IAAD and I work in this area. ISO 13485 has very specific standards for any medical device that touches patients. To get an ISO 13485 + ISO 27001 (data security) rated product with software is going to take $500k to get to the stage where you can pilot and go for second round funding.
I have found that it is easy to show that a product works in optimum conditions e.g. with people who will stay still and not move about, but put a lot of these technologies into real life situations and the data they output is landfill quality.
This is one of the really annoying things - we have politicians who think that Joe average is going to upload the data from their heart monitor and we are going to stop him going to the Emergency Department. The diagnosis I make is only as good as the data I base that on. That is why Apple has pulled all its apps with medical claims. The consequences of misdiagnosis due to poor data mean a PR disaster on the scale of Volkswagen diesels.
I am not saying that some of this stuff is impossible, but don't expect too much too soon, and if the device and software are not certified, I cannot use them in my practice so they are just shiny paperweights.
I agree. IAAD but not in US and not involved in this case.
When you practice medicine you are always surprised at what you find and you would not believe some of the things we see. Patients in wheelchairs who are physically and neurologically normal. Patients who present with strange and catastrophic conditions who then turn out to be known Munchausens.
In the case of adults if someone chooses to do strange things we do not have any interest or right to stop them, providing they are not harming others.
However in the case of children, if we believe that illness is not present, and therefore that the child is being harmed by the presumption of illness, then we have a duty of care to the child to prevent it. It is not negotiable - we have legal and moral duty to do this. An example of this is children whose parents poison (and sometimes kill) using salt. These situations are very rarely immediately obvious.
This guy has taken on himself to judge this difficult and messy situation, and unless you are directly involved in the case and have some expertise to bring to the table, a lot of people would agree with you that this indeed makes it likely to be a jerk.
This is good news and I was worried that Australia was stitched up by TPP.
As an Australian and British citizen in an IP creating industry I want something that gives me reasonable protection for my IP (and 20-25 years is about right) but at the same time gives me protection against patent trolls.
I voted for Brexit on the grounds that the EU is sleepwalking into TPP and I don't want my intellectual property to be governed by East Texas. Maybe I should move back to Aus?
I had exactly the same sentiments, but went with the iphone 6 but if there had been the option for a large capacity 5s then would have been quite happy with that.
Not sure about 'the loop bit' - I am sure this is a Malcolm Tucker reference - now that would be a product launch I would go to.
For those that do not know 'In the Loop' then judging by 'house of cards', our last great political drama, you should get your version of Malcolm in about 10 years time. NB Malcolm is very occasionally NSFW https://www.youtube.com/watch?v=xUky4_A7Zw4
This is interesting as they have also bought a UK health intelligence company (which wasn't really) called Dr Foster, and also imported the ex-head of the NHS IT and informatics - Tim Kelsey who is an ex-journalist rather than a techie. I can see why they want to build up non-primary industry services that can be exported. However
I speak as an Australian when I say that Australia is not very smart about who to hire externally and they tend to go for names rather than capabilities, although these people may be hired for their ability to sell. Unfortunately Telstra is like the Australian car and supermarket industries - an effective monopoly with poor products and (historically) poor engineering and so what they should be doing is pulling in top-end engineering talent.
Who would you be doing this for? The child or the parent?
As a parent I taught my kids to read before they went to school, and their times tables before they were 8. I think this was helpful but I will never know.
Some of my neices and nephews have been home schooled out of necessity - living in isolated African areas who have gone to normal school age 13. They have integrated well mostly and one of them was Head Boy at his school. What their parents did say is that a lot of the home schooling material is produced for children who are being home schooled to ensure that they don't learn some things. Evolution and certain facts of life mainly. Suspect it might be a bit light be a bit light on Climate Change as well!
My vote is to send to normal school and supplement with targeted extra help and trips to stimulating places. My kids now think it was really cool I took them to Bletchley Park before it was full of Benedict Cumberbatch etc !
One point I would make is that because of the internet, kids now learn at least as much from each other as they do from adults. They no longer get one single version of the truth, and the sooner they learn to sort the wheat from the chaff, the better.
I would have to ask - Is there another (?work-related) reason that your partner wants to do this?
I think the point is that Kirk presents the human-acceptable side of hard science. We are different Myers-Briggs types, and most people don't think, and that is why all our politicians are non-scientists. There are a lot of sheep out there who just want a quiet life and if going to Church on Sundays is part of that, well so be it.
Is this about looking for a moral framework or at least some reference points, if not a full 10 commandments. A lot more peole than atheists tacitly know that God doesn't exist, but they want something to believe in.
