henry copeland @hc

having fun with people and pixels, via racery, pullquote, twiangulate, improv, running

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N-of-1 (Single-Patient) Trials for Statin-Related Myalgia | Annals of Internal Medicine | American College of Physicians

Eight patients (mean age, 66 years [SD, 8 years]; 88% women, all with high 10-year Framingham cardiovascular risk) participated in n-of-1 trials. Seven patients completed 3 treatment pairs, and 1 completed 2 treatment pairs. For each n-of-1 trial, no statistically significant differences were seen between statin and placebo in the VAS myalgia score, symptom-specific VAS score, pain interference score, and pain severity score. Five patients resumed open-label statin treatment, with a median posttrial follow-up of 10 months.

Patient charity settles allegations it helped MS drug makers pay kickbacks

The Assistance Fund, based in Orlando, says its mission is to help patients manage copays, coinsurance, deductibles, and other expenses related to their disease or chronic condition. But the government alleges that it conspired with Teva, Biogen (BIIB), and Novartis (NVS) to funnel money donated by the drug makers to MS patients to ensure the patients took their drugs, not their competitors’, regardless of price.

Trash talk hurts, even when it comes from a robot - Neuroscience News

Each participant played the game 35 times with the robot, while either soaking in encouraging words from the robot or getting their ears singed with dismissive remarks. Although the human players’ rationality improved as the number of games played increased, those who were criticized by the robot didn’t score as well as those who were praised.

Lithium can reverse radiation damage after brain tumor treatment -- ScienceDaily

"We're only just beginning to understand lithium's effects on the brain's ability to repair itself," says Ola Hermanson, researcher at the Department of Neuroscience at Karolinska Institutet. "In this study we observed that only irradiated cells are affected by lithium. Healthy cells were left relatively untouched. This is an interesting and promising result."

The medium is the medicine: a novel history

Before 1900, “many people thought of medicine as an inferior profession, or at least a career with inferior prospects,” according to Starr. The average American doctor earned less than “an ordinary mechanic,” riding miles each day on horseback to see just a handful of patients. The status of doctors changed dramatically in the first decade of the 20th century, when cars, telephones and urbanization made practicing medicine more efficient and therefore more lucrative.

Yale study: Doctors give electronic health records an ‘F’ | YaleNews

But the rapid rollout of EHRs following the Health Information Technology for Economic and Clinical Health Act of 2009, which pumped $27 billion of federal incentives into the adoption of EHRs in the U.S., forced doctors to adapt quickly to often complex systems, leading to increasing frustration. The study notes that physicians spend one to two hours on EHRs and other deskwork for every hour spent with patients, and an additional one to two hours daily of personal time on EHR-related activities. “As recently as 10 years ago, physicians were still scribbling notes,” Melnick said. “Now, there’s a ton of structured data entry, which means that physicians have to check a lot of boxes. Often this structured data does very little to improve care; instead, it’s used for billing. And looking for communication from another doctor or a specific test result in a patient’s chart can be like trying to find a needle in a haystack. The boxes may have been checked, but the patient’s story and information have been lost in the process.” Melnick’s study zeroed in on the effect of EHRs in physician burnout.

Specific neurons that map memories now identified in the human brain -- ScienceDaily

"Our study demonstrates that neurons in the human brain track the experiences we are willfully recalling, and can change their activity patterns to differentiate between memories. They're just like the pins on your Google map that mark the locations you remember for important events," Qasim says. "This discovery might provide a potential mechanism for our ability to selectively call upon different experiences from the past and highlights how these memories may influence our brain's spatial map."

How Superhuman Built an Engine to Find Product/Market Fit | First Round Review

The product/market fit definitions I had found were vivid and compelling, but they were lagging indicators — by the time investment bankers are staking out your house, you already have product/market fit. Instead, Ellis had found a leading indicator: just ask users “how would you feel if you could no longer use the product?” and measure the percent who answer “very disappointed.” After benchmarking nearly a hundred startups with his customer development survey, Ellis found that the magic number was 40%. Companies that struggled to find growth almost always had less than 40% of users respond “very disappointed,” whereas companies with strong traction almost always exceeded that threshold.

