Sign Language Researchers Broaden Science Lexicon

Science in Sign:
Lydia Callis, a sign language interpreter, translates a shortened version of an article by Douglas Quenqua, explaining how new signs are being developed that may enhance scientific communication.

Imagine trying to learn biology without ever using the word “organism.” Or studying to become a botanist when the only way of referring to photosynthesis is to spell the word out, letter by painstaking letter.

For deaf students, this game of scientific Password has long been the daily classroom and laboratory experience. Words like “organism” and “photosynthesis” — to say nothing of more obscure and harder-to-spell terms — have no single widely accepted equivalent in sign language. This means that deaf students and their teachers and interpreters must improvise, making it that much harder for the students to excel in science and pursue careers in it.

“Often times, it would involve a lot of finger-spelling and a lot of improvisation,” said Matthew Schwerin, a physicist with the Food and Drug Administration who is deaf, of his years in school. “For the majority of scientific terms,” Mr. Schwerin and his interpreter for the day would “try to find a correct sign for the term, and if nothing was pre-existing, we would come up with a sign that was agreeable with both parties.”

Now thanks to the Internet — particularly the boom in online video — resources for deaf students seeking science-related signs are easier to find and share. Crowdsourcing projects in both American Sign Language and British Sign Language are under way at several universities, enabling people who are deaf to coalesce around signs for commonly used terms.

This year, one of those resources, the Scottish Sensory Centre’s British Sign Language Glossary Project, added 116 new signs for physics and engineering terms, including signs for “light-year,”  (hold one hand up and spread the fingers downward for “light,” then bring both hands together in front of your chest and slowly move them apart for “year”), “mass” and “X-ray” (form an X with your index fingers, then, with the index finger on the right hand, point outward). 

The signs were developed by a team of researchers at the center, a division of the University of Edinburgh in Scotland that develops learning tools for students with visual and auditory impairments. The researchers spent more than a year soliciting ideas from deaf science workers, circulating lists of potential signs and ultimately gathering for “an intense weekend” of final voting, said Audrey Cameron, science adviser for the project. (Dr. Cameron is also deaf, and like all non-hearing people interviewed for this article, answered questions via e-mail.)

Whether the Scottish Sensory Centre’s signs will take hold among its audience remains to be seen. “Some will be adopted, and some will probably never be accepted,” Dr. Cameron said. “We’ll have to wait and see what happens.”

Ideally, the standardization of signs will make it easier for deaf students to keep pace with their hearing classmates during lectures. “I can only choose to look at one thing at a time,” said Mr. Schwerin of the F.D.A., recalling his science education, “and it often meant choosing between the interpreter, the blackboard/screen/material, or taking notes. It was like, pick one, and lose out on the others.”

The problem doesn’t end at graduation. In fact, it only intensifies as new discoveries add unfamiliar terms to the scientific lexicon. “I’ve had numerous meetings where I couldn’t participate properly because the interpreters were not able to understand the jargon and they did not know any scientific signs,” Dr. Cameron said.

One general complaint about efforts to standardize signs for technical terms is the idea that, much like spoken language, sign language should be allowed to develop organically rather than be dictated from above.

“Signs that are developed naturally — i.e., that are tested and refined in everyday conversation — are more likely to be accepted quickly by the community,” said Derek Braun, director of the molecular genetics laboratory at Gallaudet University in Washington, D.C., which he said was the first biological laboratory designed and administered by deaf scientists.

This article has been revised to reflect the following correction:

Correction: December 4, 2012

An earlier version of this article misstated the origin of the ASL-STEM Forum.  It was developed by researchers at the University of Washington, not Gallaudet University.  Researchers at Gallaudet and the National Technical Institute for the Deaf at Rochester Institute of Technology work with the University of Washington to provide content and help the forum grow.

This article has been revised to reflect the following correction:

Correction: December 4, 2012

An earlier version of a correction with this article misstated the name of an institute that works on the ASL-STEM Forum. It is the National Technical Institute for the Deaf at Rochester Institute of Technology not the National Institute for the Deaf. 

Read More..

Sign Language Researchers Broaden Science Lexicon

Science in Sign:
Lydia Callis, a sign language interpreter, translates a shortened version of an article by Douglas Quenqua, explaining how new signs are being developed that may enhance scientific communication.

Imagine trying to learn biology without ever using the word “organism.” Or studying to become a botanist when the only way of referring to photosynthesis is to spell the word out, letter by painstaking letter.

