What I’ve Learned From Learning Javascript

Some notes as I go to bed:

The best way for me to learn Javascript isn’t through TreeHouse/CodeAcademy, but rather Googling “How to do____?

For me, this allows me to write the most crappiest code ever, debug constantly, learn about coding theory at the same time. Whereas with CodeAcademy, I am focused on the fundamentals, rather than failing constantly to become familiar with my code and programming theory over time.

ReRead Code, Copy Existing Code, and Manipulate Over and Over Again

I think this style of learning works much better than me than just going through a programming online textbook. The programming textbooks act as good references, but I have to test out different codes, understand the restriction of each code etc. 

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Learning code = Becoming a super powerful product designer

Yay I Made this Using Javascript

 

My notes on becoming a product designer & learning coding (draft notes: will revise)

I think I’ve opened a new world up when I learned how to make tables using Javascript, in order to create dynamic web pages.  While I’m still learning javascript, I want to offer my personal thoughts on why I have to code in order to be a product/ux designer.

Previously, if I wanted to communicate my ideas across, the tools I had are limited to words, sketches, drawings, wireframes, Adobe Photoshop/Illustrator/InDesign/etc.

These are tools that are restrictive of an era of the past, when pages were static. Now, many of our consumer & enterprise goods/products are becoming more and more digital. This movement is restructuring how we live, work, and play in our planet. This pace is so fast that being able to prototype, test out a digital product quickly to accurately reflect a person’s needs is becoming ever so important.

From a personal perspective, yes, it’s hard to learn how to programming. Not coming from a coding background, there are times (see here: https://giveit100.com/@fncischen/yqksun ) where I spend an entire day just on seven lines of code.

You need to know your medium and constantly churn out bad code in order to become comfortable doing hundreds of iterations in one hour. Sometimes it does take that many iterations of a product in order to be good at what you do.

The skillset of being able to build what we design will not only help us work well with developers, but also be able to accurately build a product people will use.

Before learning to code, I mostly communicated through static drawings/images (see here: my portfolio). This process reflects design standards of the past, but does not take into account the dynamic effects of digital products / web applications / interactions. These little things affect how users interact with the digital devices we see.

Static drawings don’t take into account those psychological effects, and thus are a low-efficient method of documenting/prototyping the user experience. It is harder to prototype  & build on top of it, if you aren’t aware of those experiences.

I’ll be documenting this process in more detail and seeing what outcomes I get once I get a working prototype.

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What do healthcare professionals think of Vinod Khosla’s prediction that automation and technology will replace 80% of physicians in the …

Answer by Jae Won Joh:

Let's not beat around the bush: it's complete bullshit.

Why are we even listening?

Khosla's words exemplify the type of incendiary arrogance that makes people in medicine hate to work with people in tech, particularly those of the hype-loving Silicon Valley variety.

Would you care about what a plumber has to say about quantum physics? No? Then why are you listening to Khosla babble on about a domain in which he has no training or experience? What, because he's rich, suddenly his words are golden and infallible?

The average 3rd year medical student has already forgotten more medicine than Khosla will ever learn in his entire lifetime, but Khosla seems to have no respect for this. Where did this (subconscious?) contempt for medicine come from?

I challenge you to name a single other field that a VC is perfectly comfortable dismissing 80% of people who spent 7-13+ years intensively training in a specific discipline before they're even allowed to sit for certification and become independent practitioners, particularly when a significant chunk of those years are spent working the only job in America that, due to regulations instated in 2003 after a young girl died, now has hours unwillingly capped at the equivalent of 2 full-time jobs.

What Khosla doesn't see

Read the way he describes a doctor's visit. It's blindingly obvious that he has no idea what goes on in his doctor's head.

I'll use an analogy from the coding world: it's because we in medicine "black box" our thinking. A doctor's thought process is much like an well-written function in code: you can call upon it without knowing (or needing to know) what's going on under the hood. All you have to do is give it input, and it gives you output.

But much like a well-written function, it can be orders of magnitude more complicated than you think. All you see is the serene smiling face, but underneath is a brain actively assessing your "cough" for pneumonia, bronchitis, asthma (exacerbation), COPD (exacerbation), upper respiratory infection, tumor, heart failure, bleed, trauma, to name but a few.

And all that analysis begins the moment I lay eyes on you.

