Irvine ultrasound videos

If you have in some way been involved in ultrasound you surely haven't missed hearing Chris Fox mentioned and his awesome ultrasound lectures. The Ultrasound podcast has made him appear as a god-like figure and judging from the work he's been putting into ultrasound teachings, I think they're absolutely right. You will not find any better ultrasound video tutorials in the Milky way!
Not only is his work great but he has shared them all for free. They have been available on Youtube and iTunes. Youtube got a concussion recently and thinks they're infringing copyrights and iTunes is not for all. That leaves one final option for downloading the lectures directly to your computer - the torrent system.


First of all, using torrents to share content is 100% legal, it is sharing copyright content which is not. Using torrents you will download from multiple sources instead of a single one, giving you much faster download speeds. A whoppy 10 gigabyte collection like Chris' ultrasound videos thus can easily be downloaded in 30-60mins.

First you'll need a torrent software client. uTorrent has a good reputation and has all the features needed, it's free so go and install it.

Then you need the torrent file which has the description of the contents and where to look for it. You could google something like "irvine ultrasound torrent" but there are some other similiar torrent files out there which do not include the whole 10gb package. Also, there are many bad torrent websites forcing ads and even bloatware on your computer, thus I recommend www.isohunt.com which I find better than the others and have used for a while. You can also download the file directly from my Dropbox here
 http://dl.dropbox.com/u/484919/Ultrasound%20Video%20Lectures%202011-2012-Uni%20of%20cal.torrent

That's all there is to it. Open the torrent file in uTorrent and it takes care of the rest. Remember, torrents live only as long as those who have already downloaded continue sharing them. Please keep your connection open, you can set a max upload rate in the torrent program so that your Internet connection isn't clogged.

A few shoutouts for productivity

These are some very interesting discoveries I've stumbled upon the recent weeks which I think may be useful to you.

Stereomood

http://www.stereomood.com
Stereomood is one of many Internet radio stations, providing free, streamed music. What makes Stereomood different is that you can choose the music channel appropriate for your mood. Thus you can listen to ambient background music for paper-work, inspiring drummy tunes for an energetic hour or just dreamy instrumental music while taking a nap. If you suddenly feel like jumping to the "opposite mood" there is a button for that, for example when returning to work after napping!

The mood tags are collaboratively done by the listeners so they are pretty natural and music rightly tagged most of the time.

Everytime you hear a tune that impresses you more than others you can "favorite it" for playing later. For all music there's a link to buy the tune or whole CD if you like the artist.

Finally, there's a smartphone app for both iPhone and Android.

TalkTyper

http://talktyper.com
Here is a little gem that caught me by surprise as I didn't realise how easy it has become to translate speech to text now a days. Well, TalkTyper, does that exactly and it does it amazingly well. As you talk to the microphone sentences are converted to text almost instantly and collected in a mini-notepad.

You can select input language and all major languages are provided for and I expect the list to grow quickly as the web is in the background using a Google based speech to speech server. On a technical level, it is a built in Chrome feature (version 11 and above) being decorated with additional tools.

An excellent productivity tool worth knowing about!

Online XPS to PDF converter

http://xps2pdf.co.uk
Internet Explorer is notoriously stubborn, refusing to implement features users need. Printing a document to PDF file is one such feature, whereas Chrome allows you to just select "Save as PDF" as target printer. Explorer has a similiar feature but uses a Microsoft only technology called XPS instead of PDF. And most institutions force us to use Explorer. Thus, an online XPS to PDF converting tool was very much welcomed in my productivity link/tool collection.

Pixlr

http://pixlr.com
This is the web-application of the century and should be topmost in this list but I've mentioned it already a few times. It's the one web-app I use almost everyday and is indespinsible while working with images or photos. It has all of Photoshop's most used features, it's free, it can sync your images with Google Drive or Picasa... its' totally amazing. If you haven't used it, you should now!

Finally,  a few IT tips

I love keyboard shortcuts as they make computer life so much easier - these are the latest I've discovered and definitely worth sharing!

Middle-mouse-clicking a link in your web-browser (Chrome and Firefox at least) will open it in a new tab. Also, middle-clicking an open tab closes it. So lovely!

While doing a Google search, you can anytime start writing again if you want to change your search - just start typing. No need to move mouse pointer to input field!

Impatient while scanning a Youtube video? There's a button for changing playback speed, you can play up to 2x times faster, great for example to quickly browse through a ultrasound tutorial you've seen before. Notice this works only in the HTML5 player, switch here if you're still using Flash.

Five IT skills every doctor should learn and master

IT is not a very sexy term for doctors' ears despite having potential to boost productivity and clinical skills. I find it hard to convince my colleagues that IT could be one the hopes for battling rising costs and burden of modern healthcare. Productivity and effective work is the one most important factor today - a doctor who is highly educated and trained is a much too valuable resource to be seen wasting time fighting a computer or software. Computers are everywhere today and can't be dodged - we are practising desktop medicine instead of bedside medicine. Same goes for the information tsunami, you have to ride it instead of being drowned in it. So I would like to share with you what IT skills I think every doctor should learn and master.

1. Touch type writing

Doctors write text all day long and no single skill is as underestimated as writing fast, many doctors picking the keyboard with one finger for same typing speed as Stephen Hawking.

Words per minute:
Stephen Hawking 15
Slow writer 20
2-3 days training 60
Professional writer 90
Reading aloud 150
World record 216

Training for 2-3 days will give you 300% gain in writing speed - such a number in the NNT world would normally be a breakthrough article in the medical journals!

2. Google Docs (Drive)

I have surrendered to my brain and admit that however I try I will not be able to remember everything. My brain is a powerful processor of information but for organizing and storing it I need an online, easily accessible notebook. Google Docs is exactly that and has become an indispensable tool in daily clinical work. Everything I have learned the years - tips, links, references, quotes, statistics - I have noted in a well organized collection of text and images for easy retrieval bedside or at computer.

Besides being a huge personal notebook, Google Docs will forever change the use you approach information and data - ultimately leading to the 'mobile, paperless office', essential for organizing and accessing your work from wherever you are.

# A vodcast/post about Google Docs in clinical practice is just around the corner - stay tuned! #

3. Social media

Social media for doctors is essentially
1) Great educational material coming online (and free) through blogs and related technologies.
2) Communications platforms (Twitter, Google+ etc) for expanding your contact network - where your colleagues sharing their most valuable learning points and lessons.

Learning to use social media is not about any one technology, like starting Twitter, it is a new lifestyle. It may not be for all but for those who master it I can promise doors opening to a completely new world of e-learning, yielding clinical skills not possible before. Almost every day I find my self implementing something learned from my social media network to patient care. Learning ultrasound would have been impossible for me without social media as it has provided me with teaching material to support me.

4. The web browser

Software installed locally on your hard drive is becoming a thing of the past as data cloud and web-applications take over. The heart of this revolution is the web browser and it is the one software you really have to know inside and out. Tabbed browsing, using the Omnibar (for Chrome), knowing the keyboard shortcuts, working with text (special copy & paste functions), synchronized preferences etc... Mastering these will give you maximum performance while doing your work. And for a busy doctor, productivity is everything!

5. Genuine interest!

Just as the best doctors are those who are genuinely interested and active in their field - the same goes for IT skills. Strive to always become better and have open eyes for improvements, acknowledge that your way of doing things today may not be the most efficient one. Most of your daily tasks involve IT in one way or another and you will find lots of colleagues, especially younger ones who're born with IT at their hands, who are willing to teach you and help you.

An everyday example of IT in use!

Finally, an example from work - a serbian patient who repeatedly came to the ED with mostly non-compliance based problems because he didn't understand his medication list. Problem solved with a simple IT tool, Google Translate!

Being a tech competent physician is key to productivity and efficiency at work, a win:win situation for you and your patients. In the menu above you will find a list of some 10+ posts about technology, IT and social media for doctors. I highly encourage you to check it out!

The ultimate Google+ widget for microblogs - help needed!

Ok this is a medical blog, so what is this discussion doing here you will ask? Well - many visitors here are (medical) bloggers and this is a very practical scenario that needs to be solved. So I'm asking the blogger community for advice, stay tuned and you'll learn some!


So you have a blog and you are using social media also for microblogging - ultrashort comments for quick interactions with your community, "Twitter" style. You want these microblogs to appear on the side bar of your blog - we have all seen the Twitter widget streaming recent tweets. Great for the small stuff that you don't feel like making a lengthy blog about but still want to share with your followers.

Well Twitter is all great but being minimalistic I want everything under the same roof and for me that's Google. I prefer using Google+ for microblogs because of convenience - no extra login or external website to browse to as everything is easily done from the Gmail interface or via my Android. Besides, Twitter is limited to a frustrating few 140 characters and Google+ provides for an excellent platform for professional networking and communications. Twitter is lacking for me.


So a Google+ widget is needed to display these microblogs. That's where the issues start, let me explain.

