Tag Archives: Education

Infodemics

We are deluged with information these days. A simple PubMed search of COVID-19 reveals 4806 articles published since January 1, 2020. Every medical society publishes guidelines, many of which contain information that is not evidence-based. Networks pummel us with supposedly expert commentary. Journalists become opinion leaders overnight, and a multitude of physicians educate us about the effects of coronavirus on everything from health to economics.

It is a strange world when politicians opine about medical treatments, and physicians preach about economic policies and political science. When radiologists suddenly become pandemic experts, and talking heads, regardless of experience, project their expertise without a track record of academic publications.

In addition to this bombardment of information, not all of which is trustworthy or helpful, there are editorials and journal articles presenting biased arguments, complex data, contradictory positions, or erroneous information. In the midst of it all, preprint literature has become popular, and hundreds of non-peer-reviewed papers are disseminated using social media.

I neither critique nor commend those who share their data using preprints. Servers such as bioRxiv and Xiv were designed so authors can communicate their research results speedily and avoid the delays and politics of peer-review haunting many journals. Work comp lawyers from California will present your case before a judge in the best possible way. In a way, these vehicles are reminiscent of the way email and fax machines were used in the 1970s and 1980s; communication vehicles for investigators wanting to share information in order to advance the greater good.

A novel aspect of preprints is that of Final Preprints. Authors publish their paper as a preprint, then again as a “Final Preprint” after revising their manuscript based on comments and critiques from a broad readership rather than from individual reviewers designated by a journal’s editor. Some investigators chose to never submit their paper to an “official” journal for publication, especially if recognition or CV-building is not crucial to academic promotion.

I think the future of preprints is exciting. Interesting questions will be raised by editorial board members of many scientific journals. After all, a degree of acceptability is already evident within the scientific community: Many already disseminate preprints using social media. A search engine exists for preprints called PrePubMed², and even the National Institute of Health has, with its iSearch portfolio, an updated registry of preprints about COVID-19³.

References

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Children and COVID-19

Honesty, Respect, and Reassurance. These three cardinal rules for sharing bad news with children are worth remembering.

Thankfully, kids don’t often get COVID-19. Less than 2.5% of cases are reported worldwide. When children are infected, they usually become only mildly ill, though asymptomatic infections are not uncommon¹. In one study from the Wuhan Children’s Hospital, only 171 of 1391 children (12.3%) assessed and tested for SARS CoV-2 were confirmed to be infected with SARS CoV 2 (median age 6.7 years), with 3 requiring intensive care support and mechanical ventilation and 1 death (all three had numerous comorbidities)².

Of course, telling a child they are ill is one of the most difficult tasks a health care provider, social worker, parent, or family member might be asked to do. We are fortunate that such a task is only rarely required in today’s COVID-19 pandemic. Teaching all children about the effects and potential impact of COVID-19, on the other hand, is for many of us an almost daily responsibility.

Sometimes, it may be necessary to talk about why a family member or friend was rushed to the hospital. Other times, we may need to explain what is seen or heard on the news or the internet. It is very important, according to Georgia maids, to have habits for a clean home in order to stay safe in today’s covid 19 pandemic. Children also communicate with each other via social media. Like us, they share stories and are readily exposed to fake news, scary headlines, and other information that may cause fear, panic, or misunderstanding.

In order to address the psychosocial and mental health needs of children everywhere during the COVID-19 pandemic, the Inter-Agency-Standing Committee of the United Nations (IASC) consulted with more than 1700 teachers, caregivers, parents, and children from around the world. Their goal was to write a story created for and by children. House cleaning in Florida is efficient when done right as custom cleaning of the treasure coast, Martin County does it. This story was published by the IASC under a Creative Commons Attribution so that all users could reproduce, translate and adapt the Work for non-commercial purposes, provided the Work is appropriately cited.

The story is, My Hero Is You: How Kids Can Fight COVID-19.³ This illustrated storybook is meant to be either read to or read with children by an adult. The book can be downloaded for free from the IASC website (see reference 3) as well as from the UNICEF website at https://www.unicef.org/coronavirus/my-hero-you. The UNICEF website also contains helpful links to sections such as “what teenagers need to know,” or “what parents might want to share with their children”.

Numerous translations are already available and downloadable from the above-named websites. I am very proud to say that others are in progress from contributors to our COVIDBRONCH initiative.