I look at everything about you. The way you're dressed. Your posture. Your facial expressions. Your hair. The shape and proportions of your body. Your skin.

That "friendly banter"? To you, that's a social greeting. To me, that's more data. If you can speak, your cardiovascular system is intact enough to perfuse your brain and provide adequate oxygenation for thought, and your neurological system is intact enough to coordinate thought from your brain and translate to muscular movement/coordination, and your language centers are jiving to process my speech and formulate an appropriate response; it also tells me your airway and lungs are likely ok.

Your accent? The specific pattern of words you use? To you, that's just how you communicate. To me, that's more data. I get some idea of whether or not English is your first language, and if I need to raise my suspicion for tropical diseases or pathologies more common in foreign countries.

The way your eyes move? To you, that might mean nothing. To me, that's more data. If you're a woman and your eyes keep flitting back to your "boyfriend" as if for approval before you answer any of my questions, I'm going to ask him to leave and take steps to ensure you have the privacy/safety to tell me if you're being abused.

Literally everything about you is input to me. All you might see is me doing a "tongue and throat check" or "listening to the breath and vibrations in the abdomen", but there is way more going on in my head than you will ever know. So before you think my job is simple, it would behoove you to learn a little more about it.

Some unwarranted optimism

It's clear that Khosla has strong faith in AI/machine learning/etc. That's nice. I went to a talk last year at MIT about "Modeling and Prediction with ICU EHR Data". IIRC, Professor Marlin and his group had apparently spent the last 2 years on this research, and with a lot of fancy math on a dataset of vital signs from a pediatric ICU, had determined in an intensive care setting, the following were associated with mortality:

  • Low blood pressure
  • Prolonged cap refill
  • High heart rate
  • High respiratory rate
  • Low SaO2
  • Low pH
  • Low TGCS
  • Shock and depressed cognitive function

Everyone in the audience except me appeared to be thinking, "WHOAAAAA, WE CAN NOW TELL WHAT FACTORS ARE STRONGLY ASSOCIATED WITH MORTALITY??? BALLERRRRRRRRRR!!!"

My reaction as the only person with clinical training/experience in the audience: "…I could've told you all this as a first year med student."

It was kind of awkward, but in all seriousness: we've known about those factors for over a century. They're not new. What, you thought we called them "vital" signs for no reason? We call them that because when they're abnormal, things tend to be going south.

Suffice it to say I left the room shaking my head in bewilderment at the notion that "computers will completely revolutionize medicine".

More unwarranted optimism

Khosla also appears to have strong faith in the notion of EMR-based data analysis. Where this faith comes from, I have no idea–even a cursory search of peer-reviewed literature reveals that there are significant limitations.

For example, consider the common disease process known as sepsis. It's responsible for ~20% of ICU admissions and is also the leading cause of death in non-cardiac ICU's. Mortality for severe sepsis is usually cited as being between 30-50%, with an annual estimated 751,000 deaths nationally costing ~$16.7 billion/year in the U.S. [1-4]

Given such a common critical condition and wealth of data, you would think it would be a total cakewalk to just amass and analyze the data. Not so. Why?

When a patient sees a physician in our current system, that encounter's data is collectively billed under a set of ICD codes. The billing code used and the patient's actual condition are often not the same. For example, "food poisoning" may be billed as "Nausea & vomiting". A cold may be billed as "Congestion" + "Sore throat" + "Headache".

This causes problems when you try to go back and do retrospective analysis, because in order to find the patient population or disease process you want to study in your EMR, you have to basically play a sophisticated guessing game as to what billing codes to search for.

In other words, there's ample room for significant disparity in the results depending on what codes you use. Someone who searches for "flu-like symptoms" is going to get a rather different dataset than someone who searches for "fever"+"congestion"+"cough".

There's actually a recent paper from Sweden[5] that illustrates this perfectly: they took three independently published and peer-reviewed ICD criterion for identifying severe sepsis and applied it to a single starting dataset. Guess what? Each criterion produced wildly different patient numbers: 37,990; 27,655; and 12,512.

The differences between those numbers aren't exactly…negligible. So…where is this sophisticated EMR-based analysis going to come from? There's a limit to how much you can compensate for crappy data, so I really don't care how much data you have. What I want to know is, who's going to be the mastermind that determines how sub-groups are made for clinical recommendations? When you're trying to analyze a condition with a given dataset, is analysis on a 96% sensitive but only 53% specific subgroup better than a 71% sensitive but 89% specific subgroup, or should they be used for different analyses? Who will make that call to determine how conclusions are drawn for human lives?