Google+ is based on Circles which are primarily thought as a layer of privacy. You can post something privately to your colleagues through a "Doctors' only" Circle so that your other friends and family members don't read that. It's tempting to think of Circles as a "channel" or "group" feature - a little like #hashtags are used to categorize posts - but first and foremost it is for privacy. Thus, your Circled posts are not open to the Internet as Public posts are and there is and will never be any RSS stream from these, it would simply defy the function of Circles.

A hack might be to use email forwarding; add an email to the doctors only Circle so that the post is forwarded to some service which adds it to a stream. Sounds good but the details are fuzzy - I will have to work on this. IFTTT might be the platform providing this.

So why not just post Public all the time and stream that to a widget? Well that's no good either - my blog followers would never want to read my non-medical posts. And vice versa - posting Public all the time on Google+ would drown my other followers in topics they are not interested in. Public posts using #hashtags seems like a nice intermediary solution but again I would be overflowing my followers as a whole and there is no way to make a stream from hashtags in Google+.


So I started a Google+ Page as a social-backend for my blog. All posts there are public and thus easily streamed to a widget. There are two major drawbacks with  this way;
1) Notifications on Google+ Pages cannot be forwarded to my personal Google+ or email. I'm too lazy to login to Page just to check for notifications. I like to follow up posts through comments and it's too cumbersome from a seperate Page. Remember a Page is designed to be managed by one or more individuals.
2) How do I choose if I should post a microblog with my personal Google+ profile or the blogs' Page? My  'librarian oriented' brain cannot have my posts disseminated all over in an unsystematic way!


Best of all thus would be if I could post on my personal profile and these then were forwared to the Google+ Page as a public post from where it is then displayed on the gadget. Again I'm looking into the email forwarding possibility but it seems to me there are no options currently available.



So a call out to 'bloggers united' - do you have any suggestions?

Trying to grab that text? Use OCR!

Every now and then you will encounter situations where you can't use the copy & paste technique. Indispencible in the hospital to quickly write consultation texts, letters etc. - nothing is more frustrating as when the medical record system (in an hilarious attempt to stop data theft) cripples the copy/paste function.

Other scenarious where you might need to quickly get some text in electronic format is that when you get a medical letter from a foreign patient. It has happened to me a several times and once in the middle of the night where the patient had acute dyspnea.

Here is what you need to do to do online OCR, "Optical Character Recognition"

1. Convert the text to image

If the text is on your computer you can use any screen grab app to just capture a screen image while having the text open. A favorite of mine is Lightscreen, a portable app thus allowing you to install on USB drive or within your local folder without administration rights.

Text on paper needs to be scanned of course - easily done in modern offices. Make sure the new image is in high quality, PNG is a lossless (no pixels lost while compressing) format highly recommended.

2. Remove patient identifying information

As we are going to use an online application we need to delete any information that might identify the patient. Not that I distrust the website used, just a good habit "just in case".
Open www.pixlr.com - a free, online Photoshop mimic where you can easily manipulate your new image. Just remember to save it back to PNG format agin.

3. Convert to text

So here's the magic ingredient in the cake; www.onlineocr.net is an online tool which takes an image and converts all text it can find to electronic format. Why this one stands out from the other lots out there is that you can even select which language to use! Now that wasn't so difficult!


And now you can do what you want with your text. If you're translating a medical letter just take it to Google translate.

Signs and syndromes in the emergency department

You remember the ad "you can't beat the feeling"? What they didn't know is that there actually is one thing that does beat the feeling of a fresh Cola can - eliciting a sign you've learned in medical school, glued to your cortex years ago and finally making sense! Just like fresh blood on a CT can't lie about subarachnoid hemorrhage, a positive sign can verify a diagnosis you're having in mind. And that is indeed a feeling of excitement and victory. Even drugged Dr House can't hide his wide nostrils of joy as he's hit the nail on the head.

Therefore I decided to learn more signs and even syndromes I might encounter in my emergency department. And it has already made wonders - recently I learned about Rovsing sign and what do you know - next patient coming in with ambulance was a comatose elderly man having fluctuating, horizontal eye movements caused by uremia, a positive Rovsing sign... HOWZAT!

But that's what wise masters have been telling us all the time, doctors or not - what you go looking for, you will find. It's an universal law - and a Russian proverb!.

So I decided to make a list of signs and syndromes I could expect to encounter in my emergency department. In the spirit of social media I want to share this list with you, in hope that it will also increase your skills of diagnosis and pattern recognition. As most of my notes in Google Docs (now Drive) the list is a dynamic one which I am constantly editing to make better. Please feel free to use the comments for feedback or additions if you have some favorite sign or syndrome that has helped you in the ED.

Signs and syndromes in emergency medicine

To complement this list I also have a special collection in my Picasa web album where I collect medical images representing signs or diagnostic clues in the same manner as a picture says 1000 words.

In case you are interesting in more of these there are even more detailed lists on the Internet although I find many of the entries there not so relevant to the ED;

http://medical-dictionary.thefreedictionary.com/disease
http://medical-dictionary.thefreedictionary.com/syndrome

Finally, credit must be given to some sources I have used extensively to make the list;

• Wikipedia
• Whonamedit.com
• fpnotebook.com
• gpnotebook.com
• and others who I haven’t been able to identify (just old notes from med-school)

Social media for doctors - where the brains meet

This post has been moved to here...

Why Google+ is better than Facebook as a professional social media platform

From the battle of social media platforms have come three giants we all know; Twitter, Facebook and Google+, all very likely to stay for a while. Twitter, restricting posts to 140 characters, has a different approach and has turned out to be an excellent medium to discover new, interesting information. It's also good for making new contacts but minimal profile information and communication features makes it limited for anything more than that. And thus it isn't even considered to be a competitor to the other two giants, Facebook and Google+.

Many have said that Google+ is nice but it isn't making the expected impact and I see most my colleagues ignoring Google+ because it lacks the critical mass of users to have any power. I think this is a pity since Google+ has some powerful tools and features and in my opinion is a much better network for professional networking, unlike Facebook which still today has reminders of it's roots in a network for college students. As I learn more about Google+ I find my self leaning more and more towards it and actually stepping away from Facebook as it is becoming just too much nonsense. Let me explain why.

Google+ enters the scene and breaks records

Facebook has been around for years while Google+ is the new kid on the block but it has Google's enormous back-end with complimentary IT tools- and services not to be undermined. Integrated with Gmail, Picasa and Google Docs (now Google Drive) amongst others it is so much more than just another social media platform and has many tools to be more than an entertainment platform. This along with excitement, as people were eager to see Google's implementation of a social media network, made Google+ welcomed as it was launched in July 2011. Records were broken in just a few days as users flocked in to try it out but the sunshine story faded as most users didn't return. What else was there to expect, it was like coming to a banquet full of food but with only a few attending. Google+ newbies got lonely.

Facebook is not a professional playground

Facebook was started as an online network for college students. Nobody could have foreseen the tremendous growth Facebook was to go through in the coming years but this growth spurt has also turned out to be Facebook's Achilles heel. As a network for college students, privacy was never an issue - the kids wanted to see their classmates doing heroic or stupid things and seeing someone dead drunk in a bush on the schoolyard was simply cool. Posts were open to everyone and as Facebook opened to the rest of the world this non-privacy approach lived on until new users started crying out, asking for fixes. Major issues were plastered and privacy settings introduced but too complicated for users to grasp. Still today, the average user has no idea how much of his or her posts are visible to other contacts or even rest of the world through the search engines. The fact remains; on Facebook, you mostly read everything from everyone. Not only is it a privacy concern but also you are easily overwhelmed by useless information like 'Joe just ate a meatball yesterday' and 'Jane Liked it'. A little like a kids playground if you ask me.

Google's approach: Circles

This is not the kind of media I want as my professional platform (nor for private purposes!) and Google was smart as they recognized the problem and came up with a solution: Circles. For each friend (contact) you add on your Google+ account, you define what circles your friend should belong to. A little extra work compared to Facebook's way of just adding a friend, but this way yields a high ROI (return of investment) as you, through your Circles, define not only who can read your posts but also what you want to read on your wall (called Stream in Google+). So when I want feedback from my emergency medicine colleagues I will post that post only to that circle and if it's personal family photos my colleagues will not have to read that. It is very important you understand this is not only a major leap for privacy but also a way to have your wall fed only with what you are interested in, you will not read about your friends Like-ing the meatballs somebody else ate.

To Facebook's defence, they have actually added the 'Lists' feature to try to achieve the same results and even a mute button for individuals - but these were introduced too late. Nobody has time or energy to go through their hundreds of contacts and group each and everyone to a list. Google+ does this right from the beginning and even does it with an intuitive and graphical drag 'n drop interface to make the task of circling friends an easy one to do, almost fun even.