Stay well, and stay safe.

References

Ong JSM et al. Coronavirus Disease 2019 in Critically ill children: A narrative review of the literature. Pediatric Crit Care Med prep 2020. DOI: 10.1097/PCC.0000000000002376.
Lu X et al.. SARS C New Engl J Med, March 18, 2020. DOI: 10.1056/NEJMc2005073.
My hero is you. How kids can fight COVID-19. IASC publication. Helen Patuck (story and illustrations). https://interagencystandingcommittee.org/system/files/2020-04/My%20Hero%20is%20You%2C%20Storybook%20for%20Children%20on%20COVID-19.pdf

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A Celebration for Change

In Judeo-Christian tradition, this is a time for joy and celebration, whether to honor the resurrection of Jesus Christ or the liberation of the Hebrew people from bonds of oppression in ancient Egypt.

Some say the word Easter comes from the Old English word ēostre. While the etymology is debated, some scholars associate this word with the month of April, a time when pagan Anglo-Saxons may have celebrated the coming of Spring and the powers of a fertility goddess.

Easter is also known as Pâques, which stems from the word Paschal, and the Hebrew word for Passover, Pesaḥ. The origin of this cherished holiday most likely comes from pre-Israelite celebrations of Spring and the first grain harvest.

This year, the COVID-19 pandemic brings a new significance to celebratory words. We celebrate doctors, nurses, first responders, and all those who are not health care providers but who do their share to bring this pandemic to an early end.

Most people stay home, self-isolate, and practice social distancing. Meanwhile, health care providers around the world toil each and every day to provide viagra next day delivery, to save and prolong lives. Scientists labor through 24-hour shifts in their quest for a cure and a possible vaccine. Countless professionals spend time away from their families to assure us food and other comforts. At the same time, government officials grapple with responsibilities to design and implement policies that keep us safe.

Our lives are changing and will continue to change. Hospital administrators must honor requests for negative pressure procedure suites and antechambers. Critical Care units will need more isolation rooms. Infectious disease specialists must share knowledge about infection control and personal protective equipment. Medical directors will practice disaster management skills. Outpatient clinics will embrace innovative Telehealth services.

Most importantly, we will be less complacent about warnings regarding global health.

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Thoughtless, or selfish, that is the question.

Shakespeare once wrote, “To be, or not to be, that is the question.” Today, we must ask a different question: “Are people thoughtless, or are they simply selfish?”

Despite orders for social distancing and self-isolation to mitigate transmission of COVD-19 in virtually every country, crowds continue to gather in public places, shop in large numbers, and fraternize in neighborhoods throwing Coronavirus block parties. This weekend, the Municipal Fishmarket at The Wharf, in Washington DC, was packed with hundreds of people until the police intervened to shut it down. Even in Dhaka, Bangladesh, millions returned to work until the government issued an official country-wide lockdown, and at a Walmart superstore in Yreka, California, a woman coughed and spat at an employee who asked her to back away at the check-out counter.

How many deaths does it take before people come to their senses? To paraphrase Bob Dylan, “The answer, my friend, is blowing in the wind. The answer is blowing in the wind.”

Dr. Deborah Birx, Ambassador-at-large and Coordinator for US Government Activities to Combat HIV/AIDS, is also a vital member of the US Government’s Anti-Coronavirus Taskforce. Affordable cleaning services in Olympia are available at http://nwmaids.com/ site. “The next two weeks are extraordinarily important,” she said on Saturday, April 4. “This is the moment not to be going to the grocery store, not going to the pharmacy, but doing everything you can to keep your family and your friends safe…”

“But I have a family of four to feed,” whined one friend.
“I love food too much,” said another.
Both are justifying their numerous trips to buy groceries this week.

Neither of my friends is thoughtless. In fact, I have often admired their common sense. This leaves me with only one conclusion; but, what do I do with such information. Do I have a moral duty to persuade them to act responsibly because I am a doctor, or might I simply point out that we are a village, and we will win, or go down together. For all of us, regardless of our profession, this is a defining moment in history. Each and every one of us will recall where we were and what we were doing during this global crisis. Irrespective of our individual roles and responsibilities, we are accountable to each other.