For deaf students, this game of scientific Password has long been the daily classroom and laboratory experience. Words like “organism” and “photosynthesis” — to say nothing of more obscure and harder-to-spell terms — have no single widely accepted equivalent in sign language. This means that deaf students and their teachers and interpreters must improvise, making it that much harder for the students to excel in science and pursue careers in it.

“Often times, it would involve a lot of finger-spelling and a lot of improvisation,” said Matthew Schwerin, a physicist with the Food and Drug Administration who is deaf, of his years in school. “For the majority of scientific terms,” Mr. Schwerin and his interpreter for the day would “try to find a correct sign for the term, and if nothing was pre-existing, we would come up with a sign that was agreeable with both parties.”

Now thanks to the Internet — particularly the boom in online video — resources for deaf students seeking science-related signs are easier to find and share. Crowdsourcing projects in both American Sign Language and British Sign Language are under way at several universities, enabling people who are deaf to coalesce around signs for commonly used terms.

This year, one of those resources, the Scottish Sensory Centre’s British Sign Language Glossary Project, added 116 new signs for physics and engineering terms, including signs for “light-year,”  (hold one hand up and spread the fingers downward for “light,” then bring both hands together in front of your chest and slowly move them apart for “year”), “mass” and “X-ray” (form an X with your index fingers, then, with the index finger on the right hand, point outward). 

The signs were developed by a team of researchers at the center, a division of the University of Edinburgh in Scotland that develops learning tools for students with visual and auditory impairments. The researchers spent more than a year soliciting ideas from deaf science workers, circulating lists of potential signs and ultimately gathering for “an intense weekend” of final voting, said Audrey Cameron, science adviser for the project. (Dr. Cameron is also deaf, and like all non-hearing people interviewed for this article, answered questions via e-mail.)

Whether the Scottish Sensory Centre’s signs will take hold among its audience remains to be seen. “Some will be adopted, and some will probably never be accepted,” Dr. Cameron said. “We’ll have to wait and see what happens.”

Ideally, the standardization of signs will make it easier for deaf students to keep pace with their hearing classmates during lectures. “I can only choose to look at one thing at a time,” said Mr. Schwerin of the F.D.A., recalling his science education, “and it often meant choosing between the interpreter, the blackboard/screen/material, or taking notes. It was like, pick one, and lose out on the others.”

The problem doesn’t end at graduation. In fact, it only intensifies as new discoveries add unfamiliar terms to the scientific lexicon. “I’ve had numerous meetings where I couldn’t participate properly because the interpreters were not able to understand the jargon and they did not know any scientific signs,” Dr. Cameron said.

One general complaint about efforts to standardize signs for technical terms is the idea that, much like spoken language, sign language should be allowed to develop organically rather than be dictated from above.

“Signs that are developed naturally — i.e., that are tested and refined in everyday conversation — are more likely to be accepted quickly by the community,” said Derek Braun, director of the molecular genetics laboratory at Gallaudet University in Washington, D.C., which he said was the first biological laboratory designed and administered by deaf scientists.

This article has been revised to reflect the following correction:

Correction: December 4, 2012

An earlier version of this article misstated the origin of the ASL-STEM Forum.  It was developed by researchers at the University of Washington, not Gallaudet University.  Researchers at Gallaudet and the National Technical Institute for the Deaf at Rochester Institute of Technology work with the University of Washington to provide content and help the forum grow.

This article has been revised to reflect the following correction:

Correction: December 4, 2012

An earlier version of a correction with this article misstated the name of an institute that works on the ASL-STEM Forum. It is the National Technical Institute for the Deaf at Rochester Institute of Technology not the National Institute for the Deaf. 

Read More..

Austrian Group Plans Suit Over Facebook Privacy Policies

BERLIN — An Austrian student group said Tuesday that it planned to challenge Facebook’s privacy policies in Irish court, alleging that the social networking giant had failed, despite repeated requests and formal complaints made by its members, to adapt to the restrictions of European data protection law.

The group, which calls itself Europe vs. Facebook, said it would begin collecting donations to challenge the policy in Ireland, where the company’s European business is incorporated. Max Schrems, an Austrian law student at the University of Vienna who organized the effort, said Facebook had no interest in adapting its service to meet stricter European privacy requirements.

“We have been pursing this for more than a year with Facebook, but the company has done only about 10 percent of what we had asked them to do,” said Mr. Schrems, 25. “Therefore, we are preparing to go to court.”