Hashtags for discovery

Social media is a great tool for discovering new content, you can do that either by watching posts from your contacts or follow a particular channel. The hashtag (#) is a simple technology for the latter; using #emergencymedicine as a search pattern on Twitter or Google+ will show you in real-time what people or posting, relating one way or the other to emergency medicine.
You can also save hashtag searches (Google+ calles these Sparks) for fast access later (your saved searches also affect what is displayed on your main Steam ('wall'). This is yet another feature to minimize the clutter you are confronted with on your wall (said a little rougher; cut the bullshit) as you can easily select what 'channel' you want to read from. So when I don't feel in the mood to be fed with random clutter I click the Emergency Medicine Doctors and read only posts from these. Or I click #Linux and read only what's going on in the Linux world. It's a feature you will love once you've met!

Facebook lacks this feature and actually returns a rather awkward, cluttered list of search results if you search 'emergency medicine' without the hashtag. Google+ returns a more intuitive list of results and even attempts to prioritize them to fit your interests.

Google Hangouts for easy video-conferences

Many have tried to provide for a decent interface for video-conferencing and most have failed, succumbed to technical challenges or just lack of users (in todays competitive climate you literally have to give gold to attract users). With Google+ the Hangout was introduced as a easy and quick way to start a video conversation with up to 10 users simultaneously. This is a tool companies would have paid thousands of dollars for only few years ago and is now available for free.
Add to this how easy it is to discover and contact interesting people on Google+ and you should realize the potential. Online discussion panels or debates about hot topics in emergency medicine... and you can participate from your living room - how awesome is that!

Other small stuff I like about Google+

• Google+ integrates very nicely with the mothership, Google's search engine, for smooth and easy publicity of your posts on the Internet (if you wish so). Defining posts as public or confined only to your selected circles is very intuitive and hard to do wrong. Facebook has had years of criticism for this as the settings were introduced late and are cumbersome to use. 
• Your posts can not only be deleted if you regret but also edited, something that Facebook amazingly doesn't allow.
• Google+ is tightly integrated with Picasa, Google's excellent photo & album manager. With Google+ you can instantly edit and arrange your photos stored on Picasa and those you add through Google+ are instantly accessible through Picasa. With the Android app (I don't know about the iOS or Win versions, anyone?) you can ask for all photos to be automatically uploaded to your Google+/Picasa account, sparing you the hassle of plugging the phone to a computer to get your photos. 
• On Google+ you don't get the feeling that you are a puppet being used to create treasure for money makers in the market. Advertising is minimal and I don't expect Google+ to disgust me with the idea of asking for money for prioritized status updates as Facebook has just introduced.
• Finally, this is what had me come back repeatedly to Google+ for good laughs and inspirations: animated GIFs. Just try the #GIF channel for yourself, be warned - you are going to have a hard time stepping away from your computer!

Further reading

• Google+ is better than Facebook - and this is coming from PC Magazine, a journal that usually promises Microsoft products above all
• Graphical Google+ features intro
  Great introduction to the major features of Google+
• Quick guide to Google+ basics (aka Help / Welcome Kit)
  From Google+ users to newbie Google+ users!
• This Is Why You Fail At Google Plus
  A popular and well written article for Google+ newbies wanting to learn from others' mistakes.
• The difference between Facebook and Google+
  Facebook helps you keep in touch with the people you already know, Google+ helps you get in touch with the people you want to know.
• KevinMD: Why doctors should embrace Google+
• Automatically posting to Twitter from Google+

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The PEEP mystery solved

Soon I'm finishing my 6 month ICU rotation, a period full of wisdom and clinical pearls which will certainly help me give better care in the ED in the future. I plan to write more about this later but today I was shown a short video illustrating what PEEP really does for the lungs. Seeing is believing, check it out!


 

The cryptic abdominal pain

I really love the thrill of evaluating the patient with abdominal pain of unknown origin. True abdominal pain is a symptom, not just a complaint and an underlying pathology should be sought. Emergency physicians have a critical role in diagnosing what can and should be treated and sending home everything else. They are the gatekeepers and must know uncommon diseases presenting as common symptoms.
I recently had an interesting case of abdominal pain which had valuable take home lessons for the EP, I would like to present it for you to share my learning points.

A 50y/o male who was treated three years ago for non-Hodgkin lymphoma and was cured. He now comes to the ED with two day history of sudden onset, aching pain in left lower quadrant. It was worse when he was lying on his left side. No fever/chills, nausea, diarrhea or other symptoms. Despite pain been able to eat and is not generally sick or affected by his pain.

Patient is worried that this might be his lymphoma coming back since at that time he had a similar diffuse central, upper abdominal pain going on for 5 weeks until he finally had his diagnosis.

On examination the patient has normal vital signs and is afebrile. Abdomen is non-distended, soft on palpation with localized pain about 5x5cm in left lower fossa. No muscle guarding. No palpable tumors. Lab tests all normal (WBC, CRP, hemoglobin, electrolytes, LFTs). A clever surgeon had a theory and asked for a CT abdomen which reveals a diagnostic image.

What is the diagnosis? (hint: look in LIF)

The radiologist notices "stranding of fat near colon descendens and nearby an enclosed capsule containing fat". Bull's eye for the surgeon: epicloic appendagitis it is indeed. Patient is sent home on NSAIDs to expect full recovery within 1-2 weeks.
Now this is certainly a rare condition but definitely worth knowing as we are working with abdominal pain all the time in the ED. The patient was indeed very sensitive in exactly that 5x5 area but unaffected otherwise. It was tempting to send him back home but it just didn't make sense, there had to be something explaining his pain. So in the future it will be on my ddx list of unexplained abdominal pain.

Another case of abdominal pain

Then there was another take home lesson from this particular patient. It turns out he some years earlier had a long and worrisome period of pain for 5 weeks until he screamed at the doctors to order a CT. And he was right... His epigastric/thoracal pain was at first diagnosed as 'gastritis' (the all too commonly used trashcan for unspecific symptoms!) and treated unsuccessfully with PPIs and later Tramadol. When the patient couldn't sleep any more and caught fever even he comes back and gets a CT which shows a 17x15x12cm big retroperitoneal monster tumor!

What are the take home lessons?

First of all, we need to suspect lymphoma to find lymphoma. The lymphomas are after all a relatively common disease (about 5% incidence), highly curable but presenting in many different ways. All medical textbooks describe unexplained abdominal/chest pain as one of the presenting symptoms so the lawyers will expect you to know that.

History and clinical examination are as always the cornerstone of diagnosis - nothing new here, just that they are all too commonly ignored. "B-symptoms" (fever, night sweats, weight loss), enlarged lymph nodes >2 weeks duration (be careful with unilaterally enlarged tonsil in children!) and if bone marrow is involved expect hematological symptoms (anemia, infections, bleeding...).

Use your ultrasound! As bedside ultrasound is becoming available in every emergency department there is no excuse of not making a quick look. If you know FAST you know how to localize the liver, spleen, aorta and surrounding area. Of course you are not expected to find deep enlarged lymph nodes but the above mentioned monster tumor would have been hard to miss.

LD/LDH is a cheap labtest worth considering, neither sensitive or specific but abnormal value should raise your eyebrows.


Any tips or thoughts from the readers?

Choosing the best technology platform

The Commodore Amiga story is one I like to tell to examplify that even the best technology will sometimes succumb to market (money) power. The Amiga was introduced in 1985 and was at the time a technological breakthrough as it could easily display colorful, animated graphics and play high quality sound while PCs (and even Apple) at that time were black & white and had one single speaker that could only beep. It's operating system was cleverly designed and handled windows and multitasking (like playing music and writing text simultaneously) with a breeze while PCs at that time were playing hangman with you on a green DOS screen.
The Amiga was geniously designed by brilliant engineers, incorporating clever and advanced technology so that it was way ahead of it's competitors and thus jaw-dropped everyone who saw it in action, below is one of the first demos showing of Amiga's capabilities


Despite technological advances, the Amiga was elbowed out of the market mostly because the public's attention was where the money was and vice versa, so IBM, Microsoft, Apple and the big giants won with their inferior products.

For me, like many, this was a sentimental battle. Not only did I love my Amiga but I felt the world could gain so much with it's advanced technology. The revolution came finally but only many years later as the PCs finally caught up and the IT boom set off and changed the world as we know it forever. Still today I wonder what had been if the Amiga had had the impact it was designed to have?

Today I feel pretty much in the same way about some technologies being in the shadow of others enjoying the spotlight without really having done so much to deserve it. Now you may say I am arrogant but let me remind you I've been using computers almost since infancy and I've tried many different technologies so that what I use today is the result of many years of trial and error. I have made dramatical u-turns when I feel there is another technology which fulfills my needs better -  like when I switched to Linux after having been a Windows fan for more than 10 years.

For this reason I get irritated when the world seems to believe there is only one gadget existing like Apples' i-products. Physicians are head over heels about iPhones and now iPads but what most of them haven't done is to actually compare them to the alternatives. I have done this and for many reasons (open source software, USB connection, high configurability just to name a few) I prefer Android to iPhone.