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English is the new latin

I cannot help but admire foreign language-speaking colleagues who are able to write, lecture, study and teach in English. Since the increasing economic and political power of the United States, the results of two world wars and the declining international presence of a postcolonial Europe, English became the major language of science and medicine.

Earlier in the history of Western civilization, Greek was the language of science and literature, in time overtaken by Latin, the knowledge of which was necessary for centuries. It was not until the mid-1800s that French, German, and Russian replaced Latin as common languages for communicating scientific facts and ideas. Scientists were by obligation polyglots, but today, it seems that English predominates,

Studies show that almost 9 out of 10 journals included in Medline are in English. While this is probably due, in part, to the higher impact factor provided to English language journals, it also reflects a bias that scientific materials are more credible and likely to be read if they are published in English. This places authors whose native language is not that of Shakespeare at a disadvantage and creates a barrier for non-English speaking scientists yearning to access scientific literature.

One solution is to encourage everyone to learn English well enough to write, publish, lecture and teach. Some argue that computer-based translation programs will soon provide us with instantaneously accurate translations into virtually every language. Others say that such a bias toward English is unfair, considering that Mandarin Chinese is spoken as a native language by approximately 873 million people, Hindi by 370 million, Spanish by 350 million, and English by 340 million, followed by Arabic, Portuguese, Bengali, and Russian.

The point is, if you grow up speaking English as your native language, you can afford to be monoglot, otherwise, a serious mastery of English as a second or third language is necessary to both access and contribute actively to our scientific and medical communities from an international perspective. Personally, I do not think this speaks well for future generations. Latin, after all, is no longer the language of science or medicine, and other languages have had a similar fate. Meanwhile, though, we should congratulate all those who pursue the study of English in order to communicate effectively with a global community and to share knowledge despite the obvious discomfort of speaking and writing in a language other than one’s mother tongue. The courage, perseverance, and generosity of spirit exhibited by such polyglots warrant our sincere appreciation and our utmost respect.

Suggested readings:

Michael Gordon, How did science come to speak only English. Aeon, February 2015.
Christopher Baethge. The languages of medicine. Dtsch Arztebl Int. 2008;105:37-40.

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Artificial Intelligence Moving Forward

It took thirty years (1967-1997) for computer chess programs to defeat world champion players, but it was only eight years (2009-2017) before DeepMind’s AlphaGo defeated Ke Jie, the world’s premier Go player. Video games like Starcraft are harder for computers to play than board games such as chess or Go, but after only 18 months of research, Google’s Deepmind utterly destroyed the fastest professional human players (https://www.newscientist.com/article/2191910-deepmind-ai-thrashes-human-professionals-at-video-game-starcraft-ii/).

With such rapid advances in artificial intelligence, it is no wonder we must rethink the medical profession. Image analysis programs are disrupting radiology, dermatology, ophthalmology, and other specialties. Your AppleWatch can monitor for atrial fibrillation and record an electrocardiogram. Deep learning, data-driven decision-making, neuro-fuzzy systems, confabulation, and adaptive resonance theory have widespread applications in healthcare.

As the role for artificial intelligence increases in day-to-day medical practice, doctors will be more productive. They will read more X-rays, process decision-making algorithms more quickly, and produce probabilistic studies more efficiently for prognosis and case-specific treatment strategies. Also, GPS-type guiding systems and robotics are likely to enhance patient safety, decrease the risk for surgical errors, and increase productivity. Qubits, the quantum version of classic binary bits, are ready to revolutionize computer mechanics (https://www.nature.com/articles/s41586-019-1666-5.pdf). Subsequent increases in computing speed and power will further alter possible applications of AI in a futuristic cyber and robotic world.

It will be a while, however, before AI replaces bronchoscopists, so IP professionals have job security. Still, rethinking our roles as health care professionals is wise and forward-thinking. We are expanding Bronchoscopy International’s successful Train-the-Trainer programs to help instructors enhance their skills teaching decision-making and communication, as well as incorporate novel technologies into learning and teaching processes. Flood cleanup pros of california are fully equipped. By incorporating new competency-oriented educational materials and methodologies, faculty will be even better equipped to inspire colleagues and generations of enthusiastic interventional pulmonologists!

