Stories [7]: A Strange Doctor

The theme of the next Grand Rounds hosted at TECHKNOWDOC’S SURGICAL ADVENTURES is “Humor in Medicine”.

I have been thinking and thinking, but I failed to come up with a funny story other than I have told before (and one I have to check with my mom). Most of my experiences in the medicine/health field aren’t that funny (from my perspective). I can imagine it is different for people working in the field, and especially in the field of emergency care. Life in the Fast Lane and Other Things Amanzi are a rich source of medical humor.

But I have a short story to tell, that is on the interface of science and medicine…

As you probably know I worked as scientist for many years. I did my PhD in a lab where we worked with mice and guinea pigs. I tested the immuno-enhancing effects of cytostatic drugs in mouse models, whereas others tested immunotherapeutic effects of cytostatics, interleukins and/or vaccines in tumormodels, both in mice and guinea pigs. Good for science, but not so nice for the animals: I was glad I didn’t have to do the tumor-experiments.

My boss was a guinea pig expert, he knew everything about guinea-pig immunology. As most project leaders he had his PhD-degree. In the Netherlands he is therefore called a doctor (dr.), which is different from a “dokter” (in Dutch) or a doctor of Medicine (English). But many do not understand the difference.

Sometimes in the school holidays my boss’s little girls came along. They were shown the guinea pigs, but were (of course) kept from the experimentation rooms (the rules were not that strict in the eighties, one could just walk in and out of the stables). Dad tried to explain to them why the guinea pigs were there and what he was doing with them in a simple and not too rude way.

Later, the teacher of one of the girls asked the children of the class what their parents were doing for a living. When it was the turn of my boss’s daughter, she said that both of her parents were doctors. One was a GP and the other, well…. he cured guinea pigs ….

Photo Credits

Guinea Pig: http://www.flickr.com/photos/sween/4465737889/

Silly Saturday #25 Librarians do Gaga

You probably have seen it all. First at Nikki Dettmar’s blog “Eagle Dawg‘s, then retweeted through the Twitterverse and finally even mentioned by Boing Boing (thanks @drShock). But as a librarian and a former dancer I just can’t resist this video, even though I seldom use the ca, ca, catalog….

Enjoy! it is much better than the Eurovision Songfestival, which I didn’t follow live but was “forced” to follow on Twitter. Well in a certain way the #eurovision tweets were quite enjoyable (and preferable to the live songs, I think). At visible Tweet you can follow the recent ones (for a week or so).

And now for the Librarian GaGa. Librarians rock. ♥♥♥ You did know that, didn’t you?

“Librarians do Gaga” was an entry at the the iSight Film Festival. The video was produced by Sarah Wachter, a student in the iSchool’s Master in Library and Information Science program and the dancers were students and faculty members from the University of Washington’s Information School

Ten Years of PubMed Central: a Good Thing that’s Only Going to Get Better.

PubMed Central (PMC) is a free digital archive of biomedical and life sciences journal literature at the U.S. National Institutes of Health (NIH), developed and managed by NIH’s National Center for Biotechnology Information (NCBI) in the National Library of Medicine (NLM) (see PMC overview).
PMC is a central repository for biomedical peer reviewed literature in the same way as NCBI’s GenBank is the public archive of DNA sequences. The idea behind it “that giving all users free access to the material in PubMed Central is the best way to ensure the durability and utility of the electronical archive as technology changes over time and to integrate the literature with other information resources at NLM”.
Many journals are already involved, although most of them adhere to restrictions (i.e. availability after 1 year). For list see http://www.ncbi.nlm.nih.gov/pmc/journals/

PMC, the brain child of Harold Varmus, once the Director of the National Institutes of Health, celebrated its 10 year anniversary earlier this year.

For this occasion Dr. Lipman, Director of the NCBI, gave an overview of past and future plans for the NIH’s archive of biomedical research articles. See videotape of the Columbia University Libraries below:

more about “Ten Years of PubMed Central | Scholar…“, posted with vodpod

The main points raised by David Lipman (appr. time given if you want to learn more about it; the text below is not a transcription, but a summary in my own words):

PAST/PRESENT

• >7:00. BiomedCental (taken over by Spinger) and PLoS ONE show that Open Access can be a sustaining way in Publishing Science.
• 13:23 Publisher keeps the copyright. He may stop depositing but the content already deposited remains in PMC.
• 13:50 PMC is also an obligatory repository for author manuscripts under various funding agencies mandates, like the NIH and the UK welcome trust.
• 14:31 One of the ideas from the beginning was to crosslink the literature with the underlying molecular and other databases. For instance NCBI is capable of mining out the information in the archived text and connecting it to the compound and the protein structure database.
• 16:50 There is a back issue digitization for the journals that are participating, enabling to find research that you wouldn’t have easily found otherwise.
• PMC has become international (not restricted to USA)
• The PMC archive becomes more useful if it becomes more comprehensive
• Before PMC you could do a Google Scholar search and find a paper in PubMed, that appeared funded by NIH, but then you had to pay $30 for it in order to get it. That’s hard to explain to the taxpayers (Lipman had a hard time explaining it to his dad who was looking for medical information online). This was the impetus for making the results of NIH-sponsored results freely available.