The Linux vs Windows one is a no-brainer, Windows is a totally overvalued piece of software that exists today only because of the power of money (you could start with asking yourself why it is almost impossible to buy a computer without Windows pre-installed). Read my above mentioned blog-post to find out why.

Then there is the Google Apps vs MS Office debate. I was an Office fan too and I found Google Docs to be a lousy product in it's beginnings. But it has advanced a lot and today it is one of the most important IT tools I have and has dramatically changed the way I work and stay organized both as a physician and family man with three children.



The message? Be critical, open-minded and picky about your technologies. Don't just buy a product because the word of the street says it's the best. There is no thing such as 'one size fits them all' when it comes to software and gadgets - decide what to purchase based on what your needs are and what you are going to do with it. There are plenty of blogs and IT magazines out there to do some home-learning!

Lazarus' sign

Lazarus' sign is one of these signs that you just have to know because it is just so perversely stunning. Basically it is a corticospinal reflex in the brain dead where the patient (or it's body) will flex both arms as if he was grasping after some object or even trying to 'give a hug', scaring the hell out of family members or inexperienced personnel. BTW, Lazarus's sign is *not* the same as decorticate or decerebrate reflex.

Today I heard a story from a college who was doing the apnea test to confirm a patients' brain death and while bending over to auscultate the heart, the patient performed the Lazarus' reflex and seemingly hugged the doctor while showing no other signs of life.

Backup up your data - the modern way using the data cloud

Everyone not living in a cave has sometime lost important data and consequentially had their days of remorse and pulled hairs. Classically, a laptop with years of work is stolen or a hard drive with invaluable personal photo albums crashes unexpectedly. As in the flight industry, human errors are your biggest threat - more than once I have accidentally deleted precious files.

Our data is our life-collection of work and memories and as the days of pen and paper are being replaced by electronic data it is becoming the one most important property to hold account of. As 9/11 showed us, corporations survived huge losses of business documents but there is nothing to replace your years of email correspondence or personal photo albums. Not only is it an emotional loss but it will set you back by months as you try to pick up pace again after losing all your office data. Just the thought of losing my calendar data gives me the chill - loosing track of planned meetings and events for the next week would render me butt-naked!

Backup is no more

The traditional way of backing up data is to copy to other medias such as CDs, DVDs or external hard drives. This is how it all started before the Internet came and cloud-technologies and we were happy just to have a second copy of our data in case of disaster. There are many drawbacks with this old approach such as:

• No media is safe when put up against time: DVDs and even high quality hard drives have an industry accepted failure rate of 1% meaning that your data will in time corrode.
• Modern data includes huge media files; high quality photos and videos and we are adding up more files every day. A DVD counts 4,5gbs - barely enough to hold 1.000 high quality photos. USB memory sticks are the modern DVDs and might be safer storage medias but they will also fail on you eventually.
• External hard drives are growing bigger every year but you want to store them far away from your desktop to ensure maximal security or they could easily take collateral damage if your desktop is hit. It might be a virus, hacker intrusion, water damage, fire... you have to place it far away, preferably at a friends house.
• As you are every day creating more data you will have to manually grab that hard drive, connect it and backup the new files, a process easily forgotten or just ignored in the long run.
• Eventually you will edit some old photo or document previously created and suddenly you have obsolete files on your backup hard drive. Unless you have a list of which files are updated since last backup you will have to backup your whole data collection. Or you could use software that does incremental backups but still, you will have to connect your backup drive to make it work. And know the inside and out of your software to be certain no mistakes are done.

The data-cloud is changing it all

There are plenty of problems with traditional backups but one emerging technology has the potential to relief your headache for once and for all... the data cloud. It's about moving your data from your local hard drive to online servers, virtually locked in databases which only you have access to. With the cloud, your data is available wherever you go.

Dropbox is by now know by everyone and is one of the first examples of cloud-computing and replaced many USB memory sticks, symbolizing the old approach of moving data around, between different computers. Dropbox is now loosing ground again and the reason is the lack of an interface to work with the files it stores. The amazing developments of web-technologies (such as HTML5) is moving the power from local to online software, thus the term "web-applications". Google Docs exemplifies this trend; not only can you store whatever document on it's servers but you can also work with the data (e.g. work with 'word' documents or 'powerpoint' presentations) online and even shared with closed or open group of friends and colleges. Combine these features and you have "collaborative editing" where one or many can simultaneously work with the same document in real-time without worrying about multiple versions being emailed back and forth. I have previously written about the "online office" concept which is based on this development exactly and is the sole reason for my boosted productivity despite much more information to take care of.
So... not only do you need an online host for your data (there are now too many out there to keep count of and new services being born every day) but also you need front-ends to work with your data. One service for your office documents, one for your photos, another for music, yet another for videos... Now that's a lot of accounts and passwords to keep track of and add to that, you will have to have 100% trust in each and every service since they're literally taking care of your electronic life. We need simple solutions, preferably one key to all keyholes. And now the good news: this is indeed possible and that is exactly I am going to teach you in the rest of this post.

If you insist the old way

Only five years ago I would have told you a completely different story since there was no cloud then. I used to have a huge hard drive storing my most precious memories and had a clever software solution to synchronize my backup sets. In the end though, I was totally lost  as some weeks my photo collection would grow by gigabytes and I accepted the fact that relocating my backup-drive between various physical locations  even once a month was an impossible task to do. I tried USB sticks to make it a little easier but it was the same, I gave up. I installed an online Linux server in a safe location in my house and setup automatic and synchronized file transfers but felt highly vulnerable to catastrophes such as theft, fire or water leaks. I had just started considering using a friends' online server and synchronizing backups over FTP connection when Dropbox arrived, the rest you know.

Today, all my important documents are in the cloud and my hard drive is empty besides some downloaded podcasts and vodcasts which are easily replaceable. Going online is a point of no return after which you will sleep free of all worries about loosing your data.

Going online

Now this might be the point were some might be skeptic so I would like to remind you that there are many alternatives out there but through years of experimenting I have found the Google applications to fit my preferences the best, please check my special Google post if you have doubts.

Besides a few special applications (Pixlr and Crocodoc, that's all!) I am using the Google services for all my data. They're free, I trust Google and I am very satisfied with working their applications. The true power lies in having only one account (password) to take care of.

Introducing Google Drive (previously Docs)

To most people, Google Docs (GD) is a simple, online document editor with sharing and collaboration functions. The Google Apps have a common 1 gigabyte pool for your data and you can easily add more storage like $5 for 20gb/year (which is cheap, compared to other services).
What many do not know is that GD actually allows you to upload whatever document type you wish, be it a 500mb video file, your mp3 collection or zip/rar archive to name a few examples. It literally stores whatever you throw at it (you can even upload a zip file and GD will allow you to browse it just as any folder). If you have Chrome you can even drag your files or folders to Google Docs and it takes care of the rest.

As your heap of files grow by thousands it becomes essential to organize them and GD's tagging features makes this a breeze. You can of course search your collection both from top-level or inside a tag ('folders' are known as 'collections' in GD), this way you can never loose a file in your online data-heap.
Sharing is GD's pride; every file (or collection) can be shared with one or many of your friends or even as a link to the whole Internet if you like. This way I upload my home-videos to a special folder (collection) and then send the link to my family who can either view them from there or download to their own computer (GD allows you to disable downloading if you only want files to be streamed).

Editable documents can not only be viewed but edited and while you share a document you can specify what restrictions each user has. The ABG document is private to the Internet but could also be shared openly so that anyone having the link can view or edit if I decide so.

Now this is technology we are used to these days but what makes GD unique is that the organizing and sharing functions apply to all files (and collections).

For most purposes, uploading through the web-browser is just fine but it doesn't quite meet my wish for synchronizing cloud based files with those stored locally on my hard drive (the Dropbox way). Google's highly anticipated Gdrive, rumored to be out early 2012, will change all this and provide the final functionality needed for a fully equipped online hard-drive.

Despite most software now being available through the Google Apps suite there are still some missing, requiring you to have your files on your computer for locally installed software. Adobe Photoshop and Microsoft Access files are some examples. Except for image/photo editors, online multimedia editors are still in their infancy and need local software. Downloading and uploading files back after edit is cumbersome, expect GDrive to fill this gap.

What GDrive will bring is is currently unknown but for basic backup purposes, Google Docs serves it's purpose quite well. If you wish for extended features and even editing you should consider alternative services and I will now finish this post with specific details on where to store the three multimedia types we commonly work with so that they are not only backed up but also easily viewed and manipulated.

Photos/images

What makes photos unique is that you want to organize them by years, themes and even people. Picasa used to be a standalone service but was bought by Google and as such is part of their application suite. Picasa is both a great local software for working with your photos but also an online front-end, the web-Picasa. Picasa can easily upload your photos to your online storage and smartly processes the uploaded images and always keeps a copy of the original photo file - the essential feature making it a backup tool.