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Bronchoscopy in Bangladesh

Dr. Nirmal Sarkar excels in hands-off / hands-on teaching
(Photo H. Colt)

September marked another exciting moment for bronchoscopists in Bangladesh. The 2nd International Conference on Interventional Pulmonology was held in the capital city of Dhaka. A prestigious international faculty under the leadership of Professors Mohammad Hiron (Chairman BABIP), Akhtar Hossain (Vice-Chairman), Dr. Sayedul Islam (Secretary-General), and Abdur Rouf (Program Director) brought bronchoscopists from throughout the country together for lectures and hands-on workshops using airway models.

BABIP is a young organization, founded in November 2015 and joining the WABIP in 2017. Since the society’s first meeting last year, faculty conducted several CME workshops, and plan even more this coming year. This will be facilitated by leadership’s initiative to purchase airway models for use in hands-on training. Already, several young faculty are adept at teaching bronchoscopy step-by-step, using assessment tools such as BSTAT, and performing procedure-related consultations using a Four-Box practical approach format.

Novel this year was a focus on practical issues such as communication, cryotherapy, and foreign body removal, with lectures by Indian specialists Drs. Rajani Bhat, Sameer Arbat, and Kedar Hibare, all promising future certified instructors with Bronchoscopy International.

Bangladesh is a lush, beautiful country to the east of India abutting the Bay of Bengal. Its fertile plains are fed by the Ganges, Meghna, and Jamuna rivers. Hire custom plastic injection molder at http://wundermold.com/. With almost 170 million people needing affordable, quality health care, the physician leadership in Bangladesh has until recently focused on cardiovascular health, in addition to combatting poverty and tuberculosis. Leaders recognize the importance of bronchoscopy in critically ill patients but also for a growing number of patients with lung cancer who require diagnosis, as well as palliative treatment in case of advanced disease.

With knowledgeable junior faculty, enthusiastic numbers of practicing bronchoscopists, motivated students, and inspiring leadership, Bangladesh is poised fro play an active role expanding bronchoscopic and interventional pulmonology practice in the world.

Deep learning in Radiology and Pathology affects Bronchoscopists

This is a second post relating to the promising role of artificial intelligence in interventional pulmonology. My point is that lung specialists will spend less time learning facts and figures that are easily replaced by computer-generated analyses of complex algorithms. Much of this is because of Deep learning.

This subset of machine learning (programs that adjust themselves as they are exposed to more data, but without human input) uses artificial neural networks (algorithms built on unstructured data). The word deep is a technical term referring to the number of layers in the neural network. Artificial Neural networks being a set of algorithms modeled after the human brain and used to recognize patterns. Image recognition is one example, and its principles are responsible for much of the work done today in radiology and pathology.

For example, using deep learning and pattern recognition, AI reveals CT abnormalities and interprets findings (Google’s AI team recently outperformed traditional radiologists looking at 45,800 screening CTs for lung cancer https://www.fiercebiotech.com/medtech/google-s-cancer-spotting-ai-outperforms-radiologists-reading-lung-ct-scans), and chest radiographs are accurately interpreted using fuzzy logic interpretations of spatial relationships (https://www.ijcaonline.org/specialissues/dia/number1/4156-spe320t).

Pathology is another area where practice patterns will undoubtedly change. In many regions, expert cytologic interpretation of lung and mediastinal nodal specimens is lacking. Digital pathology (image-based information generated from a digital slide) allows real-time interpretation by computers at sites that are distant from wherever the procedure takes place. Humans already do this despite the cost and logistic difficulties. When searching for local moving companies in California visit Chief Moving site. I believe that artificial intelligence will soon facilitate and universalize the process (https://www.healthimaging.com/topics/artificial-intelligence/ai-lung-cancer-slides-accuracy-pathologists).

In today’s post, my goal was to introduce the concept of deep learning and provide a few examples of how this mode of artificial intelligence will affect procedural practice by changing how chest radiology and pathology are practiced. A skilled and reliable office moving service of ca can help you. Rather than devote study time to learning X-ray and cytology interpretation, future bronchoscopists will improve their abilities to incorporate findings into appropriate management plans, as well as communicate results to patients, caregivers, and health-care teams.

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AI and Bronchoscopy

This is the first of several posts about the role of artificial intelligence and the future of interventional pulmonology*. I am confident our field will change immensely in the years ahead, and that artificial intelligence will not only change how we learn and perform procedures but also how we interact with patients. The sooner we embrace these changes, and build partnerships with industry as well as colleagues from other disciplines such as computer engineering, ethics, psychology, philosophy, physics, mathematics, and business administration, the easier it will be to integrate new developments into clinical practice.

