Saturday morning coffee [October 27 2012]

So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

The coffee mug to the right is from Galveston, TX. Galveston is an interesting place. It’s a beach town, but unlike any beach town here in California. Galveston has the warmest ocean water I’ve ever been in. Almost like bath water. That may sound like a negative, but it’s really not. Instead of having to inch my way into the water I was able to jump right in and spend some time with the kids without freezing half to death. It was a nice change of pace from the California coastline. The other distinct feature of the beach is that it has a gradual slope into the water from the shoreline. I was able to walk more than 100 yards from shore without getting into water over my head. It made for some great fun as my wife and daughters joined me and we played in the water for quite some time. I hadn’t been in ocean water for a long time. It felt good. By the time we were finished at the beach I was sticky with salt, worn out and slightly burnt. In other words, perfect.

Paranormal Activity 4 was #1 at the box office last weekend. It’s that time of year again. Because we’re nearing Halloween we’re seeing a whole slew of scary movies hitting the box office. Not my thing.  I’m not a big fan of Halloween in general. Give me Thanksgiving or Christmas every time. You can keep Halloween and the movies that go along with it.

I have a cold. Snot running from my nose, tired, kind of disconnected feeling, and so on. Know what I mean? Started feeling bad on Thursday while I was in Kirkland, WA visiting HQ. Now I have to jump on a plane Sunday with a cold and head to Chicago. The people on the plane are going to love me. Crap.

Did you know that the common cold is caused by the Rhinovirus, which is one of the most common viral infections among the human race? Rhinoviruses are non-enveloped viruses that are approximately 30 nm (3 x 10-8 meters) in diameter, i.e. they’re really small and can’t be seen by the naked eye. There are about 110 different varieties of the Rhinovirus. They tend to grow best at temperatures around 91 degrees Fahrenheit (happens to be the temperature inside the human nose), and can survive for up to 3 hours on surfaces outside the human body, i.e. phones, doorknobs, people’s hands (huh-huh-choo!). They enter the body via the upper respiratory tract, i.e. you breathe them in. The virus generally gets into the nasal passage through inhalation of particles or touching of the nose with a contaminated hand. In just a few minutes they’re transported to the back of the throat where they attach to cell surface receptors and infection begins. Bastards! They’re amazingly efficient at producing infections; 95% of people exposed to a rhinovirus strain they have not previously encountered become infected, and 75% of those infected become ill. The infection remains localized in the upper respiratory tract. This occurs for one very important reason: rhinoviruses are extremely inefficient replicators at temperatures above 91°F (remember what I just said about your nose?). The incubation period for rhinoviral infection is only 8- 10 hours. The first symptoms generally occur in this time frame and peak in 1-3 days. Within 2- 3 days of infection, the local area becomes inflamed as immune cells invade. In other words someone at HQ infected me when I arrived at the office on Monday. Dang it! The end result is symptoms of the common cold: sore throat, runny nose, watering eyes, sneezing, coughing, congestion and headache. The cause of these symptoms is the immune response. Cells under attack by rhinoviruses release chemical signals called cytokines to attract immune cells and warn neighboring cells that they are infected. These cytokines attract immune cells and stimulate a cytokine cascade, which further amplifies the immune response. More chemical messages are sent that result in the dilation of blood vessels in the area surrounding infection. They also increase blood vessel leakiness, glandular secretion, and stimulate nerve fibers. This stimulation of nerves can cause pain and trigger sneezing and coughing reflexes. All of this occurs as the body attempts to clear the viral infection. Meanwhile, within infected cells, the virus is replicating as rapidly as possible and is continually shedding progeny viruses. It wants to live! These progeny viruses are capable of propagating the infection by invading nearby cells. When the immune response has reached its peak, the shed viruses are more likely to be swallowed, washed out of nasal passages, and sneezed or coughed out than to infect neighboring cells. That’s just nasty! However, this is the turning point of infection. This is also when the person suffering from the cold feels the worst. At this point, the immune system begins to clean up the mess and return the body to normal. Infected cells are killed and cellular debris is removed. A new set of chemical messages is also sent. The production of cytokines and antibodies, calling for the proliferation of immune cells, is no longer needed. These new messages signal the immune system to return to normal. This entire process occurs in 10-14 days and, unfortunately, there is little that medical science can do to help. And the best way to treat a cold? Rest, which is something I won’t be able to do just yet. 