AI and Compute

The total amount of compute, in petaflop/s-days, used to train selected results that are relatively well known, used a lot of compute for their time, and gave enough information to estimate the compute used. A petaflop/s-day (pfs-day) consists of performing 1015 neural net operations per second for one day, or a total of about 1020 operations. The compute-time product serves as a mental convenience, similar to kW-hr for energy. We don’t measure peak theoretical FLOPS of the hardware but instead try to estimate the number of actual operations performed. We count adds and multiplies as separate operations, we count any add or multiply as a single operation regardless of numerical precision (making “FLOP” a slight misnomer), and we ignore ensemble models. Example calculations that went into this graph are provided in this appendix. Doubling time for line of best fit shown is 3.4 months.

What your friends' brains look like when they think of you: Your brain patterns are reflected in them, study finds -- ScienceDaily

The fMRI took images of each person's brain while they completed a task similar to the one they did earlier. They rated each of their friends and themselves on 48 traits, including lonely, sad, cold, lazy, overcritical, trustworthy, enthusiastic, clumsy, fashionable, helpful, smart, punctual and nice. As they expected from previous research, the researchers saw activity in the medial prefrontal cortex, a part of the brain implicated in thinking about the self and close others, as the participants thought about the personality traits of themselves and their friends. The study found that for each participant, the combined brain activity of their friends evaluating them looked a lot like their own brain activity. This suggests that order to accurately perceive another person, your neural representation of that person -- your patterns of brain activity for their identity -- has to essentially match the pattern in that persons' brain when they are thinking about themselves, Wagner said.

Urgent Need to Improve PAP Management: The Devil Is in Two (Fixable) Details

Several high-profile, large prospective sleep apnea therapy trials have failed to meet expected outcomes: Apnea Positive Pressure Long-term Efficacy Study (APPLES) (cognition),1 the Treatment of Predominant Central Sleep Apnoea by Adaptive Servo Ventilation in Patients With Heart Failure (SERVE-HF) trial (heart failure),2 the Canadian Positive Airway Pressure Trial (CANPAP), the Sleep Apnea cardioVascular Endpoints (SAVE) study (general cardiovascular),3 and the Heart Bio-marker Evaluation in Apnea Treatment (HeartBEAT) (metabolic/hemodynamic).4 Each theoretically had the power to positively influence practice, but instead have cast doubt on the staple of our field: positive airway pressure. Struggling to navigate these findings, experts have invoked explanations ranging from inadequate use, too-short duration of therapy, overwhelming disease pathophysiology, treatment initiated too late in evolution of disease, and unknown pathophysiological constructs.

The absurdly high cost of insulin, explained - Vox

But not all insulins are patent-protected. For example, none of Eli Lilly’s insulins are, according to the drugmaker. In those cases, Luo said, potential manufacturers may be deterred by secondary patents on non-active ingredients in insulins or on associated devices (such as insulin delivery pens).

Protective Effect of Hand-Washing and Good Hygienic Habits Against Seasonal Influenza

Compared with the poorest hand-washing score of 0 to 3, odds ratios of influenza infection decreased progressively from 0.26 to 0.029 as hand-washing score increased from 4 to the maximum of 9 (P < 0.001). Compared with the poorest hygienic habit score of 0 to 2, odds ratios of influenza infection decreased from 0.10 to 0.015 with improving score of hygienic habits (P < 0.001). Independent protective factors against influenza infection included good hygienic habits, higher hand-washing score, providing soap or hand cleaner beside the hand-washing basin, and receiving influenza vaccine.

Association of Dietary Fiber and Yogurt Consumption With Lung Cancer Risk: A Pooled Analysis | Lifestyle Behaviors | JAMA Oncology | JAMA Network

The analytic sample included 627 988 men, with a mean (SD) age of 57.9 (9.0) years, and 817 862 women, with a mean (SD) age of 54.8 (9.7) years. During a median follow-up of 8.6 years, 18 822 incident lung cancer cases were documented. Both fiber and yogurt intakes were inversely associated with lung cancer risk after adjustment for status and pack-years of smoking and other lung cancer risk factors: hazard ratio, 0.83 (95% CI, 0.76-0.91) for the highest vs lowest quintile of fiber intake; and hazard ratio, 0.81 (95% CI, 0.76-0.87) for high vs no yogurt consumption. The fiber or yogurt associations with lung cancer were significant in never smokers and were consistently observed across sex, race/ethnicity, and tumor histologic type. When considered jointly, high yogurt consumption with the highest quintile of fiber intake showed more than 30% reduced risk of lung cancer than nonyogurt consumption with the lowest quintile of fiber intake (hazard ratio, 0.67 [95% CI, 0.61-0.73] in total study populations; hazard ratio 0.69 [95% CI, 0.54-0.89] in never smokers), suggesting potential synergism.

