But not for this purpose. It's a good resource for handouts explaining diseases in layman's terms. It's also good for diagrams to show patients. And occasionally I'll fire it up if I don't recognize a trade name for a new medication.
But for diagnosis, no. Here are the limitations of this study as I see them. The New England Journal cases are weird, uncommon diseases. They often feature a constellation of uncommon symptoms, such as the example used in the article - IPEX (immunodeficiency, polyendocrinopathy, enteropathy, X linked). If you search for just immunodeficiency and polyendocrinopathy, you will get the answer. This is because those are rare symptoms and their combination is even rarer. You would get the same result on any of the well-traveled medical professional sites. If you had a patient with more common symptoms such as with fatigue, weight loss, and night sweats, the prospects of a successful search are low. Another problem with the study is that diagnosis requires a determination of which symptoms are important. If you search for "immunodeficiency polyendocrinopathy hangnail" you don't get IPEX. The researchers in the study got to choose which features of the disease to include and made sure to search for them in medical language. If they had searched for "immunodeficiency low thyroid" they would get an article about greyhounds. It's the same symptom, but not searched medically (polyendocrinopathy). A final issue is that one of the reason these cases are so hard (they all come from Massachusetts General Hospital, where I've cared for a few of them) is that they take awhile to unfold. Usually by the time they are written up nicely, they are far easier than when only one or two symptoms have developed or when the bloodwork is only half finished. When a case appears in the New England Journal, you start thinking rare things immediately. When it appears in your clinic, you should think of common things first.
Anyway, I definitely think that google (or more likely other diagnostic algorithms) has a role in the future of diagnosis. I don't think that it is anywhere near that point yet. I think the study actually supports that (58% is pretty poor!)
It's a shame that it's on the internet - whoever posted it should be fired. That said, it's amazing how calm the guy is and how little blood/brains there are.
Hey, you'd rather go to a campus that has the money and the drive to build than one that is stagnant...it's amazing what has been built in the last 15 years. Started with Old Main, Bell, physics building, the Biochem building, the Biology building, retrofitting SciEng, several parking decks, the band building, fixing up Brough, the Pest Control center, adding on to Mullins, adding on to the union, etc. It's a totally different campus - pretty amazing, really.
I went to the UA. They don't mix money. And they are working very hard to raise their reputation. They've done an amazing job in the 8 years since I started there...
Just wanted to say that Webpath totally rules. I ended up getting a cd of the site and used it as my primary atlas for 2nd year. I wish there were more free, well-run sites like that!
I went to UA for undergrad but am in St. Louis for med school. I enjoyed my UAMS interview, though, and wish you good luck! For me, it was a blinded interview with 3-4 people, one being a student. Set questions.
I have a lot of friends at UAMS, but they will be graduating either this year or the next...
I will be a doctor in 6 months, graduating from an American university. I feel that this idea is just going in the wrong direction. The first two years are pretty much the same all over the country. Just basic science with some clinical exposure.
What's unfortunate is that the students will still be getting the most important part of their training in their home environments. The clinical years are where the majority of applicable skills are learned. The quality of residents, attending physicians, and individual departments help determine how much exposure students get to the cutting edge of modern medicine.
These students might get a better pre-clinical education than they would have. However, they run the risk of adopting all the bad habits of American medicine (focus on pathology, not the patient) without the benefits of its strengths (appropriate application in a compassionate setting).
In short, the best and brightest from other countries will still leave their home countries...
(And just in response to other comments, medical students have much of the same experiences and training as interns and residents just without the actual responsibility)
There is no role for the thymus in the adult human. I wonder who they are going to do trials in - DiGeorge patients (22q11 deletion - often athymic). I can't imagine many parents allowing someone to install a new thymus in their kid...but I guess some people are desperate. I doubt that this will work at all.
It's your job to educate yourself. I base my knowledge of Christianity on the fact that I am a Christian born and raised in the middle of Arkansas. I base my knowledge of the Middle East and Islam from READING. Pick up a book, skip the movies.
Contemplate the founding of Israel. Where did it come from? Why did it form? What was there before? What happened to the people that were there before? The answers are important. European and American anti-Semitism combined with disregard for the "Palestinians" led to the creation of Israel. Israeli policy and racism combined with Arab anger and racism led to a powder-keg. Both sides are culpable.
Oppressed people fight back. Both Israel and Palestine believe they are oppressed, as indeed they are.