I reckon Christopher Hitchens made a pretty good job in his own way:
“Beware the irrational, however seductive. Shun the 'transcendent' and all who invite you to subordinate or annihilate yourself. Distrust compassion; prefer dignity for yourself and others. Don't be afraid to be thought arrogant or selfish. Picture all experts as if they were mammals. Never be a spectator of unfairness or stupidity. Seek out argument and disputation for their own sake; the grave will supply plenty of time for silence. Suspect your own motives, and all excuses. Do not live for others any more than you would expect others to live for you.”
I work in biomedical research and yes - a lot of money is diverted into research with incremental benefits - me-too drugs.
remember that big pharma spend more on marketing than on research.
The interesting stuff has effectively been outsourced to start-ups that find compounds, do some basic work and then sell to a pharma to commercialise. That way at least the people doing the creating get some benefit.
What hasn't happened in its stead is any good research at delivering and applying a lot of the knowledge/ practice we do have, and this is where we could get a lot of bang for our buck and we could be a lot more creative - just by doing what we know works correctly. This is particularly true in fields where there is not currently much research (because there is no big drugs market)
you need someone like Francis Maude who is a politician who just wants to get things done and doesn't want the limelight.
while the coalition government has been treading water for the last 4 years he has been getting on, quietly dismantling the vast organisational structures that had built up over the previous 10 years.
On the face of it a small triumph, but it will pull the rug from under a company that has gone from being an innovator to using its market position to stifle innovation and protect its cash cow
There are some very smart people in the Cabinet Office digital strategy group and this is good work that is clearly in the UK's interests. I am sure that Tesla would be pleased to have Francis Maude review the automotive dealerships
I can see your point.
In health we still have shedloads of horrible kludged Visual Basic and IE6 stuff around, which is why healthcare can't get rid of XP any time soon, despite being a viurs/ trojan/ worm magnet.
happy days!
absolutely right
same goes for health
however the common theme is that the way that these organisations work is that there is no structure to pay competent FOSS IT people 50-60k a year to administer the network.
It therefore seems 'cheaper' to pay for Microsoft products and to have a bunch of low grade IT staff who can only cope with Microsoft products on 25-30k a year who end up running the helldesk, which casues more unhappiness.
IT staff are like classic cars. the cheapest classic car will always work out the most expensive.
it seems that the piece is about organisational culture and how you preserve a high functioning development team in an a large organisation that becomes too focussed on bottom line and not enough on their customers and growth.
This must be a common problem for IT companies. do you need skunkworks? at the same time there is a piece in the news at the moment about how Jobs slavedrove the iphone team into spectacular creativity. maybe it only works when the driving force is as creative as the people being driven?
it is a bit unfortunate that most of the/. is 'my pain/depression/ side effects is bigger than yours' cock measuring, as it makes it look like people who contribute to/. are very concrete, limited and self-centred, which I find hard to believe.
I buy German cars, because the engineering skill adds significant value but if they are trying to get all logistics moved to Poland or Hungary then they are doing the right thing.
IANAL but IAAD and there are things in this story that sound a bit odd, and looking at his web page it sounds like he has a bit of an agenda
it sounds like he has this condition
I am cynical about this situation from experience. Like the most anti-gay republican senators, the most vocal 'disabled' people I have met have turned out to have an interesting secret - in their case some a complete absence of disease (including one member of a paralympic team!).
For the avoidance of doubt, I am not suggesting that this man has anything other than a genuine neurological condition. Just sayin'
I think this is the key to it.
In the UK having your child labelled as 'autistic' or 'autism spectrum'
a) is more socially acceptable than just being labelled as 'slow' (yes I know this is wrong but this is just the way it is) whereas with autism they have a [poorly defined] disease, which is seen as 'an act of God'
b) opens the door to a lot more state benefits (=money) and extra teaching at school (schools like having more teachers), as the child is counted as being 'disabled'.
While I am glad that more kids are being picked up and are being better supported, I am sure that part of this is the creeping medicalisation of normal human variation, and (even as a doctor) this is not a good thing
Re:I have an organ donor card...
on
When Are You Dead?
·
· Score: 5, Insightful
IAAD and sometimes diagnose brain death - a lot of this academic debate ends up just scaring people or firing up various religious groups who have a problem with donation (but often have less of a problem with receiving donated organs).
It is good to have this debate, but like abortion, this is an area where people who deal with the messy situations that life provides should get to drive the policy, rather than any particularly flavour of god-botherers.
I am a senior doctor in the NHS and am one of many trying to unravel some of this unholy mess to work out which bits are workable.
