Scenes we'd better see in the Warcraft film

  1. Someone veering away from a major battle shouting "Ooh, a herb! Be right back!" 
  2. Someone standing outside in Stormwind yelling "Want boost in Stocks, paying 150 gold!" 
  3. Number 1, but for Ore. 
  4. After a huge battle with a pack of molten lava powered hell-hounds "Loot the dogs" 
  5. An extended scene of one person using a special knife to skin the lava powered puppies.
  6. An extended montage where one of our heroes trains critters they find in the woods to battle other critters, and somehow become much more powerful themselves from doing it for a week or two. 
  7. Someone complaining about a member of the central cast's item level. 
  8. Thunderfury, Blessed Blade of the Windseeker. 
  9. Someone almost missing a climactic battle and being summoned by Warlock. 
  10. That Warlock farming soul shards for 2 hours.

Sir Terry Pratchett

I never met Sir Terry Pratchett. 

I remember taking The Light Fantastic into primary school when I was in P7. My dad had bought it for me in the airport, returning from one of his at least weekly trips. "This looks like it's a lot like Douglas Adams, you'll probably like it." 

I devoured it, a little confused by reading a second book first. I loved it.

In an age of ebooks, I still buy hardback Pratchett. And ebook. And audio. 

When I was 16 Sir Terry did a signing in Belfast. It was at lunch and I was in school. My father took a sports hold-all with all my books to date in it down. And a floppy disc with the up to date annotated Pratchett file. Sir Terry said it was a lot of books and likely to upset the line, would he leave them? Dad returned later, the books all signed, dedicated and enhanced by drawings and amusing notes. 

He wrote "Sad!" on the floppy. 

From then on any time Sir Terry came up in conversation my father always reminded me what a wonderful man he'd been that day. 

When news of the Embuggerance broke I was starting Nation. I stopped it. Put it away. For when there are no more new Pratchett novels. I promised myself "When I know there are no more, and his last book is out, then I will have one more treat left." 

I find I have three, and soon four. Nation, The Long Mars, Dragons At Crumbling Castle and soon The Long Utopia. I am unsure if Shepherd's Crown is coming. I think I'll save Dragons to read to my son.

Sir Terry Pratchett's writing has had more impact on me than anyone outside my immediate family. I quote his work, and things he has said about life, death and kindness to others form part of the core of my value system and my personality. 

I never met Sir Terry Pratchett. But the ripples he left in my life will go on until I too take the hand and step onto the black desert below the endless night.

My thoughts and well wishes lie with his family. 

ResearchKit - Tools, of course, can be the subtlest traps

If you were hanging around Twitter, and the tech blogosphere more generally, during and immediately after the Apple Spring Forward event yesterday you will have found out a few things:

  1. That watch looks neat, and everyone knows which one they want now
  2. The MacBook is somewhat desirable, and all Mac bloggers are realising they need a new laptop
  3. Apple is about to save the world and cure all ills thanks to ResearchKit

Better people than me can deal with 1 and 2, but for the record 42mm Stainless Steel with Milanese Loop and this MacBook Pro looks quite old suddenly.

But ResearchKit... This is something I am vaguely qualified to have an opinion on.

Disclosures time: I'm a doctor, I try, where possible, to be a savvy consumer of evidence, I have done some time as a research interviewer for a study into the genetics of alcohol dependence, and back when I was in training I had the dubious distinction of scoring very highly on critical appraisal exams.

Now, what you need to understand about doctors is that despite not being statisticians, and despite us all admitting that statistics are complex, somehow all doctors convince themselves they can read papers and identify flaws in them. Or as I tell my trainees "No paper ever published is good enough to withstand detailed attention".

ResearchKit is designed to solve a number of problems, the first and most obvious is that it's hard to do medical research, specifically it's hard to identify people who are happy to be experimented on. Then it's hard to do the experiments. Analysing the data, that's hard too. ResearchKit appears focussed on the "Hard to get people" problem. It gives you access to 700,000,000 iPhones worldwide, which is around 1% of the world's population. By any reasonable judgment that's a lot of phones.

