samedi 3 octobre 2015

Clinical markers of aging and mortality

Is your app a disruptive business?

The deadly Euro zone tripod: welfare for everything, over and over regulation of economy, subsidised abortion vs costly birth.

The results are slow or no recovery, increasing debt, immigration which will not solve the economic issue and aggravate social consensus and burden of welfare.

The nightmare of public health manipulated by governments

Who have to pay for the supplementary cost of patients with artery disease who keep smoking?

This is a very interesting example of the limit of mutualisation of resources in the welfare state.

This is that we all observed with our patients. Patients who quit smoking do very well and those who keep smoking experienced new procedures
-either in another site
-or because of failure of the initial revascularisation.

Cancer surgery: causes of a shortage

"The good news is that surgery is effective and surgery is cost-effective.... In fact, it's the most cost-effective treatment,"
Right. But does it mean that cancer surgery will survive?
Several empirical remarks about this paper:
1/ among young physicians and residents the choice of surgery is deeply motivated by the rewards of a very well known heavy duty. Tariffs are in some countries a negative incentive toward cancer surgery.
So every shortage should be assessed in this perspective. In other words the surgical career is by far become a highly risky career because of several risks which are not alleviated or compensated by salaries, fees or other systems.
2/ healthcare systems and their resources tended to be crowded by the low risk patients detrimentally to the high risk patient. This is a worrisome as resources are very stable due to the great stagnation either in high income countries or others. Eventually extension of the welfare state cannot be done at the expense of the mandatory resources allocated to major diseases.
3/ Recent regulations about working time and duties of interns and residents had badly impacted the efficiency of surgical programs in countries where they are implemented. Cancer surgery is still a conventional surgery where skill and surgical anatomy are keys. Consequently over-regulation is a very detrimental politics in this setting.
4/ Cancer surgery needs evaluation of results as other medical procedures. Regulation of cancer centers is the opposite. We assume that because it is a cancer center with a heavy load and high number of cases results will be as expected... We only need to know the quality of care which in cancer surgery is amazingly easy to report. Length of stay, readmissions, SSI and other complications can be easily monitored and should be the base of cancer center evaluation and cancer surgery practices.
"A powerful political commitment is needed in all countries to increase investment and training in publicly funded systems of cancer surgery," Dr Sullivan emphasized.

Increasing investment and training and on the other hand impairing the process of training is completely contradictory. A high level of autonomy should be the rule in medical training.

Comme les hôpitaux, les universités, l'enseignement public, Air France pâtit de la présence de l'État

Air France, compagnie dotée du plus grand nombre de salariés (Au 31 décembre 2014) mais pas du plus important chiffre d'affaires
Air France 63 955
Lufthansa 54 960
British Airways 39 868
KLM 23 723
Iberia 16 907

vendredi 2 octobre 2015

How to explain that growth is coming without jobs

MovNat is great

Symptom in medicine: the eight rule

  • Where is your pain or numbness? This obviously wouldn't work for more generalized symptoms like fatigue or shortness of breath.
  • How long have you had the symptom? If it's something intermittent -- like a spell of chest pain -- how often does it happen and how long does it last? Is it gradually getting worse? Getting better? Staying the same?
  • What were you doing when you first noticed the symptom? Were you just sitting there? Arguing with someone? This is particularly important if the patient is having dizziness, Ely noted.
  • Are any other symptoms associated with this one -- for example, light-headedness or shortness of breath?
  • What is the "quality" of the symptom -- what does it feel like? "Patients sometimes say to me, 'What do you mean? It's just a pain, doc.' Well, is it like an elephant stepping on your chest, a fire in your chest, someone stabbing you with an ice pick, or what? I want to stay open-ended as long as possible, so [I usually say] 'Just tell me ... what it feels like,'" said Ely.
  • What is the "quantity" of the symptom -- for example, how bad is it on a scale of 1 to 10?
  • What aggravates the symptom?
  • What alleviates the symptom?