Facebook, in a statement, said its European privacy policy had been vetted and approved by Irish regulators and was in compliance with European law.

“The way Facebook Ireland handles personal data has been subject to thorough review by the Irish Data Protection Commissioner over the past year,” the company said. “Nonetheless, we have some vocal critics who will never be happy whatever we do and whatever the D.P.C. concludes.”

Mr. Schrems’s group, which he said was made up of about 10 students at the University of Vienna, filed 22 complaints in 2010 with the Office of the Data Protection Commissioner in Ireland, which regulates Facebook’s European business because it is incorporated there.

As a result of those complaints, the regulator conducted a public audit of Facebook’s privacy policies. In September it announced an agreement with the company that required, among other changes, that Facebook shorten the time it retained consumer data and refrain from building a photo archive on individuals without their prior consent.

But Mr. Schrems said in an interview that Facebook was still violating European law in many areas, including a requirement that Facebook provide users who request it with a full copy of all the data the company has collected on them. Mr. Schrems, a Facebook user since 2007, said he requested his own summary file from Facebook in 2010.

The company, whose global headquarters is in Menlo Park, California, responded by creating a self-service tool for users to extract the data, which Mr. Schrems said supplied him only with information going back to 2010. In addition, he alleged that Facebook’s privacy policy, which users are required to agree to before they can use the service, is too broad and violates European law.

“It is basically a collection of American legalese, which is intentionally vague and gives the company adequate leeway to do basically anything they want with your data,” Mr. Schrems said.

Thilo Weichert, the data protection supervisor for the German state of Schleswig-Holstein, which has also brought legal action against Facebook, said he supported the Austrian student group’s efforts.

“Facebook’s policy is much too vague and broad and does not conform with German or European law,” Mr. Weichert said in an interview. “We think that European privacy officials need to take common action on this.”

Mr. Weichert issued an administrative order in August 2011 that barred businesses in the state, which is located along Germany’s northern border with Denmark, from using Facebook’s social plug-ins like the Like button and Fan pages. The rationale for the order: Those applications collect information on users without their consent by inserting cookies, which track individual computers, through a user’s Web browser.

In November of last year, Mr. Weichert sued several local business organizations, including the state’s own Industrie- und Handelskammer, the equivalent of the local chamber of commerce, for creating their own fan pages on Facebook. The chamber and businesses that have not been identified have challenged that suit, which is pending in court in Kiel.

The privacy policies of Facebook, Google and some other U.S.-based Web companies have come under increasing criticism in Europe.

Read More..

Mortar Attack Kills at Least 9 People at Syrian School

Narciso Contreras/Associated Press

People walked past damaged homes during heavy fighting between rebel fighters and government forces on Tuesday in Aleppo, Syria.

BEIRUT, Lebanon — Syrian forces continued to press an intense counteroffensive against rebels in the Damascus suburbs on Tuesday, as the government blamed rebels for a mortar attack that hit a school, and the United Nations warned that the increasingly dangerous situation in the country was making it hard to provide enough food to displaced Syrians.

SANA, the state news agency, reported that 29 people at the school, including one teacher and numerous children, were killed by a mortar shell fired by “terrorists,” its term for its opponents, in Bteeha, a small town north of Damascus on the road to the central city of Homs. Antigovernment activist groups confirmed the attack but said only nine people were killed at the school, at the Wafideen refugee camp. The road to Homs and on to the commercial hub of Aleppo has been strongly contested in recent fighting.

The Local Coordinating Committees, a network of rebel groups, reported the mortar attack without comment, implying that it was carried out by the government. But an activist reached in Damascus said it was unclear who had fired the shell.

Tecent bombs and mortar attacks by rebels that have killed civilians have angered both supporters and opponents of the government in recent weeks, as even some who support the rebels express concern that the violence has spiraled out of control.

An activist in the Damascus suburbs who gave only her first name, Leena, said activists were surprised that there was an attack in Bteeha, which is usually very calm, and that information had been hard to come by because there were very few activist reporters in Bteeha. She said residents were refugees who fled the Golan Heights in 1967 when Israel occupied the territory. Displaced people, mostly from the Sunni Muslim sect that makes up the bulk of the Syrian uprising, have recently moved there, she said.

“Many Golani people are actually with the revolution, and they even have their own brigades in the Free Syrian Army,” she added, referring to the loose-knit rebel umbrella group.