PRESENT/FUTURE

• 23:00 Discovery initiative: is the use of tracking tools to find out which changes to the website work for users and which don’t. Thus modifications should lead to alterations in users behavior (statistics is easy with millions of users). Discovery initiative led to development and improvement of sensors, like sensors for disease names, drug names, genes and citations. What is being measured is if people click through (if it isn’t interesting, they usually don’t) and how quickly they find results. Motto: train the machine, not the users.
• 30:37 We changed the looks of PMC. Planning to make a better presentation on the i-phone and on broad monitors.
• 31:40. There are almost 2 million articles in PubMed Central, 585 journals fully participate in PMC
• 32.30 It takes very long to publish a paper, even in Open Access papers. Therefore a lot of people are not publishing little discoveries, which are not important enough to put a lot of time in. Publishing should be almost as easy as writing a blog, but with peer review. This requires a new type of journal, with peer review, but with instant feedback from readers and reviewers and rapid response to comments. The Google Knol authoring system offers a fast and simple authoring system where authors (with a Google profile) can collaborate and compose the article on the server. Uploading of documents and figures is easy, the article updates are simple and fast, there is a simple workflow for moderators. After the paper is accepted you press a button, the paper is immediately available and the next day PMC automatically gets the XML content. There is also a simple Reference Manager included to paste citations.
• Principle: How you can start a journal with this system (see Figure). Till now: 60 articles in PLOS Currents Influenza. There are also plans for other journals: the CDC is announcing a Systematic Reviews journal, for instance.

QUESTIONS (>39:30):

• Process by which “KNOL-journal” is considered for inclusion in NLM?
  • Decide: is it in scope?, implicit policy (health peer review being done), who are the people involved, look at a dozen articles.
• As the content in PMC increases, will it become possible to search in the full text, just like in Google Scholar?
  • Actually the full text is searchable in PMC as apposed to PubMed, but we are not that happy with the full text retrieval. Even with a really good approach, searching full text works just a little bit better than searching PubMed.
    We are incorporating more of the information of PMC into PubMed, and are working on a separate image database with all the figures from books and articles in PMC (with other search possibilities). Subsets of book(chapter)s (like practice guidelines) will get PubMed abstracts and become searchable in PubMed as well.
• Are there ways to track a full list of our institutions OA articles in PMC (not picking up everything in PubMed)
  • Likely NIH will be contacting offices responsible for research to let them know what articles are out of compliance,  get their assistance in making sure that those get in.
    
  • Authors can easily update the electornic My Bibliography (in My NCBI in PubMed).
    
  • Author ID project, involves computational disambiguation. Where you are asked if you are the author of a paper if you didn’t include it. It may also be possible to have automatic reporting to the institutions.
• What did it took politically to get the appropriation bill passed (PMC initiative)?
  • Congress always pushed more open access, because it was already spending money on the research. Most of the initiative came more from librarians (i.e. small libraries not having sufficient access) and government, than from the NIH.
• Is there way to narrow down to NIH, free full text papers from PMC?
  • In PubMed, you can filter free full text articles in general via the limits.
    
• Are all the articles deposited in PMC submitted the final manuscript?
  • Generally, yes.

HT: @bentoth on Twitter

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E-Patients & I-Patients?

I read an interesting post -or perhaps rather a kick-off for a discussion- at Lucien Engelen’s posterous blog:

“To be or not to be : E-patient or I-Patient.

Lucien feels that e- and i-patients are not the same:

• An e-patient is a (ex-) patient able to advocate patients rights, needs, experiences and able to advice healthcare institutions in a neutral way on steps to be made in REshaping healthcare, so more an ambassador-role.
• An i-patient is a patient who uses the internet for information, sharing moods, questions experiences etc.

People who comment on his post do not see the need for a division between e- and i-patients.

Freek Bodemeijer for instance found that the division would make no sense as nowadays almost all Western patients use the Internet to look up information. In his view the ambassador role goes beyond the usage of e-tools.

E-patient “par excellence” E-Patient Dave deBronkart has more or less the same opinion: two overlapping memes are harmful from a marketing perspective,  but in the academic / analyst world a taxonomy of E-patient subtypes would be helpful.

While I agree that creating more terms (and certainly abbreviations) is not always clarifying and while I’m also skeptic that one can force new definitions, Lucien touches upon an important aspect: “when is an e-patient an e-patient?”

The definition of E-patients is not unequivocal.

Wikipedia, the e-medium also for e-medicine (although not always as accurate as we would like it to be [1]) defines e-patients as follows:

e-Patients (also known as Internet Patient, or Internet-savvy Patient) are health consumers who use the Internet to gather information about a medical condition of particular interest to them. The term encompasses both those who seek online guidance for their own ailments and the friends and family members (e-Caregivers) who go online on their behalf. (…)”

According to another definition (also mentioned Wikipedia):

They [e-patients] are equipped, enabled, empowered, engaged, equals, emancipated and experts:

• Equipped with the skills to manage their own condition.
• Enabled to make choices about self-care and those choices are respected.
• Empowered
• Engaged patients are engaged in their own care
• Equals in their partnerships with the various physicians involved in their care
• Emancipated
• Expert patients can improve their self-rated health status, cope better with fatigue and other generic features of chronic disease such as role limitation, and reduce disability and their dependence on hospital care.