Of course, I own 8 of them. So I'm not sure that it's a strict 1:1 phones:people ratio. Still even 0.125% of the world's population is a huge sample size.

Oh, wait, it's the population running iOS 8. Well, that's still significant.

Oh, wait, it's the population running iOS 8 who install the specific app for the research you're doing and who allow you access to the data you need. That's probably still far more than the few hundred to few thousand most studies get. I'm sure that's still wonderful.

But, by giving researchers access to these millions of people Apple may not be being quite as helpful as they'd like. The general comments I saw online about this were "Medical researchers say it's hard to get people for research, this makes it easy". As far as it goes that's true. It is not, however, the whole story. We don't need just anyone for research, we need specific people, and specific people with specific problems.

Here's a good example. When my dad had bowel cancer (see just about every blog entry on this blog for details - seriously every story I have to share includes "when my dad had cancer") he took part in some genetic research, they took a sample of his blood. Then they asked my mum would she mind helping out too, she was of course delighted. How they explained it to her was that they needed a family member who wasn't a blood relative. What they meant was that they needed an age, social class and lifestyle matched control. Since my mum lived with my dad, ate the same meals and was married to him she was about his age, in his social class and had a broadly similar lifestyle. It was an elegant way to identify a control group.

You see this in research, at the start of a paper they list off the demographic details of their control and study groups and show that they are broadly similar for a range of demographic data. That is to say their case and control groups are matched.

When we do research we need control groups. If we're looking at things that cause a disease then we need people without the disease who are broadly similar to people who have it - except in the specific exposures we want to study. If we're looking to see if a drug works then we need a group of people who take an inactive pill to make sure that it isn't the placebo effect.

So, let's say we wanted to see if cigarettes cause lung cancer (Hint: They do. Stop smoking). We would want a group of smokers and a group of non-smokers. Then we would want as far as possible for the groups to match, we would want the sex and age mixes in the groups to be similar, and ideally other lifestyle exposures such as diet. If for instance we had a group of 20 something smokers and 60 something non-smokers then we mightn't find much of a difference, because 20 somethings who get lung cancer are thankfully rare.

In one way then ResearchKit is brilliant, assuming you can capture your data in an app - you have a huge source of control groups, and the groups will be so large it should be easy to match for age, sex, weight, even diet if you're pulling that in from HealthKit. I'm about to digress, but I will return to this point in a moment.

Here, we meet what I see as being the first potential pitfall with ResearchKit. You're assuming the data is good. Data entry is a skill. When I was doing the research interviews it was drummed into me "Fill the form in this way" "We need this to be keyed reliably and quickly" "Here are the meanings behind these questions and why we ask them this way". Accuracy matters, inter-rater reliability matters. If we are going to be pulling data on dietary exposures from HealthKit, well you'd better hope your study participants are entering what they're eating and doing so reliably and correctly and fully. Otherwise they're not just cheating on their diets, they're cheating on the research too.

So, lets assume that everyone who is motivated enough to sign up for medical research apps is also motivated enough to enter all their data correctly and fully. They may well be, after all they're motivated enough to sign up for medical research apps. This is actually problem number two for ResearchKit.

The people who are willing to participate in medical research using their phones are a self-selected population. They are interested in healthcare topics, they are using their phone to track their health, they cared enough about your particular research topic to search for the app. They're not the general population, they may have a vested interest in the illness you're researching, they are likely to be more health conscious than the average population. In short, they are likely to differ in certain ways from the norm, and so research using them may not be representative of the population as a whole.

Again, this is a problem that we tend to look for in research. We drum it into medical students. One question "Is this also likely to be true in my population?".