On Tuesday, there were more signs of concern on the diplomatic front as well.

At a meeting in Brussels, NATO ministers expressed “grave concern” about reports that the Syrian government might be getting ready to use its chemical weapons. The remarks followed a warning by President Obama telling Syria not to use chemical weapons against its own people and vowing to hold accountable anyone who did, even as American intelligence officials picked up signs that such arms might be deployed in the fighting there.

“Any such action would be completely unacceptable and a clear breach of international law,” the NATO secretary general, Anders Fogh Rasmussen, said at a news conference.

In another reflection of how the conflict in Syria is spilling over its borders, NATO agreed to deploy Patriot surface-to-air missiles in Turkey, which had requested the installations as a defense against cross-border violence.

More evidence emerged on Tuesday that the situation in the country was deteriorating, a day after the United Nations and the European Union announced they were curtailing activities and pulling staff members out of Damascus, the capital. Fighting raged in an arc around Damascus on Monday, from the southwest to the northeast, and most commercial flights continued to stay away from the Damascus Airport.

The United Nations’ World Food Program, which is feeding 1.5 million people in Syria, 85 percent of them displaced by the fighting, issued a report warning that food shortages were intensifying because of rising bread prices and indiscriminate attacks on United Nations vehicles that made food distribution difficult.

The roads are so dangerous, the agency said, that it is trying to obtain more armored vehicles to allow its provincial offices to continue to monitor food distribution.

The agency, along with other United Nations organizations, has suspended its operations outside Damascus and sent home nonessential foreign staff members, further hampering its work, it said. Most food distribution is done by local partners, mainly the Syrian Arab Red Cross. Still, the World Food Program maintains 20 foreign and 100 local employees in Syria.

“I can absolutely confirm to you that we will continue our work,” Muhannad Hadi, the country director, said in an interview from Jordan, where he traveled on business with plans to return to Syria.

Food shortages are increasing, especially in Aleppo, where bread prices are 50 percent higher than in the rest of the country, the agency statement said, adding, “Food consumption is particularly low among displaced families taking refuge in schools and public buildings, due to the lack of access to cooking facilities.”

Rebels and government forces continued to clash around a strategic air base at Wadi al-Deif, near Maarat al-Noaman, a crossroads town on the road between Damascus and Aleppo, as government airstrikes around Damascus continued for a fourth day with no sign of abating and neither side apparently able to win.

Even as the government was bringing overwhelming force to bear, it was still unable to quell the rebels, who have managed to disrupt the airport and force a counteroffensive to seal off the city center from the restive suburbs. Yet although rebels have managed to put pressure on the government around Damascus in recent weeks, several fighters interviewed said the fighting had become exhausting and there was no coordinated strategy.

Hania Mourtada contributed reporting from Beirut, and Christine Hauser from New York.

Read More..

Better Economy and Storm Delays Lift U.S. Auto Sales

DETROIT (AP) — Superstorm Sandy gave an extra boost to already strong U.S. auto sales last month, although carmakers warned that uncertainty over the "fiscal cliff" could undo some of those gains.

Most major companies, from Toyota to Chrysler, posted impressive increases from a year earlier. Only General Motors was left struggling to explain its 3-percent sales gain and large inventory of unsold trucks.

Americans were already willing to buy a new car or truck last month because they're more confident in the economy. Home values are rising, hiring is up and auto financing is readily available. Also, the average age of a vehicle on U.S. roads is approaching a record 11 years, so many people are looking to replace older cars.

Sandy just boosted that demand. The storm added 20,000 to 30,000 sales industry wide in November, mostly from people who planned to buy cars during the October storm but had to delay their purchases, Ford estimated. People who need to replace storm-damaged vehicles are expected to drive sales for several more months. GM estimates that 50,000 to 100,000 vehicles will eventually need to be replaced.

November sales, when calculated on an annual basis, are likely to be 15 million or more, the highest rate since March of 2008, according to LMC Automotive, a Detroit-area consulting firm. That's higher than the 14.3 million annual rate so far this year, even though November is normally a lackluster month due to cold weather and holiday anticipation. Both GM and Chrysler predicted November sales would run at an annual rate of 15.3 million.

If sales end up at 15 million for the year, it would be a vast improvement over the 10.4 million during the recession in 2009. Sales would still fall short of the recent peak of around 17 million in 2005.