These two definitions of e-patients are overlapping but certainly not identical.

Use of Internet is necessary but not sufficient to become an E-patient in the latter sense (from now on written with a capital E to indicate the difference)

So in a way the former e-patient is what Lucien calls an “an i-patient”, a health consumer who uses the Internet to gather information about his/her/a friends or a relative’s disease.

This i-patient definition is in line with the definition and the current use of the word e-health:

eHealth (also written e-health) is a relatively recent term for healthcare practice which is supported by electronic processes and communication. (…) some would argue it is interchangeable with health care informatics (…), while others use it in the narrower sense of healthcare practice using the Internet. The term can encompass a range of services that are at the edge of medicine/healthcare and information technology, i.e.

But this definition does no right to the true meaning of e-health. I agree with the one-liner of Prof Bas Bloem, who initiated Parkinson Net in the Netherlands [2]

“Health 2.0 is not “the world of gadgets”, but a new way of thinking in healthcare”

Similarly, an E-patient compares to an i-patient (or e-patient) as a real web 2.0 attitude compares to being on Facebook or using whatever Web 2.0 tool.

Web 2.0 is “sharing”, in contrast to Web 1.0 which is “finding”.

So Lucien’s i/e-patient is only finding information and a true E-patient is sharing his/her own experience or knowledge to learn more about a disease him-/herself or to inform and help others. Some of these empowered patients grow into an ambassador role.

To be really empowered, patients should (generally)* not act on their own, they need other patients, doctors (and/or other healthcare worker) too. For real engagement all have to share knowledge, experience, thoughts and information.

And as an information specialist I have to add, that finding information doesn’t mean a lot, if the information isn’t reliable. Many patients (and alas also doctors) adopt Internet information, without checking the source.
How did the anti-vaccine sentiment become so powerful? Why do so many people turn to ineffective alternative medicine? Dr Google also feeds hypochondria.
Admittedly there are many success stories of patients finding crucial new information via the Internet, that wasn’t provided by their doctor. But good care doesn’t stop there.

So, although we do not need to invent new names, the awareness should grow, that the E-patient doesn’t not stop where dr Google ends, it is not passive, needs the involvement of doctors too and requires the (free) availability of good information on the Internet.

For this we need a ReShape, I agee with Lucien. But the reshape has already begun with patient-advocates like E-patient Dave, Gilles Frydman (@gfry on Twitter) and Sussanah Fox of e-patients.net of  and with the initiatives of doctors like Bas Bloem and Jan Kremer in the Netherlands, who created the award winning initiative MijnZorgNet (MyCareNet).

Active, well-informed, E-patients are central to this Health 2.0 movement, but not the only players.

*dependent on the nature of the disease; in case of prevention or less serious conditions, the patient/person might not need to see a doctor.

Related Posts on this Blog:

1. The Trouble with Wikipedia as a Source for Medical Information
2. Web 2.0 and Health Care Reform: Two Dutch Examples (1)
3. The Web 2.0-EBM Medicine split. [1] Introduction into a short series
4. The Doctors & the Patient

Friday Foolery #24 Social Media Revolution 2, Right Here Right Now

People who still think Social media is a fad, should watch this video…..

Social Media Revolution 2 is an update of the original video with compelling social media statistics.

Social Media Revolution was created by the author Erik Qualman to promote his book Socialnomics: How Social Media has changed the way we live and do business.

The music from Fat Boy Slim (“right here, right now”) is electric (might be another reason to watch it).

Hattip: my colleague René Spijker, seen on the Salt Magazine page on Facebook

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Reclaim your Privacy on Facebook using a Simple Bookmarklet

Of all social networking sites, Facebook causes the greatest privacy concerns. Certainly since it has changed its privacy options over time.

In the beginning, Facebook restricted the visibility of a user’s personal information to just their friends and their “network”, but the default privacy settings have become much more permissive, as you can see in the video below.
This short video is based on a visualization made by Matt McKeon and gives only an impression of a work-in-progress
(for up to date info check the original animation at http://mattmckeon.com/facebook-privacy/).

The reason? According Facebook founder Mark Zuckerberg the controversial new default and permanent settings just reflect the way the world has changed, becoming more public and less private (see ReadWriteWeb).

“Default” is the key to the problems. You have to opt out to protect your privacy. However to fully protect your privacy on Facebook, you have to navigate through 50 settings with more than 170 options (see great charts at the NY Times!). Facebook’s privacy policy is longer than the American constitution!!!

Shocked by the results of the ACLU’s Facebook Quiz (see Mashable), I already changed my privacy settings last summer. Doing a simple quiz on Facebook meant everything on your profile (whether you use privacy settings or not), is available to the quiz. Even more worrying, when your friends do a quiz, everything on your profile is made available to the developers as well.

Since the default privacy settings have changed, my settings needed to be adapted again. But where were the leaks in the 170 options?

Luckily there is a very simple bookmarklet Reclaim Privacy that can check and fix your profile in 2 minutes (see Mashable.com) It is very easy.

1. First go to Reclaim Privacy and drag the bookmarklet to your web browser bookmarks bar
(in the example I dragged the bookmarklet into Chrome’s bookmarks (upper arrow)

2. Go to your Facebook privacy settings and then click that bookmark (Scan for Privacy, see arrow) once you are on Facebook.