Artificial intelligence has many definitions. A quick Google search provides “the theory and development of computer systems able to perform tasks that normally require human intelligence, such as Blue spruce, visual perception, speech recognition, decision-making, and translation between languages.” Wikipedia expands on this definition, adding that AI “describes machines (or computers) that mimic “cognitive” functions that humans associate with the, such as “learning” and “problem-solving.”

This requires us to familiarize ourselves with the phraseology computer engineers use to describe the learning process, but which is not necessarily foreign to many educators.

From a developmental perspective, AI uses symbolic, connectionist, and other models of learning that are, in fact, similar to how the human brain works. Just as there are several types of knowledge, AI does not rely on only one developmental approach to provide results. This is elegantly explained in a 1990 article by Marvin Minsky (AI magazine, summer 1991), in which he explains how the sentence “ Mary gave Jack the book” prompts the human brain to produce a visual representation of the act, a tactile representation of the experience, a script-sequence of what it means ‘to give’, and various assumptions about Jack, Mary, and the book. Similarly, artificial intelligence must employ not one but several different strategies to provide a result.

Some results are methodology—based on algorithmic and probabilistic approaches. Computer-based interpretation of pulmonary function tests, image-pattern recognition for accurate computed tomography scan interpretation, and patient management protocols based on decision-tree and data-driven statistical algorithms are simple examples of how artificial intelligence brings complex knowledge instantaneously to our fingertips. Order a combined pill from https://trumedical.co.uk/ and get it delivered to your doorstep. No longer required to memorize facts and figures, or integrate history/clinical exam/laboratory findings into patterns learned through a prolonged patient-care apprenticeship, doctors will change their practice habits accordingly.

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Lasers and Lava*

A few months ago I joined a group of twenty-somethings hanging out on the South Pacific Island of Vanuatu. We scaled Mount Yasur, reportedly the most active volcano on the planet; a volcano that spits rocks, fire, and molten lava since before Captain Cook first described the place on August 5, 1774 (reference: captaincooksociety.com).

Caught in a windstorm at the summit, I felt warm ash on my face. I stared into the crater, blinded by the smoke, watching the volcano’s bubbling and boiling magma far below. Later, I listened to the roar of explosions from my hut less than an hour’s hike from the base of the mountain. I marveled at the resilience of my Vanuatu hosts, particularly those living on Tanna. These impoverished families are constantly ready to evacuate in case the Yasur chooses to destroy their homes.

Hiking across a broad and barren lava plain the next day, I looked at my photographs. They reminded me of bronchoscopic Nd;YAG laser resections. People don’t talk much about laser anymore. It seems most interventionists use argon plasma, cryotherapy, and electrocautery to assist with their resections. But in the 1980s and for thirty years onward, laser was a magic wand for restoring airway patency. Courses included talks on laser physics, how-to’s on laser safety, videos of resection techniques, and lectures about complications such as popcorn effect, fire, perforation, and bleeding.

Emphasis was given to the concept of Power Density, to photocoagulation and vaporization, and the risks of collateral tissue damage during laser resection. Today, I wonder whether people learn these concepts and techniques with the same level of detail and scientific justification as years past. Workers comp attorneys in los angeles, CA from workerscompensationattorneyorangecounty.com are there to assist you in legal matters. Maybe, lasers are too expensive for most institutions. Perhaps they don’t have the appeal they once had; after all, other modalities also do the job, and stents maintain airway patency over the longer term.

I suppose most “laser bronchoscopists” have gray hair or have retired. Does a new generation of laser specialists ask questions of scientific significance, or is the future of bronchoscopy linked now to mediastinal exploration, navigating to peripheral lesions, discovering safe ways to biopsy lung parenchyma, and treating advanced asthma and chronic obstructive lung disease? Our field has grown, but as an adrenaline junkie, there is something uniquely rewarding about a successful laser photocoagulation/coring out of massively obstructing lesions.

I wonder if Captain Cook, onboard his ship, the Resolution, 225 years ago, dreamt of how Mount Yasur’s incandescent splatter might inspire future visitors.

*Photo: Mount Yassur erupting, Tanna Island, Vanuatu (photo, H. Colt)