Windows 8 stuff:

  • Microsoft launched Windows 8 this week. That’s exciting. If you hurry you can download it for the low, low price of $39.99. The reviews are mixed, but from my point of view it’s a winner. I’ve been begging Microsoft to make a more tablet friendly OS for years, and now they’ve given me exactly what I wanted. It’s simple to use in tablet mode and works just as well with a keyboard and mouse. There is a bit of a learning curve and many people have whined endlessly about the lack of a start button. Get over it. Move on. Windows 8 is here. Shut up and enjoy the features.
  • Microsoft’s first round of tablet hardware to go along with Windows 8 was also released this week. I’m speaking about Surface RT of course. Surface RT starts at $499 for the 32GB version and goes up from there. The attached keyboard has been universally praised from the reviews I’ve read so far. As far as the rest of it goes, the Surface RT tablet has been met with mixed reviews. People should really quit their bitching and moaning. Surface RT is a valid option for a great many people. Given that it comes with Microsoft Office 2013 Student Edition it has value. I’m impressed with the first go-round from the big boys in Redmond. Looking forward to getting my hands on one. The video below from Engadget gives a reasonable overview of Surface RT.
  • Skitch is now available for Windows 8. It’s a screenshot utility that makes it quite easy to mark up screenshots and photos. I’ve found it to be quite useful on my Nexus smartphone. It’s not bad on the desktop, but I prefer using FastStone Capture for the desktop. One feature that is glaringly absent is support for dual monitors. Bummer. However it’s Skitch’s integration with Evernote that makes it so useful.
  • Speaking of Evernote, it’s available for Windows 8. Nice looking UI.
  • Miss having all your cool Google features on you nice new shiny Windows 8 tablet? Fear not, Google has developed this quick video to show you how to quickly get it back.
 On the Android front:
    • Quick note about Jelly Bean. My Samsung Galaxy Nexus received the update a few weeks ago. I like the new functionality, but I’ve experienced a few issues since. The things I’ve noticed most are an occasional lag when opening certain programs and random reboots. Here’s the kicker, the app that seems to be most affected by the lag is GMail. Yeah, go figure. Occasionally I’ll open GMaril and get no response for several seconds. It’s a bit frustrating. And as far as the reboots go, it appears to have something to do with the screen timing out prior to a webpage fully loading, i.e. if the screen goes dark before the webpage is loaded the phone won’t come back on and reboots itself. Weird.
    • One of the cool features of the Samsung Galaxy SIII is the ability to transfer photos, videos, music, etc by simply touching the phones together. My daughters have used it with fair success. I thought the video below was a pretty interesting use case. “You probably shouldn’t watch it on the plane.”
  • The Galaxy Note 2 is here and went up for pre-order on both Verizon and AT&T. Beautiful phone. Not sure what I’d do with it, but I’d love to have one. My wife is due for a new phone here shortly and she has indicated to me that she wants a Note 2. You don’t know how exciting that is for me since I get the chance to play with one without actually buying it. I love what Samsung has done with the S Pen. It’s all about the pen people. Your finger is a terrible writing instrument. That’s why cavemen stopped using it a long time ago.
  • Looks like the Google Nexus 10 by Samsung has been outed. BriefMobile has a little blurb about it with several photos. That story has been picked up by all the big boys in the last couple of days. Could be a rumor, but it might be the real thing too. The specs are nice, and it’s running Android 4.2, but man is the thing ugly. This is one of those times I hope it’s a hoax. If true we’ll probably hear about it at the Google event on Monday. Did I mention that it’s fugly? Well, it is.
  • Google is also likely to unveil the Nexus 4 by LG next week. That phone has got to be the worst kept secret in the history of tech. If the rumor mill has it right the Nexus 4 will be rocking a quad-core Qualcomm APQ8064 Snapdragon 1.5GHz processor, 2GB of RAM, and a 4.7-inch 1280 x 768 display. It’ll run Android 4.2 and be the first phone to support multiple accounts. That’s cool and all, but not cool enough to make me want to run out and buy one. The Note 2 is a more interesting device in my opinion.
  • Medscape Mobile for Android has a new feature called Formulary Information. The feature allows you to customize the insurance plans you accept so you can compare acceptable medications in the same class. Sounds silly, but it can be the difference between a patient getting a script filled quickly and waiting for hours. Want to know the funny part? This is something that a colleague and I thought about doing on a handheld device in 1997. I was working at a “closed door” outpatient pharmacy attached to a hospital and we were always getting scripts for things that weren’t covered. If only I had any ambition. Just sayin.

