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Thanks for stopping by. My name is John Patrick and Attitude LLC is the name of my company. My activities include writing, speaking, and board service. I am fortunate to have quite a few affiliations and I get to work with Net Attitude people from whom I am constantly learning. Prior to “e-tirement”, I was vice president of Internet Technology at IBM Corporation. Nearly everything I have ever said or written is here at patrickWeb or in my book, Net Attitude. As of today, the patrickWeb blog contains 1,432 posts. I hope you enjoy reading some of them. Get the email version of patrickWeb if you prefer. Find me on Facebook, Google+, and LinkedIn. Follow me on twitter. You can also find me in Wikipedia.

Molecular-level Health Testing for the iPhone

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Stickman with smartphone

With the power of a supercomputer, the iPhone is going to be the host for a wide range of healthcare-related consumer devices and related apps. The latest comes from a San Diego startup named Cue. The company has developed a compact consumer-oriented device that can detect five biological conditions at a molecular level. This is not a fitness tracker. To the contrary, the compact and simplistic looking device is a mini-laboratory that has been years in the making. With a simple nasal swab and insertion into the Cue device, the biological data is transferred to your iPhone and then compared with data from the Cue cloud to determine recommended dietary or other actions (see Cue health tracker brings molecular-level testing to iOS).

When Cue launches next year, it will have five tests available :

  • Inflammation
    The cue can detect the level of C-reactive protein (CRP), a commonly used marker of inflammation. Based on the level of the CRP, a consumer may get suggestions on how to optimize workouts, recovery, and a healthy heart.
  • Vitamin D
    Vitamin D, often called the “sunshine vitamin”, is a hormone produced by the body when the skin absorbs sunlight. Cue suggestions might include spending more or less time in the sun to achieve well-balanced health.
  • Fertility
    Cue says that tracking the detected level of Luteinizing Hormone (LH) is the best tool to determine the ideal time to conceive a child. The device helps you track the LH level as an indicator of fertility trends, and Cue can recommend food choices that are claimed to support fertility. Cue will provide alerts when LH is at an optimum time for conception.
  • Influenza
    Cue detection of flu can enable getting an early warning that can enable you to see a doctor early and get an appropriate treatment started.
  • Testosterone
    Testosterone is a hormone that is essential for health and well-being as well as the prevention of osteoporosis. Cue claims its recommendations can help you plan exercise, training, and diet that can boost your natural testosterone levels.

The Cue device is expected to retail for $300 next year. It is considered a “consumer health product” at this stage, but the company is hoping for an FDA approval to enable the device to join the growing list of consumer medical devices.

EndNotes

1 Bassil, Nazem, Saad Alkaade, and John E Morley. “The Benefits and Risks of Testosterone Replacement Therapy: A Review.” Therapeutics and Clinical Risk Management 5 (2009): 427-48.

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Sequencing the Genome of An Unborn Baby

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Genome

Beginning in 1990, more than 200 scientists collaborated on a $3-billion project to sequence the roughly 3 billion bases of human DNA. Between 2002 and 2008 the cost to perform the sequencing gradually declined from $100 million to $10 million. The introduction of next generation sequencing technology in 2008 led to a plummeting of the cost over the six years until now, bringing the cost down to a few thousand dollars. See Falling Fast for a comparison of the price drop to Moore’s Law.

Does this mean all of us will be sequencing our genomes? Yes, that is likely, and some will push the envelope even further. Razib Khan decided to sequence the genome of his unborn son, who was later born in early June in California (see How a Geneticist Sequenced His Unborn Son’s Genome, Using Do-It-Yourself Biology Tools). Khan believes our genetic data, and that of our unborn children, belong to us. Physicians and policymakers will not necessarily agree, and many debates will be ignited in the months and years ahead.

