ramen and pickles

science, technology, and medicine served up with some tasty noodles

Monthly Archives: June 2013

Refuge Pickle Plate

I almost feel like I should be trying to keep it a secret, but the fantastic restaurant The Refuge in San Carlos has opened a branch in Menlo Park, CA.  The Refuge is a Belgian/Jewish-Deli fusion restaurant.  That probably sounds absurd, but it really works.  They have some of the best pastrami I’ve had on the West Coast, and they have a great assortment of artisanal beers for the beer snobs.  They also have a few amazing combinations, including garlic cheese fries with pastrami bits.  It’s ridiculously delicious.  They also make their own pickles.  Below is the house mixed pickle plate, they also make half sour dills (which come with the pastrami sandwiches).

Refuge Pickle Plate

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Pork Cheek Shoyu, Santa Ramen

For lunch today, I had this delicious shoyu ramen with pork cheek (pig jowls) and quail eggs.  I had been really disappointed the last time I went to Santa Ramen, but I thought the bowl I had today was quite good.

Last time, I thought their shio ramen was way too garlicky, and I’m a little skeptical of a place that sells so much spicy ramen, as making really spicy ramen is often a way to cover up for broth that isn’t delicious on its own.  However, the shoyu broth I had today was quite good.  I’m not crazy about the noodles, as I favor ones that are a little thinner with a little more to them, but overall it was quite good.

SantaRamen

“Selena Gomez Tour Demands: Ramen, Pickles”

What?  What? What?

Selena Gomez revealed some of her own “diva demands” to MTV recently, admitting that while on tour, her rider requests “incense, pickles always,” and “I’ll be honest … ramen.”

http://www.newser.com/story/167841/selena-gomez-tour-demands-ramen-pickles.html

She has ramen and pickles in her contract?  I have to rethink my opinion of Selena Gomez and have to rethink any contract I sign from now on.

She looks kind of unhappy in the picture.  Maybe those pickles from Target are not good.

 


 

 

 

The Jerky Ratings

Confused about which kind of beef (or buffalo) jerky to buy?  Be confused no longer, Steve Johnson has tried all the carne seca under the sun so you don’t have to.

http://www.bestbeefjerky.org

 

 

Stainless Steel Jeeps

At the end of WW2, the Philippines was flooded with jeeps left by the departing US Army.   As a testament to Filipino creativity and mechanical ingenuity, many of these were extended into little buses, or as they are known in the Philippines, jeepneys, and have become a major part of Filipino culture and piece of cultural identity.

The jeepneys have also been the subject of really beautiful and astounding painting and decoration.  There is a whole set of rules of etiquette for riding on a jeepney, and although I don’t know this from personal experience, one can get the basic idea by watching videos online.  A jeepney makes a couple quick appearances in the Black Eyed Peas Filipino language music video, Bebot.

However, another aspect of Filipino jeep related creativity that I find fascinating is their development of stainless steel jeep bodies.  Although jeeps are very robust, including the original Willys jeeps from WW2, they are subject to rust, particularly in the warm salty air of a tropical island.   Instead of dealing with a rusting out body, the Filipino solution is to make one of out stainless steel.  Not only is it an incredibly practical solution, they are very beautiful to look at.

Peter Greenberg's Stainless Steel Jeep

Peter Greenberg’s Stainless Steel Jeep

CBS News journalist Peter Greenberg describes his difficult acquisition of one in this piece in Autoweek.  Although the number of craftsmen who know how to make these stainless steel jeep bodies has decreased in recent years, as open air jeeps have fallen out of favor in the Philippines in favor of enclosed cars with air conditioning and other amenities, it is possible to buy these stainless steel bodies in the United States, and there is a small company that imports them from the Philippines.  All you get is the stainless steel body, and you have to use that to build your own jeep.   There are some really great photographs showing someone doing just such a project.

You can find another detailed description of jeep assembly by the Vogt family with pictures.  This is really a beautiful looking piece of work.

jeep_finished_08_largejeep_title_01

 

There are some videos on YouTube showing them.  Admittedly, the quality of the videos is not that great, as it’s just someone with a handheld camera walking around the jeep, but you get the idea.