Picasa uses the common, above mentioned, 1GB storage pool but it doesn’t count images up to 800x800 pixels or videos <15 minutes in length. If you sign up for Google+ the photo limit goes up to 2048x2048 pixels. This has important implications; if your camera is set to store high quality photos, you will most likely have bigger sized photos and thus meet quota limitations.

My family album now counts about 250 gigabytes after 15 years of photographing digitally and most of the images are bigger than 2048x2048. Despite Google space being cheaper than most competitors I am not sure I am willing to pay $100 annually for the 400gb storage pool required for this massive amount of data even though it is probably the most secure way of keeping my digital memories away from unforeseen catastrophes, even though prices will most likely go down in the future. At least until having the synchronizing feature of GDrive, as a temporary solution, I will stick to old fashioned external hard drive backups here. In the meantime, I keep the newest (not HD backed up) files secure on my Dropbox account.

Finally, I find the web-based Picasa still a little clumsy (as opposed to the local software which is a 5 star product). It has all the features needed but it's user interface really needs to be modernized (it's been the same for years now), it's browsing and folder/collection features are ages behind Google Docs' approach. Until worked on, I am not ready to give all my digital memories to the online Picasa.

For other photos such as my collection of medical photos or saved images I use for my presentations, Picasa is my best friend - every single photo stored online for easy access and share functions.

Now all this is fine but what about advanced photo/image editing? Picasa is very very basic and you will not be able to do any photoshop effects with it. For this, you will either have to manipulate your files locally or you could try out before mentioned Pixlr. This is a gap in my backup plan - the files can only be stored on Google Docs for backup purposes; you will have to download and upload them to work with. Or you could sign up with Pixlr (for free) and use their online service. This should not be a problem unless you are editing your photos every day - in that case I suggest Dropbox and hope for GDrive to come anytime soon.

Videos and films

My video files are made up of home-videos and downloaded teaching modules such as vodcasts. The latter are for viewing purposes only and I like to be able to share them with colleges, perfect for storing in Google Docs.

Home videos are different. They are precious and must not be lost, ever. Also, I would like to be able to work with them locally, making special clips for family or friends. Now many would think that Youtube is an excellent backup service for these but that is a fallacy; Youtube does not keep the original files and you cannot get back your files in their original formats (as with Picasa). Youtube is a sharing service, videos are played as streams. Even more, you are not guaranteed that your uploaded videos will stay forever. Youtube is strict about copyrights and can anytime erase your video if it has any violations (copyright background music might be enough to trigger the deleting machine) and if violated several times might risk your whole account.

This is very important:Youtube is NOT a backup service!! So what to do?

As said above, Picasa accepts video files as well as photos - voila! Even better - you have free unlimited storage for videos <15mins which should suite most of your home videos. Actually, as Picasa works with photos and short-videos in exactly the same way, I treat my home-videos the same. So again, waiting for GDrive and Picasa update but that's where I'm heading!
Finally, Youtube is not all bad. Actually, it is a great service for putting my edited clips online to share with the world. Youtube has some basic editing functions, enough for most of my needs for home-videos.

Music and audio files

First of all, your mp3 (music) collection can easily be stored within Google Music which allows you to store 20.000 music files for free. Not only have I uploaded my music collection but also do I put my downloaded podcasts to Google Music so that I can listen to them from my mobile when I'm out jogging. After putting some work into tagging the podcast files, my collection is now easily browsed by authors, topics, production year etc.
Google Music provides a small software to install on your computer which then takes care of seamlessly uploading your collection.

Currently a podcast subscription feature is very much needed on Google Music (iTunes style), in the meantime I subscribe to them with RSS Reader, download files locally, tag and upload via GM's uploader tool. A little more work but I worth it as my podcast collection is now so easily accessed wherever I go.

Finally - what about passwords?

Passwords are also precious. Even more precious as they are the keys to all our data. Keeping account of all passwords today is a true first world problem, especially now that we need to make them very complicated to defeat hackers and viruses threatening our online presence.

I have some of my less important passwords kept in a well hidden file in Google Docs - making them easily reachable wherever I am logged in or just from my Android phone. For those more important ones there is an excellent app for keeping them in an omnipresent but safe way. Check out my previous post about passwords and the importance of protecting your online data - now that you are uploading your electronic data to the cloud, you absolutely must know how to protect yourself from intrusion!

See also

• [Mens Health] Your life, in the clouds
  Everyonë's going for the clouds!
• [Wired] How Apple and Amazon Security Flaws Led to My Epic Hacking
  A computer/IT geek looses all his data for good - but mostly blames himself. You data is only as secure as you decide.

Windows vs Linux story

You have been warned, although mostly emergency medicine related, my blog is also about IT. To the heart of my IT experience is converting from Windows to Linux, the best decision I have ever made.

I like collecting stories about why this is good. I've just read an interesting article from PC World where IT geek Tony in 30 days tries out one of the Linux flagships: Ubuntu. I will not go into his incomprehensible approach of installing it inside Windows and expecting to get a Windows clone which completely defeats the purpose of his experiment... But reading through the comments has revealed to me some very good Windows to Linux conversion success stories and learning points which I'd like to collect here.

Take home point: "... but the point should be clear. Microsoft effectively owns your Windows computer, while you own your Linux computer."

ricegf Mon Jun 06 06:55:52 PDT 2011

"@blamblam: What are some concrete examples of things that you cannot do with a Windows computer that you can do with a Linux machine

Excellent question. Though I'm not the original poster, I'm a libre software advocate based on hard-won experience, so I appreciate the opportunity to point out some practical implications for free vs proprietary software. I'll do so with first-hand anecdotes, and leave you to draw general conclusions.

I helped Mike (a friend), whose hard drive had crashed, to install a new one. When we reloaded Windows, the software refused to accept the 40 character authentication code (a pain not inflicted on Linux folk), deeming it invalid. We spent 30 minutes on the phone with 3 different people at Microsoft while they decided if we would be permitted to use the software he'd bought or would be required to purchase a new copy, since his machine might be considered "new" because of the replaced hard drive - the End User License Agreement (EULA) didn't define "new", leaving its interpretation at their discretion. In the end we were "permitted" to use the product for which he'd paid (via a new 40-character code), but this was the wake up call that caused me to begin my Linux transition.

I've received two physical letters from the Business Software Alliance (BSA) asserting their right to enter my home and "audit" our personal computers at their convenience to see if any of my applications are improperly licensed. They claim their members' EULAs grant them this right (the specific EULAs are not identified). I would certainly deny them access to my Linux computers, however, since they run no EULA-impaired software at all (the Gnu GPL is not a EULA).

I helped my daughter build a desktop, and purchased a retail copy of Windows XP so she could run certain games. After it was overrun by malware, we reloaded from CD - but the authentication code was rejected as "pirated". Unable to convince Microsoft that we'd purchased an original CD, unable to obtain a refund for an "opened product", and unwilling to continue buying new copies for the same hardware, we acquired a copy via different means to get the machine operating again (though it won't accept any non-security updates).

I have more stories, but the point should be clear. Microsoft effectively owns your Windows computer, while you own your Linux computer.

From another perspective, I'm able to upgrade any of my computers to the latest or any older version of Ubuntu, Fedora, Mint et. al. at any time, to share any of these systems and all of my apps freely with friends, and to run as many copies as I like in my virtual machine system (Windows most common EULA limits use to 3 copies total on the same hardware). I can run and publish benchmarks and comparisons (which was prohibited by Microsoft's EULA last time I checked). I also have confidence that the software isn't siphoning off information without my knowledge: I haven't checked personally, but independent people that I trust have - and have found that some proprietary software (not Windows) does indeed send personal info back to corporate headquarters without the user's knowledge or consent (instances occasionally pop up in the trade press, in case you follow it).

From a practical perspective, I've found Linux software to be generally better than Windows for my needs. New versions of Microsoft Office, for example, often require reformatting of complex documents while OpenOffice.org (which uses an ISO-standard file format) does not. Of course, we can (and do) use the same software on the Windows computers in the house, which illustrates another advantage of libre software - it typically has been ported to all systems! You can even find mainstream libre software on quite obscure systems such as Haiku and Plan 9, while many proprietary Windows apps won't even run on a Mac.

Speaking of apps, installation and maintenance (which is centralized through an "app store") is certainly far better under Ubuntu than any competitor I've tried (except perhaps the late unlamented Lindows) - Microsoft plans to address this at last with an app store for Windows 8. The Linux system is also far more useful out of the box (which you concede), and obviously is far less expensive to set up from a licensing perspective.

The biggest practical barriers to a Linux transition are for Photoshop users, those dependent on certain Windows-only vertical market apps, and for those with a large investment in DRMd media (Linux generally doesn't support DRM, since given source code DRM is trivial to defeat - though no DRM system has survived very long in the wild even on Windows).

Overall, my personal experience with proprietary software has been quite negative, because power corrupts and the BSA members seek near-absolute power over their customer's computing devices as the above anecdotes illustrate. My experience with libre software has been uniformly and overwhelmingly positive, and I'm far more productive - and certainly more free - than I was on Windows.