"Everybody lies"

Fans of the show "House" will recognize the star character's favorite line. While a jaded view, it's not without reason. Khosla's view that "You are the one telling your doctor your symptoms" relies on the highly faulty (and naive) assumption that the patient is always telling the truth. That often isn't the case.

I would love to see Khosla's theoretical algorithm take on a manipulative benzo addict.

"I'm experiencing alcohol withdrawal, Dr. Algorithm."

"When was your last drink?"

"A week ago."

"Are you having tremors?"

"Yes, see, my hands are shaking right now."

"Have you withdrawn from alcohol before?"

"Yes, several times. Please, I need help, can you give me something?"

"Thank you for this information. You will be receiving valium shortly."

It would be absurdly easy to trick a computer into dispensing unnecessary drugs and interventions. Just read on the internet what symptoms you need to endorse and what signs you need to fake, and the computer would give you what you want.

I get flat-out lies all the time from people seeking secondary gain. Part of my job is to figure out who really needs my help vs. who is trying to score more vicodin they can sell on the street. Can your computer deal with blatantly false input? Can it be made to have the clinical acumen to know when someone is lying? Somehow, I don't think most patients will appreciate being hooked up to a fancy lie detector every time they see Dr. Algorithm.

The constraints of practicality

Your robot will never match me in speed of clinical assessment and intervention, and this is most obvious when patients truly need a doctor to live.

I had a patient not long ago who came in with "shortness of breath". The first thing I see is pink frothy foam coming out of their mouth, and I immediately know this patient will need to be intubated ASAP; the scary part is that once the meds are given to sedate and paralyze the patient I'll have about 20 seconds to do it or else I might lose this particular airway, causing the patient to die.

Quick, draw up the meds. Give 'em, let's go go go.

It's done. Patient's paralyzed. I put the laryngoscope in their mouth, try to visualize their vocal cords. Oh god there's a ton of secretions in the throat. Quick, I need to suction it out. Perfect, I can see cords, but there are more secretions actively coming out of the trachea. Quick, give me the endotracheal tube before my view gets obscured again. Bam. Success.

I'd like to see your robot of the future match the lifesaving procedure I did in ~15 seconds. Is computer vision going to be perfect by 2025? Is its analysis of a difficult airway situation going to be perfect? Because…it has to be. Will it know when to try to tube the patient vs. when to try airway adjuncts? Will it even be able to quickly recognize a patient holding hands with Death just by laying eyes on them?

Conclusion

I respect that Khosla is a successful man. I respect his confidence. I respect his optimism. I have no respect for his belief that 80% of doctors can be replaced by algorithms in the near future. I find a complete and utter lack of credible evidence to support the claim. I read his TechCrunch article with initial interest which quickly turned into despair, that such a powerful man views my field with such disdain despite having such vast ignorance about how it works.

References

[1] Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001 Nov 8;345(19):1368-77.
Early goal-directed therapy in the treatment of… [N Engl J Med. 2001]

[2] Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW. Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule. Crit Care Med 2003 Mar;31(3):670-5.
Mortality in Emergency Department Sepsis (MEDS… [Crit Care Med. 2003]

[3] Bone RC, Fisher CJ, Jr., Clemmer TP, Slotman GJ, Metz CA, Balk RA. A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 1987 Sep 10;317(11):653-8.
A controlled clinical trial of high-dose methyl… [N Engl J Med. 1987]

[4] Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001.
Epidemiology of severe sepsis in the United St… [Crit Care Med. 2001]

[5] Wilhelms S, Huss F, Granath G, Sjoberg F. Assessment of incidence of severe sepsis in Sweden using different ways of abstracting International Classification of Diseases codes: difficulties with methods and interpretation of results. Crit Care Med 2010 Jun;38(6):1442-9.
Assessment of incidence of severe sepsis in Sw… [Crit Care Med. 2010]

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How Much People Think They Need for Retirement

Post by Jane Chin:

How Much People Think They Need for Retirement

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Should everyone learn to code? Or is this narrow mindedness?

Answer by Ben Werdmuller von Elgg:

It's important to understand the difference between "learning to code" and "being a coder".