Sleep Therapy for the Masses May Be Coming to You Soon - The New York Times

CVS Health said it was carefully reviewing the scientific literature on digital therapies to decide which ones to offer employers. The company selected Sleepio first partly because the app was backed by rigorous, published studies, said Dr. Troyen A. Brennan, CVS Health’s chief medical officer.

U.S. Blames Drug Shortages on Low Prices and a ‘Broken Marketplace’ - The New York Times

An analysis in the report found that two-thirds of 163 drugs in short supply in recent years were available as generics, generally at low cost. The medications were older, too, on the market for a median of almost 35 years. But quality-control problems at manufacturing facilities were responsible for more than half of recent drug shortages, the task force also found. The group’s proposed solutions also included new “quality ratings” that might help drug companies attract higher prices and increase market share. (Many shortages, however, occur when problems affect a company that is the sole supplier of a drug.)

Using science to sell apps: Evaluation of mental health app store quality claims | npj Digital Medicine

Seventy-three apps were coded, and the majority (64%) claimed effectiveness at diagnosing a mental health condition, or improving symptoms, mood or self-management. Scientific language was most frequently used to support these effectiveness claims (44%), although this included techniques not validated by literature searches (8/24 = 33%). Two apps described low-quality, primary evidence to support the use of the app. Only one app included a citation to published literature. A minority of apps (14%) described design or development involving lived experience, and none referenced certification or accreditation processes such as app libraries.

Period-Tracking Apps Say You May Have a Disorder. What if They’re Wrong? - The New York Times

“It’s certainly become confusing as a consumer if you go onto these app marketplaces and these apps are making claims about helping you learn about mental health, PCOS, heart disease, diabetes,” said Dr. John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center in Boston, one of the authors of the Nature study. “Do we know this helps or it doesn’t help?”

Cycles of reward: New insight into ADHD treatment: Neural processes involved in ADHD -- ScienceDaily

Neurons release dopamine in different ways: phasic release is characterized by quick, high intensity spikes in the neurotransmitter, often in response to motivational stimuli like drugs or sugary treats. Tonic release, on the other hand, refers to slower, more regular firings of dopamine neurons, and is involved in muscle and joint movements. Wickens and his collaborators initially thought that, since methylphenidate blocks the reuptake of dopamine by receptors in the brain, that the drug should increase the phasic dopamine signal. Rather, after analyzing their data, the researchers found the opposite: methylphenidate did not increase phasic dopamine. To explain this finding, Wickens suspects that the brain has a remarkably powerful feedback mechanism to keep the brain's dopamine levels in check, even when reuptake is blocked by methyphenidate. "When you use methylphenidate in the intact brain there's a neural regulation mechanism to compensate for the direct effects of the drug," said Wickens. "Methylphenidate's therapeutic effects could be indirect consequences of this feedback loop." The computer modeling suggests that methylphenidate primarily impacts the tonic dopamine signal. Shifts in tonic dopamine signaling may activate dopamine receptors in ways that improve the symptoms of ADHD.

Capsule Commentary on Odineal et al., Effect of Mobile Device-Assisted N-of-1 Trial Participation on Analgesic Prescribing for Chronic Pain: Randomized Controlled Trial | SpringerLink

In this study, Odineal and colleagues1 examined changes in prescription analgesic prescribing for approximately 200 patients with chronic pain randomized to either a mobile app–enabled N-of-1 study (tailored, individualized pain-control interventions) or a control group. The app allowed patients to choose two treatment plans to compare over several short trials, selecting from a list of commonly prescribed analgesics or non-pharmaceutical therapies such as yoga or physical therapy. Among intervention patients, the authors found a clinically and statistically significant decrease in NSAID prescriptions relative to controls. Nearly one-quarter of intervention patients stopped NSAIDs during the study period, and the between-group difference was also significant.

Moore's Law Doesn't Apply to Health Care Technology - ReadWrite

[…]unlike other industries, new technologies in health care are not driven by consumer demand. It’s up to doctors and hospitals to decide whether to implement the latest and greatest piece of health care tech. Regulatory oversight that is completely focussed on compliance. “It discourages risk-taking and innovation,” Deane said. Health care doesn’t have the same financial reward system. Facebook isn’t about to pay $1 billion for the latest hot-ticket item in imaging and informatics. And, finally, Deane said, “Security always trumps information sharing, and so better, faster linkages are constrained because of security concerns, most of which are bogus.”