Bounded rationality: the legacy of H A Simon

One of the major questions of our times is:
are social media increasing the extent of our rationality or the opposite? Bounded rationality is dependant on:
  • Limiting the types of utility functions
  • Recognizing the costs of gathering and processing information
  • Possibility of having a "vector" or "multi-valued" utility function
It seems that the high flow of information is sometimes a supplementary difficulty for our brain to make rational choices... This depends on the quality of the flow, its appropriateness, the power of our brain, the level of complexity of the enigma. But is it useful to modelize the process or only the result?
 U(s) \geq U^*-\epsilon
 Moss; Rae, eds. (1992). "Some Thoughts on Artificial Intelligence and Economic Theory". Artificial Intelligence and Economic Analysis. Edward Elgar. pp. 131–154.

jeudi 1 octobre 2015

The new healthcare

Le code partagé

1/ antiracisme
2/ humanisme
3/ sécurité sociale
4/ dépenses publiques
5/ zélu
6/ république
7/ état

lundi 28 septembre 2015


L'argument des personnes qui veulent à tout prix ne voir aucune différence génétique entre les humains et les groupes d'humains, ne voir que de la diversité génétique dans un même ensemble, est d'une grande stupidité. 
Ils reconnaissent que cinq à 15 % des gènes sont responsables des aspects phénotypiques des différentes ethnies ou races c'est-à-dire caucasien, asiatique, noir, océanien et indien.
Leur argument est que cela est trop peu, représente trop peu de quantité d'informations pour définir différentes races. Dans le même temps ils reconnaissent que très peu de gènes diffèrents entre les singes les plus évolués et l'espèce humaine. Environ trois à 5 %.
Ainsi trois à 5 % de gènes différents pourrait faire en sorte qu'une nouvelle espèce voit le jour et cinq à 15 % ne suffiraient pas à différencier des populations différentes d'homo sapiens, ne pourraient pas justifier l'utilisation du mot race ?
En réalité il existe des ethnies ou des races ayant des différences génétiques sensibles qu'elles soient phénotypiques ou autres et bien évidemment ces différences sont nées de l'adaptation des humains à des niches écologiques dans lesquelles ils ont vécu et se sont multipliés très longtemps.
Ces races ou ethnies ne sont ni supérieures ni inférieures, ne sont ni plus ni moins humaines mais en revanche il est certain qu'un noir est plus adapté à la vie en Afrique qu'un norvégien et qu'un européen du Nord est plus adapté à la vie en Suède qu'un noir.

"an African American is more likely to find a bone marrow match from a pool of African American donors than from a pool of white donors. "

"In summary, from a very large study of four major racial/ethnic groups within the United States and Taiwan, we found extraordinary correspondence between SIRE and genetic cluster categories but only modest geographic differentiation within each race/ethnicity group. This result indicates that studies using genetic clusters instead of racial/ethnic labels are likely to simply reproduce racial/ethnic differences, which may or may not be genetic. On the other hand, in the absence of racial/ethnic information, it is tempting to attribute any observed difference between derived genetic clusters to a genetic etiology. Therefore, researchers performing studies without racial/ethnic labels should be wary of characterizing difference between genetically defined clusters as genetic in origin, since social, cultural, economic, behavioral, and other environmental factors may result in extreme confounding (Risch et al. 2002).appendix A"

Mais qu'en pensent les autres humains? En effet le singularisme intellectuel français nous réserve souvent de mauvaises surprises.
En 2003, l'université Stanford a publié une étude dont le but était de vérifier la validité du concept de race humaine, dans le cadre de l'autodéclaration en vigueur aux États-Unis50. Leur conclusion est que l'auto-identification raciale est assez précise pour continuer à être utilisée dans le cadre médical.

En 2008, la revue Science a publié l'étude génomique la plus complète jamais effectuée. Cette étude compare 650 000 nucléotides chez 938 individus appartenant à 51 ethnies. Les nombreux généticiens qui ont participé à ce travail ont conclu de leurs travaux qu'il existait sept groupes biologiques parmi les humains : les Africains subsahariens, les Européens, les habitants du Moyen-Orient, ceux d'Asie centrale et d'Asie du Sud, les Asiatiques de l'Est, les Océaniens et les Amérindiens.

