Another Salvo in the iOS vs Android War... WWDC 2013 Aftermath!

When it comes to operating systems, whether it be for personal computers or for mobile devices, success in terms of popularity is highly dependent on the number, of what was then called "programs" or more currently, apps that are available for that platform.  The most popular platform is the one with the most apps, popularity means more "paying" customers, and that is where the bigger market is for developers to prioritize, which means EVEN more apps, and the cycle continues.  When developers perceive that a platform is running out of steam, that's the start of the fall.

The portion in Apple's WWDC 2013 Keynote that showed the graphs comparing iOS and Android were quite compelling, and I believe they prove that iOS is still a force to be reckoned with and is definitely far from losing steam.

When the Samsung Galaxy S3 and the Note 2 came out, with the synchronous release of Android Jellybean 4.2, many naysayers were chanting that, "Apple is in trouble!"  In trouble?  A company with over 137.1 billion dollars in liquid assets is in trouble... I just wish I was in such big a trouble!  Honestly, for me the fact that Android and Samsung are doing well is great news BUT let's put it into perspective, even if Apple's product releases for next 5 years were lemons, they still wouldn't be in trouble, and they would still have enough left over to get their act going and get back on their feet.

Now that the I got THAT little irritation off my chest, let's look at the presentation...

According to Tim Cook, there are are 900 thousand apps available in the App Store and 93% are downloaded per month, which is not suprising as there are 575 million accounts, most of whom have credit cards registered, in the store.  Ten billion dollars to date have been paid to developers for the iOS platform.  If you were a developer, what platform would you decide to work on?  Of course, the one with the most income.

Take note at the graph in the left.  At first, I thought that this was different from other statistics I've seen wherein Android had the larger market share until you take a closer look.  This graph refers to the APP REVENUE, and not plain number of downloads.  Android may have the larger marketshare, as far as smartphones in general, but if you're a developer trying to decide which platform will be more profitable, this graph tells him to choose iOS.  Result, more content or apps for iOS.

This is also validated by data from appannie.  Although iOS still has more downloads, it is only slightly ahead that of Android's.

However, when you look at revenue, the iOS App Store is almost 3x that of Google Play!

Again, a developer choosing a platform to prioritize, based on the added revenue, will choose iOS over Android.

Which in terms of the number and the quality of apps in a platform, this puts the advantage in the iOS corner compared to Google.

A more in-depth analysis was made by Time's Harry McCracken in his Technologizer column.  To quote him, "Android if you’re talking about market share; iOS if you mean financial success."

I believe that these figures show that more "paying" customers are with the iOS ecosystem... or that iOS users are more willing to pay for their apps than Android users... or whatever way you want to look at it.  Personally, competition of this magnitude shows one clear winner... us users!

iPads for Hospitals

To replace hospital charts with iPads is a no brainer, especially when one has watched any episode of any of the Star Trek shows where there's a scene in Sickbay.  The key to using iPads as patient charts is a fully functional, implemented and utilized electronic medical record (EMR), a concept which in the #HealthIT community is easier said than done.

Utilization, among health care personnel especially doctors, has been poor resulting in many EMR projects failing initially.  As the younger crop of doctors are coming in, doctors who grew up with computers, and their allied personal technology, utilization is improving.

One main obstacle to EMR utilization by doctors is the consequent alteration in their respective workflows that the system needs to impose.  Instead of writing on a chart, which you can do standing, sitting, in the patient's room, at the nurse's station, or in the pantry, a traditional EMR required the doctor to sit down on a terminal, usually needing to rewrite what you had written in your tickler, and frequently competing with other doctors, nurses or students who need to use the same terminal.

An iPad that connects to the hospital's WIFI network that accesses the EMR using a web-browser-based interface, gets you as close as possible to complete EMR utilization without altering the doctor's workflow by much.  Being browser-based, this makes it platform independent, allowing the doctor to access the EMR using his smartphone, tablet, or even laptop without any need for customized and installed software or a specific hardware and operating system requirement.

An article showed that one hospital piloted the use of iPads and computed it's return-of-investment (ROI) rate to be 9 days.  These numbers were based on time and motion studies and how clinical workflow impacted labor costs.  In other words, the iPads increased productivity allowing the staff to do more tasks with the same time as compared to their old workflow.

Unfortunately, in this country such a system isn't possible as a Hospital Information and Management System with a full-featured EMR with 100% utilization has not happened and thus an iPad solution won't fly as of yet.