3. You will see a series of privacy scans that inspect your privacy settings and warn you about settings that might be unexpectedly public.
In my case my friends could still accidentally share my personal information. This is indicated by a red sign: “insecure“.

4. So I clicked “prevent friends from sharing your data”, and in seconds this was the result:

5. I tweaked the contact information a bit (caution) by changing my contact settings, but I still would allow everyone to add me as a friend (I still have to approve, don’t I?)

Piece of cake!

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When #Twitter Gets Creepy: People Who Force you to #Autofollow

The third Twitter post in a row. But this one ain’t positive.

It is about privacy and spam.

Let’s first explain some basic things about Twitter.

People can follow you without your approval, at least if you  have a public account. You can follow them back if you like.

You just have to click on the follow button, that is all!
Everyone with a Twitter account can follow Barack Obama, for instance.

If Barack Obama followed me (whether I followed him or not), I could dm (direct message) him. He (or rather his staff) will receive a private message from me in his inbox.

Only people you follow, are able to dm you. This is to protect you against dm’s from whichever fool, Spam and Bots.

Barack Obama has many followers:  3,964,789. This is no surprise, because he is the president of the United States and everyone wants to know what he has to say.

Some people especially in the marketing sector find the numbers of followers that important that they will do anything to assure a lot of followers. They are even willing to pay for it.

There are several companies who specialize in it. Here is a list of paid Twitter services and their rates (from http://zacjohnson.com/buy-twitter-followers/).

• BuyTwitterFriends.com = 10,000 Followers for $49.99 (0.0049 each)
• TweetSourcer.com = 10,000 Followers for $60.00 (0.006 each)
• UnlimitedTwitterFollowers.com = 10,000 Followers for $74.95 (0.0074 each)
• Twitter1k.com = 5,000 Followers for $104.97 (0.0209 each)
• SocialKik.com = 10,000 Followers for $150.00 (0.015 each)
• USocial.net = 10,000 Followers for $447.30 (0.044 each)
• Tweetcha.com = 10,000 Followers for $474.99 (0.047 each)
• PurchaseTwitterFollowers.com = 5,000 Followers for $249.99 (0.049 each)

Buying followers….. that is rather shortsighted. My mother always used to say: “You can’t buy friends” (no real friends anyway).

What are followers worth who don’t follow you because you’re tweets are so interesting, or the stuff you sell is so good, etc… Do these followers really ‘follow’ you, in the sense that they follow what you say? And do they keep following you?

Moreover how are those followers recruited? Are they asked to do so? Are they offered money?

Well I don’t think so. There must be easier money strategies.

But how can you make people follow without asking?

Well there may be a sneaky way to force people to do so, without them being aware of it.

At least I think that has happened to me.

Saturday I got this dm:

I was alarmed.

• First, somebody sends me a dm with a link to a marketing gift. I never click such links, you never know where they lead to. Even if it comes from someone I trust, it may be that his/her account has been hacked, so I have learned…
• Second,  I’m not following this guy, at least not any longer….
• Third I have blocked him before, after a similar dm.

The first time I got a dm of @jonathanvolk I thought I made the mistake by accidentally following him. But now (having blocked him before) I was sure that that wasn’t the case.

Out of curiosity (and to block him) I checked his Twitter account. Here I found several people complaining to him about the very same thing (the first tweet appeared later in response to my tweets).

@SorbetDigital appeared to have similar problems, not only with @jonathanvolk, but also with @JohnChow (see her post).

@JohnChow did ring a bell. Didn’t I block him in the past and didn’t I see his tweets rolling by lately?

I quickly checked Friend or Follow, a fantastic program, that shows you the people you follow and don’t follow you in return (following), your fans (who only follow you) and your friends (reciprocal relationship).

And who did I see there? John Chow, plus another guy that I presumably didn’t follow voluntarily: @MrGatherSuccess.
[The 2nd robot to the upper left also isn't kosher, as I found out today.]

Their Twitter pages ((below in blue and pink) have texts according to expectations.
Their follower/following ratio is absolutely skewed (557:1 and 1090:1 respectively)  so apparently their approach works in the sense that they got more followers, probably recruited in much the same way as they “recruited” me.

Strikingly@jonathanvolk and @Shoemoney are among the 100 people John Chow has chosen to follow. @Shoemoney (follower/-following ratio of 1355:1) and @Chow are also almost the only people followed by @MrGatherSuccess. By the way there is also “College Pages”, that links to Online Colleges, you know the site I warned you about on several occasions (Beware of Top 50 “Great Tools to Double Check your Doctor” or whatever Lists and “Vanity is the Quicksand of Reasoning: Beware of Top 100 and 50 lists!”)

Oh and “the robot” tweeted this today

Common features of these people:

• they are  all Internet marketers,
• All have let me follow them, (without following me back)
• Some have sent me dm’s
• they have many followers, some having skewed follower/following ratios
• they “know” each other and may refer to each other

Strikingly @jonathanvolk has a post in which he explains how to get 25,000 Twitter followers with “Twitter Followers for Sale”. Juicy detail: Shoemoney gave him the tip. Vice versa at shoemoney.com, Shoemoney advocates to download the affiliate marketing guide of Jonathan.