Khan said his son turned out to be a “normal kid”. He used publicly available analytics tools to study the 43 gigabytes about his unborn son’s genome. Fortunately, he found nothing alarming or even unusual. But, what if he had found some disturbing news such as that his son would be born with some disability or with a likelihood of some future fatal disease? What actions would he and his wife then decide to take and what ethical issues would arise. I don’t think we know even a small fraction of the issues ahead. However, some things are for certain. The price of sequencing will continue to decline and the availability of big data about us and our children will be commonplace.

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Reflections on Bitcoin – 12: A Pause

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Bitcoins in a Jar

Bitcoin is taking a pause as it slips below $500. Some would say it is in trouble, but once again, I say that bitcoin is following the pattern of the web of the mid-1990s.  There are fits and starts, many skeptics, incomplete architecture, and looming threats. CoinDesk, a global news source for Bitcoin happenings, presented it’s State of Bitcoin Q2 2014 on July 10 at the CoinSummit in London. With regard to regulatory threats looming, the CoinDesk report highlights that 88% of the 72 countries that have taken some form of regulatory action were not hostile or in any way contentious.

There were two regulatory items in the news in recent days that spooked bitcoin investors. First was that the Consumer Financial Protection Bureau (CFPB) released a warning to consumers about the potential dangers of cryptocurrencies including Bitcoin, Litecoin, and Dogecoin. The CFPB is an amalgamation of staff that had been at the Federal Reserve, the Federal Trade Commission, and other federal regulatory bodies. They launched a website to collect cryptocurrency-related inquiries and complaints. I don’t consider this development to be a problem. The fact that the CFPB “warned” consumers about bitcoin may have scared people, but warning is what the CFPB is supposed to do — its their job. I would not expect them to come out and say bitcoin is great.

The larger concern came from the New York Department of Financial Services (NYDFS) with their release of a draft proposal for a BitLicense for virtual currency operators. BitLicense represents a sweeping regulatory proposal that could clearly stop bitcoin innovation in its tracks. The Internet has been confronted with similar threats in the past, in both the U.S. and in Europe. Back in 1995, a few of us formed the Global Internet Project, and we traveled around the world meeting with governments to help them resist the temptation to regulate the Internet. We prevailed. I think the same thing will happen with BitLicense. I recommend reading Thoughts on the New York BitLicense Proposal by Jeremy Allaire. He will not be alone in aggressively presenting to regulators about how bitcoin is a good thing.

As written here before, and as you will read in Jeremy’s post, I believe some level of regulation for bitcoin would be a good thing. I get flamed every time I say that, but I am quite sure that it is necessary, and Jeremy articulates the point quite well. The second-quarter bitcoin report from CoinDesk says that the regulatory environment is stabilizing and trending toward the positive. Bolivia made Bitcoin illegal in May, Chinese regulation has slowed, and California legalized Bitcoin in June. Although New York is just one of fifty states in one country, it is highly influential in the world of finance and not to be underestimated. However, I am optimistic that smart people like Jeremy Allaire, Marc Andreessen, and others will be effective in getting the right balance of regulation while preserving innovation.

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The Future of 3-D Printing

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3 D

I was one of the 4,000 people who attended the Inside 3D Printing Conference and Expo at the Javits Convention Center in New York in April 2014. The conference producers reported that a survey showed that 40% of the population sampled said they had never heard of 3-D printing, but it was clear from this conference that it is revolutionizing manufacturing in every industry, enabling new products, and changing business processes for how things get from concept to production. One speaker called it an industrial renaissance.  I think of it as a second industrial revolution that will be equal to the impact of the Internet and that the biggest impact will be in healthcare.