 



 

The Supreme Court and Myriad’s Patent on Disease Associated Genes

National Geographic has a nice bulleted summary of 7 Takeaway points on the Supreme Court ruling on the unpatentability of naturally occurring genes.

http://news.nationalgeographic.com/news/2013/06/130614-supreme-court-gene-patent-ruling-human-genome-science/

One thing that is apparent from watching this process is that it would be really good to have someone with a real technical background on the Supreme Court.  They hear a lot of cases which are associated with technology in various forms and yet their educational backgrounds are all limited to the humanities.  I don’t know what sort of technical support they can get (if any), as it seems like they get their information just from attorneys presenting to them, amicus briefs, and their clerks, but it seems that they don’t always fully understand the science and technology.

As a side note, it’s worth mentioning that they ALL went to either Harvard or Yale for law school, no exceptions.  How’s that for diversity of thought.

Kagan: history major at Princeton
Sotomayor: history major at Princeton
Alito: something related to international affairs at Princeton
Breyer: philosophy from Stanford
Ginsburg: government major at Cornell
Thomas: English lit at Holy Cross
Kennedy: political science at Stanford
Scalia: history at Georgetown
Roberts: history at Harvard

Educational videos onto your iPad

I’ve written a little bit in the past about how to get medical videos from online onto your local machine.  However, I thought it was a good time to write a little bit more about it.  If anyone has better suggestions, I’d love to hear them.  These are some free and relatively simple options for use on the Mac.

1) Getting videos from online streaming sources like YouTube

Wondershare has a tool that lets you download content from streaming video sites, like YouTube.  I’ve only used the free version which only works with YouTube and is pretty limited in scope, but it works great for getting stuff from YouTube.  They also have a full version which is supposed to let you grab content from a whole bunch of other streaming sites, including Vimeo, TED, etc.

http://www.wondershare.com/pro/mac-allmytube.html

If you don’t want to download any software onto your machine and you want to use a web only tool, there are a few different options out there, but I’ve found that KeepVid seems to sort of work once you can get it started and once you can figure out which buttons are advertisements and should be ignored.  It lets you save streaming video content from sites like YouTube directly to your drive.  It has the advantage of being a website that you can just surf to, although you need to execute java on your local machine.

http://keepvid.com

2) Converting different video file formats to work on your iPad

You can use VLC to play a lot of different video formats, but if you want to load things into iTunes and want to play content with the builtin viewer on the iPad, then you’ll often need to do some file conversion.  I’ve found the Miro Video Converter to be very simple and straightforward to use, and it seems to work with a lot of different formats (including .flv).  You can quickly convert to something which will play on your iPad/iPhone.  You don’t have to worry about a ton of different settings.  Things like Handbrake are powerful tools for doing all sorts of different things, but I never know quite which settings to use.  With Miro, you just drag the files into the window and pick the target device (iPhone, iPad, etc.) and let it go; it will happily chug away and dump the converted videos into a ~/Movies subfolder.  Best of all, it’s completely free.

http://www.mirovideoconverter.com

3) Downloading from SCPD

If you’re a Stanford student taking a recorded course on the main campus (as opposed to say the medical school which has its own recording archives), you might want to be able to download your recorded course videos for use offline.  Unfortunately, they make this very difficult for you, and even if you spring for the premium version of Flip4Mac, it doesn’t handle the saving and conversion to Quicktime well.  However, some smart Stanford students have written a python script to do the automatic downloading.   It’s a bit technical, and you’ll need to know a little bit about programming, i.e. have installed the Xcode command line tools, Mac Ports, etc., but it works quite well.