Are these the guys behind the link services?

Not necessarily. In a recent post (Something Fishy Goin’ On Here… Paid Twitter Followers) @Jonathanvolk seems sincerely surprised about the pissed of reaction of his forced followers. Quote:

The other week I made a post about Paid twitter followers.

In the post I outline a few methods I have used to essentially pay for twitter followers and how much it has cost me per follower. With the methods like paying twittercounter.com, for example, you know exactly where your twitter followers are coming from.

Recently my follower count has been increasing steadily (and fairly rapidly) without me paying for any more services.

I’ve received a few @ messages before saying the person didn’t follow me and they were unsure how they did. I usually brushed it off as a… how can I put it lightly… computer illiterate person.(emphasis mine)

I think however that one of the services I used is using some sort of application access to automatically make users follow those who pay for the service.

The only problem is, I’m not sure which service is doing it… or if it’s just someone trying to get my account banned.

Since I have no way of know knowing… I have no way of stopping it.

Kinda crazy. Either way, be careful buying followers unless you know explicitly where the users are coming from!

——————

Kinda bullshit “Since I have no way of know knowing… I have no way of stopping it.” …. Booh!

Let me give you one tip, guys (assuming that you are honest about this): go sit around the table and see which follower-robbering service you share, and do something about it!!

How people can force you to follow is a technical issue, I know little about. Jonathan refers to a follow bug in Twitter that they have found but should have been fixed.

Indeed @librarianbe told me the same in response to my “tweets for help”. He referred to an article in Gizmodo explaining how to force anyone to follow you on Twitter. Apparently the bug was not fixed (yet?), or there is another leak still to be discovered.

Twitter handled the p @  r  n-spam well. I hope it will find a solution to these problems too.

For such forced following and marketing dm’s are not only annoying, and an intrusion on our privacy, they are also bad for the credibility of a tool like Twitter.

So I’m going to block these guys (of course) and report them to Twitter using the ticket file @mrgunn advised me.

Similar problems? Here is the link to file a ticket with Twitter: http://help.twitter.com/requests/new

Meanwhile I advise you marketer guys to reassess the value of your followers. Do you only care about the size of the flock? Is it just the number of sheep? Do you want to impress by numbers? Or do you care about by whom you are being followed? And if what you’re tweeting does matter to them? Because only then you will have value as a twitterer and deserve to be followed. Otherwise, how can I put it lightly…you’re  a bit sheepish.

Added 18-05-2010

According to Twitter Status the bug that permitted a user to “force” other users to follow them was resolved & cleaned up May 10th. However Jonathan send the dm May 15th (although he might have forced me to follow him longer ago).

If you are still seeing folks you are following who you didn’t choose to follow, Twitter advises to use the block or unfollow tools as a remedy.

However, these buttons do not work effectively as @jonathanvolk and @johnchow keep resurrecting again after a total block.

@jonathanvolk reappeared in the Following Tab of Friend or Follow this very night, about 3 days after blocking (see comment).

Twitter, I hope you listen…

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Silly Saturday 23 # Twitter Cartoons

Like my previous Silly Saturday/Friday Foolery this a post in the style of “A Picture is Worth a 1000 Words”.

It also fits in with my last post: “A Quantitave Study suggests that Twitter is not Primarily a Social Networking Site”

[1] As a matter of fact the first cartoon is from the presentation of Haewoon Kwak et al that I reviewed in that post, although they used it in a different context.

What do you think when you see this cartoon (by Ian D. Marsden)?

My first impression is that someone twitters instead of helping people out when there is a riot, accident, terrorist attack etc., but its meaning is positive: “During the Iranian election unrest Twitter was used as a powerful tool to get news out of the country”

[2] Twitter as it is seen by many…

A bit of self-mockery is always sound. Although of course my Twitter behavior is quite unlike that depicted above.

[3] But I do recognize the behavior of Twitter sheep like these (and I don’t mean the lonely sheep but the ‘sheepish followers of celebrities). Brilliant cartoon by Gerald the Sheep (Ben Gallagher)

[4] Noise to Signal also posts some excellent Twitter-cartoons (and Facebook, i-pad etc). The Cartoon below (from RobCottingham) is from the post: “Mommy, where do hashtags come from?” Do you know where # come from?

Here a real-world example of the confusion hashtags (#) can cause…

"There are 3 hashtags in use, which one is the real one?" http://twitter.com/Dymphie/status/13776462934

That is it for now.

http://twitter.com/laikas/statuses/14033039170

And also from Ramona   ….Glad I’m not a lonely sheep)…

http://twitter.com/rlbates/statuses/14033503189

Credits:

1. Cartoon: Iranian Election Demonstrations and Twitter » Iranian Elections and Twitter by Ian D. Marsden on Marsden Cartoons
2. Twitter Tree: http://www.flickr.com/photos/pandemia/ / CC BY 2.0
3. Twitter Sheep : Gerald-sheep at bengallagher.com
4. “Mommy, where do hashtags come from?” from Noise to Signal (Rob Cottingham)

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A Quantitave Study suggests that Twitter is not Primarily a Social Networking Site

A lot can be said about Twitter, Facebook, Linkedin and other social media. What is the best, the most useful, the most popular the most social (and has the least privacy-issues, hehe Facebook)?