I speak only for me, your mileage may vary, but I hope this gives you some food for thought.

JoeAnotems5445 Wed Jun 29 05:53:34 PDT 2011

"The author missed the most important thing. With Ubuntu or Linux Mint, you don't use AV and you don't get infected. Microsoft gets infected with viruses, botnets and has many other security issues. Microsoft Windows cannot operate without AV, ever. Microsoft never had secure source code, and with millions of lines, it's unlikely they will go back and fix it. Linux has open source (freely available to anyone) source code and security is designed into every line. It's been that way since version 1 in 1991. Android is Linux.

I've used Linux for over 8 years without any AV and with absolutely no infections. Linux Mint is based on Ubuntu but has many extra codecs for playing Microsoft media and playing and recording DVD's - right after the install.

I've never seen the problems with arrogance from Linux users on the help posts the author mentions. If he is a Microsoft user, he is probably not familiar with the terminal commands that are commonly used when someone is trying to help. These commands have to be typed in exactly as described or they will not work. It can be frustrating and overpowering to a new user.

Also, Microsoft enjoys a large market share that has been developed over the years, even through some monopolistic practices.

Linux was never meant to be a copy cat of Windows. The authors' approach is to treat it like a Windows wanna-be. Remember, almost all Microsoft programs use a proprietary function called Active-X or Direct-X. Over the years, this has been responsible for a tremendous amount of security issues. Linux does not use Active-X. Neither does Firefox or Google Chrome. That's why they are becoming so popular, people are getting increased security using them with Windows instead of Internet Explorer.

Linux Mint is the #2 Linux OS in popularity. It's absolutely fantastic. I'm using the 64-bit version on a dual core HP with 2GB of ram. I have an ATI 2GB graphics card with a custom ATI driver meant for Linux. I use FireFox4 and Google Chrome 64-bit, both with Ad-Block Plus. I installed Google Earth, Google Picasa, TrueCrypt, FileZilla, K2B CD-DVD burner, Scribus publishing, Google DNS, Youtube-dl among others. Also, Mint comes with LibreOffice office suite that parallels Word, Excel, Access, and PowerPoint. It also comes with Gimp, which is a multi-layer photo editing program similar to Photoshop.

There are over 33,000 free applications that can be installed from a repository with a couple of clicks using the Software Manager. All you have to do is Google for the Linux equivalent of the Microsoft program you want, and you can usually find it. For example if you Google Microsoft Publisher, you get Scribus and Lynx, which can be installed for free.

For me, Linux installs in about 8 minutes with no product keys, WGA or DRM to contend with. I can't even imagine my family or I going back to any MS product. If you are a Windows user dealing with one or two computers, AV and infections seem to be manageable. If you're responsible for 20 or 30 computers, Linux requires virtually no maintenance and gives you your life back."

@AndreCostaubn:

"Windows is a lot harder to install than Ubuntu. People usually don't care because it's preloaded on new computers (as well as bloatware).


I have to remove all the viruses/trojans from my Mom's windows computer everytime I go visit my family. I installed Ubuntu on her laptop so that she stops complaining about it being slow. She was doing fine after that.

Windows doesn't just work, or else I'd be still using it."

Gotta love these keyboard shortcuts - speed through Google search

I love fancy keyboard shortcuts. They help me keep my hands on the keyboard and just focus on writing. This is one just incredibly powerful every Googler should know of;

When you've entered a search term on Google search, instead of moving the mouse pointer back to the input field and type more to refine your search, you can just start typing and voila!

There's even more I didn't know of; pressing enter and then tab  selects the first result and you can move up and down through the results with up & down arrows.


Oh my oh my!

Why I Google

The Google applications are a core component of my online life and thus are mentioned a lot in my blogposts. Here I will explain why exactly so that you don't think that I am bought by Google!
You might also be interested in my rant about choosing the right technology platforms.

Most of you have used Google search and very likely Gmail but not everyone is aware that those two are just a small part of the bigger Google application suite, a plethora of powerful online tools for productivity and creativity. If Google Apps is new to you, I highly recommend this short introduction to this toolset which can seriously boost your productivity.

Alternatives

It is but fair to tell you that there are alternatives to Google Apps, indeed there are thousands of them but none that I know of that has the broad spectrum of application types as Google has. For Google Docs I could mention Zoho and Office 365, commonly compared to Google Docs. Remember The Milk is a nice todo-list application. To read about the others you could check this article.

Why Google apps?

Google Apps is a prime example of web-applications - they run from the browser and use the data-cloud, providing you with easy access to your data wherever you are and a fully automated backup. They are therefor the core component of my online, mobile office - as long as I have a decent web-browser running my office is up and running, ready to untap my productivity. I have previously written a post about web-applications and the data cloud and why you should seriously consider converting to these, here I will rationalize why Google Apps are my first choice.

Single login to all apps, all data in one place

Sitting in the cockpit of a 747 is very much how I feel when I have logged into Google - I have all controls within the reach of my fingertips. With a single login account I have about 30 different applications before me and only one password to take care of. Even with only a few different web-apps, it would be a hazzle to login to every single one and major treshold to start working and getting things done.

Not only are the apps interconnected but so is their data. On the surface you will not notice it but under the hood all your data within the Google apps is pooled in a single database, just showing up differently within the different applications. This means that each and every application can access your different data pools, for example Blogger and Google Docs can easily grab photos from your Picasa account, your Gmail contacts are accessed with Google+ and vice versa. Seeing is believing - from Google's dashboard you can see how your data is stacked within the different apps.

All eggs in one basket?!

Now some will feel violated by privacy issues - the fact that a private company stores so much of your personal data and there are tons of articles and discussions wiggling this issue back and forwards. This is of course a double sided coin; there are indeed companies that will use your data to personalize your ads and some might even abuse your data but if you trust your company there is so much to gain. Consider for a moment how big Google is and that their existence relies on public opinion - they simply cannot afford violating your data in evil ways, one false move and they could go down the drain over a night. Besides, whether you like it or not, in Google's huge data-cloud, you are just an ID number and your data is handled by robots who don't give a damn about what you do or don't do, like or don't like, for them you're just a bunch of binary 1s and 0s! Some think that Google's employees have fun reading emails in the Gmail database, wake up - that's just as silly as claiming that doctors sit and read patient journals for fun. If you still feel insecure, I think you should consider leaving the Internet altogether and start using paper and pen again. This is the era of Web 2.0 tools where storing personal data online is the prerequisite for them to work. That is not unique for Google, it's just the way it is today. Google is well aware of these issues and provides you with an easy way to take out all your data if you should want to close down your account - Google takeout (also an excellent tool if you want to have an extra backup of your data on a local hard drive).

If you want a 3rd party solution there is Backupify. No need to worry!

Actually it makes me sleep better in the night to know that a corporation with pockets full of money and enormous muscle power is keeping my data safe. Should Google go bankrupt or be hijacked, your personal data is the least problem of all since that scenario would be a major event touching not only individuals but corporations, countries and even the whole world. You can be sure someone with greater interests will already be working on this before you even have had time to say "ouch"!

Google is also offline

Since the start of the Internet, downtimes have occured in all major services and Google is no exception but it is so rare and short that in effect you would barely have time to have a cup of coffee while it is being fixed.
A more likely scenario is that you are without Internet connection e.g. while flying or sitting on the train. This is yet another reason to choose Google Apps as they are very well aware of the possibility and have been eager to implement offline options to most of their applications. Their current technique is based on HTML5, an universal standard not likely to disappear over one night and since HTML5 support is growing even on smartphones, you will not have a problem with this on your Android or iPhone. Google Docs for example allows you to mark which documents should be available offline and they will be downloaded and synced automatically without you having to do anything but just enjoy.

Simplicity is power

Ever since Google's search page appeared, simplicity has been Google's style. Wether it's Google Docs, Picasa or Blogger - everything is easy to setup and work with, yet providing the most important features needed. Thus the Google Apps are easy to learn and use, you can start working in minutes.

Constantly updated

Google is eager to provide you with the best tools and state of art technology. I have used Google Apps for almost five years now and the features have grown enormously. Almost every month something new is being added and I feel that Google is listening to their users, adding the features most requested. As web-browsers become better every year we can expect even better features in the future. On the Google OS blog you can follow all additions as they are being implemented.

Android integretation

It should not come to a surprise that the Android operating system has great support for the Google applications, they are after all the brains behind this great OS. With the Google Docs app for instance, it's easy to search, read and even edit your documents and recently offline support was added - this literally means that your online office is available whenever and wherever you go. A technology most would have though to be impossible only several years ago.

Totally free

Last but not least - the Google Apps are totally free, for up to 1gb of storage. Despite having every single document of mine and 10 years of emails there, I've still only used 25% of my quota. In time, I will upload my 50gb or so of photoalbums to Google's services for an online backup and I have no problems with paying $20/year for their 80gb additional storage, if you ask me - the price is ridiculously low, it's just a fraction of the price of a hard drive.