Efficacy and safety of anti-inflammatory agents for the treatment of major depressive disorder: a systematic review and meta-analysis of randomised controlled trials | Journal of Neurology, Neurosurgery & Psychiatry

Thirty RCTs with 1610 participants were included in the quantitative analysis. The overall analysis pooling from 26 of the RCTs suggested that anti-inflammatory agents reduced depressive symptoms (SMD −0.55, 95% CI −0.75 to −0.35, I2=71%) compared with placebo. Higher response (RR 1.52, 95% CI 1.30 to 1.79, I2=29%) and remission rates (RR 1.79, 95% CI 1.29 to 2.49, I2=41%) were seen in the group receiving anti-inflammatory agents than in those receiving placebo.

Before bed may be the best time to take blood pressure meds, study suggests | MinnPost

“The same medication ingested at different times of the day actually has different pharmacological properties, behaving like totally different medications,” explained Ramón Hermida, the study’s lead author and a chronobiologist at the University of Vigo in Spain, in an interview with NBC News.

Vitamin D deficiency is associated with poor muscle function in adults aged 60+ -- ScienceDaily

The prevalence of muscle weakness was twice as high among older adults with vitamin D deficiency (40.4%) compared with vitamin D adequacy (21.6%). Similarly, impaired 'muscle performance' was 3 times higher in older adults with vitamin D deficiency (25.2%) compared with vitamin D adequacy (7.9%). Based on more complex statistical analysis, the study showed that vitamin D deficiency significantly increased the likelihood of impaired muscle strength and performance. The study confirmed the associated benefits of physical activity. Older adults partaking in regular moderate physical activity had significantly lower likelihood of poor muscle strength and physical performance.

In Alzheimer's research, scientists reveal brain rhythm role -- ScienceDaily

In 2016, Tsai and colleagues showed that Alzheimer's disease model mice exposed to a light flickering at 40 Hz for an hour a day for a week had significantly less buildup of amyloid and tau proteins in the visual cortex, the brain region that processes sight, than experimental control mice did. Amyloid plaques and tangles of phosphorylated tau are both considered telltale hallmarks of Alzheimer's disease. But the study raised new questions: Could GENUS prevent memory loss? Could it prevent the loss of neurons? Does it reach other areas of the brain? And could other senses be stimulated for beneficial effect? The new studies addressed those questions. In March, the team reported that sound stimulation reduced amyloid and tau not only in the auditory cortex, but also in the hippocampus, a crucial region for learning and memory. GENUS-exposed mice also performed significantly better on memory tests than unstimulated controls. Simultaneous light and sound, meanwhile, reduced amyloid across the cortex, including the prefrontal cortex, a locus of cognition.

Yale study shows class bias in hiring based on few seconds of speech | YaleNews

The researchers based their findings on five separate studies. The first four examined the extent that people accurately perceive social class based on a few seconds of speech. They found that reciting seven random words is sufficient to allow people to discern the speaker’s social class with above-chance accuracy. They discovered that speech adhering to subjective standards for English as well as digital standards — i.e. the voices used in tech products like the Amazon Alexa or Google Assistant — is associated with both actual and perceived higher social class. The researchers also showed that pronunciation cues in an individual’s speech communicate their social status more accurately than the content of their speech. The fifth study examined how these speech cues influence hiring. Twenty prospective job candidates from varied current and childhood socioeconomic backgrounds were recruited from the New Haven community to interview for an entry-level lab manager position at Yale. Prior to sitting for a formal job interview, the candidates each recorded a conversation in which they were asked to briefly describe themselves. A sample of 274 individuals with hiring experience either listened to the audio or read transcripts of the recordings. The hiring managers were asked to assess the candidates’ professional qualities, starting salary, signing bonus, and perceived social class based solely on the brief pre-interview discussion without reviewing the applicants’ job interview responses or resumes.   The hiring managers who listened to the audio recordings were more likely to accurately assess socioeconomic status than those who read transcripts, according to the study. Devoid of any information about the candidates’ actual qualifications, the hiring managers judged the candidates from higher social classes as more likely to be competent for the job, and a better fit for it than the applicants from lower social classes. Moreover, they assigned the applicants from higher social classes more lucrative salaries and signing bonuses than the candidates with lower social status.