You know I love Twitter. Twitter is a social networking and microblogging service that enables its users to send and read messages known as tweets. The tweets don’t exceed 140 characters, so your message must be very concise. For me Twitter is a very rich source of information and a useful networking site. But it is hard to explain that to others.

Some Most people think that individuals who twitter are just parroting others (hé this is called retweeting, guys!) or are just egocentric bores (“I eat cornflakes for dinner”).

Well, a recent quantitative study by a group of researchers at Korea’s Advanced Institute of Science and Technology suggest that they might just be right. … Or at least their data suggest Twitter may be less of a social site and more of a news site.

According to Haewoon Kwak et al this is the first quantitative Twitter study ever.

The researchers crawled the entire Twitter site and obtained 41.7 million user profiles, 1.47 billion social relations, 4,262 trending topics, and 106 million tweets. They looked at the follower-following topology, looked at the ranking by number of followers and by PageRank, analyzed the retweets and the tweets of top trending topics.

You can read the main conclusions in the power presentation below and their abstract for Proceedings of the 19th International World Wide Web (WWW) Conference, April 26-30, 2010, Raleigh NC (USA). Below the abstract you can also find links to two download files, enabling you to reanalyze the data
Going Social Now and ReadWriteWeb also give a nice overview.

What are their main conclusions:

• Twitter is not very “social”
  • It is “I follow you”, not “lets become friends” and you don’t have to approve or follow back. Following thus means that you “just subscribe” to the tweets of that person.
  • Only 22.1% of the relationships are reciprocal, thus 77.9% of the relationships is one way, just one of two is following the other. Surprisingly, 67.6% of users on Twitter are not followed by any of the people they follow.
  • this low reciprocity is unlike all other human social networks.
• For most tweople, Twitter is primarily a source of information, not a social networking or information dissemination platform.
  • The Majority of topics (54,3%) are headline topics
  • Few users reach a large audience directly.
  • The average path length between two people on Twitter is 4.12. This is much shorter than Stanley Milgram’s original experiment uncovering the “six degrees of separation” phenomena.
  • Any retweeted tweet is to reach an average of 1,000 users no matter what the number of followers is of the original tweet.
  • Once retweeted, a tweet gets retweeted almost instantly on next hops, signifying fast diffusion of information after the 1st retweet.

It is a beautiful study that highlights the topological characteristics of Twitter.

One word of caution. Twitter is analyzed as a whole. There are many subpopulations with their own kinetics and goals. So the majority of people may follow the news, and fans may follow a celebrity by the million, but there are (relatively) small niches on Twitter, like health and medicine (or science) that may not follow the same rules.
I daresay (guess) that more people in this niche follow each other and do use Twitter both as a source of information and as as  network for social communication.
But these small niches are outnumbered by others (news sites, CEOs, celebrities).
At least that is my hypothesis.

Who is going to test this??

Many different Twitter birds in a flock

Credits

• Blue Twitter Bird: http://www.flickr.com/photos/paulsnelling/3586152432/in/set-72157616036806501/ (CC)
• Wild Parrot: http://www.flickr.com/photos/artolog/267530093/ (CC)
• Many Parrots: http://www.flickr.com/photos/11268984@N07/4516341668/in/faves-laikaspoetnik/

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• The Most Influential Twitter Users Aren’t The Ones With The Most Followers, Study Shows (businessinsider.com)
• How to Measure a Retweet (twitterrati.com)
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What One Short Night’s Sleep does to your Glucose Metabolism

As a blogger I regularly sleep 3-5 hours just to finish a post. I know that this has its effects on how I feel the next day. I also know short nights don’t promote my clear-headedness and I also recognize short-term effects on  memory, cognitive functions, reaction time and mood (irritability), as depicted in the picture below. But I had no idea of any effect on heart disease, obesity and risk of diabetes type 2.

Indeed, short sleep duration is consistently associated with the development of obesity and diabetes in observational studies (see several recent systematic reviews, 3-5). However, as explained before, an observational design cannot establish causality. For instance, diabetes type 2 may be the consequence of other lifestyle aspects of people who spend little time sleeping, or sleep problems might be a consequence rather than a cause of diabetogenic changes.

Diabetes is basically a condition characterized by difficulties processing carbohydrates (sugars, glucose). Type 2 diabetes has a slow onset. First there is a gradual defect in the body’s ability to use insulin. This is called insulin resistance. Insulin is a pancreatic hormone that increases glucose utilization in skeletal muscle and fat tissue and suppresses glucose production by the liver, thereby lowering blood glucose levels.  Over time, damage may occur to the insulin-producing cells in the pancreas (type 2 diabetes),  which may ultimately progress to the point where the pancreas doesn’t make enough insulin and injections are needed. (source: about.com).

Since it is such a slow process one would not expect insulin resistance to change overnight. And certainly not by just partial sleep deprivation of 4-5 hrs of sleep.

Still, this is the outcome of a study, performed by the PhD student Esther Donga. Esther belongs to the study group of Romijn who also studied the previously summarized effects of previous cortisol excess on cognitive functions in Cushing’s disease .

