Probably many will follow up on this one - paper here.
Aerobatic flight, the hammer, lots of possibilities:-)
Validation of a Functional Pyelocalyceal Renal Model for the Evaluation of Renal Calculi Passage While Riding a Roller Coaster
Marc A. Mitchell, DO; David D. Wartinger, DO, JD
Abstract Context: The identification and evaluation of activities capable of dislodging calyceal renal calculi require a patient surrogate or validated functional pyelocalyceal renal model.
Objective: To evaluate roller coaster facilitation of calyceal renal calculi passage using a functional pyelocalyceal renal model.
Methods: A previously described adult ureteroscopy and renoscopy simulator (Ideal Anatomic) was modified and remolded to function as a patient surrogate. Three renal calculi of different sizes from the patient who provided the original computed tomographic urograph on which the simulator was based were used. The renal calculi were suspended in urine in the model and taken for 20 rides on the Big Thunder Mountain Railroad roller coaster at Walt Disney World in Orlando, Florida. The roller coaster rides were analyzed using variables of renal calculi volume, calyceal location, model position on the roller coaster, and renal calculi passage.
Results: Sixty renal calculi rides were analyzed. Independent of renal calculi volume and calyceal location, front seating on the roller coaster resulted in a passage rate of 4 of 24. Independent of renal calculi volume and calyceal location, rear seating on the roller coaster resulted in a passage rate of 23 of 36. Independent of renal calculi volume in rear seating, calyceal location differed in passage rates, with an upper calyceal calculi passage rate of 100%; a middle calyceal passage rate of 55.6%; and a lower calyceal passage rate of 40.0%.
Conclusion: The functional pyelocalyceal renal model serves as a functional patient surrogate to evaluate activities that facilitate calyceal renal calculi passage. The rear seating position on the roller coaster led to the most renal calculi passages.
Reverse engineering the EpiPen There are certainly other costs like getting approval, but this is a very simple and cheap device and the current price is out of line. Bad regulations, waste in the system and, above all, greed.
It is well established that equating calories burned from exercise with those taken in doesn’t work .. basically we can’t measure the input numbers well enough and calculate a personal metabolism accurately enough to make a meaninful call. In fact evidence suggests fitness trackers are a bit worse than no tracker if weight loss is the goal (over time means > one year).
A new study has a twist .. lifestyle intervention plus a fitness tracker . The wearable was only doing the exercise component. What is interesting is the people who used the fitness trackers did significantly worse than those who didn’t use one.
The caution is human metabolism and the measurement of interventions is very very tricky and it is easy for biases to creep in. Perhaps devices will get smart enough to do expert coaching, but our understanding of our social and psychological nature is probably more primitive than that of metabolism.
I still like the idea of devices for people who want one .. weight management is *much* less important than physical conditioning. It has been shown that motivated people tend to increase their level of conditioning independent of device .. but if one fits your personality, then it probably should be considered a necessary device. I’ve seen successful exercises swear by and at fitness trackers and I’ve seen the same from people who have failed.
Against a growing outcry over the surging price of EpiPens, a chorus of prominent voices has emerged with a smart-sounding solution: Add the EpiPen, the lifesaving allergy treatment, to a federal list of preventive medical services, a move that would eliminate the out-of-pocket costs of the product for millions of families — and mute the protests.
Dr. Leonard Fromer, a clinical professor of family medicine at the University of California, Los Angeles, just promoted the idea in the prestigious American Journal of Medicine. A handful of groups are preparing a formal request to the government. And Tonya Winders, who runs a patient advocacy nonprofit organization, reached out late last month to crucial lawmakers on Capitol Hill.
“We can save lives by ensuring access to these medications,” said Ms. Winders, chief executive of the Allergy and Asthma Network.
A point not mentioned by these advocates is that a big potential beneficiary of the campaign is Mylan, the pharmaceutical giant behind EpiPens. The company would be able to continue charging high prices for the product without patients complaining about the cost.
An examination of the campaign by The New York Times, including a review of documents and interviews with more than a dozen people, shows that Mylan is well aware of that benefit and, in fact, has been helping orchestrate and pay for the effort.
The journal article says it was “drafted and revised” by a medical writing consulting firm paid by Mylan, in consultation with Dr. Fromer. And Dr. Fromer himself has served in the last year as a paid Mylan consultant — which he discloses as part of the journal article. The company has also contributed money to many other groups behind the effort, and it has met with them — and Ms. Winders’s organization in particular — to coordinate its strategy, the participants said.