Just so you know since you apparently have no clue about the Middle East, blaming the Palestinians for the work of Bin Laden is stupid. What others do in your name is not your fault. The Palestinians are a group of people fighting for the right of self-determination. Bin Laden is a millionaire set on plaguing the US for its Middle East policy, which apparently accepts the subjugation of the Palestinian people. People saw one group of cheering Palestinians and drew conclusions. How do you know that those kids didn't spend last night huddled in a corner while Israeli tanks ran through their village with US support? All Arabs are not the same!
Since I have no idea where the study was published, I can't comment on the methodology, etc. However, I do have to wonder how this research can be groundbreaking.
People with preexisting heart problems who are at risk for arrhythmias or recurrent myocardial infarctions are already warned not to take caffeine. Any stimulant will increase heart rate and blood pressure. Most people with problems know this an ignore this just as those with lung/heart problems ignore our advice to stop smoking.
An interesting side note, those people who suffer from migraine headaches often experience them most severely on the weekends, when they no longer take caffeine, which can work wonders...
His site has been around for at least as long as I've been on the web (6 years or so). Too bad he's being slashdotted all of a sudden. Good guy with a heckuva nice collection who has been so generous to put it all on the web. Funny how these things suddenly draw so much attention after so many years...
I'm not sure if you remember, but the opening scenes showed at least one orangutan. They weren't all chimps. Sure, they didn't show gorillas. We can just assume that they were there...
I think it was pretty obvious that the humans came from the Oberon. They had a shared genesis. My question is why they couldn't just program a computer to go into the nebula instead of using monkeys. Kinda silly.
As I told my friends who were trying to figure out the ending: The ending is not supposed to make sense. The ending is supposed to shock. It was probably tacked on last week when they were scrambling to complete the movie (they made 7 endings, apparently). In any event, it's supposed to show that a)time travel is weird and b) Marky Mark is a moron for wanting to go back to his ship which is obviously going to just crash c) Marky Mark is only thinking about himself and that is BAD
Invicta{HOG}
This was actually something that some of the Survivor web sites were doing this summer in order to draw traffic and "spoil" the show. They would have someone watch the early feed and then post the entire episode. I'm not sure why everyone really wanted to know early, but the producers changed the way they sent out the episodes around midseason.
This is true. I've always thought that the piezoelectric theory of bone growth was fascinating. Osteoclasts do indeed resorb bone (they are from the blood-derived monocyte lineage)and many of the current pharmacologic interventions in osteoporosis either inhibit their activity or stimulate the activity of the bone-building osteoblasts.
One of the main problems with osteoporosis is that, for women, density is lost in the wrong way. Whereas men usually maintain an appropriate matrix which helps protect against common fractures, women lose many of the stabilizing trabecular bone "cross-beams." I had always wondered if this were in part due to differences in weight-bearing exercises. Maybe so, and maybe the piezoelectric effect induced by this vibration will solve part of the problem. The most important thing in this case is not the density of bone, however, but whether the end result (Colles fractures, spinal compression, hip fractures) are reduced. Hopefully there will be some good trials in the future to address this. Hip fractures, because they are usually in the elderly, are a major public health problem. 25% of women with osteoporotic hip fractures die within 6 months. It's just sad to see people who were formerly able to take good care of themselves waste away after a bad fall.
So, I suppose, until this and other devices/drugs make osteoporosis a thing of the past, a public service announcement is in order. If you are a white/East Asian female 10-25, GET LOTS OF CALCIUM! It really is the time when your bones are packing away the calcium for the rest of your life. Osteoporosis is quite debilitating, even to geeks. Maybe especially to geeks, since they are maybe more likely to get less exercise! Take supplements, drink milk, do whatever. Just know that you will probably thank yourself 30-40 years down the road...
You are exactly right about the immune system. The actual Nature article (and my immuno book) mentions that the cd45 receptor is a negative regulator for erythropoiesis, meaning that attempts to stimulate the receptor will not only wipe out "immune cell" proliferation, but red blood cell production. Hardly helpful for any real long-term maintenance. RBCs average 120 day lifespans, so perhaps one month courses could be done without significant anemia. With such obvious major side effects (and that's before an unperfect drug is actually developed!) it's hard to see how trading prednisone for this would be helpful.
I suppose, though, that an antagonist to this receptor might be useful for revving up the immune system in pancytopenic states. In that way, I think that this receptor could be a big help.
The real work lies in identifying ways to turn off individual lineages.
Actually, this finding just gives us insight into the possible evolution of lymphoid tissue tumors. Many leukemias have no cd45 and, thus, have "evolved" past the point where the knowledge and targeting of this receptor are helpful. But an agonist of this receptor could probably help chemotherapeutically for many of the hematogenous cancers.