A British gentleman in his 60s was suffering from chondrosarcoma of the pelvis, a rare form of cancer that could not be treated with radiation or drugs. The only option was to replace the diseased half of his pelvis. Such surgery would have been unheard of in the recent past, but with the advent of 3-D scanners and printers, there was a chance of success. A United Kingdom implant maker used a 3-D scan and then printed a custom model of the half-pelvis. Stephen Levy wrote an elegant story (see Man with 3-D Printed Pelvis Walks Again) about the steps involved. The 3-D printing process used a laser to fuse multiple layers of titanium powder to create the new pelvis part. The new part was then coated with a mineral that would be hospitable to the growth of new bone. The surgical team used a surgical robot to assist in the 12-hour procedure. The final step was to perform a hip replacement that fit into a socket of the new pelvis part. U.K. newspapers reported that three years after the complex procedure, the gentleman is able to walk with the help of a cane. Many more marvels are in our future. The breakthrough is not just 3-D printed body parts, but parts of parts that can accommodate growth of new tissue or bone into the replaced parts. See my earlier story about Regenerative Medicine.

Science Daily reported that ground breaking hip and stem cell surgery was completed in the United Kingdom using a 3-D-printed implant. Scientists and doctors have now collaborated to perform hip surgery using a 3-D-printed implant and a bone stem cell graft. The 3-D hip was designed using a CT scan of the patient’s own hip that was transferred to computer aided design and computer aided manufacturing software (CADCAM). The hip was designed using the exact specifications of the patient’s measurements. The 3-D hip was then printed using titanium. The new implant will provide a socket for the ball of the femur bone. Stem cell grafts were inserted behind the implant and between the pelvis. Creating grafts with stem cells from the patient helps insure that the cells are not rejected. In a few years from now, the procedure will seem primitive and the enhanced and more fully automated processes will seem commonplace.

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Reflections on Bitcoin – 11: Dell.com

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Dell

There was no doubt that one day we would wake up to find that a multi-billion dollar e-commerce operation now accepts bitcoin. On July 18, Coinbase reported that Dell.com has become the largest e-commerce merchant to accept bitcoin. See (The Coinbase Blog — Dell.com Partners With Coinbase to Become the Largest Ecommerce Merchant to Accept Bitcoin.) Dell said that the reason they made the decision is that bitcoin offers more flexibility for customers, payments can be made easily from anywhere in the world, and bitcoin offers lower payment processing costs. All true. They expect to offer some product promotions offering a discount if the purchase is made with bitcoin. See Dell.com’s bitcoin payment welcome page. I believe the move by Dell puts pressure on other major online merchants to defend why they do not yet accept bitcoin.

 

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Reflections on Bitcoin – 10: State of Bitcoin

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Bitcoins in a Jar

Bitcoin continues to gain momentum. CoinDesk, a global news source for Bitcoin happenings, presented it’s State of Bitcoin Q2 2014 on July 10 at the CoinSummit in London. There are a number of highlights to their report. Bitcoin price has back come back 39% from the end of Q1. The number of stories mentioning Bitcoin in the mainstream media Rose 439%. The all-time bitcoin VC investment has reached $240 million. There are now approximately 63,000 businesses that except Bitcoin and 5.3 million digital wallets exist to pay for things. Larger and more established consumer brands are adopting bitcoin; e.g. Dish, Expedia, Newegg, 1800flowers.com, and others.

Bitcoin now represents 93.4% of total cryptocurrency market cap. Some pundits believe that cryptocurrency is going to take hold, but bitcoin may not be the major player. As written here before, the grass roots is hard to beat, and with 93.4% of the capitalization, it seems clear to me that bitcoin will be the winner, even if there maybe some technically superior alternatives available.

Bitcoin has the potential to disrupt numerous financial services including payment processing, title insurance, deposits, exchange trading, withdrawal and overdraft, escrow, foreign exchange, trust management, float, collections, transfers and wires, and notary. The total revenue of these services exceeds $3 trillion and the market cap of the companies that provide those services is more than a half-trillion. I see major disruptions ahead.

Venture capitalists see significant upside investing in bitcoin. One example is bit pay, which has received $30 million of financing. Here is why: bitpay has more than 30,000 total merchants. As of the beginning of 2014, they were adding more than 1,000 merchants to their network each week and processing $1 million in bitcoin payments every day. During 2013, they processed more than $100 million in Bitcoin payments.