Donga et al. have studied the effects of one night of sleep restriction on insulin sensitivity in 9 healthy lean individuals [1] and in 7 patients with type 1 diabetes [2]. The outcomes were practically the same, but since the results in healthy individuals (having no problems with glucose metabolism, weight or sleep) are most remarkable, I will confine myself to the study in healthy people.

The study design is relatively simple. Five men and four healthy women (mean age 45 years) with a lean body weight and normal  sleep pattern participated in the study. They were not using medication affecting sleep or glucose metabolism and were asked to adhere to their normal lifestyle pattern during the study.

There were 3 study days, separated by intervals of at least 3 weeks. The volunteers were admitted to the clinical research center the night before each study day to become accustomed to sleeping there. They fasted throughout these nights and spent 8.5 h in bed.  The subjects were randomly assigned to sleep deprivation on either the second or third occasion. Then they were only allowed to sleep from 1 am to 4 am to secure equal compression of both non-REM and REM sleep stages.

(skip blue paragraphs if you are not interested in the details)

Effects on insulin sensitivity were determined on the day after the second and third night (one normal and one short night sleep) by the gold standard for quantifying insulin resistance: the hyperinsulinemic euglycemic clamp method. This method uses catheters to infuse insulin and glucose into the bloodstream. Insulin is infused to get a steady state of insulin in the blood and the insulin sensitivity is determined by measuring the amount of glucose necessary to compensate for an increased insulin level without causing hypoglycemia (low blood sugar). (see Figure below, and a more elaborate description at Diabetesmanager (pbworks).

Prior to beginning the hyperinsulinemic period, basal blood samples were taken and labeled [6,6-2H2]glucose was infused  for assessment of glucose kinetics in the basal state. At different time-points concentrations of glucose, insulin, and plasma nonesterified fatty acids (NEFA) were measured.

The sleep stages were differently affected  by the curtailed sleep duration: the proportion of the stage III and stage II sleep were greater (P < 0.007), respectively smaller (P < 0.006) in the sleep deprived night.

Partial sleep deprivation did not alter basal levels of glucose, nonesterified fatty acids (NEFA), insulin, glucagon, or cortisol measured the following morning, nor did it affect basal endogenous glucose production.

However, during the CLAMP-procedure there were significant alterations on the following parameters:

• Endogenous glucose production – increase of approximately 22% (p< 0.017), indicating hepatic insulin resistance.
• Rate of Glucose Disposal - decrease by approximately 20% (p< 0.009), indicating decreased peripheral insulin sensitivity.
• Glucose infusion rate – approximately 25% lower after the night of reduced sleep duration (p< 0.001). This is in agreement with the above findings: less extra glucose needed to maintain plasma glucose levels.
  
• NEFA – increased by 19% (p< 0.005), indicating decreased insulin sensitivity of lipolysis (breakdown of triglyceride lipids- into free fatty acids).

The main novelty of the present study is the finding that one single night of shortened sleep is sufficient to reduce insulin sensitivity (of different metabolic pathways) in healthy men and women.

This is in agreement with the evidence of observational studies showing an association between sleep deprivation and obesity/insulin resistance/diabetes (3-5). It also extends results from previous experimental studies (summarized in the paper), that document the effects on glucose-resistance after multiple nights of sleep reduction (of 4h) or total sleep deprivation.

The authors speculate that the negative effects of multiple nights of partial sleep restriction on glucose tolerance can be reproduced, at least in part, by only a single night of sleep deprivation.

And the media conclude:

just one night of short sleep duration can induce insulin resistance, a component of type 2 diabetes (Science Daily)

healthy people who had just one night of short sleep can show signs of insulin resistance, a condition that often precedes Type 2 diabetes. (Medical News Today)

even a single of night of sleep deprivation can cause the body to show signs of insulin resistance, a warning sign of diabetes (CBS-news)

And this was of course the message that catched my eye in the first place: “Gee, one night of bad sleep, can already disturb your glucose metabolism in such a way that you arrive at the first stage of diabetes: insulin resistance!…Help!”

First “insulin resistance” calls up another association than “partial insulin resistance” or a “somewhat lower insulin sensitivity” (as demonstrated in this study).  We interpret insulin resistance as a disorder that will eventually lead to diabetes, but perhaps adaptations in insulin sensitivity are just a normal phenomenon, a way to cope with normal fluctuations in exercise, diet and sleep. Or a consequence of other adaptive processes, like changes  in the activity of the autonomous nervous system in response to a short sleep duration.

Just as blood lipids will be high after a lavish dinner, or even after a piece of chocolate. And just as blood-cortisol will raise in case of exercise, inflammation or stress. That is normal homeostasis. In this way the body adapts to changing conditions.

Similarly -and it is a mere coincidence that I saw the post of Neuroskeptic about this study today- an increase of blood cortisol levels in children when ‘dropped’ at daycare, doesn’t mean that this small increase in cortisol is bad for them. And it certainly doesn’t mean that you should avoid putting toddlers in daycare as Oliver James concludes, because “high cortisol has been shown many times to be a correlate of all manner of problems”. As neuroskeptic explains:

Our bodies release cortisol to mobilize us for pretty much any kind of action. Physical exercise, which of course is good for you in pretty much every possible way, cause cortisol release. This is why cortisol spikes every day when you wake up: it helps give you the energy to get out of bed and brush your teeth. Maybe the kids in daycare were just more likely to be doing stuff than before they enrolled.