  • I know how to do some math. I am not a mathematician.
  • I know how to drive. I am not a professional driver.
  • I know how an engine works. I am not a professional mechanic.
  • I can cook. I am not a professional chef.
  • I can unclog a toilet and hook up a sink. I am not a plumber.

In this context, yes, I think everyone should learn to code.

Sure, you can get away without math, but you're more likely to be ripped off. You can get away without knowing how to drive yourself, but it limits your transport options. You can get away without understanding your car, but you'll spend a fortune on mechanics (and get ripped off). You can avoid learning how to cook, but you'll spend more on food, eat worse and probably get fat. If you can't do basic plumbing, you're at the mercy of the people who can.

I'll repeat that again, in the context of computing: if you can't do basic coding, you're at the mercy of the people who can.

That's meaningless in a world where computers are boxes that sit under TVs in bedrooms and maybe perform a few limited tasks and play games. But that's not the world we're living in. Computers are everywhere, and you're using them hundreds of times a day without even realizing it. More and more, the people who design those computers are getting to dictate how you live your life.

Not everyone should be a professional coder. Your skills are important, and nobody's suggesting that being an engineer is more glorious than being a teacher or an investment banker or a farmer. But being able to bend the machines all around us to your will just a little bit more? That gives you an edge. That gives you greater freedom.

Or, let's put it this way. You know the demographics of software engineers; they're getting better, but they're pretty narrow. And you also know how software design is influencing virtually every part of our lives. Software's influence is only going to get broader, deeper, and more integrated. Do you really want to give that narrow demographic the monopoly on laying the scaffolding for the 21st century?

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The Bullsh*t that is “Follow Your Bliss”

Post by Jane Chin:

The Bullsh*t that is "Follow Your Bliss"

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How does one develop EQ?

Answer by Ellen Vrana:

This is a great question, implicit in it is that you actually care to develop EQ, which is great!
 
As I write, I have Big Bang Theory on.  I realize Sheldon Cooper is the best pop-culture example of someone without ANY emotional intelligence. He has no concept of what other people might be thinking or feeling other than what they actually say. The hidden subtext of human emotions is just that, hidden.  
 
I cannot tell you how to develop an EQ, there are brilliant psychologists on Quora who can take up that mantle.
 
But I can give a personal anecdote, I hope it helps.
 
I have an ok EQ, in fact, I think it is what has contributed to the few successes I've had.  Not my IQ.  I'm smart enough, but nothing amazing. School was hard for me; I relied on extra credit, easy classes and, at times, even mild cheating to get mediocre results.
 
My husband is a genius.  He can do math sums in his head faster than I can name my favorite food.  He is so smart that he relied on his data-driven intellect and as a result, his EQ was bad.  (And when I say bad, I mean almost Sheldon Cooper- bad.)  To be fair, he didn't ever need it to be successful and I'm NOT saying that he – or others like him – are bad people.
 
Then he met me, I demanded a slightly higher awareness of others' emotional subtext than he was used to.
 
This awareness included:
 

  • being aware of how his thoughts and actions affected others and that if they are acting in a way he didn't like, it might be because of a way he acted first
  • recognition that just because he intended to be helpful/kind/nice does not mean that the other person interprets it that way
  • being aware of people's unspoken motivations that might actually contradict their actions
  • being aware that sometimes people are not aware of their own motivations
  • being aware of how his own prejudices and experiences influence his opinions in a way that is not universal nor universally understood.

We approached it together.  I was responsible for not judging him as he tried to improve.  He was responsible for asking himself, in difficult moments, whether one of circumstances above was happening. 
 
The more he practiced, the better he got. The better he got, the more he cared.  The more he cared, the more he practiced.. and so on.  To the point where just this week, I was acting ornery and I got "Honey, you're acting out because you're really worried about your life goals and lack of fulfillment. Let's talk about that instead."  And he was RIGHT!  Damn this Frankenstein.
 
Having a good EQ means being sensitive to others' emotional needs.  If you don't do it naturally, it doesn't mean you can't, doesn't mean you're a bad person.   What worked for my husband was to literally write a list of questions (above) and to revisit them when he felt a pang of guilt, anger, etc.  His analytical mind is his best gift, so he approached it analytically.
 
 If you want to develop your EQ, find an approach that works best for you, this is just one example.

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