The total venture capital investment in crypto currency startups to date is $240 million. This is approximately equal to the 1995 investment in Internet startups. Developers see bitcoin as a big opportunity also. There are now approximately 340 bitcoin apps for iOS and 250 for Android. The open question is who will dominate the enterprise-level infrastructure for the financial services industry. Will it be IBM, Microsoft, Amazon, or Oracle? Or, will it be Coinbase, Circle, coinplug, or some other startup that most of us have never heard of?

As written here before, I believe some level of regulation for bitcoin would be a good thing. I get flamed every time I say that, but I am quite sure that it is necessary. The second-quarter bitcoin report from CoinDesk says that the regulatory environment is stabilizing and trending toward the positive. Bolivia made Bitcoin illegal in May, while Chinese regulation has slowed, and California legalized Bitcoin in June. I am optimistic.

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Billy’s Other Downtown Diner — Not Your Ordinary Diner

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Bill and George at Billy's Downtown Diner

There are quite a few stories on patrickWeb about the Trike. It was a sad day when I sold it, but I am happy the person who bought it from me on eBay is a fine gentleman, and he and I and a friend of his got acquainted at Billy’s Downtown Diner in Bethlehem, Pennsylvania last summer (see last year’s post about our rendezvous). We planned a “Second Annual Billy’s Diner Breakfast” for today. It turns out that the diner where we had breakfast last year is closed for renovations, but we discovered that Billy has a second restaurant in Allentown, PA. We expanded the group to include my wife plus my brother and his wife. Three Harley-Davidson trikes and my can-am Spyder RT Limited pulled up to Billy’s at 9 a.m.

Bill and George, my new Trike friends, and my brother are kindred spirits, for sure. We had a good time talking about motorcycles, rides, and of course healthcare.  I won’t cite any specific ages other than me about to turn 69, but I can say that the sum of the ages at the breakfast table was more than 425 years!

This post would not be complete without a comment or two about Billy’s Downtown Diner. They have an amazing piece of technology that produces great orange juice. They drop oranges in the top and out comes fresh juice. I don’t know where the peels go. When it comes to the food, the menu has something for everyone — unless you have any dietary concerns. If I ate there regularly, I would have qualified as a congestive heart failure patient in my research study! However, I don’t think having Huevos Rancheros once a year will kill me. Ingredients?

Huevos Rancheros: Corn tortilla topped with refried beans, chorizo sausage, melted pepper jack and cheddar cheese with two fried eggs, guacamole and green chiles. Served with Idaho homefries.

The ride back to our lake house in the Pocono mountains was much longer than expected, and the temperature was in the low 90′s. We took the back roads, and things were going great until we ran into a detour at the same time that we went to reserve fuel. The detour was a wild goose chase, and the GPS was as confused as I was. When we found a gas station, my 5-gallon tank took 4.88 gallons. The ride for the day was just shy of 200 miles. I think we all look forward to the “Third Annual Billy’s Downtown Diner Rendezvous”.

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Reflections on Bitcoin – 9

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Bitcoins in a Jar

Bitcoin continues to gain momentum. There are different estimates of how many merchants accept BTC, but there are thousands. Coindesk said that innovative merchants have been installing bitcoin payment-processing services in their stores and integrating it into their POS and ordering systems. Coindesk points out that bitcoin is a great way for merchants to appeal to tech-savvy customers. Some recent and notable additions to the merchant list include DISH, 1-800-flowers.com,  Newegg, Expedia (for hotels), New York Holiday Inn, Digital River, and 1000bulbs.com. Although no commitments were made, eBay CEO John Donahoe said that PayPal “will have to integrate digital currencies”.

