would do good to another must do it in Minute Particulars: general Good is the plea of the scoundrel, hypocrite, and flatterer, for Art and Science cannot exist but in minutely organized Particulars.

And yet, I think I am using the quote in a way he would have strongly disagreed with. Some of the time ‘Minute particulars’ are not the place to be if you want to change the world. Especially in biology.

Boutique experience

by reestheskin on 29/08/2017

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So, you are interested in medical education? Discuss.

Skincancer909

by reestheskin on 28/08/2017

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No, still not finished but useable.

Its science Jim, but not as we (now) know it.

by reestheskin on 28/08/2017

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If you are interested in the history of science. Or put another way, how science can work when it is allowed to, check out this wonderful site: ‘Molecular Tinkering: How Edinburgh changed the face of molecular biology’.

I first became aware of ‘Edinburgh’ and its role in molecular biology by accident. In the late 1970’s I spent three months here doing a psychiatry elective, on the unit of Prof Bob Kendell. I stayed in self-catering University accommodation through the summer, knowing nobody, spending most of my free time tramping around the city on foot. Not always bored. There was a motley crew of people staying in the small hall, and one was a biologist from China. I had never met anybody from this far away and mysterious place. Of course, mostly I asked about barefoot doctors and the like, and questions that you would not now use your mobile phone to ask. No Alexa then. But I wondered why he was here. Molecular biology, he explained. Now, I could recite the story Jim Watson told about Watson and Crick, and even mention a few names who followed. But no more than a handful. ‘Recombinant DNA’ might have passed my lips, but please do not ask me to explain it. But from him, I learned something special has awoken. And for me it was literally a couple more years before the waves of this second revolution broke on the shores of MRC Clinical Training Fellowship applications.

A sample:

Throughout the 20th century film editors worked by identifying key scenes in their film reels, snipping precise frames and re-joining them to create a new narrative. This is exactly how the Murrays wanted to work with the long molecules of DNA. Restriction enzymes would be the editor’s scissors, making the cuts. As well as doing the cutting, the enzymes would be the editor’s eyes: recognising the precise frame at which to snip.

Or if you ever doubt that the space for discovery is infinite, listen to this from Noreen Murray:

“Looking back, it is amazing that Ken and I were the only people in the UK in the late 60s and early 70s to notice the potential of restriction enzymes.”

Or this, for a definition of what research leadership is all about:

Waddington had a real knack for selecting and recruiting interesting but often unproven biologists.

Profit over prophet

by reestheskin on 24/08/2017

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I actually found this quite witty. But it is more than that. It playfully raises some of those issues about education, assessment, and certification. I would love to say medical education has got this right, but I do not believe that. It is easy to list the problems, but hard to solve them. Numbers and formal systems will always be used by those who understand them least, to exile judgement.

  1. Foundational knowledge does exist, it is just not as common as many believe. Teachers, accreditors and other institutions always want to exaggerate the importance of foundational learning because they rent seek on it: the more there is, the more money they make. They will create a world which suits them. It is not just the world some of use live in.
  2. Assessment may drive learning, but assessment frequently wrecks the learning that is education. I post this on the day that the ‘O’ level results come out: education as a proxy war for  politicians seeking reelection.
  3. Demands for better ‘metrics’ will often come at the cost of what many consider most important. Defending exam procedures, may lead to a quasi- legalistic obsession with reliability at the expense of education. This is not a new problem, and is far broader than psychometrics and indeed permeates much science (see Cornfield, J., & Tukey, J. W. (1956). Average values of mean squares in factorials. The Annals of Mathematical Statistics, 27, 907–949). The danger is people think that metrics are ‘theory free’ and forget that in education (and many other domains) metrics causally alter subject behaviour.
  4. Education is about the future. Any designer or educator has to live in the future. And since most of have enough difficulty understanding the present, we can only see it using metaphor. Blake said it well: every honest man is a prophet. Universities increasingly like to spell that sound with different letters.

Dons no more

by reestheskin on 23/08/2017

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For British academics, and probably students too, the heyday of university life came straight after the Second World War. British universities, tiny and cosy by today’s standards, enjoyed enormous autonomy over degree content, expenditure and admissions. Wealthy Oxford and Cambridge enjoyed the highest prestige, but there was no fixed hierarchy, and the standards for a first-class degree seem genuinely to have been quite uniform across the sector.

None of this could survive rapid expansion.

Alison Wolf as ever talking sense. Terrific article.

Pity the poor dermatophyte

by reestheskin on 22/08/2017

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”On the business side , its advertising inventory, whether it is sold directly or via third parties, is made of different kinds of ads, ranging from high-value brands such as Rolex or Lexus to low-paying advertisers, like the toe fungus ads used to fill unsold spaces.”

You can’t sell news for what it costs to make – The Walkley Magazine – Medium

Passwords

by reestheskin on 21/08/2017

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Awhile back the University of Edinburgh changed some of their guidance around passwords. In my 1Password app, I counted over 250 passwords. Some of these are old and no longer used, but the large number reflects the nature of academic life, in which information and knowledge flow is more outside the institution than within it. My bugbear is of course the NHS and the practice of making people remember hard passwords and change these passwords every 3-4 weeks. This is just bad practice, and leads to people writing them down close to where they use them, or choosing more guessable passwords. Another example of bad practice is below.