But the ongoing "fiscal cliff" negotiations between Congress and the White House could still derail the industry's recovery. The term refers to sharp government spending cuts and tax increases scheduled to start Jan. 1 unless an agreement is reached to cut the budget deficit. Economists say that those measures, if implemented, could push the U.S. economy back into a recession.

"Exactly how much growth we can expect next year will depend in part on how Congress and the president resolve the fiscal cliff issue," said Kurt McNeil, GM's U.S. sales chief. "Markets and consumers hate uncertainty."

McNeil and other GM executives tried to explain the automaker's disappointing performance. GM's biggest brand, Chevrolet, reported flat sales over last year despite new products like the Spark minicar. Silverado pickup sales fell 10 percent.

GM's sales have been trailing the industry all year. They were up 4 percent through October, compared to the industry-wide increase of 14 percent.

GM said its competitors resorted to higher than usual incentives last month to get rid of 2012 model-year trucks. GM, which had more 2013 trucks on its lots, was only offering an average of $500 per truck, or a third of what others were offering. GM has been trying to hold the line on costly incentives, which can hurt resale value and brand image.

"We want to be known for great products, not great incentives," McNeil said.

But some analysts think GM will be forced to offer more deals in December to clear out higher-than-forecast inventory.

Asian brands also got a boost from some unusually big discounts, said Jesse Toprak, senior analyst for automotive pricing site TrueCar.com. TrueCar estimated that Hyundai and Kia, which were admonished by the U.S. government in late October for overstating gas mileage, increased incentive spending by nearly 30 percent. Nissan spending was up 45 percent to $4,273 per vehicle, by far the highest incentives in the industry.

Toyota said its 17-percent sales increase was partly due to post-Sandy demand. Honda was up 39 percent thanks to strong sales of the new Accord sedan and clearance deals on the outgoing Civic, which was replaced by a new 2013 Civic at the end of the month.

Luxury cars saw their usual yearend surge as holiday commercials started crowding the airwaves. Porsche's sales rose 71 percent to 3,865, a record month for the automaker. Infiniti, Acura, BMW and Lexus all reported big gains.

Edmunds.com analyst Jessica Caldwell said luxury brands have historically targeted their customers at this time of year because of holiday bonuses. That's no longer a driving factor, she said, but it's still a good time of year for people to buy 2012 model-year luxury vehicles because dealers are trying to clear them out.

Other automakers reporting sales Monday:

— Chrysler's sales were up 14 percent. Ram pickups were up 23 percent, while sales of the Fiat 500 minicar more than doubled.

— Hyundai's sales rose 8 percent, led by the Sonata midsize car and the Elantra compact. TrueCar said Hyundai increased incentives by 30 percent it was admonished by the U.S. government in late October for overstating gas mileage.

— Volkswagen's sales rose 29 percent on the strength of the Passat sedan, which was up 75 percent.

— Nissan's sales climbed 13 percent as sales of its new Pathfinder SUV more than tripled over last year.

Read More..

Quest to Eliminate Diagnostic Lapses

SAN FRANCISCO — The man on stage had his audience of 600 mesmerized. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation.

At last he spoke. “Lymphoma with secondary hemophagocytic syndrome,” he said. The crowd erupted in applause.

Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice.

The case Dr. Dhaliwal was presented, at a medical  conference last year, began with information that could have described hundreds of diseases: the patient had intermittent fevers, joint pain, and weight and appetite loss.

To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.

Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?

The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data.

And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.

In some ways, Dr. Dhaliwal’s diagnostic method is similar to that of another I.B.M. project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world’s best player at the time, to claim an unambiguous victory in the computer’s relentless march into the human domain.

Although lacking consciousness and a human’s intuition, Deep Blue had millions of moves memorized and could analyze as many each second. Dr. Dhaliwal does the diagnostic equivalent, though at human speed.

Since medical school, he has been an insatiable reader of case reports in medical journals, and case conferences from other hospitals. At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.

Dr. Dhaliwal regularly receives cases from physicians who are stumped by a set of symptoms. At medical conferences, he is presented with one vexingly difficult case and is given 45 minutes to solve it. It is a medical high-wire act; doctors in the audience squirm as the set of facts gets more obscure and all the diagnoses they were considering are ruled out. After absorbing and processing scores of details, Dr. Dhaliwal must commit to a diagnosis. More often than not, he is right.

When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.

Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”

He added: “Getting better at diagnosis isn’t about figuring out if someone has one rare disease versus another. Getting better at diagnosis is as important to patient quality and safety as reducing medication errors, or eliminating wrong site surgery.”