Interviewer - Stewart Wills The worldwide genetic diversity of humans is a matter of both basic biology and how humans have moved across the globe over time. DNA studies can provide insights into both dimensions. Now, a team of researchers from Stanford University has put together the largest genetic exploration of human diversity yet. I spoke with two of the study's authors, Richard Myers and Gregory Barsh, about the work and its significance. Dr. Myers began with a quick description of what the work was all about. Interviewee – Richard Myers What we did was, we measured genetic variation in more than a half a million places around the human genome, in almost a thousand people whose DNA had been collected by geneticists over a several-decade period, led by Luca Cavalli-Sforza here at Stanford. And this culminated in the formation of a group called the Human Genome Diversity Project – these are the samples that we analyzed. These people are from 51 regions, really spread around the world; although there are regions that are not well covered, it shows a, quite a bit of diversity from around the whole planet. What we did was that, by measuring the genetic variation of each of these loci – which is now made possible by very recent technology, to do this fast and cheap and accurately – we were able to get a picture of the genetic differences and similarities between people in these populations from around the world, at much, much, much greater detail than had been measured before. Interviewer - Stewart Wills So you mentioned the Human Genome Diversity Panel that you, that you used – what made that population a particularly good vehicle for studying this kind of thing? Interviewee - Richard Myers These 51 groups, regions of the world, were places where geneticists and anthropologists worked together over several decades collecting DNA samples from individuals who came from those regions. And what’s particularly useful about this is that they are from all over the planet, not just in one continent or one region. Interviewee – Gregory Barsh Right – what really makes the panel unique and different from what’s been done before is the large number of individuals and their diversity in terms of the different regions around the planet where they’re from. I think it’s worth comparing that to another very large group of individuals that has formed the basis for many disease studies, genetic disease studies; it’s called the HapMap. And the HapMap is based on four populations, two of whom are very closely related. And what’s different about the HGDP sample is it’s based on 51 populations, who when we into it, we really didn’t know how they were related to one another. Interviewer - Stewart Wills So this is potentially a much, a much bigger sort of window into human diversity generally. Interviewee – Gregory Barsh Absolutely. Interviewer - Stewart Wills Well let’s drill down now a little bit more into what your group specifically did with these samples. What, how did you go about studying them to kind of, to kind of address this problem? Interviewee - Richard Myers What we did was we took the DNA – and by “we” I mean 2 senior scientists in our group at the Stanford Human Genome Center, Dr. Jun Li and Dr. Devin Absher – and what, what Jun and Devon did was they took the DNA, and by using a genotyping system, we measured DNA sequence variation at 650,000 loci, or 650,000 regions of the genome, that were known to vary in at least the HapMap populations. These are all singlenucleotide polymorphisms, or single bases that differ – they’ll have either an A or a G for instance at a particular position. Interviewer - Stewart Wills So you were starting out with what had already been found about specific parts of the genome where these single nucleotide variations were common, and then you were, you were looking at those specific areas across this larger, more diverse data set. Interviewee - Richard Myers That’s exactly right. And so then – we call that genotyping, of course – and so we genotyped these individuals – about 1,000 individuals. We actually chose the thousand of that set of the Human Genome Diversity Panel that were from the 51 populations, none of whom were related to each other, at least not related to each other in very recent history. Obviously we’re all related to each other, and that’s one of the things you learn from this type of study. And so, we collected those data, and that actually only took a several-month period for us to. But then we spent a lot more time analyzing the data. Interviewer - Stewart Wills What are some of the more interesting things that you have found about human genetic diversity and populations in looking at these data? Interviewee – Gregory Barsh Well, I think that one of the most interesting things is the realization that we are, in fact, all related to one another. And looking at the way in which these 650,000 places in the genome vary, tells us the ways in which we’re related. One of the striking things to emerge from the analysis is that many people in populations that we would have thought of as relatively homogenous, actually have ancestors or ancestry from multiple different continents, and that’s particularly apparent in the Middle East. And in retrospect that makes sense because the Middle East, of course, has served as a bridge as early humans migrated out of Africa into Europe. And that’s reflected now when we look at populations that are in the Middle East, and we see well where are their ancestors from, in an agnostic way, that is – you know, let their DNA sequence tell us where their ancestors are from. And we see ancestry in Middle Eastern populations from both Africa and Europe. Another very nice example is the relationship between the Yakut population and Native American populations. And that, of course, makes lots of sense when we think about the origin of Native American populations. I think it’s also worth stating explicitly that the study adds to the now I would say overwhelming support that we have for the notion of where humans are from initially – that is, early humans really first appeared in Africa and then populated the rest of the world as they migrated out of Africa. Interviewer - Stewart Wills Well, we’ve talked a bit about population – does this help us also in genomic medicine? Interviewee - Richard Myers Having the ability to understand the genetic variation within groups will help us in genetic disease studies. One of the biggest problems, and I’ll let Greg elaborate on this, but one of the biggest problems is that when you don’t take population or geographic origin into account in a, in a large genetic study for studying something like heart disease, one of the complex traits for instance, you end up confounding the study such that you don’t actually get real signals. Interviewee – Gregory Barsh It’s clear that many important common human diseases vary in their incidence among different populations. And sometimes that clearly is due to culture – for example, the incidence of obesity in western society. You know, other times it’s probably due to genetic differences between populations. And many times it’s probably due to a combination of environment and ancestry. And figuring out what the ancestry is for any human on the planet is really a prerequisite to deconvoluting the interrelationship between ancestry and environment in understanding common human diseases. Interviewer - Stewart Wills Gregory Barsh and Richard Myers are the authors, with nine colleagues, of a new study that provides the most detailed description to date of human genetic diversity. The paper appears in the February 22nd issue of Science.