Slashdot asks if password masking — replacing password characters with asterisks as you type them — is on the way out. I don’t know if that’s true, but I would be happy to see it go. Shoulder surfing, the threat it defends against, is largely nonexistent — especially with personal devices. And it is becoming harder to type in passwords on small screens and annoying interfaces. The IoT will only exacerbate this problem, and when passwords are harder to type in, users choose weaker ones.

Original link Bruce Schneier.

A week in quotes: 5

by reestheskin on 18/08/2017

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“What we see unfolding right before our eyes is nothing less than Moore’s Law applied to the distribution of misinformation: an exponential growth of available technology coupled with a rapid collapse of costs.”

Frederic Filloux.

A week in quotes: 4

by reestheskin on 17/08/2017

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“In a profession that is all about untapping individual potential, increasingly impersonal corporatism hangs like a dark cloud”

Interview with Stephen Milner

A week in quotes: 3

by reestheskin on 16/08/2017

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”There are the cohorts of bureaucrats in every university making a living out of keeping score of publications and citations, manipulating the impact of papers and producing empty marketing verbiage extolling the supposed research excellence of their institutions.”

A week in quotes: 2

by reestheskin on 15/08/2017

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“Fortunately, Bowie’s schooling didn’t interfere with his education.”

 

A week in quotes: 1

by reestheskin on 14/08/2017

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“Management is the antidote to innovation.”

FT. Comment on an article about GSK.

Conspicuous education

by reestheskin on 11/08/2017

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Veblen’s conspicuous consumption rides on:

Rather than filling garages with flashy cars, the data show, today’s rich devote their budgets to less visible but more valuable ends. Chief among them is education for their children: the top 10% now allocate almost four times as much of their spending to school and university as they did in 1996, whereas for other groups the figure has hardly budged.

Book review in the Economist: The Sum of Small Things: A Theory of the Aspirational Class. By Elizabeth Currid-Halkett

Keeping the patients coming: Not so elementary, Watson.

by reestheskin on 10/08/2017

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Well, I thought the Swiss connection with Sherlock Holmes were the Reichenbach falls (I had to visit, a few years back). But no, I read that:

Except in Switzerland, where the stories were banned from railway bookstalls for fear they’d inspire criminality, Sherlock Holmes was big business from the moment of his inception.

But of more interest to the medic:

In 1882, as a newly qualified doctor with a practice in Southsea, Arthur Conan Doyle found himself chronically short of sick people. He therefore used the empty office hours to write his tales about the “consulting detective” who was based on Joseph Bell, the Edinburgh surgeon who knew at a glance what was wrong with the patients parading before him

There is a widespread delusion in the UK that you can accurately plan how many doctors you need. This is a mistake, both for society and for the doctors themselves. As we move forward, I think we will see more medics emulating one of the great ones.

And, as for the book, reviewed in the FT (‘The life and death of Sherlock Holmes’), it highlights that Holmes’ nemesis was not Moriarty, but lawyers.

Punctuated non-equilibrium

by reestheskin on 09/08/2017

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This is via the ever insightful Status-Q:

“A couple of months ago I quoted this phrase from Sam Altman:”

‘The hard part of standing on an exponential curve is: when you look backwards, it looks flat, and when you look forward, it looks vertical. And it’s very hard to calibrate how much you are moving because it always looks the same.’

Plotting the future | Status-Q

I talk about a variant of it that I thought Larry Summers used, although when I have tried to check my memory, I turn nothing up. I see two straight lines, one with a shallow gradient close to zero, the other with a steep one, joined at an inflection point. When you are on the shallow line, you never perceive anything is changing. And even when you know things are going to change  — or you wish for change —you have no idea when. At least with an exponential function you can calculate: with a sudden shift, all you can do is pray. An optimist is somebody who wishes the inflection point comes soon. As does the fool.

Sunsetters on the horizon

by reestheskin on 08/08/2017

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WHAT do you call someone who is over 65 but not yet elderly? This stage of life, between work and decrepitude, lacks a name. “Geriactives” errs too much on the side of senescence. “Sunsetters” and “nightcappers” risk being patronising. Perhaps “Nyppies” (Not Yet Past It) or “Owls” (Older, Working Less, Still earning) ring truer.

I am OK with soon (as in the David Bowie song) being patronised. I like ‘sunsetters’ best. Sipping G+T watching the sun go down, in Africa.

Economist.

Note added in proof: Here are some more:

Hopskis: Healthy Old People Spending Kids’ Inheritance

Woopies and Jollies: Well Off Older People, and Jolly Old Ladies with Lots of Loot

Turbotic teaching awards

by reestheskin on 07/08/2017

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“I’ve written extensively on the now famous Georgia Tech example of a tutorbot teaching assistant, where they swapped out one of their teaching assistants with a chatbot and none of the students noticed. In fact they though it was worthy of a teaching award”

I keep reading this as ‘turbot’, and wondered what the fish things was. I guess the tutorbot would have corrected me soon enough.