Extremely high levels of cortisol over a long period certainly do cause plenty of symptoms including memory and mood problems, probably linked to changes in the hippocampus. And moderately elevated levels are correlated with depression etc, although it’s not clear that they cause it. But a rise from 0.3 to 0.4 is much lower than the kind of values we’re talking about there.

So the same may be true for a small temporary decrease in glucose sensitivity. Of course insulin resistance can be a bad thing, if blood sugars stay elevated. And it is conceivable that bad sleep habits contribute to this (certainly when combined with the use of much alcohol and eating junk food).

What is remarkable (and not discussed by the authors) is that the changes in sensitivity were only “obvious” (by eyeballing) in 3-4 volunteers in all 4 tests. Was the insulin resistance unaffected in the same persons in all 4 tests or was the variation just randomly distributed? This could mean that not all persons are equally sensitive.

It should be noted that the authors themselves remain rather reserved about the consequences of their findings for normal individuals. They conclude “This physiological observation may be of relevance for variations in glucoregulation in patients with type 1 and type 2 diabetes” and suggest that  “interventions aimed at optimization of sleep duration may be beneficial in stabilizing glucose levels in patients with diabetes.”
Of course, their second article in diabetic persons[2], rather warrants this conclusion. Their specific advise is not directly relevant to healthy individuals.

Credits

• Effects of Sleep Deprivation:  Wikimedia Commons, made by Mikael Häggström
• Assessing Insulin Sensitivity and Resistance in Humans by Ranganath Muniyappa and Michael J. Quon, M.D., Ph.D. on the wiki diabetesmanager (http://diabetesmanager.pbworks.com/Assessing-Insulin-Sensitivity-and-Resistance-in-Humans

References

1. Donga E, van Dijk M, van Dijk JG, Biermasz NR, Lammers GJ, van Kralingen KW, Corssmit EP, & Romijn JA (2010). A Single Night of Partial Sleep Deprivation Induces Insulin Resistance in Multiple Metabolic Pathways in Healthy Subjects. The Journal of clinical endocrinology and metabolism PMID: 20371664
2. Donga E, van Dijk M, van Dijk JG, Biermasz NR, Lammers GJ, van Kralingen K, Hoogma RP, Corssmit EP, & Romijn JA (2010). Partial sleep restriction decreases insulin sensitivity in type 1 diabetes. Diabetes care PMID: 2035738
3. Nielsen LS, Danielsen KV, & Sørensen TI (2010). Short sleep duration as a possible cause of obesity: critical analysis of the epidemiological evidence. Obesity reviews : an official journal of the International Association for the Study of Obesity PMID: 20345429
4. Monasta L, Batty GD, Cattaneo A, Lutje V, Ronfani L, van Lenthe FJ, & Brug J (2010). Early-life determinants of overweight and obesity: a review of systematic reviews. Obesity reviews : an official journal of the International Association for the Study of Obesity PMID: 20331509
5. Cappuccio FP, D’Elia L, Strazzullo P, & Miller MA (2010). Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes care, 33 (2), 414-20 PMID: 19910503

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• Study links sleep deprivation and diabetes (nationalpost.com)
• One Sleepless Night Ups Insulin Resistance (nlm.nih.gov)
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• Irreversible Effects of Previous Cortisol Excess on Cognitive Functions in Cushing’s Disease (laikaspoetnik.wordpress.com)
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The subjects were studied on 3 d, separated by intervals of at
least 3 wk. Subjects kept a detailed diary of their diet and physical
activity for 3 d before each study day and were asked to maintain
a standardized schedule of bedtimes and mealtimes in accordance
with their usual habits. They were admitted to our clinical
research center the night before each study day, and spent 8.5 h
in bed from 2300 to 0730 h on all three occasions. Subjects fasted
throughout these nights from 2200 h. The first study day was
included to let the subjects become accustomed to sleeping in our
clinical research center. Subjects were randomly assigned to sleep
deprivation on either the second (n4) or third (n5) occasion.
During the night of sleep restriction, subjects spent 8.5 h in
bed but were only allowed to sleep from 0100 to 0500 h. They
were allowed to read or watch movies in an upward position
during the awake hours, and their wakefulness was monitored
and assured if necessary.
The rationale for essentially broken sleep deprivation from
2300 to 0100 h and from 0500 to 0730 h, as opposed to sleep
deprivation from 2300 to 0300 h or from 0300 to 0730 h, was
that in both conditions, the time in bed was centered at the same
time, i.e. approximately 0300 h. Slow-wave sleep (i.e. stage III of
non-REM sleep) is thought to play the most important role in
metabolic, hormonal, and neurophysiological changes during
sleep. Slow-wave sleep mainly occurs during the first part of the
night, whereas REM sleep predominantly occurs during the latter
part of the night (12). We used broken sleep deprivation to
achieve a more equal compression of both non-REM and REM
sleep stages. Moreover, we used the same experimental conditions
for partial sleep deprivation as previously used in other
studies (7, 13) to enable comparison of the results.