Week of June 17, 2024
My second patient during last Friday's clinic was a farmer I've known for ten years. Our appointments often feel like a syndicated sitcom where we play stock characters. He playful mocks me as an "over-educated, rich doctor," representative of a complex healthcare system. He plays the self-deprecating, inflexible, and snarky "simple country farmer." For the last decade, he and I have had the same conversations - take your medications, use your sleep apnea device, and eat less salt - without a significant change in his behavior. Nevertheless, I look forward to his visits. While I don't appreciate his motivation, giving him time away from his work and some space to ridicule his kidney doctor's ignorance [about chicken farming, cows, and scaled farming] seems to be the care he wants.
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The waste water-based forecasting continues to indicate a stable national rate of COVID. I continue reading about the increasing number of COVID cases in Spain and various U.S. cities. See Wastewater Scan data below.
The Pandemic Mitigation Collaborative (PMC) website uses wastewater levels to forecast 4-week predictions of COVID rates.
https://pmc19.com/data/
based upon https://biobot.io/data/
Wastewater Scan offers a multi-organism wastewater dashboard with an excellent visual display of individual treatment plant-level data.
https://data.wastewaterscan.org/
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COVID articles
The Atlantic offered a thoughtful article describing how observed changes in the coronavirus genome are hard to link to physiologic consequences. In this instance, recent coronavirus strains no longer express a protein thought to help evade human immune cells, leaving scientists rethinking how to understand tradeoffs. It is a fantastic example of how the pandemic continues to offer data into complex biological systems (evolutionary pressures, genomic changes, and their real-world impact).
https://www.theatlantic.com/science/archive/2023/05/coronavirus-evolution-orf8-protein-gene-loss/674017/
Medical Trends and Technology
German researchers published a 2-patient case report about using (gene-edited) modified (CAR)-T cells to treat multiple sclerosis (a neuroinflammatory disease). The study intended to monitor the proliferation of the modified cells, patient safety, and any early signs of efficacy. Both patients did well, with patient 1 demonstrating modest clinical improvement in walking. I like this article - it is a complex topic but illustrates how science is incremental - in this case, taking a relatively new technology (modified T cells) and conducting small-scale tests to advance our knowledge in specific use cases.
https://www.cell.com/med/fulltext/S2666-6340(24)00114-4
Japanese scientists used gene editing (CRISPR) on my favorite microscopic organism, Tardigrades. The intent was to understand the relationship between the various Tardigrade genes and the real-world physiologic impact. The scientists used various gene editing techniques that propagated to the tardigrade's offspring, which permitted a clearer understanding of the impact of any given genome change. This article is an excellent example of using CRISPR and how research can better understand the real-world impact of genetic alteration.
https://www.popsci.com/science/cripsr-tardigrades/
The original article's title is very catchy: "Single-step generation of homozygous knockout/knock-in individuals in an extremotolerant parthenogenetic tardigrade using DIPA-CRISPR."
https://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1011298
I have yet to find satisfying answers or suggestions for several quality-of-life-threatening topics my patients routinely ask about. There is not a lot of research into issues like why some people urinate more at night or treatment for nighttime cramps. So, I was a bit disappointed in the underwhelming results from a randomized trial looking at stretching and meditation for leg cramps in patients with liver disease. Both interventions were equally (and moderately) effective.
https://onlinelibrary.wiley.com/doi/10.1111/liv.16007
Infographics
There are many ways to depict nutrient absorption along the G.I. tract. I offer two competing infographics for your consideration:
https://x.com/SciencNews/status/1801626177330889173/photo/1
and
https://x.com/Innov_Medicine/status/1673508575212126208/photo/1
Things I learned this week
Welcome to my latest Rabbit hole. In 2014, the Finnish Reindeer Herders Association attempted to paint Reindeer antlers with reflective paint to avoid traffic accidents. Social media posts of reindeer art - an orange-antlered reindeer- recently brought the story back to the news. As for actual reindeer protection, the reflective paint trial (along with other labor-intensive interventions) was a failure 7-8 years ago. However, at the time Geo-fenced mobile phone alerts of reindeer migration patterns were found to be the most effective means for protecting the animals from traffic accidents.
https://www.reuters.com/article/idUSL1N2OP2K9/
and
https://www.bbc.com/news/blogs-news-from-elsewhere-26244339
and
Check out the Reindeer Herders' Association website.
The association's tips about what to do if your car strikes a reindeer(like "don't take the carcass with you") seems unironically entertaining. I learned that the most typical Finnish vehicles are the Toyota Corolla and V.W. Gulf—neither of which seems appropriate for transporting reindeer carcasses.
https://stat.fi/til/mkan/2021/mkan_2021_2022-03-01_tie_001_en.html#:~:text=The%20most%20common%20models%20of,93%2C000).&text=Pick%20the%20data%20you%20need,Database%20tables%20and%20their%20variables
The Cornell Lab of Ornithology (the same group that makes the excellent bird identification app) published a paper on the A.I. analysis of elephant rumbles. "Scientists say they have found evidence, using artificial intelligence-powered tools, that elephants can individually call specific members of their family with unique rumbles." I suspect there will not be a ChatGPT elephant translator soon, but we are getting closer to the dog translator from Up!
https://www.nytimes.com/2024/06/10/science/elephants-names-rumbles.html?smid=nytcore-ios-share
and
https://www.nature.com/articles/s41559-024-02420-w
Living with A.I.
A new A.I. video tool, Dream Machine, is now animating meme images
https://x.com/hey_madni/status/1801900554488291414
I didn't realize OpenAI polices its users. However, a recent blog post from the OpenAI security team highlights some banned uses of their LLM in manipulating social media.
https://openai.com/index/disrupting-deceptive-uses-of-AI-by-covert-influence-operations/
Thanks to a loyal reader, I now know A.I. is not quite ready to take the work of a human Catholic priest. As the N.Y. Post put it, "An A.I. priest was defrocked just days after its inception when the chatbot repeatedly claimed to users that it was a real member of the clergy and performed sacraments."
https://nypost.com/2024/04/26/us-news/ai-priest-defrocked-by-developer-after-taking-confessions-like-real-priest/
and
https://www.youtube.com/watch?v=0XhQDCJs4lQ
A.I. art of the week
Photo of a large tardigrade riding on the back of a reindeer. The tardigrade is wearing sunglasses and a lab coat. The tardigrade holds "The elephant and reindeer song book." The tardigrade is herding other reindeer wearing safety orange vests while crossing a road. Cars are waiting for the herd to cross.
https://drive.google.com/file/d/1Zs2T2q-QHsNCNPaxSwnzOhlLX4eBkxLk/view?usp=sharing
Clean hands and sharp minds,
Adam
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