Week of December 11, 2023
I noticed the Picasso sketch of Don Quixote hanging on the restaurant wall behind my wife as the waitress removed the guacamole bowl from our table. The image provoked a sudden rush of memories - the art on the walls of my childhood home from the late 1970s. The moment felt quasi-Proustian (accompanied by corn chips instead of a madeleine) with vivid recollections of a sketch of Golda Meir, the photo of a tall ship at sunset, the burnt orange macrame wall art, and the Picasso sketch in my father's home office. Memory is fragile – and the rapid burst of so many forgotten details was intense and a bit scary.
Memory is even more fleeting than we realize; we forget a lot:
See the Picasso Print!
https://en.m.wikipedia.org/wiki/Don_Quixote_(Picasso)
Did Adam really compare his Spanish restaurant experience to Proust's Remembrance of Things Past? Referencing Proust is so pretentious.
https://www.finedininglovers.com/article/hundred-years-prousts-madeleine
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As expected, and predicted by wastewater data, hospitalization rates are rising. Wastewater data imply that case rates are also increasing but are less than the 2022 post-Thanksgiving, pre-Christmas time window.
The N.Y. Times COVID Tracker reflects only CDC-gathered hospital data. Hospitalization data are a (lagging) indicator.
https://www.nytimes.com/interactive/2023/us/covid-cases.html
Wastewater monitoring is more of a LEADING indicator.
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COVID articles
Unsurprisingly, the air in school environments contains numerous airborne viruses, including the coronavirus. A recent JAMA paper compared methods of detecting airborne pathogens (in Oregon) and found COVID and influenza A viruses by three air sampling methods. I suspect masking is not acceptable, but good air filters are warranted. I would like to see this data compared with patterns of school absences.
https://twitter.com/DcrInYYC/status/1732165375578779915
and
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812566
There are many unanswered immunologic questions arising from the pandemic. Two of the more common include:
1) The notion that COVID depletes/damages immune cells (CD4+ T Cells), leaving repeatedly infected individuals immune compromised.
2) That repeated infection and vaccination may "exhaust" the immune system (specifically, the ability to develop new antibodies to new coronavirus variants).
New data suggests assertion #2 (immune exhaustion) is false. Data demonstrates that vaccination after infection enhances T-cell function against COVID infection.
https://twitter.com/EricTopol/status/1733209104473371005
and
https://www.science.org/doi/10.1126/sciimmunol.adh0687
Assertion #1 may be partially true, but the story is more complex. Time magazine recently published a very understandable article about how the immune system responds to COVID and how that response varies amongst people.
https://time.com/6343427/does-covid-19-make-you-more-likely-to-get-sick/
Medical Trends and Technology
Duke researchers have created a sound-wave sensitive biologically safe ink. When injected into organs or other places inside a body, the ink can be "solidified" into the appropriate 3D shape using focused ultrasound waves. This research demonstrates how we generate custom 3D-printed body parts (like bones or supportive scaffolding on which tissue can grow) without surgery.
https://www.statnews.com/2023/12/07/ultrasound-3d-bioprinting-inside-tissue-medical-applications/
and
https://www.science.org/doi/10.1126/science.adi1563
An A.I.-driven phone app used to take pictures of EKGs and interpret them outperformed guideline-based, algorithmic care in deciding which patients with chest pain and a suspected heart attack require cardiac stenting. The retrospective study requires more prospective validation but is another example of how A.I. will augment healthcare - by seeing more subtle patterns in data and increasing the sensitivity and specificity of human physicians.
here is the company
https://www.powerfulmedical.com/
Dr. Eric Topol interviewed Dr. David Liu, a molecular biologist, about the current state and future of gene editing (like with CRISPR CaS9). It is an excellent primer on some basic concepts and the state of the technology. Here is the key quote, "[All of this discussion on gene editing] stimulates a healthy discussion around the surprisingly gentle continuum between disease treatment, disease prevention, and what some would call human improvement."