On the government front, the U.S. Marshals Service conducted an auction of 30,000 bitcoins that were seized in a raid of Silk Road, an illegal drug operation. The value of BTC was lower the week prior to the auction, perhaps in anticipation that “dumping” 30,000 BTC would depress the price. I did not think so, because there are nearly 13 million BTC in circulation. As suspected the auction went off without a hitch and the price of BTC then rose more than ten percent. Venture capitalist Tim Draper was reported to be the sole winner of the auction. In partnership with a startup named Vaurum, Draper plans to use the BGT as a source for new trading platforms in emerging markets. This should further cement the global role of BTC in countries with unstable currencies. Since the supply of BTC is limited by the bitcoin algorithm, expanded use of BTC should mean the value of BTC will increase.

On the exchange and software front, Coinbase announced that they will be offering bitcoin vaults. Bitcoin wallets are great for day-to-day spending, but storing more significant amount of bitcoin you may be holding as an investment is more suited to the Coinbase Vault, which will add an extra layer of security. I look forward to adding a vault to my Coinbase account.

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My Doctoral Journey – Part 9

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ScholarA number of readers, and the university, have asked me if I would recommend University of Phoenix. It depends. I had searched for an accredited, online, healthcare-related doctoral program. U of P was the best one I could find. The structure of the program, with 25 online courses and three 7-10 day residencies in your choice of Phoenix, Washington, or Atlanta, was well organized and rigorous. I will describe my prior college education and the method of learning at the University of Phoenix, and discuss pros and cons.

I earned an LLB in law in 1971 from LaSalle Extension University (LSEU). LSEU was a nationally accredited private university based in Chicago, Illinois. Courses were delivered by “distance learning”. I read a library of printed law books, wrote assignments with a pen and paper, submitted them by the U.S. Postal Service, and received grades in letters delivered to my physical mail box. I started the courses in 1969 while I was in the U.S. Army, and finished the degree in 1973. (LSEU was founded in 1908, and ceased operations in 1982). An LLB is no longer relevant, but I did learn a lot, and gained respect for today’s lawyers who earn a Doctor of Jurisprudence (J.D.) degree. It is a bit hard to imagine how archaic the LSEU method of learning was compared to what is available today at a massive open online course (MOOC).

I attended “brick and mortar” universities for a bachelor’s degree in electrical engineering at Lehigh University (1967) and a master’s degree in management at the University of South Florida (1971). During my years at these schools, there were no Macs, PCs, iPhones, Android, nor the World Wide Web. The word “device” meant an object, machine, or piece of equipment made for some special purpose. There was no concept of a computer that fit in your pocket or purse. The two universities each had one computer. Lehigh had a GE 225 and USF had an IBM System 360 Model 67. Neither would fit in the house where I am writing this post.

University of Phoenix is predominantly an e-learning school. The online courses are taken at the e-campus. Twenty-five courses taken over 43 months had an average of 15 students in each. The courses were each eight weeks in duration. For most of the course, the first two weeks of the course were dedicated to reading three to five text books, mostly e-books. The professor of a course posted weekly discussion questions that each student answered in an online post. Each student was required to write at a half-dozen posts responding to what other students had written. A weekly paper of 1,500 to 5,000 words served as a basis for the course grade. The most significant benefit of the e-learning environment derives from learning from the other 14 students, some of which had vast personal and professional experience. In the traditional university, 15 students learn from one professor. At the e-campus, I felt that I was learning from one professor and 14 students that had each worked in healthcare for 10-30 years. Like a traditional university, University of Phoenix students and faculty had a bell curve of capability.

Online learning is not for everyone. The learning model is very good, but it requires a significant commitment of time on the part of the student, and support from friends and family. Although the online model offers flexibility, the eight-week courses have deadlines and participation requirements. The text book reading assignments required significant amounts of time. It is hard to take a vacation or a business trip while you are taking a course. Most of the courses have learning team assignments. These require active participation on a timely basis. Many of the students in my cohort held full-time jobs while meeting family and caregiving responsibilities. I marvel at the commitment of many of my fellow learners.