Clinical Precision

Dr. Dhaliwal does half his clinical work on the wards of the San Francisco V. A. Medical Center, and the other half in its emergency department, where he often puzzles through multiple mysteries at a time.

One recent afternoon in the E.R., he was treating a 66-year-old man who was mentally unstable and uncooperative. He complained of hip pain, but routine lab work revealed that his kidneys weren’t working and his potassium was rising to a dangerous level, putting him in danger of an arrhythmia that could kill him — perhaps within hours. An ultrasound showed that his bladder was blocked.

There was work to be done: drain the bladder, correct the potassium level. It would have been easy to dismiss the hip pain as a distraction; it didn’t easily fit the picture. But Dr. Dhaliwal’s instinct is to hew to the ancient rule that physicians should try to come to a unifying diagnosis. In the end, everything — including the hip pain — was traced to metastatic prostate cancer.

“Things can shift very quickly in the emergency room,” Dr. Dhaliwal said. “One challenge of this, whether you use a computer or your brain, is deciding what’s signal and what’s noise.” Much of the time, it is his intuition that helps figure out which is which.

Read More..

Quest to Eliminate Diagnostic Lapses

SAN FRANCISCO — The man on stage had his audience of 600 mesmerized. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation.

At last he spoke. “Lymphoma with secondary hemophagocytic syndrome,” he said. The crowd erupted in applause.

Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice.

The case Dr. Dhaliwal was presented, at a medical  conference last year, began with information that could have described hundreds of diseases: the patient had intermittent fevers, joint pain, and weight and appetite loss.

To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.

Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?

The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data.

And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.

In some ways, Dr. Dhaliwal’s diagnostic method is similar to that of another I.B.M. project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world’s best player at the time, to claim an unambiguous victory in the computer’s relentless march into the human domain.

Although lacking consciousness and a human’s intuition, Deep Blue had millions of moves memorized and could analyze as many each second. Dr. Dhaliwal does the diagnostic equivalent, though at human speed.

Since medical school, he has been an insatiable reader of case reports in medical journals, and case conferences from other hospitals. At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.

Dr. Dhaliwal regularly receives cases from physicians who are stumped by a set of symptoms. At medical conferences, he is presented with one vexingly difficult case and is given 45 minutes to solve it. It is a medical high-wire act; doctors in the audience squirm as the set of facts gets more obscure and all the diagnoses they were considering are ruled out. After absorbing and processing scores of details, Dr. Dhaliwal must commit to a diagnosis. More often than not, he is right.

When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.

Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”

He added: “Getting better at diagnosis isn’t about figuring out if someone has one rare disease versus another. Getting better at diagnosis is as important to patient quality and safety as reducing medication errors, or eliminating wrong site surgery.”

Clinical Precision

Dr. Dhaliwal does half his clinical work on the wards of the San Francisco V. A. Medical Center, and the other half in its emergency department, where he often puzzles through multiple mysteries at a time.

One recent afternoon in the E.R., he was treating a 66-year-old man who was mentally unstable and uncooperative. He complained of hip pain, but routine lab work revealed that his kidneys weren’t working and his potassium was rising to a dangerous level, putting him in danger of an arrhythmia that could kill him — perhaps within hours. An ultrasound showed that his bladder was blocked.

There was work to be done: drain the bladder, correct the potassium level. It would have been easy to dismiss the hip pain as a distraction; it didn’t easily fit the picture. But Dr. Dhaliwal’s instinct is to hew to the ancient rule that physicians should try to come to a unifying diagnosis. In the end, everything — including the hip pain — was traced to metastatic prostate cancer.

“Things can shift very quickly in the emergency room,” Dr. Dhaliwal said. “One challenge of this, whether you use a computer or your brain, is deciding what’s signal and what’s noise.” Much of the time, it is his intuition that helps figure out which is which.

Read More..

Quest to Eliminate Diagnostic Lapses

SAN FRANCISCO — The man on stage had his audience of 600 mesmerized. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation.

At last he spoke. “Lymphoma with secondary hemophagocytic syndrome,” he said. The crowd erupted in applause.

Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice.

The case Dr. Dhaliwal was presented, at a medical  conference last year, began with information that could have described hundreds of diseases: the patient had intermittent fevers, joint pain, and weight and appetite loss.

To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.

Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?

The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data.

And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.