This brings back to a very subtle problem about cases and controls I alluded to above. It's a variation of an old story. A lot of research in psychology is done on university undergraduates. This means it's WEIRD research. Which is to say research into Western, Educated, Industrialized, Rich, and Democratic people. Their psychological biases and processes may vary systematically from people who aren't university undergraduates; without broader based research it's very hard to tell. Yet a lot of research is done on this population because it's so easy to get.

Likewise ResearchKit gives access to a lot of iPhone users, but it is possible, and indeed likely, that iPhone users as a whole will differ as a class from non-iPhone users. They are likely to be more affluent, more middle-class, and so on. It is likely that a lot of good demographic digging can be done to identify exactly how this population varies from the general population, and some statistical massaging can be done.

If you were to study lung cancer but manage to somehow build a study population with no smokers, you would miss the smoking gun entirely. It is possible that the population of iPhone users, whilst huge on a scale that can scarcely be imagined, is still systematically different from the population at large. For example iPhone owners, and especially Apple Watch owners, may well be more affluent. It may represent San Francisco very well, but do less well globally. Or it may look like a pretty good match, but have some subtle but important (and statistically significant) differences which could skew research findings.

Apple are building a massive potential resource, and it'll be a great resource for research into the illnesses that people who track their health using Apple products and who don't mind sharing that information with researchers. Care will however need to be taken to make sure that the results are generalisable.

The next problem I can foresee is identifying cases. When I was doing research interviews for the alcohol dependence genetics study we spent 90 minutes or more doing very detailed diagnostic interviews to identify if the study participants had alcohol dependence, substance dependence, depression, nicotine dependence and so on. Then we took their blood. The blood was the important part. Yet we still spent huge amounts of time interviewing. The reason, we needed to be very sure that they met the tight criteria being used to define what we were interested in. Sometimes diagnoses are wrong, and should confirm them in research. ResearchKit allows studies for people with pre-existing diagnoses, but who is confirming the diagnoses.

The apps that are out there actually do some great work working within the limits that ResearchKit has. It is likely to be most useful for large scale population studies, for recruiting huge and hopefully relatively broad cohorts of both cases and controls, and for looking at common illnesses. They are looking at things which your iPhone can measure, or which sensors connecting to it can measure. The asthma one also gives some basic advice, and that could probably be studied as a low grade intervention.

Despite my many paragraphs of cold water being poured up there, I am cautiously excited about ResearchKit, it gives access to massive numbers of people willing to share information and help with medical research, and a lot of the information is automatically gathered and so probably accurate. I just think that suggestions that it can fix all research overnight are a little optimistic, and it's worth considering that it may carry with it some traps around population bias etc.

ResearchKit is a powerful tool, and hopefully one which will enable larger scale, more accurate, better studies. But not all studies will be a good fit. In the end the most important thing will be the quality of the study design, not the bells and whistles. As long as the tool is used carefully and appropriately, it is likely to be useful.

To fix a Windows laptop

I have a decent 22 month old Windows gaming laptop. It has been useless since last summer when a driver update caused the nVidia GTX 680m to give an Error 43. Only solution... Old drivers. So I moved to the PS4 and all was fine. 

Last night I finally decided to attack it. Reinstall did nothing. I did find some reference to Hyper-V breaking it, but no dice.

Eventually I found one reference to UEFI breaking it, and a recommendation to get a new video BIOS. Sadly the tiny mob who made my laptop are gone, so I had to find the BIOS modding community. I then put a more up to date stock BIOS in, then a modded one, then a modded up to date video BIOS.

Now my new drivers work. But my sound has disappeared! One reinstall later and the sound works, the video works, and if I play my cards right all the updates Microsoft is pushing may even install for me!

Still, it's easy to see why the Glorious PC Master race spend so much time talking online about how great their rigs are, they're doing it from their phones while they fix the broken machines... again.

On Migration Assistant

I bought a new MacBook Pro.

Nine times out of ten if I buy a piece of hardware it's a response to stress, I find setting new hardware up to be relaxing, it helps distract me. When my father was dying I went through a very large number of laptops. It's an expensive habit, but I don't drink or smoke and rarely buy anime any more.