The area of greatest concern during the entire doctoral journey was the administrative and information technology (IT) processes of the university.  For a university that has a College of Information Systems and Technology and offers both bachelor’s and master’s degrees in IT, they do not totally practice what I assume they teach. The e-campus is online but rather than utilize contemporary cloud computing approaches, the classes used attachments of Word and PowerPoint documents. When collaborating as part of a “learning team”, it was awkward at best. A typical posting would contain “who has the latest version of the team paper?”

A second admin/IT concern was with the process for submitting and gaining approval of the research dissertation. After the dissertation committee members all approved the draft by January 12, the next step was to submit the dissertation and a half-dozen related documents to a new workflow system at the university called the Editorial Manager. In theory the new system would eliminate email-tag and uncertainty plus provide 24×7 status information. This turned out to be untrue.

A central and essential element of a doctoral program is the dissertation committee. I was fortunate to have an outstanding, supportive, and constructive committee. The chair of the committee was a member of the faculty and was my advisor throughout the process. The other two members of the committee included another faculty member and a medical doctor from the hospital. After my submission of the dissertation on January 12, the committee members were asked to review the manuscript again following a detailed rating scale. They completed their review and approvals on January 14. At that point, the system showed a status of “Under Review”. It remained that way for 45 days. No feedback. No target review completion date. A fourth reviewer had been appointed by the university. The committee members nor myself would know who the reviewer was. An independent review is appropriate and adds integrity to the overall process. However, there was a lack of accountability and no expectation as to how long such a review should take.

After the 45 days, I received an email outlining 16 requested changes to the dissertation. Some were trivial and some were substantive. I spent a week researching the questions raised and editing the document with the requested changes. The committee members then approved the revised dissertation and I submitted it to the Editorial Manger with all the related documents (unchanged) again. Included with the updated dissertation was a change matrix that I used to list each of the 16 requested revisions and an explanation of what changes I had made. The “process” now indicated “Under Review” for a second time. No feedback. No expectations as to how long it would take for the reviewer to look at my changes. It took the three committee members one day. It took the external reviewer 13 days — not hours — days. I am surely not alone in observing that the doctoral dissertation process is not an efficient business process. My tuition was paid in full. I had completed 62 credit hours of academic studies. At this stage, I was powerless and the university was unresponsive. The administrative delay caused me to receive an email from the university that said “According to our records, it appears you may no longer be with University of Phoenix.”

On March 25, I received an email saying that the reviewer had approved the dissertation “with changes”. The six additional changes were reasonable and mostly constructive. Since no resubmission was required, I made the changes and scheduled the oral defense for the following Friday. The purpose of the oral defense was to provide a final checkpoint in the journey — to validate if the doctoral candidate can explain his or her research, conclusions, implications, and recommendations. I made a 26-slide presentation to the committee (by teleconference), which was then followed by a Q&A session. I then dropped out of the conference call to allow the committee to decide: pass, pass with changes, or fail. Ten minutes later, I received a call from the committee chair informing me that the dissertation was accepted without changes. Following that I received an email saying “Congratulations Dr. Patrick! Enjoy your weekend.”

On March 28, the doctoral journey was over – almost. The last step is to get the dissertation published. I uploaded the final approved dissertation on March 28, immediately after the oral defense. It is now July. More on this last step coming in a final doctoral journey posting.

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Ridgefield

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Ridgefield Magazine interview pic of JRPI feel very fortunate to live in Ridgefield, Connecticut. A few weeks ago, Geoffrey Morris, President at Morris Media Group and publisher of Ridgefield Magazine, and I had a chat about the future of healthcare and the Internet (see Ten Minutes with John Patrick). The following week, I gave a lecture at the new Ridgefield Library on the same topic.

Ridgefield Library

The new library is beautiful and has a leading edge program room for lectures. Approximately 100 people attended. Many people are interested in the future of healthcare. I am planning a new book that I intend to name Health Attitude. I will be launching a website for it this month and will seek input on the matters of most interest to readers.

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