A very interesting paper:

Encore un super papier de Risch sur les clusters:

Mais comment arrivent ils à séparer à différencier les européens des asiatiques, sinon par des clusters de gènes partagés.

Le débat sur les réseaux sociaux:

Et le super papier de Nicholas Wade

Race determination by hair

Des lions menés par des ânes à des assistés bernés par des pervers:l'affaire Morano révèle la soumission sans condition à la gauche

“Thinking is difficult, that’s why most people judge.”~C.G. Jung

Morano a dit race. 

L'assisté qui dépend de l'état mais n'a pas de job, le fonctionnaire qui n'est plus augmenté et que Macron méprise, le bien-pensant parce qu'il ne faut pas discriminer, le religieux parce que le Pape l'a dit, le franc maçon du GODF, bref tout ce que la France compte d'humanistes s'est levé dans un réflexe pavlovien : honte à Morano, halte au mot; à ce mot qui exhale cette odeur nauséabonde que vous n'avons jamais connue, halte au mot qui évoque ces années les plus noires où nos parents se sont battus au moins pour quelques uns, toutes circonstances que nous n'avons jamais vécues, nés dans l'abondance que nous sommes.

Dans ce réflexe canin né du conditionnement il y a le triomphe de la classe médiatique.

Chaque mâtin elle choisit ses cibles, excite les chiens et sa sonnette les fait aboyer. Mais nos dociles canins à rationalité limitée sont fainéants, aussi se sont ils trouvé une immense proximité fraternelle. Au lieu de réfléchir, d'analyser, de raisonner, nos assistés des 35 heures que la "droite" n'a pas réussi à supprimer en 15 ans se sont sentis tout d'un coup très proches de la nullité absolue d'un Bedos. Nul besoin d'argumenter, de réfléchir, utilisons les mots de ce grand homme de gauche qui vit de subventions : Connasse. Rien de plus.

Oui devant la bête immonde il faut se battre depuis son fauteuil, on se doit d'être grossier. 

C'est une preuve de courage immense. On se sent mieux après. La gauche caviar nous tend une sucette.
Race quelle honte, d'abord elles n'existent pas puisque les généticiens français patentés à la Axel Kahn vous le disent! Peu importe que vous voyiez des différences patentes, puisqu'on vous dit de la fermer.
Mais surtout nos assistés aux statuts extravagants, nos humanistes qui distribuent avec libéralité l'argent des autres, tous nos élus qui ont explosé la dette publique à 2100 milliards d'euro sont devenus de bons socialistes égalitaristes; pour eux race c'est insupportable car dans ce mot il y a différence, un vrai non sens. Pourtant quelques différences sont mieux que d'autres.
En réalité l'erreur de nombreux non biologistes c'est de ne pas comprendre que c'est un pb de définition et non de racisme .
Soyons simples et surtout rationnels il y a des ethnies différentiables à l'œil nu ce qui ne veux pas dire des ethnies supérieures et d'autres inférieures mais qui signifie differentes.
Et l'erreur de Morano mais aussi de CDG c'est de ne pas avoir considéré la question de la civilisation. C'est en réalité ce qui nous différencie le plus et de loin. 
Personne ne critique l'adjectif multiethnique mais les journaleux veulent tuer celui qui prononce le mot race c'est stupide!
Ce qui caractérise l'Europe l'Amérique et l'Australie c'est la civilisation occidentale et on la définit par une série de critères .
La gauche dicte en réalité son agenda a toute la classe politique.
Je dois applaudir quand j'entends Zizou, la team Black, Blanc, Beur, la race créole chère à Taubira et toute la diversité qui est une chance (oui on me l'a dit) pour nos retraites et la démographie, mais de là à parler de race et blanche impossible! Et en plus nous serions différents? Pas égaux en tout, mon voisin serait peut-être plus intelligent que moi, plus adapté, non ce n'est pas possible, la gauche a raison nous sommes tous les mêmes, tous égaux et comme elle nous le promet nous serons tous pauvres. Et nous nous plaindrons.