A success story for me

A few years ago I uploaded every single document from my hard drive to Google Docs. My laptop now has no hard-drive installed (runs much faster off a 4gb SD memory card with Linux installed), backup and working with different versions of the same document are a things of the past. With Google's Chrome installed on a USB chip I can start my office up from any computer in the hospital in just seconds and the IT department won't have anything to say about it since I'm not opening any security threats to their in-house network. With my Android I can easily access all my online data and I use it every day for better patient care and to steepen my learning curve in emergency medicine. I am a happy Googler.

Please check out my post about the online, mobile office if you wan't to know the details!

Finally - the disclosure

And now you should understand that my choice of Google for almost everything in my online life is not just a sentimental one, it is truly the one tool that helps me the most for my productivity and creativity. I have nothing to disclose; I have no affiliation in any way with Google or related services and my choice to use their tools tools is utterly my own and solely based on years of "trial and error" with various solutions. There was even an era in my life where I had almost grown roots into the flagships of Microsoft, Windows and Office - but I woke up one day and found out there were better ways to achieve my goals.

More on this topic

• I've been Googled
  A blogger describes how Google grew on him from being a search engine only to his complete online Swiss army knife and why Google's applications are growing fast in the small/medium sized business world.
• Google Privacy: 5 Things the Tech Giant Does With Your Data
  Mashable e-magazine explains in a user-friendly way what the Google privacy issues are really about. As it turns out, a lot of fuzz out of nothing...

6. Searching efficiently - finding what you're looking for

It is said that nowadays you can find whatever you want to find on the Internet, if you just search for long enough. That's a problem for doctors who are not searching to just find anything but looking for the right answers. We need quality much more than quantity. We want information from accredited sources and containing relevant information. A Google search for pneumonia will give you results in the count of millions, even veteran sites describing pneumonia in horses. Surely somewhere in there is the answer to your question but you will probably have had your own pneumonia when you finally find it! In this post I will try to help you get better search results, an essential IT skill for the modern physician.

I will be mentioning Google's search engine a lot since it is the one I use and know from inside and out. Most of what I write here below can be applied to other engines such as Bing or Yahoo.

Refine your question - what do you really want to know?

Googlin' for "pneumonia" is not very smart. Pneumonia is a broad topic and the facts and details are endless. Before blaming Google for stupid results, you might consider what is it exactly that you want to know and what kind of result are you willing to read? Is it the pathogenesis or just a general description? Or do you need a patient information leaflet?

To begin with, you might consider Wikipedia for a quick introduction to whatever you want to read about, Wikipedia's credentials are thought to be excellent and it's quality has been scientifically compared to Encyclopedia with good results. The medical topics in Wikipedia even have dedicated doctors onboard, scanning topics for obvious errors (see BMJs "Wikiproject medicine").

Google has a very powerful search engine and cleverly indexes all words within a website for best results. A special syntax (see below) allows us to use Google to search every open website there is and this can be useful for sites not having their own search function. Some sites have sloppy search engines where using the Google machine gives us much better results. Sometimes though you will want to use their own, advanced engines - the Pubmed search is definitely one of these.

Special syntaxes for advanced searching

Google will accept "human queries" such as "i need patient information about pneumonia" but let me introduce to you special search syntax parameters which give you the real power of web searching. The two most important to know are:

• "xxx" (quotation marks) will search for the exact term, without them (the default), pages will be found where words in the query are close to one another but not necessarily. This will filter out a lot of irrelevant results.
• minus (-) sign will exclude words, say for example you want to find a nice ABG calculator but online, not iPhone app: "abg calculator -iphone". This way you could exclude pneumonia in horses or even veterinary medicine.

All of the special syntaxes can be called through Google's advanced search page and by just taking a quick look you will quickly familiarize yourself with them. Some of these even are found on the left margin of Google's main search page. Those that I use regularly are:

• Order by time brings up newest results and can make your results much more relevant. Some months ago I read an extensive article about "posterior circulation stroke and HINTS", refining the search to display only results from the past year immediately brings up Scott Weingart's post and the CMAJ 2011 article I needed.
• site operator: As I actually remembered having the article on his blog, emcrit.org I could also have refined the search using "site:emcrit.org" which then reveals results from emcrit only. Now that is a very powerful function and worth knowing. Emedicine is every emergency physicians' darling and now you know how to get to their pneumonia article with one click only!
  Commonly I use the "site:.se" operator to find local, swedish guidelines.

Search all your favorite sites simultaneously!

The "site" operator can be used to search more than one source but a lot of "site:xxx" operators will make your query long and prone to errors. I have a few favorite websites I regularly use to find specialized answers, sites I've used for many years and have my full trust in. So the question arises - can they all be searched simultaneously? The answer is yes and the solution is Google custom search, click to read another post I've written about it - it will be one of your most powerful online tools.

Tricks & tips

Google has a lot special search features providing you with instant answers to special questions like weather, flight times and stock prices, some of them are definitely worth knowing. There are some I use very commonly in the ED:

• The built in calculator is a very time saving feature for instant calculations right from the search bar. Even better, you can use the calculator from insde Chrome. In the same way you can convert units on the instant eg 3 miles returns 4.83 kilometers
• Using "define xxx" you can in an instant look up word definitions, synonyms, translations or grammatics, very useful for an Icelander living in Sweden, trying to speak English! With the tilda sign I can ask for synonyms for a word eg "restricted~" revealing answers in just seconds.
• Conversion is ridiculously simple, try for instance
• "98.4 fahrenheit to celsius"
• "5 inches to meters"
• You can even use Google search to check spelling, right now I made a quick check to see if I had spelled "ridiculously" correctly, and got corrected!
• Finally, try putting this query in Google and see what the magic is all about
  sqrt(cos(x))cos(300x)+sqrt(abs(x))-0.7)(4-x*x)^0.01, sqrt(6-x^2), -sqrt(6-x^2)

=> list of all the special search features

The best the lot: ctrl+f and Quick scroll plugin for Chrome

Learning keyboard shortcuts is one of the best things you can to do boost your productivity. Ctrl+f is one of these I use every day to faster locate search results. Say I have searched for "erythromycin" and opened a page full of text, containing all there is to know about this antibiotic. Using ctrl+f  I can type "breast" and I will instantly see the chapter about breast-feeding to find out if there are any risks involved.

If you are using Chrome you will wan't to use a great plugin which helps you scrolling directly to what you were searching for.


=> Quick search plugin for Chrome

Social media might be changing it all

The evolution of the social network has been so fast that even the king of search, Google, missed it and didn't realize it's potential until it came up with Google Plus in 2011. Social networking essentially means power to the people and in the context of finding relevant answers could mean the end of finding results through Internet-browsing robots but having the answers from the people around you - the ones you trust. That is the good old "before Google" way - remember the days when our grandparents knew anything and we'd ask them the complicated questions?

Technology surely is catching on. Facebook as the flagship of social networks has already taught us how we can ask our circles of e-friends and often get relevant answers within minutes.

Even better is Quora, started in 2009 and now rising to become one of the Web 2.0 titans. The idea of a Q & A web is simple and hundreds of others have been there before, it's just that Quora somehow has the easy yet powerful user interface and packed with features. The idea is simple: you ask a question and tag it so that followers of this particular interest ("specialists") are immediately there and answering it. You and others then vote up or down the answers and a powerful and user-moderated Q/A wiki is being built, growing every day. So that if you ask a question that Quora already thinks has been answered, you are hinted to check that one. The Quora concept is thus a mixture of Google's 'smart robots answer your questions" and Web 2.0's "power of users". A really exciting development.

I am waiting for more emergency physicians signing up but I have a feeling this could be a breakthrough technology for physicians all around the world since it allows for instant (or almost instant) expert answers from hundreds or thousands of online colleges. To be continued!

See also

• [AMIA Annu Symp Proc 2012] Emergency Department Physician Internet Use during Clinical Encounters

Have you met Linux?

Did you know that Linux powers some of the worlds biggest websites such as Facebook, Wikipedia and Google? Did you know that 95% of the world's supercomputers are powered by Linux? Or that Android is built on Linux? Have you heard about LiMux, the project of converting all IT systems in Munich (Germany) from Windows to Linux and that many others are now doing the same since it has been shown to be highly efffective?

Considering that the operating system (OS) is your one most important interface to your computer, don't you  think Linux deserves some of your attention? I used to be a Windows/Microsoft fan for many many years, digging deep into Windows as it was my programming platform. One day I wanted to try "this Linux" I had heard about on a 7 year old HP laptop I used as a media server in the kitchen, I got it for free from a friend who thought that it was too slow. Well, I haven't touched Windows again and for the first time I feel I am in total control of my computer and worries about malware and viruses are a thing of the past.