In some ways, Dr. Dhaliwal’s diagnostic method is similar to that of another I.B.M. project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world’s best player at the time, to claim an unambiguous victory in the computer’s relentless march into the human domain.

Although lacking consciousness and a human’s intuition, Deep Blue had millions of moves memorized and could analyze as many each second. Dr. Dhaliwal does the diagnostic equivalent, though at human speed.

Since medical school, he has been an insatiable reader of case reports in medical journals, and case conferences from other hospitals. At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.

Dr. Dhaliwal regularly receives cases from physicians who are stumped by a set of symptoms. At medical conferences, he is presented with one vexingly difficult case and is given 45 minutes to solve it. It is a medical high-wire act; doctors in the audience squirm as the set of facts gets more obscure and all the diagnoses they were considering are ruled out. After absorbing and processing scores of details, Dr. Dhaliwal must commit to a diagnosis. More often than not, he is right.

When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.

Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”

He added: “Getting better at diagnosis isn’t about figuring out if someone has one rare disease versus another. Getting better at diagnosis is as important to patient quality and safety as reducing medication errors, or eliminating wrong site surgery.”

Clinical Precision

Dr. Dhaliwal does half his clinical work on the wards of the San Francisco V. A. Medical Center, and the other half in its emergency department, where he often puzzles through multiple mysteries at a time.

One recent afternoon in the E.R., he was treating a 66-year-old man who was mentally unstable and uncooperative. He complained of hip pain, but routine lab work revealed that his kidneys weren’t working and his potassium was rising to a dangerous level, putting him in danger of an arrhythmia that could kill him — perhaps within hours. An ultrasound showed that his bladder was blocked.

There was work to be done: drain the bladder, correct the potassium level. It would have been easy to dismiss the hip pain as a distraction; it didn’t easily fit the picture. But Dr. Dhaliwal’s instinct is to hew to the ancient rule that physicians should try to come to a unifying diagnosis. In the end, everything — including the hip pain — was traced to metastatic prostate cancer.

“Things can shift very quickly in the emergency room,” Dr. Dhaliwal said. “One challenge of this, whether you use a computer or your brain, is deciding what’s signal and what’s noise.” Much of the time, it is his intuition that helps figure out which is which.

Read More..

Royal Baby a ‘Delight,’ Especially to Britain’s Tabloids

LONDON — The speculation began virtually the moment Kate Middleton said “I will” to Prince William in April 2011, saddling an industry full of tabloid newspapers and gossip magazines with a big black hole where the wedding coverage used to be.

Why, they asked, was the former Ms. Middleton, now the duchess of Cambridge, drinking water instead of wine at an official dinner, in what appeared to be a deliberate manner? And those photographs in which her stomach seemed microscopically less flat than normal, what was that all about?

On Monday, everyone who had incorrectly guessed what was going on before could now finally claim to be right. Yes, St. James’s Palace announced, the duchess had successfully become pregnant.

The royal family is not known for its effusions of public emotion, but in statements posted on the royal Web site, the duke and duchess of Cambridge said they were “very pleased,” while the queen and other family members went with “delighted.”

On Twitter, Prime Minister David Cameron declared that he, too, was delighted.

The pregnancy is in its very early stages and has not yet reached the three-month threshold that would normally have triggered the announcement. But the duchess is in the hospital suffering from “acute morning sickness,” the palace said, and hospitalizations are hard to keep secret.

“Her royal highness is expected to stay in hospital for several days and will require a period of rest thereafter,” the palace said.

There are many interesting things about this possible future royal baby. First, it will be third in line to the throne, even if it is a girl; the laws of succession were recently changed for this very reason. Second, its presence would make the chances of the current No. 3, Prince Harry, becoming king ever more remote, barring some bizarre development in which four generations of his family — his grandmother, his father, his brother and his future niece or nephew — all stepped aside.

Also, it gives Britain something to be excited about at a time when life here has not been so exciting, what with austerity and widespread flooding across huge parts of England after a period of nearly biblical rainfall.

“A royal baby is something the whole nation will celebrate,” the Labor leader, Ed Miliband, observed on Twitter. “Fantastic news for Kate, William and the country.”

In addition to being delighted, the prime minister revealed that in his opinion, the duke and duchess of Cambridge would be “wonderful parents.”

But few people could be more excited than the editors of the newspapers and magazines that cover the royal family, who with any luck will have months of things to write about: What will it be, boy or girl? How fat will the duchess look in her pregnancy clothes? What is happening behind closed doors?