The obvious stuff - own a basic infrastructure, use open standards, manage contracts tightly and locally, encourage a diverse IT culture within and outside hospitals and use competition to drive down price and drive up performance - this just didn't happen. As the parent says - a centralised system specified by obsessive compulsive people who don't touch patients and with an irresistible urge to gold plate everything.
The NHS doesn't even own the N3 network - it rents it off BT.
We are tied down with a vast number of closed systems that will cause untold unhappiness, waste and frustration in years to come - my hospital is about to go live with CERNER, which has a Windows 3.1/ 'visual basic by a first year programmer' look and feel. It takes >30 seconds to authenticate every time you want to do anything (often)! this alone will steal many hours of medical and nursing time waiting.
They as the parent says, the contracts were poorly specified, carved up by the usual management consultancy clowns and their mates, and then just left to fester.
Unfortunately, the people running the whole thing were not equipped with the mental or managerial experience to make it work. There was one head of IT, Richard Grainger, who might have had a chance at doing it properly from the off, but was brought in too late when the carve up had taken place, and ran away as fast as he could. The rest is history.
What they could have done differently?
1. read ' the mythical man month'
2. pay someone to re-engineer VISTA in c++/ c# / java
3. get some people in who are successful doctors, not just the nearest beardy muppet who doesn't want to touch patients any more.
IAAMD, also national data representative for medical college.
this is absolutely right
big taxonomies are are designed by people who don't use them. There is a degree of prick measuring - 'my taxonomy is bigger than yours'
Silly to go to ICD10 when that's already out of date and SNOMED is available.
In the long term, complete EPR with native SNOMED coding is the way to go, but in the meantime give me a small taxonomy with minimal inter-coder variation.
Slashdot Mirror
How long before they get C-Beams - now those would be worth seeing!
So while I think that might be overkill, maybe it is simpler than my solution:
Main Browser
Firefox browser with random agent spoofer, noscript, privacy badger and adnauseam so that I am actively obfuscating tracking.
Secondary Browser
Secondary browser (chrome) that I use to book tickets, use web outlook or do anything that the main browser will sometimes break.
Tertiary browser
Use Torbrowser on the rare occassion that you really don't want to be tracked.
IAAD and I work in this area.
ISO 13485 has very specific standards for any medical device that touches patients.
To get an ISO 13485 + ISO 27001 (data security) rated product with software is going to take $500k to get to the stage where you can pilot and go for second round funding.
There are all sorts of really good sounding projects out there
http://www.oxehealth.com/
http://intelligentultrasound.c...
I have found that it is easy to show that a product works in optimum conditions e.g. with people who will stay still and not move about, but put a lot of these technologies into real life situations and the data they output is landfill quality.
This is one of the really annoying things - we have politicians who think that Joe average is going to upload the data from their heart monitor and we are going to stop him going to the Emergency Department.
The diagnosis I make is only as good as the data I base that on. That is why Apple has pulled all its apps with medical claims. The consequences of misdiagnosis due to poor data mean a PR disaster on the scale of Volkswagen diesels.
I am not saying that some of this stuff is impossible, but don't expect too much too soon, and if the device and software are not certified, I cannot use them in my practice so they are just shiny paperweights.
I agree. IAAD but not in US and not involved in this case.
When you practice medicine you are always surprised at what you find and you would not believe some of the things we see.
Patients in wheelchairs who are physically and neurologically normal. Patients who present with strange and catastrophic conditions who then turn out to be known Munchausens.
In the case of adults if someone chooses to do strange things we do not have any interest or right to stop them, providing they are not harming others.
However in the case of children, if we believe that illness is not present, and therefore that the child is being harmed by the presumption of illness, then we have a duty of care to the child to prevent it. It is not negotiable - we have legal and moral duty to do this. An example of this is children whose parents poison (and sometimes kill) using salt. These situations are very rarely immediately obvious.
This guy has taken on himself to judge this difficult and messy situation, and unless you are directly involved in the case and have some expertise to bring to the table, a lot of people would agree with you that this indeed makes it likely to be a jerk.
I foresee a good market in mobile Faraday cages.
While I am honoured that they try this technology in London, really Liverpool is the ne plus ultra of the retailing world challenge.
They would need to replace all the phones every hour at the rate they will get scoused there.
In medical research when we are comparing groups it is normal to specify the power/ do a power calculation
power is a measure of the risk of finding a result when none exists (falsely rejecting the null hypothesis)
the null hypothesis is that your two treatments are equal
more here:
http://powerandsamplesize.com/...
The obvious use case that might make this viable, and also the BRAVE browser
http://www.theregister.co.uk/2...
would be porn, which tends to power most great IT advances.
This is good news and I was worried that Australia was stitched up by TPP.