Science-Based Pharmacy: “So how did a meningitis outbreak occur in the United States this fall? Through a loophole in the Act. The contamination of injectable steroids is one of a long string of medical harms caused by “compounding pharmacies” — pharmacies that skirt FDA regulations by acting as chameleons. To hospitals and physicians, they’re businesses selling drug products, just like any other pharmaceutical company. But to the FDA, they claim to be pharmacies, not pharmaceutical companies, which put them under the jurisdiction of state pharmacy regulators. Why the loophole? Until fairly recently, all pharmacies used to be compounding pharmacies. Each store made its own dosage forms like creams and capsules. Everything could be personalized. Today, compounding in the pharmacy has dwindled for most products, as Pharma can do it faster, cheaper, and more accurately. But compounding is a legitimate part of pharmacy practice, and can fill real patient care needs. And in an era of regular drug shortages, they can manufacture drug product – but without any of the quality standards mandatory for pharmaceutical companies. Unlike federal requirements which are uniform across the USA and around the world, regulations for pharmacies are determined at the state level, by pharmacy regulators. The same degree of oversight simply does not exist.” – It’s a well written article and I recommend that everyone read it in its entirety. With that said I don’t necessarily agree with all of it. Here’s the comment I left: “One thing that is lost in all this is that the art of compounding is not meant to be used in the manner used by NECC. Extemporaneous compounding fills a niche for some patients with unique ingredient or dosage form needs. This is especially true in veterinarian medicine. The issue here is that NECC clearly went outside the spirit of pharmacy compounding and moved into the role of a manufacturer. They broke the law and should be punished. However, based on what I’ve read it is likely that the entire profession will be unduly punished for the behavior of NECC. To put it simply, it only takes a few knuckleheads to mess it up for everyone.”

Know much about electronic prescribing in the outpatient world? No? Me neither. A recent article in JAMIA (J Am Med Inform Assoc 2012;19:1059-1065 doi:10.1136/amiajnl-2011-000779) takes a look at “staff perceptions of design strengths and weaknesses of electronic prescribing”. One significant weakness was differences between pharmacy and prescriber computer systems. The differences in systems caused the selection of wrong patient or drug ; name, directions, dose, strength, formulation, package sizes. You could see that coming a mile away, i.e. disparate systems.

I’ve mentioned the NECC meningitis outbreak a couple of times recently. There is an interesting article at Medscape covering how quickly fungal meningitis kills. It’s really quite scary. The article gives details on a couple of different patients. One patient died within 10 days of hospitalization while the other on hospital day 22. The summary of the patient’s decline is covered in more detail in Annals of Internal Medicine and in NEJM, respectively.

Gizmag: “One of the stars of the Australian International Motor Show this week is this piece of automotive sculpture called the Lexus LF-LC Blue.” – Dude, I’m not a sports car kind of guy, but this car is an attention grabber to be sure. Interested in having one? All you need is a measly $400,000. For anyone looking for a last minute Christmas gift for me I’ll take mine in red.

That’s it folks. I’m now going to take a bunch of legal over-the-counter drugs and move to the couch where I plan to take a nap and watch about 16 hours of college football. TTFN.

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