Already, The Daily Mail has revealed a gaggle of purportedly insider-ish details about what is really going on, including the news that the duchess began feeling sick over the weekend and was “unable to keep any food or water down.”

It continued: “Sources suggested that the duchess was hooked up to an intravenous drip to increase her fluid and nutrient levels.”

The papers have also made much of a retrospectively significant incident from last Wednesday, when a member of the public handed Prince William a baby outfit decorated with a helicopter and the words “Daddy’s little co-pilot” — and William smiled as he accepted it.

Read More..

John McAfee Plays Hide-and-Seek in Belize

Photo Illustration by The New York Times

John McAfee, right, a pioneer in computer security who lives in Belize, is a “person of interest” in the murder of his neighbor. More Photos »

DANIEL GUERRERO promised during his campaign for mayor here to clean up San Pedro, the only town on this island, a 20-minute puddle jump from the mainland. But if he ever runs for re-election, don’t expect him to mention that vow.

“I meant clean up the trash, the traffic, that sort of thing,” he says. “I didn’t mean this.”

“This” is a full-blown international media frenzy and the kind of mess that no politician could have seen coming. It started on Nov. 11, the morning that Gregory Faull, a 52-year-old American, was found dead, lying face up in a pool of blood in his home. He had been shot in the head. His laptop and iPhone were missing. A 9-millimeter shell was found nearby.

What happened next turned this from a local crime story to worldwide news: The police announced that a “person of interest” in the investigation was a neighbor, John McAfee, a Silicon Valley legend who years ago earned millions from the computer virus-fighting software company that still bears his name.

A priapic 67-year-old, with an improbable mop of blond-highlighted hair and a rotating group of young girlfriends, Mr. McAfee quickly melted into the island’s lush green forest. Then, for Belizean authorities, the real embarrassment began.

Asserting his innocence, Mr. McAfee became a multiplatform cyberdissident, with a Twitter account, and a blog at whoismcafee.com with audio links, a comments section, photographs and a stream of invective against the government and the police of Belize. He has done interviews on podcasts, like the “Joe Rogan Experience,” and offered a $25,000 reward for information leading to the arrest of “the person or persons” who killed Mr. Faull. He has turned lamming it into a kind of high-tech performance art.

“I am asking all people of conscience to read this blog, especially the links in the ‘Background’ section,’ and see the ugly truth unfolding here,” he posted on Nov. 18. “Speak out. Write your congressmen. Write the prime minister. Do what you can.”

Before he went underground, Mr. McAfee led a noisy, opulent and increasingly stressful life here. He was known for the retinue of prostitutes who he says moved in and out of his house, and for employing armed guards, some of whom stood watch on the beach abutting his house. He also kept a pack of untethered dogs on his property who barked at and sometimes bit passers-by.

Two days before the murder, someone had poisoned a handful of those dogs. As it happens, Mr. Faull had complained about the animals, as well as the guards and the constant late-night inflow and outflow of taxis on the dirt path that runs behind his and Mr. McAfee’s homes — a path so tiny that it’s supposed to be off-limits to cars.

Mr. Faull had shown up at the town council office a few weeks ago with a letter decrying the din and the dogs, as well as Mr. McAfee’s guns and behavior. Nothing came of it.

“We were planning to meet with John McAfee and hand him the letter,” Mr. Guerrero said. “But it never happened. We were busy doing other work.”

In hindsight, that looks like a blunder. Mr. McAfee has since said on his blog that he had no choice but to flee because police and politicians in Belize are corrupt and eager to kill him. As proof, he has written at length about a late April raid that the country’s Gang Suppression Unit conducted at a property of his on the mainland, in a district called Orange Walk.

Some McAfee watchers have a different theory — namely, that he grew paranoid and perhaps psychotic after months of experimenting with and consuming MDPV, a psychoactive drug. These experiments were described in detail by Mr. McAfee himself, under the pseudonym “Stuffmonger” in a forum on Bluelight, a Web site popular with drug hobbyists.

So, here’s one hypothesis: Rich man doses himself to madness while seeking sexual bliss through pharmacology. Then shoots neighbor in a rage. Case closed, right? Ah, but those Bluelight posts were a ruse, Mr. McAfee would later blog, just one of the many pranks he has perpetrated over the years — part of a bet with a friend to see if he could create Bluelight’s largest-ever thread.

Read More..