As an Australian and British citizen in an IP creating industry I want something that gives me reasonable protection for my IP (and 20-25 years is about right) but at the same time gives me protection against patent trolls.
I voted for Brexit on the grounds that the EU is sleepwalking into TPP and I don't want my intellectual property to be governed by East Texas.
Maybe I should move back to Aus?
I decided not to post anything interesting or relevant.
I had exactly the same sentiments, but went with the iphone 6 but if there had been the option for a large capacity 5s then would have been quite happy with that.
Not sure about 'the loop bit' - I am sure this is a Malcolm Tucker reference - now that would be a product launch I would go to.
For those that do not know 'In the Loop' then judging by 'house of cards', our last great political drama, you should get your version of Malcolm in about 10 years time.
NB Malcolm is very occasionally NSFW
https://www.youtube.com/watch?v=xUky4_A7Zw4
This is interesting as they have also bought a UK health intelligence company (which wasn't really) called Dr Foster, and also imported the ex-head of the NHS IT and informatics - Tim Kelsey who is an ex-journalist rather than a techie.
I can see why they want to build up non-primary industry services that can be exported.
However
I speak as an Australian when I say that Australia is not very smart about who to hire externally and they tend to go for names rather than capabilities, although these people may be hired for their ability to sell. Unfortunately Telstra is like the Australian car and supermarket industries - an effective monopoly with poor products and (historically) poor engineering and so what they should be doing is pulling in top-end engineering talent.
Who would you be doing this for? The child or the parent?
As a parent I taught my kids to read before they went to school, and their times tables before they were 8. I think this was helpful but I will never know.
Some of my neices and nephews have been home schooled out of necessity - living in isolated African areas who have gone to normal school age 13. They have integrated well mostly and one of them was Head Boy at his school.
What their parents did say is that a lot of the home schooling material is produced for children who are being home schooled to ensure that they don't learn some things. Evolution and certain facts of life mainly. Suspect it might be a bit light be a bit light on Climate Change as well!
My vote is to send to normal school and supplement with targeted extra help and trips to stimulating places. My kids now think it was really cool I took them to Bletchley Park before it was full of Benedict Cumberbatch etc !
One point I would make is that because of the internet, kids now learn at least as much from each other as they do from adults. They no longer get one single version of the truth, and the sooner they learn to sort the wheat from the chaff, the better.
I would have to ask - Is there another (?work-related) reason that your partner wants to do this?
I think the point is that Kirk presents the human-acceptable side of hard science.
We are different Myers-Briggs types, and most people don't think, and that is why all our politicians are non-scientists. There are a lot of sheep out there who just want a quiet life and if going to Church on Sundays is part of that, well so be it.
Is this about looking for a moral framework or at least some reference points, if not a full 10 commandments.
A lot more peole than atheists tacitly know that God doesn't exist, but they want something to believe in.
I reckon Christopher Hitchens made a pretty good job in his own way:
“Beware the irrational, however seductive.
Shun the 'transcendent' and all who invite you to subordinate or annihilate yourself.
Distrust compassion; prefer dignity for yourself and others.
Don't be afraid to be thought arrogant or selfish.
Picture all experts as if they were mammals.
Never be a spectator of unfairness or stupidity.
Seek out argument and disputation for their own sake; the grave will supply plenty of time for silence.
Suspect your own motives, and all excuses.
Do not live for others any more than you would expect others to live for you.”
I work in biomedical research and yes - a lot of money is diverted into research with incremental benefits - me-too drugs.
remember that big pharma spend more on marketing than on research.
The interesting stuff has effectively been outsourced to start-ups that find compounds, do some basic work and then sell to a pharma to commercialise. That way at least the people doing the creating get some benefit.
What hasn't happened in its stead is any good research at delivering and applying a lot of the knowledge/ practice we do have, and this is where we could get a lot of bang for our buck and we could be a lot more creative - just by doing what we know works correctly.
This is particularly true in fields where there is not currently much research (because there is no big drugs market)
you need someone like Francis Maude who is a politician who just wants to get things done and doesn't want the limelight.
while the coalition government has been treading water for the last 4 years he has been getting on, quietly dismantling the vast organisational structures that had built up over the previous 10 years.
On the face of it a small triumph, but it will pull the rug from under a company that has gone from being an innovator to using its market position to stifle innovation and protect its cash cow
There are some very smart people in the Cabinet Office digital strategy group and this is good work that is clearly in the UK's interests.
I am sure that Tesla would be pleased to have Francis Maude review the automotive dealerships
I can see your point.