The Apple story

Increasingly Apple products are being seen, pushing ever more users out the Windows monopoly. Especially I noticed this at MEMC in Kos where many physicians spent their time between lectures gaming their gadgets instead of enjoying 30’ and sunny weather outside. Apple is certainly king of user-friendliness renowned for high-quality multimedia software. I have never had an Apple product my self and thus can't make any bold statements about it when comparing with Windows or Linux (actually, Mac OS X is based on Unix, a common ancestor to Linux). From what I've heard from friends and seen over their shoulders, OS X seems to be a pretty decent product, giving their users speed, stability and functionality, the main requirement for the productivity boost I want from my computer. So OSX might be better than Windows but still I think Linux rivals them both and I will now ask for a few minutes of your time to tell you why.

Why bother?

You are a busy physician and always in lack of time. Your computer probably is a very important tool in your daily life and you depend on it to start up smoothly every day, be fast and responsive, reliable and user friendly. Most importantly you need it to be immune to security threats since your important data resides inside it.  You may or may not be a geek but you want to be able to configure your computer and adjust to your own preferences. Without hacking the command line.
The description above is just that of Linux. It is one of the most secure OS:es made, so secure actually that  anti-virus software is not needed (but exists for the faint hearted - besides no OS will protect from human mistakes like opening bad attachments or links), sparing about 10-20% of CPU and memory resources. Not only are you free of viruses but annoying malware (ad-displaying banners and toolbars) will never plaque you on Linux. This article about the US military converting to Linux because of security issues really says it all!

Windows is a bloated OS with updates stacked one after another on older versions, eating up hard drive space, memory and CPU power. The sole reason Linux can be installed on a dusty, old laptop is that it is extremlely light on resources. My own laptop has Linux running on a cheap 4gb SD memory chip, no hard drive needed. Slick and smooth, from power on it's up and running in ca. 15 seconds. Chrome starts in 2-3 seconds and even then there's only mere 250mb of memory used, doing the same on a Windows 7 installation eats about 1,2gb of memory.

Windows also tends to grow fatter. One of the most common question I get from my friends is “why is my computer getting so slow”? Linux stays slim and fit for years, software you add is compartmentalized so that it's libraries and plugins don't leak into the big OS pool. No additional load is put on the core. Because of this you don't have to upgrade your computer hardware every two years or buy software to clean your computer, Linux will not grow old on you!

Linux is free. All applications on Linux are free. What's even better, installing software is so easy it will make you laugh. For instance if I want to install GIMP, a high quality (free!) image editor I can either go to the "software installer", browse to GIMP and click install or from the command line I could write "pacman -S gimp" and voila. Let me repeat this again; Linux is free - the installation is free, updates are free and you get assistance from a huge online user community for free.

In 5 minutes only you can put Linux to an USB stick and try it out without changing anything on your computer. If you like it you can install it alongside your Windows or OSX and choose on startup which one to go with. Linux does not take over your computer - it's your choice!

=> Why Linux is better, a very good, detailed and graphical summary of Linux's strengths.

So what is Linux?

Linux is one of the earliest operating systems made and has since been developed and updated by the worlds most active programmers and computer enthusiasts. Thus it has a word for being for computer geeks only and people commonly visualize someone with thick glasses writing complex commands in the terminal. It's true that Linux originated from a world of geeks but that is also it's strength, it is a community based OS.
Linux has endless of different versions for different requirements - there exists a very minimalistic command line driven Linux and a full-blown desktop version with advanced 3D user interface features and everything there between. Linux is commonly compared to Lego since the user has the power to choose how to put together the individual Linux bricks. The user can do it himself or have a ready built package, called “distros” (short for distributions).

You can choose a highly advanced distro where you build everything from scratch (Arch Linux) or a simple works-for-all distro which will run on every computer imaginable (Linux Mint is currently the most popular one). This is the elegance of Linux - the power of choice is left to the user. Compare this to Windows (and even Apple OS) where everything is pre-cooked and decided for you. In Linux, you decide if you want fancy 3D effects or just a plain, minimalistic interface to focus on your work. If you don’t like your choice, you can remove it just as easily as you installed it and try something else. Below is a short video of Ubuntu (very similiar to Mint) effortlessly running 3D desktop effects:

Another important distincting feature of Linux is that it is open-source, meaning there is no one commercial company behind it. Linux is a project “owned by nobody but managed by everybody”. The source code is open for anyone to read or edit - if you spot a missing feature you can whenever you wish join the team and design this as you wish to have it. If you accidentally dropped an error or misfeat the matrix of programmers all around the world will quickly fix it and the next time you choose to update your Linux all this is included. A great example of crowd-sourcing!

The open-source community thrives on a totally different way of thinking, since money and making income is not the driving force but rather the ambition to have software push technology to its limits and seeing the world enjoying it. In the Linux community, like in a symbiotic ecosystem, your ask for help is welcomed and newbie’s are well taken care of on multiple of forums and help channels. Compare this to the big M & A who will not lift a finger unless money is involved. I am not saying this is wrong, just that the Linux community is a much more friendly one, everyone equal... aarg I knew I couldn’t write this without getting political! To cut it short, all I wanted to say is that you should not be afraid of Linux - on the contrary, you will have more help available then ever before!

If Linux is so great why isn't it all over?

Good question and I cannot give you any good answer but as many will tell you, most probably it has to do with money. Microsoft with it's deep pockets presses manufacturers to have Windows preinstalled on every computer sold (the Windows tax). Linux is not a corporation pushing it's products actively (no ad campaigns for instance), it is community based and spreads by word of mouth. That's just the way it is today, money rulez.
 => MS struggles to discredit Linux

Nothing is perfect and there are two major issues with Linux which might keep some refrained; drivers and software. Unlike Windows, 99% of all drivers are built inside the "Kernel", the heart/core of Linux common to all distros. The Kernel is constantly being worked on and since version 2.6 driver issues are becoming a thing of the past. There are some peculiarities with older computers but support from the community is very good and with a few searches with Google this can almost always be fixed. Besides, Windows is no angel with regards to drivers either - last month I had to throw away my sons graphics card because it was not supported on Vista. Had no problems running it on Linux!

Software on the other hand is not straight forward. Since Linux is an open-source community, proprietary software is rare and the big software makers have very little profit of porting to Linux. In effect, you will have to revert to new software you have not worked with before. Not a problem really, just an inconvenience since it takes time to learn new software, just as it would on Windows or OSX. And so, LibreOffice  (previously OpenOffice) replaces MS Office, GIMP replaces Photoshop etc. All of these are absolutely free. The Alternativeto website is a great site for helping you finding alternatives.
If you insist using proprietary Windows/OSX software, you can always run the other OS from inside Linux with a so called “Virtual machine”. It will behave 100% as if your computer is running your other OS, just inside a window in Linux. There are both Windows and Apple OS emulators available making most proprietary software work. Another option is to install Linux alongside your other operating system and then you simply choose at startup which one your prefer for your session (see more on dual-bootin').

I have installed Linux on my friends' computers and unlike before when Windows was causing them pain and struggle, I haven't heard a word from them afterwards. Happy as hippos.

OK, you’ve got me excited - what next?

Before we continue, you might want to read this blog post from someone who tried installing Linux (Ubuntu) for the first time, it will give you a short introduction of what is to come.

You will first want to decide which distro is the most appropriate for you and this and this time only I will decide for you what is your best option. If you do your own research you will get drowned in thousands of different opinions.

Ubuntu is one of the best known distros and is famous for it’s easiness of use but recently has had criticism because of their choice of the standard user interface. Thus many are now going for Linux Mint and friends of mine who’ve tried it have been delighted. Here is a recent article comparing the major distros for 2011. If you want to run a distro even lighter on your resources (great for very old computers) I would like to recommend Lubuntu.

Now don't get me mistaken, all of these distros are Linux and they will all run the same software and have the same options under the hood. As said before, they are just different configurations of Lego bricks and you can always adjust their setup afterwards.

Just remember it's easiest to install from a USB drive and follow those instructions and you will be fine. When you feel comfortable, set aside a few gigabytes of your harddrive and make a full installation. Later on you can remove the Windows/OSX partition or just have it there for fun. By the way, Linux has no problems with reading your documents on that other partition.

Last year I switched from Ubuntu to ArchLinux which is has a very minimalistic user interface (desktop) and is intended for advanced users, providing total control of it's configuration and settings. It is by far the fastest Linux distro I have tried yet and after some fiddling learning by mistakes I now have it installed on all of my computers, faster and snappier than ever before, all running from a small 4gb SD memory card and without hard drives (my data is all in the cloud anyways!). Oh sweetness!

Finally

You're off to go! I would love to hear feedback from you in the comments if you go all the way. I might even lend you a helping hand. Now that I've finally written this long introductory post to Linux I will most likely be shedding off a few tips and thoughts every now and then from my own personal experiences so stay tuned.

I will end this post with a few recommended readings if you are eager to know more about Linux:

• A great site about the strengths of Linux and graphically explained
• [Lifehacker] An easily comprehended article about the first steps of starting Linux
• [MakeUseOf] Debian vs. Ubuntu vs. Linux Mint (and check out the user comments, lots of valuable feedback)
• No games for Linux? Not true!