While this makes sense logically, it is obviously not necessary to isolate any endogenous ligands to the cd45 (although several are already known). What is needed is a careful study to determine whether cd45 activation is lower in actual patients with immune-mediated disease. If not, it would be nice to see whether increased stimulation of cd45 would suppress the immune system and block progression of the disease. Then, a drug might be developed which would stimulate the cd45. However, due to the decreased erythropoiesis this would cause, such a drug would probably not be helpful for chronic (ie MOST) immune diseases.
Using much more sound methodology (i.e. case-control study with larger sample sizes)researchers just this week reported NO CORRELATION between brain tumors and cellular telephone use. Now, tell me why that didn't make headlines. Frankly, I'd much rather have eyeball cancer (very rare, even if this correlation truly is causation) than glioma or meningioma. At least Stang recognized that this whole issue requires more to pin down than just his study. I sometimes feel sorry for people like him. He's probably a good researcher in the wrong place at the wrong time.
There are a couple of good review articles by one of the best surgeons in the field (Dr. Susan MacKinnon: Hand Clin 1999 Nov;15(4):643-66, ix). The major problems that I see with an allograft such as this is the need for immunosuppression. Is it worth it to gain use of an arm but lose your immune system, kidneys, and countless other organs? I really have to question why this was done...I suppose that the child is young enough to perhaps not need immunosuppression after awhile. And I guess they could always take it back out or let it get fibrosed...
Invicta{HOG}
The saddest quote on the MSNBC site...
on
Microsoft Cracked
·
· Score: 2
Other possible motives include economic espionage, though experts said only a rogue company might knowingly buy stolen software, using it either to improve its own products or make those products more compatible with Microsoft's best-selling operating systems.
I'm not sure how you can label a company as ROGUE whose purpose is to provide more compatible software...maybe now we'll get open source windows...
It was funny when I was traveling in Europe to see the "aluminum-ware" of all the royalty. What's cheap and throw-away today was amazingly hard to find back then. Hopefully this, mixed with new separation techniques for the rare earth metals mentioned in this month's Science help usher in all kinds of cool cheap alloys and nifty materials...
FYI, the mint asked all major retailers to help them distribute the dollar. As in, "take these tons of gold dollars and ship them around the country for us in order to help the government out." 7-11 thought about it but decided it was too expensive. Wal-Mart was the only retailer who helped out. If you ask me, they did us a favor by helping distribute the coins. Heck, banks wouldn't touch the coins after the Susan B. Anthony debacle.
And as to who shops at Wal-Mart anymore...only most the country. You can still pretty much find whatever you want at the lowest price.
Slashdot Mirror
But not for this purpose. It's a good resource for handouts explaining diseases in layman's terms. It's also good for diagrams to show patients. And occasionally I'll fire it up if I don't recognize a trade name for a new medication.
But for diagnosis, no. Here are the limitations of this study as I see them. The New England Journal cases are weird, uncommon diseases. They often feature a constellation of uncommon symptoms, such as the example used in the article - IPEX (immunodeficiency, polyendocrinopathy, enteropathy, X linked). If you search for just immunodeficiency and polyendocrinopathy, you will get the answer. This is because those are rare symptoms and their combination is even rarer. You would get the same result on any of the well-traveled medical professional sites. If you had a patient with more common symptoms such as with fatigue, weight loss, and night sweats, the prospects of a successful search are low. Another problem with the study is that diagnosis requires a determination of which symptoms are important. If you search for "immunodeficiency polyendocrinopathy hangnail" you don't get IPEX. The researchers in the study got to choose which features of the disease to include and made sure to search for them in medical language. If they had searched for "immunodeficiency low thyroid" they would get an article about greyhounds. It's the same symptom, but not searched medically (polyendocrinopathy). A final issue is that one of the reason these cases are so hard (they all come from Massachusetts General Hospital, where I've cared for a few of them) is that they take awhile to unfold. Usually by the time they are written up nicely, they are far easier than when only one or two symptoms have developed or when the bloodwork is only half finished. When a case appears in the New England Journal, you start thinking rare things immediately. When it appears in your clinic, you should think of common things first.
Anyway, I definitely think that google (or more likely other diagnostic algorithms) has a role in the future of diagnosis. I don't think that it is anywhere near that point yet. I think the study actually supports that (58% is pretty poor!)
I have treated patients with this. No one scoffs that these people need help. But this disease is not of primary skin pathology
It's a shame that it's on the internet - whoever posted it should be fired. That said, it's amazing how calm the guy is and how little blood/brains there are.