https://github.com/jkeesh/scpd-scraper

4) Variable speed playback

Variable speed playback used to be easy on the iPad, but in an effort make things simpler, they removed a lot of functionality, or at least embedded it only in the video Podcasts.  You can trick iTunes into thinking any video you’ve downloaded is a podcast, but there is also a simple, good app, Swift, that works well at speeding up or slowing down videos.  It also has a nice function that lets you flip ahead (or back) a fixed amount with a finger flick.  I have mine set at 30 seconds, so as I’m watching things, I can just flip ahead quickly through things, or jump back if I miss something important.  When running Swift, you just click on the little iPhone like icon in the upper corner and it goes to your regular video library, where you can play the videos in Swift instead of the standard player.

https://itunes.apple.com/us/app/swift-player-speed-up-video/id545216639?mt=8

Hope these tips help you in helping you get good quality educational video content onto your iPad, and I hope you can use your iPad to help your learning, whether it is on a beach, on a plane, or on a treadmill.

 


 

 

 

Bootstrapping Correlations to find Stability

Bootstrapping Correlations to find Stability

One of the problems with using correlations is that they can be incredibly unstable with small sample sizes. Here’s a nice blog discussion of stabilization and a nice figure that depicts the problem:

http://www.nicebread.de/at-what-sample-size-do-correlations-stabilize/

Book Review: Monday Mornings

Book Review: Monday Mornings

I started Sanjay Gupta‘s novel Monday Mornings very excited to read some realistic and exciting stories of compelling and interesting characters working on exciting cases.  However, in a lot of ways I was disappointed.  It was an okay medical novel, but felt a bit like I was reading the novelization of an okay medical show.  It felt a bit like Gupta has watched some medical dramas and then wrote a novel based on tropes and themes he considered popular.  Instead of using his unique and special perspective as both a practicing neurosurgeon at a major research center and an expert on health policy, he has written the plot for just another TV medical drama mini-series.   This is especially unfortunate given the popularity of realistic views of the activities and personalities in real emergency departments and operating rooms, as demonstrated by Terence Wrong’s series Hopkins, Boston Med, and NY Med.

I understand the need to make things extra dramatic (although there is likely no dearth of real drama he could draw from) and to simplify things for lay readers; however, I don’t think he needs to make things so unrealistic.  One of the main characters is a very young neurosurgery attending who has 15 New England Journal of Medicine publications and who (until the novel) has never made a surgical mistake.  Now, to put the first part in perspective, the chair of neurosurgery at Stanford has 2 NEJM publications (out of over 200 total publications) and the neurosurgery chief at Harvard/MGH has one review on Neurofibromatosis and is quoted in a few Case Reports of the Massachusetts General in NEJM.  Practicing surgeons just don’t typically do the kind of research that gets into NEJM, and even if they worked full time doing clinical research, I know of many mostly full time research, full professors of internal medicine who have maybe 4 NEJM publications.

Ignoring the outstanding publication record of the young surgeon, he also is renowned for never making any mistakes.  That doesn’t even make any sense in the context of the novel which is about the hospital’s Morbidity and Mortality meetings on Monday mornings.   The reason these meetings are held is that surgeons make a lot of mistakes and they need to review and discuss these mistakes in order to become better at their jobs.   If you look into any of the work on expertise, be it Atul Gawande’s writings, Outliers, or even go to the source such as the research of K. Anders Ericsson, the only way to become an expert is to make a ton of mistakes along the way.  To quote Niels Bohr, “An expert is a man who has made all the mistakes which can be made, in a narrow field.”   Another way to look at a perfect record is that a string of successes invites a failure, not because of any kind of universal karma, but simply because of regression to the mean.   Even the greatest perfectionists make mistakes along the way, that is how they get better.  The character in the novel is a bit like a caricature of character like Perry Mason (from the 1950’s) who has never lost a case.