In health we still have shedloads of horrible kludged Visual Basic and IE6 stuff around, which is why healthcare can't get rid of XP any time soon, despite being a viurs/ trojan/ worm magnet.
happy days!
absolutely right
same goes for health
however the common theme is that the way that these organisations work is that there is no structure to pay competent FOSS IT people 50-60k a year to administer the network.
It therefore seems 'cheaper' to pay for Microsoft products and to have a bunch of low grade IT staff who can only cope with Microsoft products on 25-30k a year who end up running the helldesk, which casues more unhappiness.
IT staff are like classic cars. the cheapest classic car will always work out the most expensive.
it seems that the piece is about organisational culture and how you preserve a high functioning development team in an a large organisation that becomes too focussed on bottom line and not enough on their customers and growth.
This must be a common problem for IT companies. do you need skunkworks? at the same time there is a piece in the news at the moment about how Jobs slavedrove the iphone team into spectacular creativity. maybe it only works when the driving force is as creative as the people being driven?
it is a bit unfortunate that most of the
I buy German cars, because the engineering skill adds significant value but if they are trying to get all logistics moved to Poland or Hungary then they are doing the right thing.
IANAL but IAAD and there are things in this story that sound a bit odd, and looking at his web page it sounds like he has a bit of an agenda
it sounds like he has this condition
http://en.wikipedia.org/wiki/Periodic_paralysis
I am cynical about this situation from experience. Like the most anti-gay republican senators, the most vocal 'disabled' people I have met have turned out to have an interesting secret - in their case some a complete absence of disease (including one member of a paralympic team!).
For the avoidance of doubt, I am not suggesting that this man has anything other than a genuine neurological condition. Just sayin'
I think this is the key to it.
In the UK having your child labelled as 'autistic' or 'autism spectrum'
a) is more socially acceptable than just being labelled as 'slow' (yes I know this is wrong but this is just the way it is) whereas with autism they have a [poorly defined] disease, which is seen as 'an act of God'
b) opens the door to a lot more state benefits (=money) and extra teaching at school (schools like having more teachers), as the child is counted as being 'disabled'.
While I am glad that more kids are being picked up and are being better supported, I am sure that part of this is the creeping medicalisation of normal human variation, and (even as a doctor) this is not a good thing
IAAD and sometimes diagnose brain death - a lot of this academic debate ends up just scaring people or firing up various religious groups who have a problem with donation (but often have less of a problem with receiving donated organs).
It is good to have this debate, but like abortion, this is an area where people who deal with the messy situations that life provides should get to drive the policy, rather than any particularly flavour of god-botherers.
digital radiology works, but is generally a standalone system and poorly integrated.
GP to GP transfers - well that would have happened anyway.
Lorenzo is totally dead in the water. Involved in product testing of modules in last 3/12 - doesn't even get to first base. hopelessly broken.
Yes CERNER Millennium works, but is a maladapted dinosaur, with the same evolutionary potential.
I am a senior doctor in the NHS and am one of many trying to unravel some of this unholy mess to work out which bits are workable.
The obvious stuff - own a basic infrastructure, use open standards, manage contracts tightly and locally, encourage a diverse IT culture within and outside hospitals and use competition to drive down price and drive up performance - this just didn't happen. As the parent says - a centralised system specified by obsessive compulsive people who don't touch patients and with an irresistible urge to gold plate everything.
The NHS doesn't even own the N3 network - it rents it off BT.
We are tied down with a vast number of closed systems that will cause untold unhappiness, waste and frustration in years to come - my hospital is about to go live with CERNER, which has a Windows 3.1/ 'visual basic by a first year programmer' look and feel. It takes >30 seconds to authenticate every time you want to do anything (often)! this alone will steal many hours of medical and nursing time waiting.
They as the parent says, the contracts were poorly specified, carved up by the usual management consultancy clowns and their mates, and then just left to fester.
Unfortunately, the people running the whole thing were not equipped with the mental or managerial experience to make it work. There was one head of IT, Richard Grainger, who might have had a chance at doing it properly from the off, but was brought in too late when the carve up had taken place, and ran away as fast as he could. The rest is history.
What they could have done differently?
1. read ' the mythical man month'
2. pay someone to re-engineer VISTA in c++/ c# / java
3. get some people in who are successful doctors, not just the nearest beardy muppet who doesn't want to touch patients any more.
COI: IAANHSD
IAAMD, also national data representative for medical college.
this is absolutely right
big taxonomies are are designed by people who don't use them. There is a degree of prick measuring - 'my taxonomy is bigger than yours'
Silly to go to ICD10 when that's already out of date and SNOMED is available.
In the long term, complete EPR with native SNOMED coding is the way to go, but in the meantime give me a small taxonomy with minimal inter-coder variation.