Hey, you'd rather go to a campus that has the money and the drive to build than one that is stagnant...it's amazing what has been built in the last 15 years. Started with Old Main, Bell, physics building, the Biochem building, the Biology building, retrofitting SciEng, several parking decks, the band building, fixing up Brough, the Pest Control center, adding on to Mullins, adding on to the union, etc. It's a totally different campus - pretty amazing, really.
I went to the UA. They don't mix money. And they are working very hard to raise their reputation. They've done an amazing job in the 8 years since I started there...
It might be devoid of meaning, but it's full of funny! Some people just don't recognize humor, I suppose. Did you even read the articles?
Just wanted to say that Webpath totally rules. I ended up getting a cd of the site and used it as my primary atlas for 2nd year. I wish there were more free, well-run sites like that!
I went to UA for undergrad but am in St. Louis for med school. I enjoyed my UAMS interview, though, and wish you good luck! For me, it was a blinded interview with 3-4 people, one being a student. Set questions.
I have a lot of friends at UAMS, but they will be graduating either this year or the next...
I will be a doctor in 6 months, graduating from an American university. I feel that this idea is just going in the wrong direction. The first two years are pretty much the same all over the country. Just basic science with some clinical exposure.
What's unfortunate is that the students will still be getting the most important part of their training in their home environments. The clinical years are where the majority of applicable skills are learned. The quality of residents, attending physicians, and individual departments help determine how much exposure students get to the cutting edge of modern medicine.
These students might get a better pre-clinical education than they would have. However, they run the risk of adopting all the bad habits of American medicine (focus on pathology, not the patient) without the benefits of its strengths (appropriate application in a compassionate setting).
In short, the best and brightest from other countries will still leave their home countries...
(And just in response to other comments, medical students have much of the same experiences and training as interns and residents just without the actual responsibility)
Invicta{HOG}
There is no role for the thymus in the adult human. I wonder who they are going to do trials in - DiGeorge patients (22q11 deletion - often athymic). I can't imagine many parents allowing someone to install a new thymus in their kid...but I guess some people are desperate. I doubt that this will work at all.
It's your job to educate yourself. I base my knowledge of Christianity on the fact that I am a Christian born and raised in the middle of Arkansas. I base my knowledge of the Middle East and Islam from READING. Pick up a book, skip the movies.
Contemplate the founding of Israel. Where did it come from? Why did it form? What was there before? What happened to the people that were there before? The answers are important. European and American anti-Semitism combined with disregard for the "Palestinians" led to the creation of Israel. Israeli policy and racism combined with Arab anger and racism led to a powder-keg. Both sides are culpable.
Oppressed people fight back. Both Israel and Palestine believe they are oppressed, as indeed they are.
Just so you know since you apparently have no clue about the Middle East, blaming the Palestinians for the work of Bin Laden is stupid. What others do in your name is not your fault. The Palestinians are a group of people fighting for the right of self-determination. Bin Laden is a millionaire set on plaguing the US for its Middle East policy, which apparently accepts the subjugation of the Palestinian people. People saw one group of cheering Palestinians and drew conclusions. How do you know that those kids didn't spend last night huddled in a corner while Israeli tanks ran through their village with US support? All Arabs are not the same!
Since I have no idea where the study was published, I can't comment on the methodology, etc. However, I do have to wonder how this research can be groundbreaking.
People with preexisting heart problems who are at risk for arrhythmias or recurrent myocardial infarctions are already warned not to take caffeine. Any stimulant will increase heart rate and blood pressure. Most people with problems know this an ignore this just as those with lung/heart problems ignore our advice to stop smoking.
An interesting side note, those people who suffer from migraine headaches often experience them most severely on the weekends, when they no longer take caffeine, which can work wonders...
Invicta{HOG}
Invicta{HOG}
I'm not sure if you remember, but the opening scenes showed at least one orangutan. They weren't all chimps. Sure, they didn't show gorillas. We can just assume that they were there... I think it was pretty obvious that the humans came from the Oberon. They had a shared genesis. My question is why they couldn't just program a computer to go into the nebula instead of using monkeys. Kinda silly. As I told my friends who were trying to figure out the ending: The ending is not supposed to make sense. The ending is supposed to shock. It was probably tacked on last week when they were scrambling to complete the movie (they made 7 endings, apparently). In any event, it's supposed to show that a)time travel is weird and b) Marky Mark is a moron for wanting to go back to his ship which is obviously going to just crash c) Marky Mark is only thinking about himself and that is BAD Invicta{HOG}
This was actually something that some of the Survivor web sites were doing this summer in order to draw traffic and "spoil" the show. They would have someone watch the early feed and then post the entire episode. I'm not sure why everyone really wanted to know early, but the producers changed the way they sent out the episodes around midseason.