In a weird juxtaposition with hypercompetence attributed to the medical staff of the world class medical center (Chelsea Hosptial), the mistakes they do make are either rookie mistakes or things which are a bit outdated and counter to current practice.  An example is an argument in the book about counting sponges, and the search for a missing one in a patient or the trash bag.  A world class medical center should have very clear guidelines and a protocol for what to do when a count is off, and yet it is surprising that there is so much resistance to following this in the book.  It’s a well known problem.  What would have maybe been more realistic and interesting is if the hospital were to be prototyping a new system to deal with this problem (like the bar code scanners being used at some places on a trial basis).  I don’t think the medical public is surprised about the existence of common medical errors or surprised that physicians feel really badly when they make them, both a mix of feeling terrible for their patients but also professional shame amongst their peers.  Those are common stories in medical dramas, and there isn’t really much a new twist in this novel.

Gupta goes to so far as to insert the incredibly common and totally unrealistic trope of TV and film medical dramas of having the team “shock a flatline“.   In chapter 28 of the novel, a patient during bowel surgery suddenly, without warning, completely flatlines (with a monotonous, continuous beep tone that alerts the team).  They shock the heart once, add some medication in a few tense moments of activity and then use the defibrillator again, restarting the heart.  What?  That’s straight out General Hospital or something.  There has been ton written online about why it doesn’t make sense to defibrillate asystole, and why it would typically be counter productive or injurious.  It’s really like he pulled this scene from a bad TV show.  This would be a great opportunity for him to have a more realistic adverse event happening, using his medical knowledge and experiences to come up with something good.

The way that neurosurgical training is done also seemed to be very outdated.  The novel made it sound like the traineess all did a full general surgery residency and then a neurosurgery residency on top of that.  This is a very outdated model, as everyone now goes right into neurosurgery residency.  As of 2009, trainees are no longer even required to have a general surgery intern year.  Even the procedures described as being revolutionary and exceptionally challenging, such as endoscopic endonasal approachesdeep brain stimulation or 3D guided stereotactic surgery should be relatively standard fare at the world class hospital Chelsea is supposed to be.  Given they have such prolific researchers publishing so much, maybe they are a little behind on recent clinical advances or something.  To be really compelling and fun, why not add some patient supplied music.  There was just a lot of the book that made it sound like it was from an earlier era.

There is also an important scene where the hospital staff (physicians and nurses) do a terrible job taking care of a scumbag patient.   In one part, the nurses are refusing to give care to a murderer with swastika tattoos.   I am sure many nurses would find this depiction offensive.  At a major medical center with an active emergency department, they have all sorts of unsavory characters, including many perpetrators of horrible crimes (rapes, murders, assaults) coming in that they provide care for.  It’s their job and something they have to get used to.  Having one physician provide a low level of care because of his own revulsion is a realistic exception, having a whole group of providers requiring a rousing pep talk from management before they will act just seems very unrealistic.   This is an important part of medicine, but it seems like the issues healthcare providers face when dealing with reprehensible patients could have been dealt with using a lot more complexity.

These are just a few examples of things taken from the novel that seem more like medical stereotypes or fables.  How is it just as a novel?  Again, the writing didn’t stand out as exceptional and for some reason the characters were not that compelling, which is unfortunate.  It makes a novel a lot more fun when you really root for some of the people, but most of the characters came off as so self-absorbed that it was hard to really like them very much.

Overall, it’s not a bad novel, but I can’t help but feel like it is a missed opportunity to be something really exceptional and revolutionary in terms of medical fiction.  I hope Gupta keeps writing novels, as practice and trial and era are what lead to improved work, the key message of the Monday Mornings of the title.

 

Pickled Mustard Greens

I really like good pickled mustard greens, and got a few different kinds at Nijiya.

I had high hopes for this kind, but was a bit disappointed. I was expecting it to be a little more spicy because it actually had a little bit of a reddish hue and red pepper was number three on the ingredients, but the main overpowering flavor was of sesame oil. Sesame seeds can be a really enjoyable addition to many dishes, but dark sesame oil has a strong, smoky flavor which is not always so pleasant.

These pickles are a little piquant, and were good paired with Indian food. A lot of Indian pickles can be quite oily too, often with mustard seed oil I believe, so maybe that is why they paired so well together. They would be good with just plain white rice too, but I don’t think I would put these pickles out with a regular Japanese meal, as it would be too over powering and ruin some of the other flavors.

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