Pourtant il se passe des choses en France mais dans cette bronca il est terrifiant de constater la passivité des mêmes devant les vrais évènements qui impactent notre pays.

Ils en ont tué plusieurs comme au ball trap, ils ont mis en déroute les flics et leur pistolet à grenaille, ils ont décapité un chef d'entreprise; Mérah le nazislamiste a tué une merveilleuse enfant de 8 ans à bout portant dans la tête, et nous n'avons pas bougé notre cul de la chaise sauf pour aller faire la claque à Hollande.
Nos retraités sont dans la misère mais nous accueillons 400 000 immigrés (je sais vous ne savez pas mais c'est voulu) par an avec tout ce qui va avec de droits à, d'avantages à et subventions pour.
Notre économie est au tapis et la perspective de la génération qui vient est moins de formation moins d'emplois moins de richesse et moins de liberté.
Mais l'urgence, la réaction violente c'est pour Morano bien sur.

Au fait qui sont les racistes, les antisémites, les menteurs ?

Morano n'est pas la seule à évoquer la couleur de peau ou l'appartenance à une religion:

 "On a une télévision d'hommes blancs de plus de 50 ans et ça, il va falloir que ça change".Delphine Ernotte Présidente de France Télévisions (Europe1- 23 sept 2015)

«Zemmour est juif. Mais il veut être plus français que les Français… Mon grand-père était bâtonnier à Alger, il a milité pour le décret Crémieux qui a fait des juifs d'Algérie des Français. Rétrospectivement, quand je vois Zemmour, je le regrette.»
Guy Bedos (La Cinq -25 sept 2015)

  "A compétences égales, eh bien désolée, on choisira (...) autre chose que le mâle blanc pour être clair". Anne Lauvergeon (France 2 - 16 oct 2009)

« Nous sommes à un tournant identitaire. Les Guyanais de souche sont devenus minoritaires sur leur propre terre. » Christiane Taubira (RFI repris par MFI hebdo - 20 avril 2007)
"Je fais mon travail aux Républicains dans les conditions qui sont celles de la liberté totale de parole. Si pour en être, il faut se taire, je n'y suis pas".
NKM, sur Europe 1, le 29 septembre 2015.
"Je trouve la tonalité de cette déclaration exécrable. Je souhaite que Nadine Morano soit sanctionnée pour ses propos par notre bureau politique".
NKM, sur Europe 1, le 29 septembre 2015.

Et bien sûr Manuel Valls:

Remarquons que dans ces déclarations, les individus cités sont tous favorables à une discrimination, explicite ou implicite. Madame Morano n'a nullement discriminé elle a simplement fait un constat qui d'ailleurs est indiscutable quand au nombre de personnes de peau blanche en France.


Nous sommes en déclin et ce n'est pas la faute des politiques c'est le destin que nous choisissons chaque minute chaque fois qu'au lieu de nous dresser nous capitulons qu'au lieu d'être fier nous acceptons la soumission sans condition à la gauche.

Lumbar disk regeneration

Is the french healthcare system safer since the 21st century?

The ministry of health instead of dealing with this important issue spends money to finance a free phone line for abortion information managed by french planning parenthood. This is because: "there are still a lot of obstacles to abortion". On the contrary stats show an increasing number of procedures year after year.