https://open.substack.com/pub/erictopol/p/david-liu-a-master-class-on-the-future
Infographics
I found a lovely chart of theories explaining UFOs from Information is Beautiful. I lean towards "hyperspace entities that are manifestations of our collective psychosocial energy," or maybe the "Earth is just a zoo for aliens" theory. (Imagine what they would sell in the Earth gift shop. Perhaps "not space" ice cream?)
https://informationisbeautiful.net/visualizations/what-are-ufos-uaps-the-leading-theories/
Things I learned this week
For the last ten years, some British, French, and Canadian physicians have been prescribing museum wellness programs whereby patients receive a doctor's order to attend museums to manage various chronic illnesses. Various retrospective, non-randomized studies have demonstrated mixed results, linking cultural activities to possible improvements in dementia, blood pressure, and salivary cortisol levels (a surrogate of stress).
https://theconversation.com/could-visiting-a-museum-be-the-secret-to-a-healthy-life-216978
While there are many confounding variables (frequency of museum visit, type of museum, degree of engagement, type of art, etc.), I am sure museums love the potential for health benefits and have responded with various programs to encourage "meditative" and "restorative" visits.
Canadian "slow looking" tours
Yoga at the Museum of London
https://museumlondon.ca/yoga-at-the-museum
Mediation at the Aga Khan Museum in Toronto
https://agakhanmuseum.org/programs/mindfulness-and-education-sessions
While I knew large magnets attract metal, I had never considered the intersection of the Second Amendment and an MRI. Thanks to a loyal reader, I have a deeper appreciation for how the laws of physics limit one's constitutional rights (for instance, at the door to the radiology suite).
'Wisconsin woman sneaks gun into MRI; it goes off, shooting her in buttocks.'
I offer the Adverse Event report filed with the FDA about this event: "[A] patient brought a concealed ferrous handgun into [the MRI room]. [T]he handgun was attracted to the magnet and fired a single round. The patient received a gunshot wound in the right buttock area. The patient was examined by a physician [who] described the entry and exit holes as very small and superficial, only penetrating subcutaneous tissue. Per protocol, the patient was taken to the hospital [and did well]. The site reported that prior to the [MRI] exam, the patient had undergone a standard screening procedure for ferrous objects, which includes weapons specifically, and answered no to all screening questions."
Living with A.I.
Google researchers tested a new medical LLM model by asking 20 clinicians to evaluate 302 challenging, real-world medical cases from the New England Journal of Medicine (NEJM) case reports. Two clinicians reviewed each case report. They were asked to provide a differential diagnosis (DDx) and then offered standard medical resources (like online references) or standard resources plus an LLM to refine their diagnoses. Researchers also queried the LLM about the cases independently of the clinicians. The new LLM exhibited performance that exceeded that of the clinicians. The follow-up comments by physicians in the Twitter thread are simultaneously informative and defensive (I suspect they are rightly both in awe and a bit anxious about this new technology).
https://twitter.com/EricTopol/status/1731698370773676512
Paper - check out the tables and charts on pages 14-17
https://arxiv.org/pdf/2312.00164.pdf
Google, OpenAI, Anthropic, and Microsoft are launching an industry-sponsored self-regulatory body to develop best practices for safe and responsible artificial intelligence tools.
The European Union strengthened its A.I. regulations last week.
https://www.nytimes.com/2023/12/08/technology/eu-ai-act-regulation.html
If all of this is confusing, ChatGPT can quickly compare and contrast the U.S., E.U., and industry efforts at regulation.
https://chat.openai.com/share/a8e08d76-46b4-4473-a471-c2927bd6aa22
A.I. art and animation of the week
And back to my opening: "Doctored photographs create false memories of spectacular childhood events." Multiple studies in several countries demonstrate that exposure to altered photographs can induce vivid, detailed, and false memories in 40 to 50% of participants. Human memory is fallible and alterable.
https://www.tandfonline.com/doi/full/10.1080/09658211.2023.2200595
In my first (potentially hubristic) attempt at editing existing artwork, I generated an observer child in Photoshop and animated Picasso's Don Quixote.
https://app.runwayml.com/creation/b744ea47-cfb3-4423-9ce6-d53a0d47e01f
Clean hands and sharp minds,
Adam
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