(At this point I should point out the old adage "Anime, drugs would be cheaper" - I don't have a clue how much drugs cost, but I know how much I used to spend on anime. It was a lot.)

So, I decided to get a new Retina MacBook Pro with a 1TB SSD. But for once I didn't want to do a setup from scratch, I'd just sync'd a couple of hundred gigs out of the cloud and didn't want to do that again, even over fibre. So I bought a Thunderbolt cable to do the migration from my old Mac.

It worked very well, but here's the things that happened.

Remember first of all to turn off FileVault on the old Mac. I did this before I started. That meant I could use Target Disk Mode.

I didn't read the instructions from Apple, so the first migration I tried in Target Disk Mode, the connect glitched after 20% of the copy or so and the new Mac thought it was done and booted. Almost nothing was copied. I didn't think of restarting Migration Assistant, I just used Recovery to reinstall OSX and go again.

Second time I tried not using the old Mac in Target Disk mode, which was what Apple advised, it looked like it should work, but when it came time to copy it couldn't see my Home folder and thought there were no files to copy.

So I restarted the old Mac in Target Disk mode again, and this time it worked. Once it booted I had to reconnect Google Drive, reauthorise Dropbox, put back in passwords for iCloud and the App Store and then it was good go. My Backblaze backup picked up seamlessly. I renamed my main disk to the same as my old Mac then told it to do a Time Machine backup too. It had to deep scan my old backup then said it had 310 gigs to backup. I woke up 7 hours later to find that whatever it had done it had worked out it didn't need to copy all those files again. I verified the backup, then checked it still had my old data in Time Machine. It does.

So, I cautiously recommend a Thunderbolt Migration. The first one failed, and Apple's instructions didn't work, but when I used Target Disk mode and the connection didn't glitch it was very fast, and all my old data is over - it's just like my old machine got much larger and slightly faster.

On Colonoscopies

So. My dad died of cancer. Bowel cancer. He was 64 at the time, and the tumour appeared fairly suddenly. I was having some symptoms that were a little worrying and my GP sent me to see a gastroenterologist, and he suggested a colonoscopy.

I, it needs to be explained, do not like needles. Putting them into others no problem, but putting them into me. No thanks. Terrifies me. Always has. So I googled and found some stories about people who did it without sedation. My mother mentioned that my father did one without sedation and thought it was ok. 

So I asked, and my gastroenterologist agreed to do me without sedation.  It was an odd feeling, and not one which I would describe as pleasant, but certainly I have had much less pleasant experiences. I could feel the camera moving around inside, especially going across my transverse colon. The gas inflating my bowel felt odd, and when the camera turned corners it felt like someone pulling inward on my belly button, dragging it down towards my back. So uncomfortable and odd, but not particularly painful.

So, colonoscopy without sedation, fine. And I was all clear - which was good news too.

What was a lot less fun was the Moviprep bowel clearing stuff. It tastes vile even chilled. And drinking 1.5 litres at a time of refrigerated liquid made me quite shivery. The super clear out was not very pleasant. Still had to be done, and I'm glad I did it. 

By Special Request - On Dieting

So, on January 25th 2011 I weighted 19 stone 11.6lb, by November 30th 2012 I was 11 stone 3lb. Today I am 13 stone 3.7lb, but back on the way down from 13 stone 11.6lb. None of this I could achieve without the incredible support of my long-suffering wife, whose dietary intake has been impacted just as much as mine.

I've been asked on Twitter for some rules that helped me lose weight in the hopes it would help some other folks, so here's what I tend to eat. So here goes.

For breakfast I tend to have about 30g of Honey Cheerios or Curiously Cinnamon, or about 20g and 10g of All Bran. I have about 70-80ml of semi-skimmed milk with them. Recently I've added 250ml of semi-skimmed milk in a Nespresso latte to that. 