A Beautiful iOS 7 Concept and Wish Lists...

On June 11 at around 1 am (PhST), the keynote at Apple's 2013 Worldwide Developer's Conference will start and we'll find out when iOS 7 will be coming out.  iOS is among the most anticipated Apple products at this time since this is were we will finally see the results of Apple's 230 days of silence (since they released the iPad Mini on October 23, 2012) and their counter to their competitor's efforts of which there are a lot!  (To see what's been happening to the gadget world since the iPad Mini release check this excellent article...)

They may announce iOS 7 tomorrow, or they many not.  but this is a small video that not only shows you how it MAY look like, but also summarizes the most common wish list items people have been screaming for in a future iOS release.


Aside from the announced "flatter" appearance by Jony Ive, which are cosmetic after all, they show:

• A sleeker and more functional lock screen.
• Customizable widgets so that the content of your choice can instantly bee seen on the home screen.
• A more intuitive calendar app.
• A cleaner camera gui.
• A simpler and more useful Siri screen.

Every veteran iOS user has their own wish list.  There are also a slew of articles out there about their own wish lists.  Let me give you mine:

Early Detection of Prostate Cancer: AUA GUIDELINE

The PSA era started at the end of 1980's, even though it had been discovered as far back as the 70's. Although it is common knowledge that an elevated PSA is an indicator for prostate cancer, exactly how to use it in determining the next step in a patient's management has always been controversial.

In fact, in May 2012 the U.S. Preventive Services Task Force released a recommendation, "against PSA-based screening for prostate cancer."

"Prostate cancer is a serious health problem that affects thousands of men and their families. But before getting a PSA test, all men deserve to know what the science tells us about PSA screening: there is a very small potential benefit and significant potential harms. We encourage clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms."

The also conclude that, "many men are harmed as a result of prostate cancer screening and few, if any, benefit."  They rated this as a Grade D recommendation, which is indicates that, 

"The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits." And that they, "Discourage the use of this service." Such a sweeping recommendation by a prominent agency prompted the American Urological Association to respond within a month. Dr. John M. Lynch said,  © Fox Broadcasting Corporation "I think we would all agree that the appropriate use of PSA and DRE, combined with informed consent, especially in at-risk populations, does indeed reduce deaths from prostate cancer. It is a disservice to men to deny them the opportunity for potential treatment and cure, when necessary, for a disease that affects one in six over the course of their lifetime."  These reflect my own personal opinions on Prostate Cancer screening. These are think are the keywords for practical consideration.  PSA should be combined with DRE... a patient should be informed about the issues about screening... AND it is absolutely essential for patients who are at risk! This seems to have stimulated the AUA to produce a concrete set of guidelines for the Early Detection of Prostate Cancer which is now sort of an update to their previous 2009 Prostate-Specific Antigen Best Practice Statement.

My Kids' are Trekkers... and I can't be happier!

When the Star Trek Enterprise series was cancelled in 2005 in it's fourth season (just when the storylines and quality were "taking off"... no pun intended), it left the franchise in limbo with seemingly no hope.  Being a devout Trekkie or "Trekker" (as we prefer to be called) this was a depressing thought.  Sort of like when I heard that Frank Herbert and Isaac Asimov had died.  I had the feeling that a part of your soul had also gone the same way.

So, I couldn't be happier that the franchise had been revived by the start of a new "timeline" with the showing of the 2009 Star Trek movie (Yes, I refuse to use the term "reboot" but that's for another day).

Sometime during this hiatus, I decided to rewatch the entire Star Trek run from TOS, all the movies, TNG, all it's movies, DS9, Voyager, and Enterprise... took around 8 months.  During the course, my son and daughter started to watch with me.  Soon they became Trekkers as well.

What makes me happy, and it's not just the fact that I have other people to talk Trek, but I absolutely love the moral values that they learn from Star Trek. 

What makes Star Trek unique among the different versions of Earth's future, as imagined by the myriad of sci-fi writers is that it shows the best possible future.  Gone is poverty, sloth, greed... most crime has been eradicated, there's no more money, I guess you can call it "true communism"... but in Star Trek, mankind is not motivated by money or power, but by the desire to better one's self in the best way possible.

Many ethical and moral issues arise in Star Trek, sometimes they mimic the news headlines at the time of shooting.  Sometimes the outcomes aren't the best, but given the circumstances, the characters make the most ethically correct decisions that are humanly possible.