Invicta{HOG}
This is true. I've always thought that the piezoelectric theory of bone growth was fascinating. Osteoclasts do indeed resorb bone (they are from the blood-derived monocyte lineage)and many of the current pharmacologic interventions in osteoporosis either inhibit their activity or stimulate the activity of the bone-building osteoblasts.
One of the main problems with osteoporosis is that, for women, density is lost in the wrong way. Whereas men usually maintain an appropriate matrix which helps protect against common fractures, women lose many of the stabilizing trabecular bone "cross-beams." I had always wondered if this were in part due to differences in weight-bearing exercises. Maybe so, and maybe the piezoelectric effect induced by this vibration will solve part of the problem. The most important thing in this case is not the density of bone, however, but whether the end result (Colles fractures, spinal compression, hip fractures) are reduced. Hopefully there will be some good trials in the future to address this. Hip fractures, because they are usually in the elderly, are a major public health problem. 25% of women with osteoporotic hip fractures die within 6 months. It's just sad to see people who were formerly able to take good care of themselves waste away after a bad fall.
So, I suppose, until this and other devices/drugs make osteoporosis a thing of the past, a public service announcement is in order. If you are a white/East Asian female 10-25, GET LOTS OF CALCIUM! It really is the time when your bones are packing away the calcium for the rest of your life. Osteoporosis is quite debilitating, even to geeks. Maybe especially to geeks, since they are maybe more likely to get less exercise! Take supplements, drink milk, do whatever. Just know that you will probably thank yourself 30-40 years down the road...
Invicta{HOG}
You are exactly right about the immune system. The actual Nature article (and my immuno book) mentions that the cd45 receptor is a negative regulator for erythropoiesis, meaning that attempts to stimulate the receptor will not only wipe out "immune cell" proliferation, but red blood cell production. Hardly helpful for any real long-term maintenance. RBCs average 120 day lifespans, so perhaps one month courses could be done without significant anemia. With such obvious major side effects (and that's before an unperfect drug is actually developed!) it's hard to see how trading prednisone for this would be helpful.
I suppose, though, that an antagonist to this receptor might be useful for revving up the immune system in pancytopenic states. In that way, I think that this receptor could be a big help.
The real work lies in identifying ways to turn off individual lineages.
Invicta{HOG}
Actually, this finding just gives us insight into the possible evolution of lymphoid tissue tumors. Many leukemias have no cd45 and, thus, have "evolved" past the point where the knowledge and targeting of this receptor are helpful. But an agonist of this receptor could probably help chemotherapeutically for many of the hematogenous cancers.
Invicta{HOG}
While this makes sense logically, it is obviously not necessary to isolate any endogenous ligands to the cd45 (although several are already known). What is needed is a careful study to determine whether cd45 activation is lower in actual patients with immune-mediated disease. If not, it would be nice to see whether increased stimulation of cd45 would suppress the immune system and block progression of the disease. Then, a drug might be developed which would stimulate the cd45. However, due to the decreased erythropoiesis this would cause, such a drug would probably not be helpful for chronic (ie MOST) immune diseases.
Invicta{HOG}
Invicta{HOG}
There are a couple of good review articles by one of the best surgeons in the field (Dr. Susan MacKinnon: Hand Clin 1999 Nov;15(4):643-66, ix). The major problems that I see with an allograft such as this is the need for immunosuppression. Is it worth it to gain use of an arm but lose your immune system, kidneys, and countless other organs? I really have to question why this was done...I suppose that the child is young enough to perhaps not need immunosuppression after awhile. And I guess they could always take it back out or let it get fibrosed...
Invicta{HOG}
Other possible motives include economic espionage, though experts said only a rogue company might knowingly buy stolen software, using it either to improve its own products or make those products more compatible with Microsoft's best-selling operating systems.
I'm not sure how you can label a company as ROGUE whose purpose is to provide more compatible software...maybe now we'll get open source windows...
It was funny when I was traveling in Europe to see the "aluminum-ware" of all the royalty. What's cheap and throw-away today was amazingly hard to find back then. Hopefully this, mixed with new separation techniques for the rare earth metals mentioned in this month's Science help usher in all kinds of cool cheap alloys and nifty materials...
Invicta{HOG}
And as to who shops at Wal-Mart anymore...only most the country. You can still pretty much find whatever you want at the lowest price.
Invicta{HOG}