Chips, chips, chips. And more chips, please.

by reestheskin on 04/08/2017

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“Children say they prefer IT in their lessons and courses? Do schools listen when kids say they prefer chips for lunch every day?”

An understatement follows:

Education policy is particularly vulnerable to political whims, fads and untested assumptions. From swapping evolution for creationism to the idea that multiple types of intelligence demand multiple approaches, generations of children are schooled according to dogma, not evidence.

Amen to all that. And not just school children, but university students. The Nature article is referring to: original paper here (The myths of the digital native and the multitasker. Paul A. Kirschnera, Pedro De Bruyckerec. DOI)

No scab doctors here

by reestheskin on 03/08/2017

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“Just fun or a prejudice? – physician stereotypes in common jokes and their attribution to medical specialties by undergraduate medical students”

Paper here. Seriously.

Undergraduate medical teaching

by reestheskin on 02/08/2017

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The survey found that UK medical schools employed 3041 full time equivalent clinical academic staff employed by UK medical schools, with a headcount of 3361. This is a 2.1% decline since 2015 and a 4.2% decline since 2010. By comparison, since 2010 the number of NHS consultants has risen by 20.6%.

(link here, from report here)

Reform of, and improving how we educate medical students requires a rethink of medical school staffing, and how clinical academics work. There are plenty of heads in the sand. I think you can improve education and drastically cut costs at the same time. Just stop accelerating into the rose tinted image in the rear view mirror.

Science works! Rewrite the textbooks

by reestheskin on 01/08/2017

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Little evidence is found for higher-order organization into 30- or 120-nm fibers, as would be expected from the classic textbook models based on in vitro visualization of non-native chromatin.

Well, chromatin structure might not be everybody’s cup of tea but I once shared an ‘office’ with a couple of French / Polish researchers in Strasbourg. It was all above my head, so I had to make do with the textbooks, and I stuck to my simple cloning of upstream regulatory regions of a retinoid receptor. Now, it appears from this article in Science, the textbooks will need rewriting. Science works.

RCTs and the kudos of stacking shelves

by reestheskin on 31/07/2017

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Many many years ago I wrote a few papers about — amongst other things — the statistical naivety of the EBM gang. I enjoyed writing them but I doubt they changed things very much. EBM as Bruce Charlton pointed out many years ago has many of the characteristic of a cult (or was it a Zombie? — you cannot kill it because it is already dead). Anyway one of the reasons I disliked a lot of EBM advocates was because I think they do not understand what RCTs are, and of course they are often indifferent to science. Now, in one sense, these two topics are not linked. Science is meant to be about producing broad ranging theories that both predict how the world works and explain what goes on. Sure, there may be lots of detail on the way, but that is why our understanding of DNA and genetics today is so different from that of 30 years ago.

By contrast RCTs are usually a form of A/B testing. Vital, in many instances, but an activity that is often a terminal side road rather than a crossroads on the path to understanding how the world works. That is not to say they are not important, nor worthy of serious intellectual endeavour. But the latter activity is for those who are capable of thinking hard about statistics and design. Instead the current academic space makes running or enrolling people in RCT some sort of intellectual activity : it isn’t, rather it is a part of professional practice, just as seeing patients is. Companies used to do it all themselves many decades ago, and they didn’t expect to get financial rewards from the RAE/REF for this sort of thing. There are optimal ways to stack shelves that maths geeks get excited about, but those who do the stacking do not share in the kudos — as in the cudos [1] — of discovery.

Anyway, this is by way of highlighting a post I came to by Frank Harrell, with title:

Randomized Clinical Trials Do Not Mimic Clinical Practice, Thank Goodness

Harrell is the author of one of those classic books…. . But I think the post speaks to something basic. RCT are not facsimiles of clinical practice, but some sort of bioassay to guide what might go on in the clinic. Metaphors if you will, but acts of persuasion not brittle mandates. This all leaves aside worthy debates on the corruption that has overtaken many areas of clinical measurement, but others can speak better to that than me.

[1] I really couldn’t resist.

The end of an age of optimism

by reestheskin on 28/07/2017

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This is from CP Snow’s ’Two Cultures’. I have never read the book, always warming to critiques of it from others. But I like this snippet quoted by John Naughton, recently.

“I can’t help thinking of the Venetian republic in their last half-century. Like us, they had once been fabulously lucky. They had become rich, as we did, by accident. They had acquired immense political skill, just as we have. A good many of them were tough-minded, realistic, patriotic men. They knew, just as clearly as we know, that the current of history had begun to flow against them. many of them gave their minds to working out ways to keep going. It would have meant breaking the pattern into which they had been crystallised. They were fond of the pattern, just as we are fond of ours. They never found the will to break it.”

Maybe I should go back and look at it. CP Snow, Two Cultures

First again!

by reestheskin on 27/07/2017

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“One-third of UK universities and colleges are awarding firsts to at least 25% of their students, four times as many as five years ago, figures show.”

Surprised this figure is not an input into the TEF……..