The way the various captains, although having different styles, interact with their subordinates, how they command and earn respect and how they themselves respect those of lower ranks.  How they can be seen as friends and yet one is their commanding officer.  So many people skills can be gained from watching Star Trek.

I mean, kids can do a lot worse than watching and be influenced by Star Trek!

My daughter was watching a rather complicated storyline in ST:VGR with a multitude of time paradoxes confusing the issue, and she spotted right on a plot hole which for me, only a hardened Trekker can do! 

It makes me happier especially since I live in a country where Trekkers are really a rare breed.  The few Trekker friends I have are at most only casual ones... watching only a comparative "handful" of shows compared with us.

Well... having my kids be my Trek buddies isn't a bad proposition at all!

"Dif-tor heh smusma!"  

NEW AUA Guidelines for Castration-Resistant Prostate Cancer

During the 2013 Annual Meeting of the American Urological Association, new guidelines for the treatment of Castration-Resistant Prostate Cancer (CRPC).  CRPC has always been a vexing problem to Urologists since Hormone Therapy was developed by Charles Huggins in 1941.  Although quite effective initially, especially for advanced prostate cancer, it had been found that castration or hormone ablation gradually became less effective after several years, and thus the identification of "Hormone-Resistant Prostate Cancer (HRPC)" made.

In recent years, it has been found that HRPC was found to still be quite sensitive to other forms of hormone therapy, in particular, those that interrupt the steroid synthesis pathway at a "higher" level compared to medical or surgical castration.  This also explains why second-line hormone therapies such as estrogens and ketoconazole was found to be somewhat effective. Thus, the term "Castration-Resistant Prostate Cancer" came into being.

With the development of novel new therapies that are still hormonal in nature, the AUA has now released treatment guidelines that focus on six (typical) "index" patients.  These include:

1. Index Patient 1: Asymptomatic, non-metastatic CRPC
2. Index Patient 2: Asymptomatic or minimally symptomatic, mCRPC without prior docetaxel chemotherapy
3. Index Patient 3: Symptomatic, mCRPC with good performance status and no prior chemotherapy
4. Index Patient 4: Symptomatic, mCRPC with poor performance status and no prior docetaxel chemotherapy
5. Patient 5: Symptomatic, mCRPC with good performance status and prior doxetaxel chemotherapy
6. Index Patient 6: Symptomatic, mCRPC with poor performance status and prior docetaxel chemotherapy

Many clinicians have recognized the importance of releasing such guidelines as in the past, there was lack of cohesion in what exactly would be the best course for these groups of patients.  Most of the time, clinicians would have to wade through tons of research material or attend special symposiums to get some degree of clarity... only to be debunked a few months later.

"Prior to 2004, once patients failed primary androgen deprivation, treatments were administered solely for palliation,"

To read the full text fo the guidelines, visit the website of the American Urological Association or click here.

Yes, we can now PUSH Stones with Ultrasound!

During this year's Annual Meeting of the American Urological Association, one rather interesting State-of-the-Art Lecture delivered on May 7, 2013 by Mike Bailey, Senior Principal Engineer of the Center for Industrial and Medical Ultrasound (CIMU) department of the Applied Physics Laboratory in the University of Washington, showed the ability to PUSH urinary stones using focused bursts of ultrasound directed in the opposite end from where you want the stone to move.

He actually showed videos of stones hopping to and fro experimentally in vitro and in vivo in pig kidneys.  

Urologists will have to learn how to image the kidney stone and how to push it with the device.



Stone in the upper calyx before pushing.

Upper calyx stone is jumping to the pelvis due to ultrasound.

The video demonstrations he showed were actually quite compelling since every Urologist knows the frustration of having the ability to pulverise urinary stones with Extracorporeal Shock Wave Lithotripsy (ESWL) but not able to extract the stones, as opposed to Percutaneous Nephrolithotomy (PCNL) or Ureteroscopy with Stone Basket Extraction (SBE). 

My only concern with this technology is the learning curve for this technology.  Unlike in imaging ultrasound, you merely need to hold the probe in a position that allows you to see the stone.  For SonoMotion, which is probably what this technology will eventually be called, you need to position your probe manually at the side of the stone opposite to the direction you want it to go.  Thus, this requires a good knowledge of the detailed anatomy of the kidney, as well as the specific anatomy of a the patient's kidney.  In my view, this is easier said than done.  That being said, this technology should be closely followed by Urologists with an interest in ESWL.

The State-of-the-Art Lecture presented in the AUA can be viewed here.