For lunch it's a tortilla wrap with some very low fat mayonnaise (like 3g) and some hamhock or slices of ham. I used to have Hula Hoops or Quavers with them, but have swapped that for the coffee at breakfast. I drink a Diet Coke at lunchtime.

For dinner it depends on what we have in and how much I've eaten during the day. We tend to have baked potatoes with low fat Flora, sliced ham and a little salt. Alternatively we have roast chicken breast, 200g of mashed potato and some Yorkshire puddings. Or we sometimes have mince and 200g of mashed potatoes. Our most recent addition is braising steak and mash. We used to do sausages, but they ended up as a little too calorific for me in the end.

For "big" dinners we have lean roast beef, mash and Yorkshire puddings. 

If I'm out I tend to eat: 

American food: Fillet steak and mash or fries

Chinese food: Chicken chow mein

Pizza: Mostly vegetables with ham or chicken

Coffee shop: Skinny latte and a wrap of some sort

Chip shop: Cod and chips or a chicken kebab - with chips if I have not had much else, in a pitta if I have been eating a lot

McDonalds: Quarter pounder with cheese and if possible onion rings (their lowest calorie side)

Burger King: Angus burger and large fries (their fries are lower calorie)

KFC: A twister of some sort and popcorn chicken (better than fries beeline it or not)

Cinema: Popcorn, sweet is bizarrely better than salt

In terms of dessert if there's pavlova or meringue then that's what you go for. 

If I want junk foot breakfast the sausage and egg wrap at McDonalds is a nice balance of calories and taste. Better than the breakfast wrap but almost as nice. 

As for exercise, I walk when I can so walk round work and tend to walk at lunch time. I have a bike and cycle round the site in work. But other than that I'm fairly sedentary. But when I stall on weight loss a little cycle or walk kickstarts it again. 

Oh, and where possible I don't snack or eat after about 7pm. Sometimes dinner is after that. But I don't take snacks to bed any more. 

For snacks I tend to have Quavers or Hula Hoops. For chocolate it's kids sized Dairy Milks, Fudges or Fun size Twirls. I love Creme Eggs, but have to account for them. 

That's pretty much how I do it. My diet is fairly restricted, but I've found things I like and that I can eat and lose weight. I'm just lucky I am married to someone who can tolerate my narrow range!

Hope that helps!

 Updated 16:40 - more dinner meals added.

Imagineering

Long ago, back when I didn't know what I was going to do with my life, there was one job which sounded magical. It combined fun with technology and science. It was a great neologism (not that I knew the meaning of the word back then).

I wanted to be an Imagineer. I loved Disney World when my parents and grandmother took me in 1987, and again in 1989 and 1991. Mostly I fell in love with the (then) EPCOT Center. I read a book about the parks which explained there was a Disneyland in California and a Disneyland in Tokyo as well as the one in Florida.

In 1992 about 3 months after it opened we went to EuroDisneyland, and were a little underwhelmed. Then in 1996 I saw Disneyland. I was sufficiently nerdy that what I really wanted was more EPCOT, and so I couldn't see the wood for the trees as regards how nice a Disneyland style "Magic Kingdom" park can be.

In 2003 my fiancee and I went back to Disneyland Paris on holiday and had a nice time. In 2004 and 2005 we managed to get to Tokyo Disneyland, which is amazing. Then in 2007, 2008, 2011 and 2012 we went to Anaheim and saw the original Disneyland and the various evolutions of (Disney's) California Adventure, initially just the two of us and then with our son aged not quite 2 and not quite 3. We even had Annual Passports, despite living thousands of miles away and almost a whole day of flying.

I'm not an Imagineer, and I never will be, but over time my appreciation for the non-EPCOT parks has developed. I can see the pleasure in a "Magic Kingdom" park and the various other parks around the world. I am, proudly I hope, a Disney geek. The various Disney parks are places where I can feel happy and forget myself for a while. They are, to use a stupid phrase, my happy place. My Happiest Place On Earth in fact.